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Resume Objectif Etudier l'effet de l'ephedrine intramusculaire pour la prevention de l'hypotension arterielle durant la rachianesthesie (RA) chez la personne âgee. Type d'etude Etude prospective randomisee en double aveugle contre placebo. Patients Vingt patients âges de 60 ans et plus devant subir sous RA une intervention reparatrice apres fracture du col du femur. Methode Apres remplissage vasculaire avec un solute cristalloide a la dose de 10 mL kg−1, une RA avec de la bupivacaine a 0,5 % etait realisee. Immediatement apres celle-ci, chaque patient recevait une injection IM de 1 mL contenant soit 30 mg d'ephedrine (groupe ephedrine), soit du serum physiologique (groupe placebo). Une injection IV de 6 mg d'ephedrine, repetee si besoin, etait faite chaque fois que la pression arterielle systolique etait inferieure a 100 mmHg. Resultats La pression arterielle a chute plus rapidement et de maniere plus importante chez les patients du groupe placebo. La pression arterielle systolique etait significativement plus basse dans le groupe placebo. La pression arterielle moyenne etait inferieure dans le groupe placebo, sans difference significative. Au-dela de la 20e minute, l'evolution de la pression arterielle dans les deux groupes etait similaire. Conclusion L'ephedrine intramusculaire semble efficace pour prevenir l'hypotension arterielle et assurer une meilleure stabilite hemodynamique au cours de la RA chez la personne âgee.

To examine the effect of an alpha-2 agonist, clonidine, on oxygen uptake and on the incidence of postoperative shivering, 28 patients presenting for major abdominal surgery were randomly assigned in a double-blind manner to one of two groups. Intraoperatively, 14 patients received 5 micrograms.kg-1 clonidine infused over 3 h (clonidine group), and 14 patients received placebo (placebo group). Oxygen uptake was measured continuously over the first 3 postoperative hours with a mass spectrometer system. Circulatory variables, esophageal temperature, and skin temperature were measured over the first 6 postoperative hours. Heart rate, mean arterial pressure, rate pressure product, and norepinephrine concentration were decreased in the clonidine group (P less than 2 x 10(-4)). There were no differences among groups in the incidence of shivering and in the rate of increase of esophageal temperature. By contrast, oxygen uptake was lower in the clonidine group (P = 4 x 10(-4)). This contrasting pattern may be secondary to a reduction in the intensity of mean muscular tremor in the clonidine group.

A randomized study of 30 patients undergoing uncomplicated surgery under spinal anesthesia was conducted to assess the influence of colloids on the kinetics of plasma fibronectin and complement. Both are opsonins of the reticuloendothelial system; moreover fibronectin is concerned with host resistance against septic complications following trauma and surgery. The patients were assigned to receive either Ringer's lactate (Group 1), gelatin (Group 2) or dextran 40 (Group 3). Blood samples were withdrawn before colloids or Ringer's infusion and during the 4 postoperative days. There was a reduction in plasma fibronectin throughout the study in groups 1 and 3, but an increase in group 2 by 24 h. The adhesion of plasma fibronectin to gelatin was maximal 1 h after infusion (44%) and remained significant up to day 2 in group 2. There was no relationship in groups 1 and 3. C3 and C4 components of complement exhibited a low value in the early post-operative period, due to hemodilution. This study shows an in vivo fibronectin-gelatin interaction, and suggests that gelatin infusion inhibits the increased shift of plasma fibronectin at the site of tissue injury after surgery.

Evaluation of a blood storage of six concentrates red blood cells of groupe O RH:-1KEL:-1 in a surgical emergency treatment center.All patients transfused with this concentrates; main points of utilisation are analysed.The concentrates, used by the anaesthesiologists, are part of the treatment strategy care in case of severe bleeding.

Resume Chez dix patients volontaires sains, nous avons compare l'hematocrite determine soit par micromethodes (centrifugation ou resistivite), soit par technique standard (Coultronics S + 2) lorsqu'un echantillon sanguin etait progressivement dilue par une gelatine ou un dextran. L'hematocrite mesure par micromethode est sous-estime de facon non significative lorsque l'echantillon sanguin est dilue avec le dextran. Avec une gelatine, la sous-estimation est non significative quand on utilise la centrifugation, alors qu'elle est croissante et atteint 15 % (p

To assess the efficacy of intramuscular ephedrine for prevention of hypotension following subarachnoid block (SB) in the elderly.Prospective, randomized double blind study vs placebo.Twenty patients, aged 60 years or more, of physical class ASA 2 or 3, scheduled for surgical fixation of fractured neck of femur under SB, allocated into two groups of ten each.After oral premedication with hydroxyzine 50 mg, 90 min before surgery, and preloading with cristalloid solution 10 mL.kg-1, the subarachnoid space was punctured with the patient in lateral position using a 22 Gauge spinal needle at the L3-L4 or L4-L5 interspace. Patients were given 0.5% hyperbaric bupivacaine intrathecally, according to body weight. Patients in ephedrine group received intramuscular ephedrine 30 mg immediately after SB. Patients in placebo group received 1 mL of intramuscular saline immediately after SB. When blood pressure decreased below 100 mmHg repeated bolus of ephedrine 6 mg were given intravenously.Patients in both groups experienced a significant decrease in systolic pressure after SB, the decrease being significantly greater in the placebo group.Prophylactic intramuscular ephedrine is effective to prevent hypotension associated with SB in the elderly.

To examine the effect of an alpha-2 agonist, clonidine, on oxygen uptake and on the incidence of postoperative shivering, 28 patients presenting for major abdominal surgery were randomly assigned in a double-blind manner to one of two groups. Intraoperatively, 14 patients received 5 micrograms.kg-1 clonidine infused over 3 h (clonidine group), and 14 patients received placebo (placebo group). Oxygen uptake was measured continuously over the first 3 postoperative hours with a mass spectrometer system. Circulatory variables, esophageal temperature, and skin temperature were measured over the first 6 postoperative hours. Heart rate, mean arterial pressure, rate pressure product, and norepinephrine concentration were decreased in the clonidine group (P less than 2 x 10(-4)). There were no differences among groups in the incidence of shivering and in the rate of increase of esophageal temperature. By contrast, oxygen uptake was lower in the clonidine group (P = 4 x 10(-4)). This contrasting pattern may be secondary to a reduction in the intensity of mean muscular tremor in the clonidine group.

In this prospective and randomized trial involving 38 patients operated upon for generalized or localized peritonitis, 2 combinations of antibiotics were assessed on the basis of 5 predetermined criteria: number of successes and failures, duration of fever, leucocytosis, antibiotic therapy and stay in hospital. No significant difference was observed between the two therapeutic groups. The spectrum of sensitive organisms and the effectiveness of treatment could be considered satisfactory whatever the combination utilized. The 86.8 percent clinical success rate suggests that the cefotaxime-clindamycin combination should be used more frequently than it is now.

A study was carried out to determine whether centrifugation and resistivity were reliable methods for measuring haematocrit of blood diluted with dextran or gelatin. The values obtained with the minicentrifuge Compur M 1100 (Bayer) (group 2) and with the Stat-Crit (Fumouze) (group 3) were compared with those obtained with the reference method (Coulter counter Model S + 2, Coultronics) (group 1). The study included 10 healthy subjects, aged 21 to 43 years. In each, sodium, potassium, chloride and protein concentrations were determined. Two further 10 ml blood samples were taken to be diluted with increasing amounts of either a fluid modified gelatin (Plasmion) or a dextran 40 (Piasmacair). The dilutions carried out were 0, 10, 20, 30, 40 and 50%. For each one, the haematocrit was measured using all three methods. The values obtained with undiluted blood were similar with the three methods. However, when blood was diluted with a dextran, haematocrit values were underestimated, whatever method was used, but by no more than 5% (difference not statistically significant). The result was the same with the centrifugation method for blood diluted with gelatin. On the other hand, values obtained with the resistivity technique for these samples were underestimated up to 15.5% (50% dilution; p less than 0.05). This was due to the negative electric charge of the gelatin, which lowered the haematocrit value in proportion to the concentration of gelatin. Although the technique is easier than centrifugation, measuring haematocrit with a resistivity method should be avoided in patients receiving a fluid modified gelatin.

We report a system for the continuous measurement of oxygen uptake (Vo2) and carbon dioxide output (Vco2) during open-circuit anaesthesia. Gas concentrations were measured by a mass-spectrometer, and expired flow by a pneumotachograph. The values measured by the system were compared in vitro to values produced by a nitrogen-dilution technique. Excellent correlations were found. Continuous measurements were performed in 21 patients anaesthetized for abdominal surgery. Compared to pure intravenous anaesthesia (flunitrazepam-fentanyl), anaesthesia including the administration of nitrous oxide or nitrous oxide and halothane led to more pronounced and sustained decreases in Vo2 and core temperature, with a better cardiovascular stability. Two hours postoperatively, Vo2 was not different from preoperative values. After a transient increase at the onset of anaesthesia, the respiratory exchange ratio (Vco2/Vo2) returned to preoperative values, and then remained subsequently unchanged. Based on these observations, the system described provides an accurate approach to noninvasively monitoring the pulmonary gas exchange in the operating room.

Among 67 blunt hepatic traumas treated during a 4 years period, 34 required an emergency surgery for reasons of severe bleeding, with 16 deaths of which 11 were directly due to the liver injury. 33 patients, whose hemodynamic stability contrasted with major hepatic lesions (5 deep fractures, 28 central hematomas combined with 5 subcapsular hematomas and 3 multiple parenchymatous fractures), were subjected to nonoperative management. One patient died from sudden hemorrhage and a second one underwent further drainage for a residual pelvic abscess. In the 32 alive patients, a close watch over with ultrasound and CT scan gave prominence to a complete disappearance of the lesions within 4 to 24 weeks. The nonoperative management of such hepatic injuries may be a safe and reasonable alternative to a high risk surgery, as far as the hemodynamic condition or associated visceral lesions do not require an emergency surgery.