[Co-analgesic effect of ketorolac after thoracic surgery]

Thoracotomies are painful surgical procedures and adequate pain relief is associated with improved respiratory function and fewer respiratory complications. After thoracotomy for lung resection, patients received morphine-based patient-controlled analgesia [PCA]. Three groups were propectively and randomized investigated: patients receiving preemptive ketorolac, those given postoperative ketorolac and controls. No differences among groups were found for demographic data, anesthesia and surgery durations, or for the amounts of anesthesia drugs administered. The blood loses were also comparable: 565 +/- 374 ml for the preemptive ketorolac group, 749 +/- 491 ml for the postoperative ketorolac group and 674 +/- 323 ml for the controls. At 48 h after surgery, compared to control, morphine consumption was 36% lower for the preemptive ketorolac group and 17% lower for postoperative ketorolac group [p< 0.05]. No statistically significant differences were observed for pulmonary function tests. These results suggest that non-steroidal anti-inflammatory drugs can reduce the opioid requirements after thoracic surgery but do not improvement lung function

Notre experience a propos de la ventilation ceventionnelle dans la chirugie orl au laser co2

In order to improve the vision and to facilitate the access to the operatory field in the ENT surgery with laser CO2, multiple ventilatory technics was proposed. The idea of our work is to assess the advantages and the limits of the conventional ventilation. 38 patients, ASA I-II foreseen for ORL surgery to the laser CO2 were inclued in a prospective study. After premedication [atropine and hydroxyzine], the induction was achieved by propofol [2-3 mg/kg], fentanyl [3 Fg/kg] and atracurium [0,5 mg/kg]. The tracheal access was achieved by a probe of intubation of small caliber, protected by aluminium adhesive paper. A controlled ventilation was instituted with a tidal volume [T.V] [7 ml/kg], Heart rate [16 beats/ min] and mixture air /02 with inspired fraction of O2 < 30%. The ventilatory technic was judged efficient if the expired T.V was equal to the inspired one' 50 ml/min, a pressure of crest < 30 cm H20, Sp02297% and a laryngal exposition judged adequate by the operator. The statistical analysis used no parametric tests of Wilkoxon Kruskal Wallis. The mechanical ventilation was judged efficient in all the cases. The mean of crest pressures in the respiratory ways were significantly more elevated in orotracheal [24 + 4 cm H20 vs 1 8 - 1 cm H2O in nasotracheal and 1 8 + 2 cm H2o by way of tracheotomy [p< 0,001]]. The watertightness of the airway, the guarantee of tidal volume, the correct vision of operatory field and the moderate cost, seem to make of the conventional ventilation an elegant alternative to the jet ventilation. The nasotracheal access seems to improve the technic of ventilation by reducing the risk of plicature of the tube and discomfort for the operator