[Bovine heterologous graft in replacement of a small calibre artery]. / Greffe hétérogène bovine en remplacement d'une artère de petit calibre.

An experimental study of a new biologic vascular graft for reconstruction of small diameter arteries was carried out in 50 sheep. Results up to 2 years allow us to conclude that the new vascular prostheses may be "reutilized" by the host. Infections and aneurysmal degeneration were be observed. Early occlusion of the graft due to technical reasons occurred in only one case.

[Place of surgical treatment of lung metastases]. / La place du traitement chirurgical des métastases pulmonaires.

From 1.1.1980 to 31.12.1992, ninety-four of our patients underwent surgical removal of pulmonary metastases. The classification of the primary tumours found cas as follows: sarcoma 24.5% (n = 23), renal carcinoma 22.3% (n = 21), malignant melanoma 19.1% (n = 19), colon carcinoma 15.9% (n = 15) and ovarian and testicular tumours with 10.6% (n = 10). Three cases presented metastases from a carcinoma of the floor of the outh. The remaining cases were secondaries from bronchial, oesophageal and larynx carcinoma and from a malignant thymoma. In 71 cases, the tumour was removed using an atypical resection technique, and in 22 cases by carrying out a lobectomy. In one case an "extended lobectomy" was performed. Hospital mortality was 1.1%. Survival rate was 60% at 1 year and 40% at 3 years. 38.3% of the patients lived for five years or more.

[Continuous monitoring of spontaneous respiration in the postoperative phase. 4. The effect of postoperative pain therapy on cutaneous oxygen and carbon dioxide partial pressure following gynecologic surgery with neuroleptanalgesia]. / Kontinuierliches Monitoring der Spontanatmung in der postoperativen Phase. Teil 4. Auswirkungen der postoperativen Schmerztherapie auf kutane Sauerstoff- und Kohlendioxidpartialdrücke nach gynäkologischen Eingriffen unter Neuroleptanalgesie.

METHODS: Cutaneous O2 and CO2 pressures were monitored for 16 h in 55 female patients recovering from major gynaecological surgery performed under neurolept anaesthesia. Postoperative pain was managed either with an antipyretic analgesic (i.m. or i.v. metamizol up to 2.5 g/4 h; group NLA) or with i.v. patient-controlled analgesia using fentanyl (demand dose 34 micrograms, infusion rate 4 micrograms/h, hourly maximum dose 0.25 mg, lock-out time 1 min; group NLA/PCA). In addition, 11 patients received a single i.v. bolus injection of 150 mg amiphenazole, a respiratory stimulant, at the beginning of PCA treatment (group NLA/PCA/AMI). Data were collected and stored by a personal computer, using the TCM3 system with a combination electrode for simultaneous measurement of cutaneous oxygen and carbon dioxide partial pressures (TINA, Radiometer) at 30-s intervals. The overall observation period was four times 240 min; patients from the NLA group who required additional opioids were excluded from the analysis. Means and standard deviations were calculated for individual data and data pooled for 15- or 60-min intervals. Groups were compared by means of the chi-square test, Student's t-test or analysis of variance (level of significance, P < or = 0.05). RESULTS: The 55 patients were classified as ASA I-II. The study groups were comparable with respect to demographic and anaesthesiological data, except that those in the NLA group were younger and had received less intraoperative fentanyl (Table 1). Mean PCA fentanyl consumption was 0.6-0.7 mg in the 16-h observation period (Table 2). In all groups, pctO2 levels were decreased and pctCO2 levels elevated in the first observation hours and slowly returned to normal within the first observation period (Figs. 1, 2, Tables 3, 4). Episodes of hypercapnia (pct-CO2 > 50 or > 55 mm Hg) were frequent in the first 2 h (8-29% of individual values for pctCO2 > 50, up to 5% of values recorded for pctCO2 > 55; Table 4). There were no statistically significant differences between patients treated with metamizol and those treated with fentanyl. Amiphenazole did not significantly improve postoperative respiration. PCA patients had occasional episodes of hypercapnia (up to 19% of all values for pctCO2 > 50, up to 5% for pctCO2 > 55) even in the last observation period (13-16 h after surgery), indicating the need for close monitoring of spontaneous ventilation during PCA following neurolept anaesthesia. DISCUSSION AND CONCLUSIONS: The present study confirmed that spontaneous respiration in the early postoperative period can be monitored non-invasively by measuring cutaneous partial pressures of carbon dioxide and, less precisely owing to wide individual variations, oxygen. It showed that spontaneous respiration is less effective immediately after termination of surgery under neurolept anaesthesia and recovers slowly over the next 4 h. During the first observation period, ventilation was no worse with i.v. PCA using fentanyl than with conventional pain management using the antipyretic analgesic metamizol, confirming the hypothesis that opioid-induced respiratory depression occurs only at overdosage (which is not a problem with individualized dose titration using PCA). Since all patients in the NLA group required additional opioids after the first observation period and had to be excluded from further analysis, it cannot be decided from the present data whether late hypercapnia was due to PCA or to residual effects of surgery and anaesthesia. The respiratory stimulant amiphenazole (150 mg i.v.) was not helpful in improving ventilation; there was no indication of analgesic effects or interactions of amiphenazole.

[Continuous monitoring of spontaneous postoperative respiration. 3. The effect of amiphenazole on cutaneous oxygen and carbon dioxide partial pressure following gynecologic surgery under halothane anesthesia]. / Kontinuierliches Monitoring der Spontanatmung in der postoperativen Phase. Teil 3. Enfluss von Amiphenazol auf kutane Sauerstoff- und Kohlendioxidpartialdrücke nach gynäkologischen Eingriffen unter Halothannarkosen.

METHODS: In an attempt to verify non-invasive respiratory monitoring for patients in the early postoperative period, cutaneous O2 and CO2 pressures were monitored in 30 female patients recovering from major gynaecologic surgery under halothane anaesthesia. In a double-blind and randomized fashion, in the recovery room the patients received a single intravenous bolus injection of placebo or 150 mg amiphenazole, a respiratory stimulant. The data were collected and stored in a personal computer, using the TCM3 system with a combination electrode for simultaneous measuring of cutaneous oxygen and carbon dioxide partial pressures (TINA, Radiometer) at 30-s intervals. The overall observation period was 240 min. Means and standard deviations were calculated for individual data and for data pooled at 15- or 60-min intervals. Groups were compared by means of the chi 2 test, Student's t-test, Wilcoxon rank sum test or analysis of variance (level of significance P < or = 0.05). RESULTS: The study groups were comparable with respect to demographic and anaesthesiological data. The partial pressures for both O2 and CO2 were not statistically significant between groups. Electrode heating was slightly higher with amiphenazole (n.s.), indicating a trend for peripheral vasodilation without a true improvement of spontaneous ventilation. pctO2 and pctCO2 levels were decreased or elevated, respectively, in the first observation hours and slowly returned to normal within the 240-min observation period. Episodes of hypercapnia (pct-CO2 > 50 or > 55 mm Hg) were frequent in the first 2 h (10-30% of individual data for pctCO2 > 50, 2-7% for pctCO2 > 55, respectively), indicating the need for close monitoring of spontaneous respiration after general anaesthesia with halothane. DISCUSSION AND CONCLUSION: The present study confirmed that spontaneous respiration in the early postoperative period can be monitored non-invasively by measuring transcutaneous partial pressures of carbon dioxide and, less precisely due to large individual variations, oxygen. It showed that spontaneous respiration deteriorates after gynaecological surgery under halothane anaesthesia and recovers slowly during the next 4 h. The respiratory stimulant amiphenazole (150 mg i.v.) was of no significant value with respect to the improvement of ventilation.

[Development of a method of continuous monitoring of spontaneous respiration in the postoperative phase. 1. Normal values for cutaneous pO2- and pCO2-partial pressure together with pulse oximetry determined oxygen saturation in healthy young volunteers]. / Entwicklung eines kontinuierlichen Monitorings der Spontanatmung in der postoperativen Phase. Teil 1. Normalwertbereiche für kutane pO2- und pCO2-Partialdrücke sowie pulsoxymetrisch bestimmte Sauerstoffsättigungen bei gesunden jungen Erwachsenen.

METHODS: Twenty-eight healthy volunteers of both sexes (14 male, 14 female, age 31 +/- 7 years, weight 70 +/- 12 kg) breathing room air were monitored for cutaneous partial pressures of oxygen and carbon dioxide (pctO2, pctCO2) and partial oxygen saturation (psO2) as determined by pulse oximetry. Data triplets were collected and stored by a personal computer at 30-s intervals during a 4-h resting period to establish a confidence range for the devices in use (TCM 3 with a combination electrode E 5270, and Pulse Oximeter, Radiometer). This data range was intended to be used in later noninvasive, continuous respiratory studies with postoperative patients. Means, standard deviations, and ranges were calculated for individual data and data pooled from 15-min intervals. Data distribution over time was calculated for 30-min intervals. RESULTS: Contrary to the saturation data delivered by pulse oximetry, the pctO2 and pctCO2 readings needed about 15 min to stabilize. The mean +/- SD of a total of 12,600 pctO2 measurements (77.2 +/- 10.9 mmHg) could not simply be compared with arterial normal values, whereas the pctCO2 measurements (39.9 +/- 3.6 mmHg) fit well with arterial data from the literature. Interestingly, pctCO2 values in unmedicated healthy adults were not uniformly distributed, suggesting individual differences in either skin permeability of central regulation of respiration. Additionally, the pctO2 readings were characterized by serious inter-subject variability, which confirms earlier studies that pctO2 is not suitable for routine monitoring procedures in adults, the mean +/- SD of a total of 4500 psO2 measurements was 94.9 +/- 1.6%. A statistically significant correlation was found between pctO2 and psO2 (r = 0.358). Cutaneous carbon dioxide readings of greater than 50 mmHg were observed in only 0.06% of all 12,600 data sets (maximum 51.3 mmHg; 28 volunteers), desaturations (less than 90%) in only 0.24% of all 4,500 saturation measurements (minimum 86%; 10 volunteers). DISCUSSION AND CONCLUSION: Monitoring of spontaneous respiration in the recovery room is regarded as essential to prevent serious complications resulting from surgery and anesthesia. This has become particularly true with newer analgesic techniques like spinal opiates or patient-controlled analgesia. Since minor degrees of opiate-induced respiratory depression are easily influenced by external stimulation, it is mandatory that any monitoring of spontaneous respiration must be nonstimulant, and prefereably noninvasive. The present communication is the first of a series of investigations to develop of monitoring technique for postoperative patients. Because normal values for the parameters studied are either lacking or dependent on the monitoring devices in use, the present paper defined the respective data ranges. It is concluded that pulse oximetry and pctCO2 measurement are both useful and sensitive for continuous, non-invasive respiratory monitoring in adults, whereas pctO2 measurements are of lesser value. Results in volunteers treated with opiates and postoperative patients under patient-controlled analgesia using the above mentioned equipment will be reported in following publications.