[Ropivacaine infiltration during breast cancer surgery: postoperative acute and chronic pain effect]. / Infiltration de ropivacaïne en chirurgie carcinologique du sein: effet sur la douleur postopératoire aiguë et chronique.

OBJECTIVES: Decrease acute pain after breast cancer surgery by an infiltration of ropivacaine. Analyse effect on chronic pain. STUDY DESIGN: Prospective randomised double blind versus placebo study. PATIENTS AND METHODS: Eighty-one patients randomised between two groups received wound infiltration with 40 ml of ropivacaine 4.75 mg/ml or placebo. Acute pain was assessed during 24h with analogical visual scale and antalgic consumption. One year later, telephonic interviews looked for chronic pain and evaluate it with McGill Pain Questionnaire. RESULTS: Analogical visual scale pain score, antalgic consumption and chronic pain incidence were similar between groups. CONCLUSION: Ropivacaine scar infiltration provided no acute or chronic pain relief after breast cancer surgery.

[Severe obstetric complications nescessitating hospitalization and intensive care: a ten year retrospective study]. / Complications obstétricales graves nécessitant une hospitalisation en réanimation: étude rétrospective sur 10 ans au CHU de Besançon.

OBJECTIVES: To assess the serious maternal morbidity during pregnancy, delivery and post partum, which led to an hospitalization in a medical or surgical intensive care unit. STUDY DESIGN: A Retrospective study was carried out on a period of ten years, from July 1986 to July 1996, in the University Teaching Hospital of Besançon. PATIENTS: The criterions of inclusion come from the definition of the serious maternal morbidity decided by the Inserm: any admission of a pregnant woman in a medical or surgical intensive care unit in the 42 days of the post-partum, whatever the term of the pregnancy and the type of the post-partum, extra uterine pregnancy, spontaneous miscarriage and medical or voluntary abortion. METHODS: Forty-six patient's medical file hospitalized in a medical or surgical intensive care unit between July, 1st 1986 and July, 31st 1996, have been studied. RESULTS: The analysis of the cause underline the gravity of the pathologies handled with young patients and initially healthy, the short length of controlled ventilation and hospitalization, the avoidability of great number of transfer in an intensive care unit, and the lack of hospitalization due to anaesthesia. The frequency of hospitalisation in an intensive care unit during and after the pregnancy was estimated at 0.17% of lives births. CONCLUSION: The serious maternal morbidity could be an indicator of the quality of the obstetrics cares which would complete the study of the maternal mortality. The potential gravity of the complication of the pregnancy and the delivery require better care of this patients.

[Hemodynamic effect of intrathecal clonidine]. / Retentissement hémodynamique de la clonidine intrathécale.

Intrathecal administration of bupivacaine and clonidine results in a significant prolongation of both motor and sensitive blocks but side effects-hypotension and bradycardia-are observed. We compared two groups of patients allocated randomly. One group received intrathecal bupivacaine-morphine and the other one received clonidine-bupivacaine-morphine. In the group which received clonidine a blood pressure decrease was observed from 2nd to 8th hour, independently from the sympathetic block and easily corrected by i.v. ephedrine. Some possible explanations are discussed. No complications due to clonidine were observed.

Effect of cytidine diphosphate choline on anoxia tolerance of cultured myocardial cells.

Three series of cultured Wistar rat heart cells (10 treated and 10 controls x 3) were examined with a laser contraction-meter in a special chamber for anoxia to determine whether cytidine diphosphate choline (CDPC), a membrane phospholipid precursor, can protect against total oxygen deprivation. Heart rate and force of contraction (inotropism) were monitored during a 40-minute period of hypoxia. CDPC in a concentration of 142 micrograms/ml-1 was added to the culture medium only during the anoxia period in series I, during the 3 days of culture in series II, and during the 3 days of culture and the 40-minute hypoxia period in series III. In series I, inotropism decreased by 21% versus 55% in control group (P less than 0.05). In series II, inotropism decreased by 25% versus 43% in control group (P less than 0.05). In series III, inotropism decreased by 22% versus 44% in control group (P less than 0.05). Compared with control cells, cells treated with CDPC during anoxia maintained a significantly greater inotropic state. The effect is greatest if the cells are weak, as in series I. CDPC may be a useful component of the cardioplegic mixture during cardiopulmonary bypass and in the treatment of myocardial ischemia.

[Choice of respirators for anesthesia]. / Choix d'une machine d'anesthésie.

Criteria of quality of gases and vapours supply, ventilator, patient's circle circuit and monitoring devices are recalled to help the anesthetist to choose his anesthesia machine. Advantages of compact or modular apparatus are discussed. Four, now wellknown, anesthesia machines (modulus II+, Siemens 900 D+SAC985, Roche Kontron 4300 and Engstrom Elsa) were analysed in clinical controlled ventilation and in simulated spontaneous ventilation to study the imposed work of breathing. Results are discussed with regard to safety rules and to ergonomics, bearing in mind their respective prices. Comparison is made with an original "bisontin" prototype.

[High frequency jet ventilation in heated gas saturated in water vapor without a reserve of medical gas under pressure. An original method]. / Jet ventilation à haute fréquence en gaz réchauffés et saturés en vapeur d'eau sans réserve de gaz médical sous pression. Une méthode originale.

A prototype of high frequency jet ventilator is compared with a classic device: Gambro Soxijet ventilator. The advantages of the prototype are: no need of pressured medical gas; warming and saturated moisture of the gas. A powerful compressor (2 M3.H-1 flow--3 bar pressure) draws up the moistened and warmed gases and injects them into a double pneumatic capacity. The first capacity is pressure limited by a relief valve (3 bar). Exhausted gases flow back to the pump. A miniature pressure regulator, placed between the two capacities, rules the driving pressure. Gas mixture is injected through a solenoid valve controlled by an electronic twin-timer. Results of both devices are similar. However, our prototype seems to be very convenient for developing countries where medical gases under high pressure are not often available.

[The reliability of slow flow isoflurane vaporizers]. / De la fiabilité des évaporateurs d'isoflurane aux bas débits.

Two new vaporizers for isoflurane were tested and verified with very low flows: Ohmeda Tec 5 and Penlon PPV Sigma vaporizers. This work completes a previous one [1]. The Ohmeda Tec 5 appeared to be quite reliable. The Penlon vaporizer gave pretty good results too. However a gas flow with vibratory component can affect the result by decreasing dramatically the concentration of inhaled isoflurane.

[An analgesic strategy for tympanoplasties]. / Stratégie analgésique au cours des tympanoplasties.

UNLABELLED: After induction with vecuronium, etomidate and then isoflurane or enflurane, nitrous oxide, useful at the beginning of tympanoplasty is washed out before the end of operation. So barotrauma on the graft is avoided. In the expectation of analgesia insufficiency, alfentanil is infused intravenously all over the operation period following two modes: constant flow mode (1.25 micrograms.kg-1.min-1) after a bolus (25 micrograms.kg-1): 33 patients; decreasing hyperbolic flow mode (H): cumulative dose = 10.8 x t0.5 (where t = minutes of infusion) = 47 patients. In this mode, plasma concentration is measured by 12 patients. RESULTS: the mean plasmatic level of alfentanil is steady during the 120 minutes duration of anaesthesia: standard deviation is higher than 30%. After high quality anaesthesia in both technics, recovery time was shorter with H mode than with constant flow one (extubation time = 46 +/- 31 min. versus 92 +/- 54 min). H. mode seems to be safer. Though, individual reactivity, drug interaction and genetic polymorphism must make us cautious! Two patients presented apnea 20 and 60 minutes after an efficient awakening.

[Emergency anesthesia with halothane-air. Techniques; indications; limits]. / Anesthésie par halothane-air en urgence. Techniques; indications; limites.

A new apparatus for anaesthesia has been developed for disaster situations. A turbine pushes room air through a halothane vaporizer to a modified D. Mapleson system. A battery provides an autonomy of two hours with an air flow of 5 liters per minute. Electrical current used is 220 volts external or 12 volts. Oxygen can be added during inductions and when there is imbalance in the hemodynamic or respiratory function. One series of 20 patients successfully underwent this procedure. Oxygen monitoring was performed with percutaneous PO2, SaO2, FiO2. Only one patient with cardiac disease needed oxygen adjonction (2 l.min-1) to raise his SaO2 level above 95%. Thus it is possible to have the optimum FiO2 with the lowest amount of halothane and oxygen.

[Rapid tissue expansion: value of the measurement of the transcutaneous oxygen pressure and intraprosthetic pressure]. / L'expansion tissulaire rapide: intérêt de la mesure de la pression transcutanée d'oxygène et de la mesure des pressions intraprothétiques.

Tissue expansion is often unpleasant for the patient because of its long duration. The authors present a series of 16 rapid expansion prostheses implanted in 10 patients. The expansion was monitored by measuring the percutaneous oxygen partial pressure and intraprosthetic pressure. The expansions were performed without any complications. Monitoring of the expansion by measuring the pcPO2 appears to ensure good results.

[Value of the radionetwork of the transportation company in Besançon for alarm forwarding]. / Intérêt du réseau radio de la compagnie des transports bisontins (CTB) dans le cheminement de l'alerte ("CB or CTB").

The C.B. users offered for a few years a way for putting-out the distress on the highway. There were 2,000 in Besançon and surroundings in 1982. Today they are becoming no existent. Since then a new system of alarm run is born with 150 buses, 178 kilometers of net-travel and a sweep frequency of 10 min from 6h30 a.m., to 8h p.m, and of 30 min until 12h p.m. The 250 "C.T.B." drivers assume a regular surveillance of the urban and suburban highways. A standard message in used between the C.T.B. (Besançon Company of Buses.) regulation and Samu 25, regulation which allows to fix circumstances, place of road accident and inventory of casualties: 27 emergency calls are received in 1987, 50 in 1988. It might be possible to use other private or public radiotelephonic network.

[Repetitive inhalation anesthesia in rats]. / Anesthésies itératives par inhalation chez le rat.

Inhalational anesthesia in the rat seems a good process, by a rapid induction and awakening if a steady state ventilation-perfusion ratio and no pollution are obtained. Animals are cooped up in an "induction-box" which is joined to a scavenger system. Anesthesia maintenance is assumed with a Bain circuit and allows short and frequent anesthesia. Isoflurane does not markedly decrease circulatory and respiratory factors at low concentration (2%). So any anaesthetist can do himself such a practical system.

[Flumazenil and volatile anesthetics. Study of possible interferences in rats]. / Le flumazénil et les anesthésiques volatils. Etude des interférences éventuelles chez le rat.

Many works suggest contradictory experimental or clinical results of flumazenil effects during inhalation anaesthesia. In ten rats anaesthesia was induced with 5% isoflurane or halothane during one minute and maintained during 5 minutes with 1% the same halogene anaesthetic in 50% N2O and O2. Then 0.2 mg of flumazenil or a same volume of placebo were administered intraperitoneally and during the last 5 minutes, the rats were exposed in 1% volatile anesthetic gas flow. Sleep times were measured in terms of reestablishment of the righting reflex. Each rat was anesthetized four time: halothane and isoflurane, with flumazenil or placebo. In those conditions, there were no significant changes in sleep times either the anaesthesia were associated, with flumazenil or with placebo.

[Two-years' experience of ambulatory anesthesia in otorhinolaryngology in children]. / Expérience de deux années d'anesthésie ambulatoire en ORL chez l'enfant.

Three hundred children were anaesthetized for E.N.T. operations. The anaesthetic consultation took place one week prior to operation. The anaesthetic comprises premedication, inhalation of halothane for infants, or propofol drip for the others with tracheal tubing for 10% of them. Recovery in every case is supervised in the recovery room. There are few setbacks with this method. Eleven children were not accepted for operation for sociological or medical reasons (Willebrand diseases) and only 3 had to remain in hospital until the following day due to slow recovery from anaesthetic.

[The indirect calorimeter, "do it yourself"]. / Calorimètre indirect, "do it yourself".

An original metabolic calculator is realized with common and fiable transducers: a "microgaz Roche Kontron 7640" gives the PiO2-PeO2 and PeCO2 (Clark and Stow Severinghaus electrods), a pneumotachograph Gould 17212 (or the reliable integrated flow meter of the respirator) gives the expiratory minute volume. These values are inserted in an micro computer (Sharp PC 1261). The soft is wrote so that results are not altered when high FiO2 are used. Consumption of lipids and glucids is displayed in percentage when diuresis and urea values are entered. This device is compared with a well known expenditure monitor: Deltatrac (Datex): simultaneous measures are carried out in patients with miscellaneous diseases (15 series of 10 measures). Regression curves appear to be very reliable, as well for VO2(r = 0.98), VCO2 (r = 0.94) energy expenditure (0.97) as for R.Q (r = 0.77).

[Monitoring of gases and vapors in the anesthesia system]. / Monitorage des gaz et vapeurs dans les circuits d'anesthésie.

By now inhalation anesthesia makes anesthetic gaz and vapours analysis compulsory. This paper give an account of numerous gaz analyzers which are available today. Different kinds of oximeters (galvanic, polarographic, paramagnetic) carbon dioxide analysers, halothane, enflurane or isoflurane-meters are reviewed. Advantage/cost ratio of mass spectrometer is discussed too. Practical advices on use and site of slow and fast analysers are recalled.