ABSTRACT
Haemodynamic investigations were performed in nine patients during aortic surgery for Leriche's syndrome. Most of these patients had ischaemic heart disease without cardiac failure. Fluid loading was carried out before and during aortic clamping. It was controlled according to the optimal wedge pulmonary pressure determined the day before surgery. Only six of the nine patients receive nitroglycerin (NTG : 0.2 micrograms X kg-1 X min-1) throughout the operation. Before clamping, cardiac index was improved in patients treated with NTG. During clamping, the patients not treated with NTG showed a drop in cardiac index, an increase in peripheral resistance and in left cardiac work. After declamping, there were no haemodynamic differences between the two groups. Two patients not treated with NTG developed azotaemia postoperatively; one patient developed cardiac failure requiring a dopamine perfusion during surgery. In this series, the association of optimal volume loading with a peroperative perfusion of 0.2 micrograms X kg-1 X min-1 NTG gave a good haemodynamic stability.
Subject(s)
Aorta, Abdominal/surgery , Fluid Therapy , Hemodynamics/drug effects , Nitroglycerin/pharmacology , Adult , Aged , Humans , Intraoperative Care , Male , Middle AgedABSTRACT
Circadian rhythms of cortisol were studied in 10 patients. This study was made shortly after the burn and for a short period of one or two days maximum in 9 patients. Blood level measurements of cortisone were made in 4 patients. 7 patients died. The analysis of circadian rhythm was made with a computer (méthode de régression harmonique combinée à une analyse de variance). The results are deceiving: there are qualitative and quantitative disturbances but we could not give a significance to them, each patient reacting differently. In one case, a drop of cortisol to 0 was observed and the patient died, this observation shows the development of corticosurrenal failure. So, one or several measurements do not allow the study of corticosurrenal function which differs in each case. Theoretical appreciations in handbooks on the subject must be tempered.
Subject(s)
Burns/blood , Circadian Rhythm , Hydrocortisone/blood , Adult , Aged , Child , Cortisone/blood , Female , Humans , Male , Middle AgedABSTRACT
The psycho-motor sedative action of tiapride, which has been demonstrated in internal medicine, was studied in anesthesiology. A group of 253 patients hospitalized for urological (203 cases) or gynaecological (50 cases) operations were given standard premedication together with 100 to 300 mg of tiapride. Preoperative sedation and reduction of anxiety was excellent in 138 cases, moderate in 97 cases, and nil in 18 cases, under the influence of tiapride. Tiapride was perfectly well tolerated even in patients with debility, obesity, alcoholism and cardiac or respiratory insufficiency.
