[Anesthesia for aorto-coronary bypass]. / Anesthésie des pontages aorto-coronaires.

The authors have analysed a series of 357 patients undergoing aortocoronary bypass. The onset of complications was studied in relation to the past history, the anaesthetic protocol, the period of extra-corporeal circulation and the type of myocardial protection. Complications consisted of acute hypertensive episodes, arrhythmias, peroperative myocardial ischemia and myocardial infarction. The degree of beta-blocker therapy and above all its continuation up to the time of operation would seem to be an important factor in effective myocardial protection.

[Prinzmetal's angina during myocardial revascularisation. Cardiovascular complications in 71 patients (author's transl)]. / L'angor de Prinzmetal au cours de la chirurgie du pontage aorto-coronaire. Comportement cardio-circulatoire de 71 malades.

71 patients undergo myocardial revascularisation for Prinzmetal's angina; among them, 50 p. cent are operated upon in emergency according to three ways of anaesthesia: neuroleptanalgesia, analgesic anaesthesia, combined anaesthesia. The authors lay stress on the importance of per- and post-operative complications: electrocardiographic ischemia in 22 p. cent of the cases, severe ventricular excitability perturbations were observed in 21 p. cent, myocardial necrosis in 14 p. cent, cardiovascular collapse in 21 p. cent and hypertensions in 22 p cent. These complications are often associated. In the discussion, the authors underline anesthetic induction as a cause of Prinzmetal's angina in 50 p. cent of the cases. They put the accent on the severity of peroperative crisis followed in 50 p. cent of the cases by serious ventricular excitability perturbations. In 25 p. cent of the cases myocardial necrosis is a complication of the spasm of a coronary artery. In this field, posterior necrosis are more frequent and correspond to the spasm of the right coronary artery. All the patients of this series, except one, develop necrosis in the spastic area (by-passed or not). Per-operative hypertension has no incidence on the occurrence of post-operative complications. Lastly, continuous per-operative infusions of nitroglycerine has been performed in several patients in order to reduce morbidity of this type of surgery.