ABSTRACT
In high-risk anaesthetic patients, the choice of a preoperative anaesthesia remains a difficult challenge before performing a heavy surgery such as colon excision. Nowadays, hypnosedation may be considered as an additional anaesthetic technique given to be associated with local or regional anaesthesia, in order to permit more surgery possibilities in high risk patients.
Subject(s)
Anesthesia, Conduction , Colectomy/methods , Conscious Sedation , Aged , Female , HumansABSTRACT
Caesarean section was performed under spinal anaesthesia in 55 women using a 25-gauge diamond-tipped needle and in a further 55 mothers with a 24-gauge Sprotte needle. Eight patients (14.5%) developed a headache in the former group, five of whom required a blood patch. There were no headaches reported in the Sprotte group.
Subject(s)
Anesthesia, Obstetrical/instrumentation , Anesthesia, Spinal/instrumentation , Cesarean Section , Headache/prevention & control , Needles , Adolescent , Adult , Anesthesia, Spinal/adverse effects , Dura Mater/injuries , Equipment Design , Female , Humans , Postoperative Complications/prevention & control , PregnancyABSTRACT
In 18 women A.S.A. physical status 1, a noninvasive thoracic electrical bioimpedance method was used to evaluate haemodynamic changes during gynaecological laparoscopy. A significant decrease in cardiac index was observed after peritoneal insufflation, from 3.2 to 2.8 L.min-1.m-2 and returned to the initial values after ten minutes of Trendelenburg's position. Elevated intra-abdominal pressure was also associated with a significant increase in mean arterial pressure (from 68 to 88 mmHg) and systemic vascular resistance index (from 1620 to 2491 dyn.s.cm-5.m-2). However, values were not restored after peritoneal exsufflation: systemic vascular resistance index values remained 30 per cent higher than that before insufflation. Decreased venous return may account for the significant decrease in cardiac output but mechanical compression does not explain the persistent elevation of systemic vascular resistance.
Subject(s)
Cardiography, Impedance , Hemodynamics , Laparoscopy , Plethysmography, Impedance , Adult , Anesthesia, Inhalation , Blood Pressure , Cardiac Output , Female , Heart Rate , Humans , Pneumoperitoneum, Artificial , Posture , Vascular ResistanceABSTRACT
Au cours de 18 cÅlioscopies chez des jeunes femmes A.S.A. status physique 1, les conséquences hémodynamiques du pneumopéritoine et de la position de Trendelenburg ont été évaluées par la méthode non invasive de bioimpédance électrique thoracique. L'index cardiaque chute significativement de 3,2 à 2,8 L · min-1 · m-2 à l'insufflation intra-abdominale et retrouve ses valeurs de départ après dix minutes de Trendelenburg. La pression artérielle moyenne et les résistances vasculaires systémiques indexées sont très augmentées de 1620 à 2491 dyn · s · cm-5 · m-2 après insufflation; l'exsufflation ne permet pas un retour aux valeurs de départ: l'élevation résiduelle des RVSI est de 30 pour cent. L'obstacle au retour veineux pas compression intra-abdominale explique bien la chute du débit cardiaque, conformément aux données de la littérature. En revanche, l'augmentation des résistances vasculaires systémiques ne peut être expliquée par les seuls phénomènes mécaniques du fait de leur persistance après la levée de la compression. L'hypothèse de l'intervention d'un médiateur humoral doit done être discutée.In 18 women A.S.A. physical status 1, a noninvasive thoracic electrical bioimpedance method was used to evaluate haemodynamic changes during gynaecologycal laparoscopy. A significant decrease in cardiac index was observed after peritoneal insufflation, from 3.2 to 2.8 L · min-1 · m-2 and returned to the initial values after ten minutes of Trendelenburg's position. Elevated intra-abdominal pressure was also associated with a significant increase in mean arterial pressure (from 68 to 88 mmHg) and systemic vascular resistance index (from 1620 to 2491 dyn · s · cm-5 · m-2). However, values were not restored after peritoneal exsufflation: systemic vascular resistance index values remained 30 per cent higher than that before insufflation. Decreased venous return may account for the significant decrease in cardiac output but mechanical compression does not explain the persistent elevation of systemic vascular resistance.
