Single dose i.v. tropisetron in the prevention of postoperative nausea and vomiting after gynaecological surgery.

In a prospective, randomized, multicentre, double-blind, placebo-controlled study, we have compared the efficacy of a single i.v. dose of tropisetron 0.5 mg, 2 mg and 5 mg in the prevention of postoperative nausea and vomiting (PONV). We studied 385 ASA class I and II female patients undergoing abdominal or vaginal gynaecological surgery, including laparoscopy. Tropisetron or placebo were administered before a standardized general anaesthetic. The frequency of vomiting in the 24-h period after entry into the recovery room was reduced from 44% after placebo to 31%, 26% and 30% after tropisetron 0.5 mg, 2 mg and 5 mg, respectively (P = 0.06, P = 0.009 and P = 0.043; unadjusted). Compared with placebo, nausea was reduced from 55% to 46%, 34% and 46% (P = 0.25, P = 0.003, P = 0.22), and need for rescue treatment from 39% to 29%, 23% and 35% (P = 0.13, P = 0.017 and P = 0.59) for the same groups. Tropisetron 2 mg appeared to be the optimal dose for prophylaxis against PONV with a side-effect profile similar to that of placebo.

Neurophysiologic detection of a unilateral motor deficit occurring during the noncritical phase of scoliosis surgery.

STUDY DESIGN: A four-path neurophysiologic monitoring system was designed for spinal cord monitoring during spinal surgery. It was used mainly during scoliosis surgery. OBJECTIVE: To evaluate the efficacy of this technique. METHODS: Sensory and motor pathways were continuously monitored bilaterally from skin incision to awakening, with independent evaluation of the right and left pathways for each modality. RESULTS: This monitoring technique detected a transient unilateral motor deficit that occurred during the dissection phase of spinal surgery for scoliosis before any instrumentation or mobilization of the spine.

Cardiac surgery with extracorporeal circulation in severe factor VII deficiency.

We describe here successful open heart surgery with extracorporeal circulation and haemodilution in a child with severe congenital factor VII deficiency. Substitution therapy was realized with factor VII concentrate (SD proconvertin concentrate, Bio-Transfusion). This is the first report case of successful cardiac surgery in severe congenital factor VII deficiency.

[Value of POR 8 in the treatment of burns]. / Intérêt du POR 8 pour le traitement des brûlés.

Excision and skin grafting is the best treatment for burn wounds. In order to avoid excessive bleeding during the operation, sub-eschar infiltration with POR 8 (para ornithine 8 - vasopressin) has been performed in 115 patients between 1979 and 1984. The results being encouraging, infiltration was later also performed under the donor site. Bleeding was reduced enough by this technique to allow one stage excision and grafting of surfaces up to 20% of the body surface. No general or local complication of POR 8 infiltrations has been observed except a slight increase of blood pressure without clinical consequence.

Induction of anaesthesia with ketamine during an acute crisis of hereditary coproporphyria.

An appendectomy operation was undertaken in a 29-year-old patient with signs of an acute crisis of hereditary coproporphyria. Anaesthetic induction with ketamine 75 mg IV was uneventful. The safety of ketamine in patients with coproporphyria is discussed.

Rectal benzodiazepines for premedication in children. Review and personal experience.

Modern anesthetic techniques have modified the aims of premedication in pediatric practice. Anxiolysis, amnesia and easiness of induction are now the the main targets. This paper reviews both the literature and the personal experience of the authors on the subject. Many authors now prefer a benzodiazepine. Rectal instillation of benzodiazepine in solution avoids the trauma of the intramuscular route and produces a faster and more predictable effect, than suppositories. Diazepam (.1 to .2 mg/kg) and flunitrazepam (40 to 80 micrograms/kg) have been extensively used in this indication. Diazepam's duration of elimination being much longer than that of flunitrazepam, this last drug is preferred by many pediatric anesthetists. Midazolam (.4 to .5 mg/kg) has a much faster onset and shorter duration of action. It should thus be preferred if the environment enables the administration of premedication within 10 to 15 minutes of induction.

Coronary vasospasm after myocardial revascularisation. Treatment by verapamil.

Coronary vasospasm occurring after myocardial revascularisation must be quickly and efficiently treated to avoid the haemodynamic complications that it may cause. Treatment by nitroglycerin intravenously (i.v.) is not always efficient and an alternate possibility of treatment is essential. During the period from March 1982 to August 1983, we observed in our institution three patients with coronary vasospasms occurring after myocardial revascularisation which did not respond to nitroglycerin i.v. and were successfully treated by verapamil. Recurrence of vasospasm was prevented in those cases by verapamil perfused i.v. (dosage: 0.37 to 0.75 microgram/kg/min). The clinical evolution of these 3 cases are described here. Dosages of verapamil used to treat and to prevent the incident are discussed. The limitations of this therapy are briefly reviewed.

Comparative value of peripheral and central venous pCO2 in predicting normal paCO2 during anaesthesia.

The ability of venous pCO2 to predict arterial pCO2 within the normal range was tested by measuring pCO2 in blood sampled simultaneously from a large forearm vein (PER), from the superior vena cava (SVC), and from an artery in 35 anaesthetized patients. The relationship between arterial and both venous pCO2's were studied in a first series of 15 patients (ASA physical status class I-II) anaesthetized with methohexitone, fentanyl, pancuronium and nitrous oxide/oxygen, and in a second series of 20 patients scheduled for cardiac surgery anaesthetized with flunitrazepam, fentanyl, pancuronium and nitrous oxide. A marked correlation was found between arterial and both venous pCO2's samples in the normal patients (a/PER: r = 0.922; a/SVC: r = 0.940); in the patients with abnormal cardiovascular status the correlation observed was less pronounced (a/PER: r = 0.501; a/SVC: r = 0.507). In view of the similar correlation coefficients observed from the PER or SVC blood sampling sites, we conclude that the degree of accuracy of the prediction of paCO2 from the venous pCO2's is not modified by the origin of the venous blood. The differences between the coefficients of correlation found in the normal patients and in those with abnormal cardiovascular function indicate that venous pCO2 as estimate of paCO2 appears useful only in subjects with normal haemodynamic status.

A study of the action of oral cimetidine or placebo on the pH and the volume of gastric contents when administered the evening or the morning before general anesthesia. A double blind study.

A double blind experiment studied the effect on the pH and on the volume of gastric fluid after the administration of either cimetidine or a placebo as premedication before scheduled operations. The patients were divided into 4 groups. Group A received 400 mg of cimetidine the night before the operation and the placebo in the morning. Group B received 400 mg of cimetidine the night before and 200 mg in the morning. Group C received the placebo in the evening and in the morning and group D received the placebo in the evening and 200 mg of cimetidine in the morning. Compared to the placebo group C, the action of cimetidine on the pH was only significant in the 2 groups (B, D) which received a morning dose (p less than 0.01), but cumulative evening and morning administration of cimetidine (group B) was the only method which statistically diminished the mean volume of gastric fluid (p less than 0.05). The administration of repeated doses of cimetidine increased the pH and decreased the volume of gastric fluid and would thus seem to be a good method to prevent inhalation pneumonia during anesthesia.