[Comparison of the action kinetics of alcuronium and vecuronium by electromyographic monitoring]. / Comparaison de la cinétique d'action de l'alcuronium et du vécuronium par monitorage électromyographique.

Twenty-eight ASA I or ASA II adults undergoing microsurgery were anaesthetized according to a standard protocol using droperidol, phenoperidine and thiopentone followed by enflurane. The patients were randomly assigned to two homogeneous groups: the first group (n = 14) received 0.2 mg.kg-1 alcuronium, whereas the second group (n = 14) received 0.08 mg.kg-1 vecuronium. There was no reinjection of either drug and curarization tapered off spontaneously. Neuromuscular monitoring was begun once anaesthesia was stable and after intentional isovolaemic haemodilution. The type of stimulus used was the train-of-four, delivered by a Relaxograph monitor to the ulnar nerve. Muscle response was measured at the hypothenar eminence. The kinetic study considered the time interval required between the injection of the muscle relaxant and the appearance of the minimal value of the twitch (first response of the train-of-four = T1min). The times to recovery of the twitch height to 25, 75 and 100% of the reference value (T1/T0) and of the fourth response of the train-of-four to 25 and 75% of the ratio (T4/T1) were also recorded. Finally, the recovery indexes represented by the times required for T1/T0 and T4/T1 to rise from 25% to 75% respectively were studied. The maximal twitch height inhibition was significantly greater (p less than 0.001) in the vecuronium group (T1min = 0.36 +/- 1.33%) than in the alcuronium group (T1min = 4.36 +/- 5.08%); it occurred significantly more quickly (p less than 0.001) with vecuronium (139 +/- 48 s) than with alcuronium (316 +/- 133 s).(ABSTRACT TRUNCATED AT 250 WORDS)

Thallium 201 muscle scintigraphy: application to the management of patients with arterial occlusive disease.

Skull (S), thigh (T), and calf (C) scintigraphies were performed by using 2 mCi thallium 201 IV in 30 patients suffering from stages II, III, and IV arterial occlusive disease (Fontaine's classification). Two indexes were calculated: P = T/C-C/S (T/C and C/S were the absolute values of radioactivity ratios measured before medical treatment) and R = delta(C/S)-delta(T/C) (where delta expressed the relative variation of the ratios measured after treatment and compared with initial values). Angiography was performed on all patients prior to treatment, and the results were quantified as 1 in the case of obliteration and 0.5 in case of stenosis of major arterial axes. Clinical improvement was demonstrated by a 100% increase in walking distance for stage II disease, abolition of pain at rest for stage III disease, and reepithelialization of trophic lesions for stage IV disease. Paraclinical effectiveness was evaluated by measuring ankle systolic pressure (SP) and index (SI) before and after treatment. The correlation observed between the values of P and angiography results was p less than 0.025 (Student t-test). The mean of P (measured before treatment) was 1.75 for the improved patients and 0.56 for the others (p less than 0.005). After treatment, R was +58% for improved patients versus -13% in those in whom the treatment was inefficient (p less than 0.025). P expresses the microcirculatory effects of arterial lesions detected by angiography. It is a prognostic index: satisfactory proximal perfusion (high T/C), associated with lesions that are essentially peripheral (low C/S), predicting a positive effect of medical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of hemodilution on the ventricular function of the coronary patient]. / Retentissement de l'hémodilution sur la fonction ventriculaire du coronarien.

Ten patients (9 males and 1 female: mean age: 64.8 +/- 7 yr) were studied. They were all stabilized coronary heart disease patients free of cardiac failure who where to undergo normovolaemic haemodilution as medical treatment of lower limb arteritis. Ventricular function was assessed by a radioisotope method: myocardial perfusion (thallium-201 and dipyridamole scintillation scan) and left ventricular contraction by technetium-99m angiography. Blood volume was measured by iodine-131 marked albumin. The following parameters were also measured: plasma viscosity, blood viscosity at seven different speeds, red blood cell aggregation index and filtration index. These were all measured before and 24 h after normovolaemic haemodilution which was carried out with à 5% albumin solution. This haemodilution was well tolerated: 1,062 +/- 335 ml of blood were sampled, the same volume of albumin being transfused, thus reducing the mean haematocrit from 0.42 +/- 0.05 to 0.32 +/- 0.02 (p less than 0.01). Normovolaemia was respected. Blood viscosity was reduced, especially at low speeds and the red blood cell aggregation index was also reduced. Ventricular contraction did not vary. Moreover, the basal myocardial state as assessed by the thallium scintillation count was not modified by the haemodilution, even being improved in three cases. The dipyridamole perfusion (the equivalent of an effort test) gave no changes in seven patients, resolved the ischaemic signs in two patients and slightly increased ischaemia in one case.

[Intentional normovolemic hemodilution in the medical treatment of lower limb arteritis]. / Hémodilution normovolémique intentionnelle dans le traitement médical de l'artérite des membres inférieurs.

Thirty patients suffering from arterial occlusive disease (stages II, III or IV of Fontaine's classification) were treated by isovolaemic haemodilution (IDH). Most of these patients received conventional medical treatment without success (negative selection). Angiography was performed on all patients prior to treatment. 500 ml of whole blood was withdrawn from each patient. 250 ml of dextran 40 mixed with 250 ml of 5% albumin solution was injected intravenously to avoid hypovolaemia. This procedure, carried out three or four times, was repeated until a haematocrit of 0.30 was reached. This haematocrit level of 0.30-0.35 was maintained for 60 days. The measurement of ankle systolic pressure, systolic index at rest, treadmill performance and lower limb thallium-201 muscular scintigraphy were used to assess laboratory efficiency. On the sixtieth day, 14 patients (46%) showed clinical improvement, nine were stable and arterial occlusive disease worsened in seven patients. Clinical improvement persisted for several months (15 months in one case). Clinically, it seemed that patients treated by IHD showed improvement of their arterial occlusive disease. However, the prediction of the chances of success of IHD, as well as the quantification of results by common laboratory examination, were difficult. Muscular scintigraphy with thallium-201 gave a good assessment as well as a quantifiable analysis of results.

[Peripheral circulatory effects of sodium nitroprussate. Evaluation by plethysmography and capillaroscopy]. / Effets circulatoires périphériques du nitroprussiate de sodium. Appréciation par pléthysmographie et capillaroscopie.

Circulatory effects of intravenous injection of sodium nitroprusside are appreciated in 6 patients by monitoring systemic pressure, heart rate, digital systolic pressure, pulse plethysmography and nail-fold capillaroscopy. Low doses of nitroprusside (1.5 microg./kg/mn) enhance digital blood flow (+ 78.9%) and maximum height of the plethysmographic curve (+ 71.6%), without any significant modification of the systemic blood pressure (- 0.6%), heart rate (+ 6.3%) and digital pressure (- 1.15%). The peripheral resistances are strongly reduced. Nail fold capillaroscopy is unchanged. Higher doses, even with an adequate vascular filling, are potentially harmful for microcirculation.