Ultrarapid induction.

We report 250 rapid induction anesthesias performed for the purpose of preventing regurgitation and vomiting in patients with full stomach. The anesthetic technique includes administration of morphine 20 mg and droperidol 5 mg intravenously 10-15 minutes before induction, a voluntary air hyperventilation at the anesthetist's command, during which induction drugs are introduced and an induction with a mixture containing suxamethonium 2 mg/kg and thiopentone 1.4 mg/kg, administered within 1-2 seconds. Eighteen seconds after the onset of injection the loss of lid reflex is observed followed 7 seconds later by masseter muscle relaxation. Within the following 5-10 seconds intubation is carried out in full fasciculation process, before cardia relaxation. With this technique, a mean intubation time of 35 seconds is achieved. The interval of maximum regurgitation risk is lowered to 15 seconds, so that ventilation by mask and cricoid pressure are no more necessary. The technique is indicated in the young and vigorous adult and contraindicated in the old and tainted patient, in coronary patients, in those with low heart output and slowing of circulation.

Stress ulcers in intensive care (etiology, symptomatology and therapy).

The authors present a group of 48 patients with stress ulcers (36 men, 13 women) average age 56.2 years. The analysis of the cases allowed to establish, for the first time in medical literature, a correlation between the etiology, the symptomatology and the moment of onset of the haemorrhage, with important practical implications in the adoption of a treatment regime. These considerations permitted us to delineate four categories of stress ulcers: The first category included stress ulcers caused by a cerebral lesion and manifested through cerebral hypertension. The upper digestive haemorrhage occurred within 24-48 h after the aggression and required the correction of the cerebral hypertension and of the anaemia. The second category comprised stress ulcers brought about by a hypovolaemic shock through myocardial infarction, burns, frost-bite and multiple traumas. Haemorrhage in the upper digestive tract appeared within 3-6 days after the moment of aggression and required surgical control unless it was caused by myocardial infarction. The third category was represented by post-operative stress ulcers. These forms occurred usually late, between the eighth and the thirty-seventh day after the aggression, and were due to the super-imposition of the septicaemia on the post-aggressive systemic reaction. The chief aim of treatment here was the surgical control of infection. The fourth category encompassed the stress ulcers occurring after protracted coma, especially in patients with ventilatory assistance. In these conditions, the ulcers of the digestive tract and the consequent haemorrhage represented terminal elements of irreversible diseases, in which no treatment was effective.

[Continuous peritoneal lavage in severe post abortion peritonitis]. / Lavaj peritoneal continuu in peritonitele grave post-abortum.

PIP: The authors report on 7 cases of severe postabortum peritonitis treated with hysterectomy and postoperative perinoteal lavage. The technique consisted of placing the tubes subhepatically, parietocolic on the right, Douglas cul-de-sac on the right, supramesocolic on the midline, in the splenic recess, parietocolic on the left, and Douglas cul-de-sac on the left. Each of the left. Each of the 2-way tubes was irrigated clockwise every hour with a 0.9% sodium chloride solution, at room temperature, in a volume of 24 liters/24 hours at a rate of 1 liter/hour. The lavage lasted for 24-72 hours. Improvement of the toxicoseptic phenomena was obtained within this interval, with rapid resumption of diuresis and natural nutrition. Peritoneal lavage is an efficient procedure, completing the surgical intervention as demonstrated by survival of all patients, with a small number of complications and a brief period of postoperative hospitalization. (author's)^ieng

[Subarachnoid anesthesia with pethidine]. / L'anesthésie sous-arachnoïdienne par la péthidine.

The authors present their experience about spinal anesthesia with pethidine as the sole medication. 713 patients whose mean age was 56.5 years received 1 mg . kg-1 of pethidine in 50 p. 100 aqueous solution administered by subarachnoid route. Indications were surgical procedures involving upper and lower abdomen, perineum and lower limbs. The set up of anesthesia is quite similar to those obtained with local anesthetics. Sensitivity disappears during the first three minutes in the area below the puncture site and in the following two or three minutes areflexia and paralysis is noted. The duration of the motor and sensory block is 90 to 120 minutes. Recovery appears to be in a reverse order. Spinal anaesthesia with pethidine exhibit the following characteristics: --sensory and motor blockade with minimal adverse reactions giving good and very good results in more than 90 per cent of cases, when involving perineum and lower limbs; --the most frequent adverse effect is a syndrome including hypotension, bradycardia and hypoxemia, appearing 20 to 30 minutes after injection, reversal is easily obtained by administration of pressure drugs and artificial ventilation. Neither delayed respiratory depression nor neurologic damage were noted; --a long lasting post-operative analgesia. In conclusion, this work demonstrates that: --1 mg . kg-1 of pethidine administered by subdural route realize a complete spinal anesthesia including motor, sensory and sympathetic blockade allowing surgical procedures in good conditions of security; --increasing the dosage of pethidine over 1 mg . kg-1 is not wise in order to avoid the occurrence of adverse side effects such as hypotension, bradycardia and bradypnaea; --this technic is only indicated for surgery in perineum and lower limbs.

[Hyperlipoproteinemia, a factor of severity in acute pancreatitis]. / Hiperlipoproteinemia, factor de gravitate in pancreatita acuta.

The authors make a retrospective analysis of 95 cases of acute pancreatitis hospitalized between 1975 and 1979. In 3,8% of all the cases the acute pancreatitis was associated with hyperlipoproteinemia. The study of the 4 patients involved revealed the primary origin of hyperlipoproteinemia as a result of alimentary abuse in 3 of the cases. In a fourth case the increased serum lipoproteins were due to prolonged use of contraceptives. From the clinical viewpoint, pancreatitis associated with hyperlipoproteinemia was more severe, with signs of shock and collapse, respiratory failure, high serum nitrogen an hyperglycemia. The blood and the serum had a lactescent aspect, with a thick layer of chylomicrons. The serum and blood values for lipids were higher than 4000 mg%. The increase in the amount of lipids was especially due to high triglycerides values. From the anatomopathologic viewpoint the 4 patients presented as acute cases of cholecysto-pancreatitis with major and extensive haemorrhagic necrosis which involved almost the entire pancreas. The evolution of the four patients was difficult. Two of the patients recovered after a long hospitalization, and had definitive sequels - insulin-dependent diabetes. The other two patients died following septic complications (bronchopneumonia and visceral gangrene), and hypovolemia due to upper digestive haemorrhage.