[Progress in ambulatory anesthesia applied to gynecological surgery]. / Progrès de l'anesthésie ambulatoire appliqués à la chirurgie gynécologique.

Ambulatory gynecological surgery enables fast recovery of vital functions, ambulation and a relational life of quality. Patients whose disease is well-controlled at the anesthesia consultation can benefit from ambulatory procedures. Improved material and surgical practices broaden potential indications, limiting the risk of postoperative pain which can be controlled with simple analgesic protocols. The choice of the anesthesic techniques or the agents used during the intervention ensures fast recovery of higher functions. Nausea and vomiting, which may develop after returning home and compromise oral drug intake, must be prevented. More ambulatory gynecological procedures can be expected in the near future, pointing out the importance of developing more adapted medical structures.

Modifications of spontaneous cerebral blood flow oscillations during cardiopulmonary bypass.

UNLABELLED: Spontaneous slow waves are present in the systemic circulation including the intracranial compartment. They are supposed to reflect the cerebral autoregulation. We hypothesised that in the absence of cardio respiratory variability, during cardiopulmonary bypass (CPB), we should reveal extreme physiologic controls. MATERIAL/METHODS: Ten patients were included. Arterial blood pressure (ABP, radial invasive), extracorporeal circuitry pressure and cerebral blood flow velocity (CBFV, middle cerebral artery) were recorded. We analysed the slow waves in the B (8 to 50) and the UB (>50 to 200) bands (in milli-Hz). The analysis, before and during CPB, was performed in the tine domain (correlation coefficient, entropy, mean quantity of mutual information, relative entropy) and in the frequency domain (spectrogram, frequency spectrum, coherence). RESULTS: CPB dramatically changed monitored signals decreasing their entropy and revealing a dominant CBFV 70 mHz-frequency and a dominant ABP 9 mHz-frequency. There was no association between the signals (p < 0.05). Before CPB we found complex patterns where B and UB waves were present. CONCLUSION: We hypothesised that CPB provoked a highly protective mechanism, reducing the fluctuations of CBF, by a deactivation of B waves, revealing monotonous UB waves.

[Laboratory animal anaesthesia: influence of anaesthetic protocols on experimental models]. / Anesthésie des animaux de laboratoires, réflexion de son influence sur l'interprétation des résultats.

The use of experimental animals requires anaesthesia to provide immobility and analgesia. Animals require anaesthesia not only for ethical reasons but also because pain and stress can alter the quality of research results. Recognition of pain, and its treatment is important throughout the procedure. Before anaesthesia, animals are acclimated and rehydrated. Except in small rodents and in ruminants, in order to avoid vomiting, a fast of 8 to 12 hours before anaesthesia is recommended. In order to protect animals against suffering and distress during transfer, restraint and management, a premedication is administered. Most human anaesthetic products can be used in animals. There are some specific veterinary anaesthetics. Moreover, the anaesthetic effects could be different from specie to an other. In most big animals, induction is realized by intravenous administration. In small rodents, venous puncture and contention could be difficult, and anaesthetic agents may be injected via intraperitoneal or intramuscular way. The principal inconvenient of these administration routes is the impossibility to adjust dose to animal response. In large animals, human anaesthesia material can be used. Some technical adaptations could be necessary in smaller animals. In rodents or in neonatology, specific devices are recommended. ECG, arterial pressure, tidal volume, expired CO(2) and oxygen saturation monitoring assess quality of, and tolerance to anaesthesia. If animals are awaked after anaesthesia, postoperative management is closed to human clinical problems. During animal experimentations, anaesthesia may interact with results. All anaesthetic drugs alter normal physiology in some way and may confound physiologic results. In the literature, most publications do not mention this possible interaction. Investigators need to understand how animals are affected by anaesthetic drugs in order to formulate anaesthetic protocols with minimal effects on data. Extrapolation between different animal species and human and animals about the effects of anaesthetic agents are very hazardous. Great differences exist between the effects observed in vitro and in whole animals. The effects of the anaesthetics could be totally different if they are used alone or in association. The same anaesthetic could have opposite effects from an organ to another. For results validation, the anaesthesia side effects (hypoventilation, hypotension, cooling em leader ) have to be minimized. All new experimental models should require discussing the possible interferences between anaesthesia and results and to compare results obtained with different anaesthetic protocols.

Slow pressure waves in the cranial enclosure.

Slowly varying pressure oscillations in the cranial enclosure are well known, especially intracranial pressure waves as best described by the pioneering works of Janny and Lundberg. Nevertheless, in spite of over twenty five years research on intracranial pressure waves, their origin and regulation remain unclear but are often considered only as pathological. Our aim was to review data on these phenomena to clarify their biological status and the role that they could play in the management of patients suffering from such intracranial neurosurgical diseases as intracranial hypertension, severe head injury, and hydrocephalus. It appears that these pressure waves reveal important information on the function of the cerebral vasculature and as such have significance for influencing intracranial compliance. Pressure waves are also closely associated with autoregulation, in particular dynamic autoregulation. It seems evident that they are not only pathophysiological but also physiological, linked with other biological parameters such as the neurovegetative cardiovascular system, breathing, and sleeping. This study shows that it is not only important to continue to explore these slow waves, but also the methods of analysis in order to more fully clarify their clinical significance.

[Prolonged effect of midazolam with delayed postanesthetic recovery from the possible interference of famotidine]. / Effet prolongé du midazolam avec retard de réveil postanesthésique par interférence possible avec la famotidine.

We report the case of a 79-year-old woman, in chronic renal insufficiency who recovered from anaesthesia after a delay of 24 hours, after flumazenil (Anexate) administration. She was given famotidine (Peptidine) the day before surgery. Midazolam was administered for premedication (5 mg per os) and for the induction of anaesthesia (2 mg intravenous). Among the various causes of delayed recovery in this elderly patient, an interaction between midazolam and famotidine is discussed.