[Comparison between conventional and continuous spinal anesthesia using bupivacaine]. / Comparaison entre rachianesthésie conventionnelle et rachianesthésie continue utilisant la bupivacaïne.

A study was carried out to find out whether dividing the dose of local anaesthetic would give a better control of the spread and duration of sensory blockade due to spinal anaesthesia. It was carried out in 34 patients (mean age 62 years) scheduled for elective limb vascular surgery. All were classed ASA 2 or 3. Sensory blockade was assessed using a fine needle, and the degree of motor blockade with Bromage's scale. This was carried out every 5 min for the first 30 min, and thereafter, every 15 min until recovery from anaesthesia was complete. In the first group of patients (n = 16), spinal anaesthesia was obtained with a 26 gauge needle, the patient lying on his side; 4 ml of 0.5% bupivacaine were injected (1 ml every 10 seconds) before putting the patient supine. In the second group (n = 18), the catheter for continuous spinal anaesthesia was set up with the patient in the same position as for the first group. Once a length of 1 cm had been introduced in the subarachnoid space, the patient was placed supine and 2 ml of 0.5% bupivacaine were injected. If 15 min later sensory blockade did not reach T10, further 0.5 ml aliquots were given every 10 min so as to obtain a level of sensory blockade between T9 and T11. Maximum extension of sensory blockade was 15.1 +/- 2.3 metamers in group 1, with an extension to T3 in 2 patients. In group 2, 12.9 +/- 3.1 mg bupivacaine anaesthetized 14.2 +/- 1.9 metamers.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative development of sympathetic and sensitive blocks during spinal anesthesia]. / Evolution comparative des blocs sympathique et sensitif au cours de l'anesthésie spinale.

The extent and duration of sympathetic and sensory blockade were compared in 13 patients after spinal anaesthesia with 0.5% tetracaine (20 mg) in either isobaric (n = 6) or hyperbaric solution (n = 7). Sensory blockade was assessed by pin-prick and sympathetic blockade by the sympathogalvanometric method respectively at L5/S1, L2, T8 and C8/T1 levels. The time to onset and the duration of sensory or sympathetic blockade was identical. The mean extent of sympathetic blockade was 6 segments greater than that of sensory blockade. Hypotension was related to the extent of sensory but not sympathetic blockade. This study confirms that sympathetic blockade is more extended than sensory blockade during spinal anesthesia but does not allow to predict the occurrence of hypotension.

[Comparison of blood pressure profiles with flunitrazepam/fentanyl/nitrous oxide vs cervical epidural anesthesia in surgery of the carotid artery]. / Comparaison des profils tensionnels sous flunitrazépam/fentanyl/N2O vs anesthésie péridurale cervicale pour chirurgie carotidienne.

A study was carried out to compare the evolution of arterial blood pressure during carotid endarterectomy performed under either general anaesthesia (GA) or cervical epidural anaesthesia (CEA). 20 patients were randomly assigned to two equal groups. In the CEA group, 15 ml of 0.375% bupivacaine and 150 micrograms fentanyl were injected into the epidural space at C7-D1 level. In the GA group, patients were anaesthetized with 0.2 mg.kg-1 flunitrazepam and 5 micrograms.kg-1 fentanyl; intubation was carried out using 0.08 mg.kg-1 vecuronium, and the patients were ventilated with a mixture of nitrous oxide and oxygen (50% of each). Further injections, every 30 min, of 2 micrograms.kg-1 fentanyl were given to the patients in group GA. Blood pressure was monitored continuously, up to 4 h postoperatively, with a radial arterial catheter. Per- or postoperative hypertension was defined as a rise in systolic arterial blood pressure (Pasys) over 180 mmHg for greater than 3 min; this was treated with 20 mg nifedipine intranasally (group CEA) or 100 micrograms fentanyl with 0.5 mg flunitrazepam with or without nifedipine (group GA). Per- or postoperative hypotension was defined as a fall in Pasys below 100 mmHg and or a 30% fall in mean arterial blood pressure for greater than 3 min; this was treated, in both groups, with an intravenous bolus of 3 mg ephedrine. Patients in group CEA experienced more frequent episodes of peroperative hypertension (8/2; p less than 0.02) and postoperative hypotension (5/1) than group GA.(ABSTRACT TRUNCATED AT 250 WORDS)

[Goodpasture's syndrome. Development of its prognosis from 1955 to 1982]. / Syndrome de Goodpasture. Evolution du pronostic de 1955 à 1982.

A retrospective study of 258 reports of Goodpasture's syndrome published from 1955 to 1982 has made it possible to follow changes in prognosis and to determine the present prognostic factors. In these 27 years, the mortality rate has dropped from 86% to 13%, and 51% of the patients now survive without dialysis. Death from respiratory failure virtually disappeared as soon as plasmapheresis was introduced. However 36% of patients are still threatened with chronic renal failure, the risk being higher in patients with initial oliguria or anuria and with extra-capillary crescents involving more than 50% of glomerules, and still higher when these two factors coexist. In such a case, only 21% of patients may hope to survive in renal autonomy.