[A comparative study of the cost of open-circuit as opposed to closed-circuit ventilation]. / Etude comparative du coût de la ventilation en circuit ouvert et en circuit fermé.

The authors compared two open randomized groups of patients undergoing surgery through general anaesthesia. Group 1 consisted of 54 patients ventilated by a Siemens 900 B ventilator in open circuit, and group 2, 56 patients ventilated by an ELSA de Gambro ventilator in a closed circuit. Comparative hour cost for nitrous oxide (N2O), oxygen (O2) and halogen gas, Enflurane, Isoflurane, was noted. All patients received the same regimen of anaesthesia and the two groups were identical in age, weight, surgery, respiratory volume and ventilation time. The evaluation of comparative hour cost included specific materials of close circuit ventilator: CO2 filter (Aridus), Lime. Were excluded maintenance and gas consumption expenditures before patient connected to the ventilator. The total hour cost (O2, N2O, specific materials for close circuit, without halogen gas) was 8.23 FF in closed circuit against 13.28 FF in open circuit, an economy of 38.27%. Hence, for oxygen, the hour cost was 0.70 FF in open circuit against 0.27 FF in closed circuit (gain of 65.3%). For nitrous oxide, the hour cost in open circuit was 12.50 FF against 2.44 FF in closed circuit (80.5%). For Isoflurane, the open circuit hour cost was 41.38 FF against 22.44 FF in closed circuit (47%). For Enflurane, the open circuit hour cost was 14.17 FF against 5.94 FF in closed circuit (58.1%). And, lastly for Enflurane, open circuit hour cost was 14.17 FF against 5.94 FF in close circuit, gain of 58.1%. These "modest" economy against those found in previous studies can be explained by the long-time duration of ventilation, saturating time in open circuit more or less long, depending on the physician, specific materials for closed circuit ventilation--lime, CO2 filter--in not taken into account, the hour cost of O2 + NO2 goes from 8.23 FF to 2.71 FF, and the gain against the close circuit becomes 79.6%: reducing hour cost by 5 times. In order to improve the effective cost of close circuit, the authors proposed: the use of closed circuit ventilation for more than 3 hours surgery, gas saturation in closed circuit after denitrogenation--which demands the use of halogen infjectors, and lime in containers cheaper than disposable cartridges. Respecting the above criteria, the total hour cost in close circuit fell to 4.90 FF, gain of 63% against open circuit. For O2 et N2O, the hour cost goes from 1.34 FF in close circuit to 13.28 FF in open circuit, 90% economy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Does the Leveen valve still have a place in the treatment of refractory ascites? An evaluation of 107 cases]. / La valve de Leveen dans le traitement de l'ascite réfractaire reste-t-elle d'actualité? Bilan de 107 cas.

One hundred and seven patients have been treated by the peritoneovenous shunt (PVS) : 54 patients from 1979 to 1984 (P1) and 53 patients from 1985 to 1990 (P2). The mean age was 58 years (25-79 years) and 73 % of the patients had a cirrhosis of alcoholic origin. The mortalities at two weeks and one month were 22 % and 26 % for P1 and 6 % and 11 % for P2. The risk of operation was related to the importance of hepatic and kidney insufficiency and to the importance of hyponatremia. Long term outcome depended on the causal illness. At short term, the morbidity can be reduced and the PVS should be indicated earlier in the progression of the illness.

[Evaluation of the efficacy and tolerance of flumazenil in antagonism of the effects of flunitrazepam on the central nervous system]. / Evaluation de l'efficacité et de la tolérance du flumazénil dans l'antagonisme des effets du flunitrazépam sur le système nerveux central.

The efficacy and tolerance of flumazenil were assessed in a double-blind randomized multicentre trial on 120 ASA I or II patients aged 40.3 +/- 13.9 years. They were anaesthetized with flunitrazepam (25.1 +/- 10.5 micrograms.kg-1.h-1), fentanyl (4.4 +/- 1.9 micrograms.kg-1.h-1) and either vecuronium or pancuronium; residual neuromuscular blockade was antagonized at the end of surgery. 61 patients received flumazenil and 59 a placebo. Sedation comprehension and temporo-spatial orientation were scored at 0, 5, 15, 30, 60, 120 and 240 min after the administration of flumazenil or placebo. Local and general tolerances were evaluated 1 h and 24 h after administration. At the 24th h, the observer's assessment of consciousness, pain, respiration, coughing and vomiting were noted, as well as his identification, or not, of flumazenil or the placebo and their efficacy. Both groups were statistically homogeneous and comparable. Significant and marked efficacy was noted between the 5th and 30th min. There was no difference, at 24 h, between the flumazenil and placebo groups. In most cases, flumazenil was identified by the observer and its efficacy felt to be excellent. No major untoward effect of flumazenil was noted; however a mild and short lasting anxiety occurred in three patients. Tolerance was deemed to be excellent.

[Pharmacokinetics of pethidine after spinal anesthesia. Clinical implications]. / Pharmacocinétique de la péthidine après rachianesthésie. Implications cliniques.

Eleven male patients undergoing endoscopic resection for prostatic adenoma and bladder tumours under spinal anaesthesia received intrathecal pethidine 1 mg X kg-1. Plasma concentration and its evolution with time were assessed; pethidine plasma concentrations were determined by high performance liquid chromatography. Pethidine was rapidly and extensively absorbed. The peak plasma concentration of pethidine was 176 +/- 66 ng X ml-1 (range: 84-208) and the time to peak concentration was 2.3 +/- 1.4 h (range: 0.5-6 h). The terminal elimination half-life was 7.2 +/- 2.2 h (range: 4-11.5 h). The plasma concentrations of pethidine remained below 500-700 ng X ml-1, the minimum concentration necessary to obtain a systemic analgesic effect. Two patients required noramidopyrine as a complement at the 8th and 12th h respectively. No respiratory depression was observed. Intrathecal pethidine (1 mg X kg-1) was an effective agent for spinal anaesthesia: the prolonged postoperative analgesia was due to the drug acting on opioid receptors in the spinal cord. This led to the necessity of postoperative monitoring during 24 h after intrathecal pethidine administration.

[Comparative study of cefoperazone and cotrimoxazole in kidney stone surgery via percutaneous approach]. / Etude comparative de la céfopérazone et du cotrimoxazole dans la chirurgie lithiasique rénale par voie per-cutanée.

The effectiveness and drawbacks of cefoperazone and cotrimoxazole in the prevention of postoperative infections following percutaneous removal of renal stones were studied comparatively. 60 patients were divided at random into two groups. 30 subjects were given 1 g cefoperazone IV every 8 hours for 5 consecutive days starting on the day before the procedure. The 30 other patients had an infusion of 800 mg sulfamethoxazole and 160 mg trimethoprim every 12 hours on the same 5 days. Age, sex and type of surgical procedure were comparable in both groups. Results were as follows: in the cefoperazone group, one patient had intraoperative septic shock due to a stone infected by a resistant Pseudomonas aeruginosa; in the cotrimoxazole group, 2 patients had postoperative fever due to stones infected by resistant Gram negative rods (Pseudomonas aeruginosa) and three patients had a urinary tract infection (Candida albicans in 1 case, Escherichia coli in 1 and Pseudomonas aeruginosa in 1). Tolerance was satisfactory for both regimens. The authors conclude that intravenous cefoperazone in the more effective drug and should be continued throughout the first three postoperative days.

[Lumbar puncture: indications and limitations]. / A propos de la ponction lombaire: indications et limites.

Fast deterioration of the neurological status of patients with raised intracranial pressure after lumbar puncture is not rare. Cerebral coning or rebleeding occur in consequence of cerebrospinal fluid leak. An experimental model correlates leakage with needle gauge. Computed tomography is indicated for diagnosis at the time of the initial examination. Puncture with needles of small diameter (less than 0.5 mm) is recommended.