[Postoperative analgesia with thoracic peridural morphine in pulmonary surgery. 117 cases]. / Analgésie postopératoire par la morphine péridurale thoracique en chirurgie pulmonaire. Cent dix-sept observations.

Post-operative analgesia by peridural injection of morphine in the thoracic spine was evaluated in a series of 117 successive patients with pulmonary pathology operated upon by the same surgeon. The catheters were introduced, either on the day preceding the operation or at the end of it, above or below T6-T7, after localization of the peridural space by the hanging drop technique or by loss of resistance to a liquid mandrel; 5 mg of preservative-free morphine diluted in 3 ml isotonic saline were injected. The catheter was left in situ for 3 days, then systematically removed and cultivated. Analgesia was considered excellent in 66.7% of the cases, good in 26.5% and insufficient or non-existent in 6.8%. Each dose was effective for 15 hours on average. The mean total dose administered was 18.2 mg and did not exceed 40 mg during the first three post-operative days. There was no respiratory depression requiring naloxone or mechanical ventilation. Urinary retention occurred in 62% of the patients and troublesome pruritus in 0.3%. No death attributable to the method and no neurological or infectious complication was noted. There was no problem in removing the catheter, and no redness, pain or haematoma was observed at the site of injection. In view of the potential risk of insidious and delayed respiratory depression, the patients must be closely supervised specialized by staff. This technique must not be used unless the conditions required are fulfilled.

[Experimental study of changes in the pressure of the posterior segment of the eye under general anesthesia. Consequences for surgery of the anterior segment]. / Etude expérimentale des variations de la pression du segment postérieur de l'oeil sous anesthésie générale. Conséquence pour la chirurgie du segment antérieur.

Animal studies were conducted to compare variations in intraocular (IOP) and posterior segment pressure (PSP) during general anesthesia to assess the role of PSP in the development of anesthesia for ophthalmological procedures. Anesthetic agents appear to have a marked effect on IOP during operations involving opening of hypertonic globe or examinations of children under general anesthesia, but their action on IOP has no significance during procedures requiring opening of the anterior chamber because of alteration of aqueous humor physiology. The PSP, defined as pressure in the posterior segment when the anterior segment is at atmospheric pressure, is the main factor affecting surgical conditions, a rise in PSP possibly resulting in typical complications of cataract surgery but having beneficial effects in corneal grafts for example. Posterior segment pressure cannot be studied in humans and an experimental model using rabbits under artificial ventilation following tracheotomy after general anesthesia was developed. Pressure gauges recorded arterial and central venous pressures and were connected to needles inserted in both eyes to monitor IOP and PSP, the latter from a needle passed into the anterior chamber through the cornea, which was incised over the needle to enable permanent drainage of aqueous humor. All pressures were recorded simultaneously and no correlations were observed between IOP and PSP after pentobarbitone, neosynephrine, succinylcholine, or asphyxia (interruption of ventilation and curarization). These findings suggest that IOP is not a valid measurement for assessment of anesthetic techniques, whereas PSP provides a better guideline for development of ophthalmological anesthesia.

[Ionized plasma calcium variations and injection of radiologic contrast media]. / Variation du calcium ionisé plasmatique et injection de produit de contraste radiologique.

Ionized serum calcium was determined, using a selective electrode, after administration of 80 ml of radiological contrast medium. The ionized calcium concentration was significantly diminished during five minutes after injection (control: 0,98 +/- 0,02 mmol/l; 3 min: 0,94 +/- 0,02 mmol/l, p less than 0,01; 5 min: 0,94 +/- 0,01 mmol/l, p less than 0.05). Determinations were also performed in vitro on whole blood and separated plasma after addition of contrast medium. These determinations revealed a direct interaction between ionized calcium and contrast medium and the importance of the delay after mixing. Clinical consequences under the conditions of the study are probably null but this secondary effect of the contrast medium can explain incidents or accidents observed during the first local circulation of contrast medium especially during coronarography.

[Enzymatic changes after arteriography of the lower limbs (author's transl)]. / Modifications enzymatiques après artériographie des membres inférieurs.

Various serum enzyme activities were studied in 15 adult patients before aortography and at the 6th hour and on the first five days after investigation; and at comparable intervals in 8 adult patients who had a bilateral transfemoral arteriography. A significant rise in serum creatine phosphokinase (CPK) level was noted at the 6th hour (p < 0.01), on the 1st day (p < 0.001) and on the 2nd day (p < 0.05) after aortography. Serum aspartate-aminotransferase (ASAT) level increased significantly (p < 0.02) on the 1st day after aortography. No significant change occurred for those two enzymes after transfemoral arteriography. In both groups minor changes were noted for the other enzymes studied: lactic dehydrogenase (LDH), alanineaminotransferase (ALAT) and gamma glutamyl transpeptidase (gamma GT). Rise in CPK and ASAT levels after translumbar aortography is attributable to skeletal muscle trauma and to the retroperitoneal haematoma at the site of puncture. Agents used in anesthesia are apparently not responsible.

[Translumbar intra-aortography. Hemodynamic consequences (author's transl)]. / L'aortographie par voie translombaire. Variations hémodynamiques.

The hemodynamic consequences of the translumbar intra-aortic injection of 80 ml of contrast media were studied in 28 patients, in whom cardiac output was determined using thermodilution. These measurements revealed that the vasoplegia produced by the intra-aortic injection of contrast media is of smaller amplitude and longer duration than that evidenced during regional flow determinations. Moreover, the decrease in vascular peripheral resistances and the increase in cardiac output, accompanied by bradycardia, persist for several minutes. These phenomenons are related to an increase in ventricular filling, resulting from the expansion of the intravascular compartment secondary to plasma hyperosmolality.