Hemodynamic and echocardiographic effects of hemofiltration performed during cardiopulmonary bypass.

OBJECTIVE: To evaluate the effects of hemofiltration performed during rewarming before emergence from cardiopulmonary bypass on hemodynamic and echocardiographic parameters. DESIGN: Prospective randomized study; blind analysis of echocardiographic parameters and hemodynamic parameters. SETTING: Single-center study performed in a university hospital. PARTICIPANTS: Two groups of 13 adult patients undergoing coronary artery bypass graft surgery. INTERVENTION: Patients were randomized to conventional procedure or hemofiltration performed with a polysulfone hemofilter. Hemofiltration, started at the time of rewarming on cardiopulmonary bypass, was performed with a flow rate adjusted to achieve an ultrafiltrate volume of 15 mL/kg on completion of rewarming. MEASUREMENTS AND MAIN RESULTS: Hemodynamic (systemic mean arterial pressure, right atrial pressure, heart rate) and echocardiographic parameters (shortening fraction, segmental kinetic score, cardiac output, systemic vascular resistance) were measured before and after hemofiltration and on arrival in the intensive care unit. Heart rate and cardiac index were increased significantly in both groups during the postoperative period. In the control group, systemic vascular resistance was decreased significantly, and cardiac index was increased during the postoperative period, together with significant alterations of segmental kinetic score and shortening fraction. In the hemofiltration group, systemic vascular resistance remained unchanged, associated with a significantly improved segmental kinetic score compared with the control group. CONCLUSIONS: Hemofiltration performed during rewarming before emergence from cardiopulmonary bypass is associated with stability of hemodynamic parameters and improved segmental myocardial kinetics.

[Intravenous anesthesia for cesarean section. Comparison of propanidid and methohexital]. / Anesthésie intraveineuse pour césarienne. Comparaison du propanidide et du métohexital.

Propanidid and methohexital were compared retrospectively to assess the possible neonatal depression following general anesthesia for caesarean section: both have rapid onset and short duration of action and their transplacental passages are similar. Anesthesia was induced with equivalent doses of the two agents in 90 women (45 in each group). For each anesthetic agent, three subgroups were defined according to the indications, depending on emergency criteria and fetal state. There was no significant statistical difference (Student test) regarding clinical and biochemical criteria except for the fetal arterial pH which was more acidic in the propanidid group. In both groups, Apgar scores, arterial and venous pH were significantly more altered when caesarean section was performed for acute fetal depression.

[Labor under peridural anesthesia. Experience at the Maternity Center of the Amiens CHRU]. / L'accouchement sous péridurale. Expérience de la Maternité du CHRU d'Amiens.

The study has been carried out on 476 epidural deliveries. 69 per cent of the patients were satisfied. Amongst the 31 per cent of unsatisfied, most claimed that the analgesia was not sufficient, mainly due to delayed re-injections. Instead of a continuous administration, the authors prefer the use of a bolus which is better adapted to the different times of labour. 80 per cent of the patients who had a caesarian delivery under epidural anaesthetic were very satisfied. The efficacy of the re-injection for post-operative analgesia is also to be noted (92 per cent success). Finally, whatever the stage of perfection of the epidural technique, it is always better to associate the latter with a good psychoprophylaxis.