[Bronchospasm during extracorporeal circulation]. / Bronchospasme en cours de circulation extracorporelle.

Six cases of bronchospasm are reported, which occurred at the end of cardiopulmonary bypass (CPB). One patient developed this condition twice within one year. This was a rare occurrence (6 cases for 3714 CPB). Symptoms were the same every time: increased inflation pressures, impossible deflation, and low left atrial pressures. Adrenaline given by way of the bypass was the quickest and most effective treatment. The favourable outcome in all 5 patients was due to the continuing of circulatory assistance by the CPB. Although the prevention of anaphylactoid accidents in atopic patients has been well documented, the cause of the bronchospasm in our patients has not been recognized, and it may well not have been due to a particular drug.

Side-effects of mixed agonist-antagonist analgesics used in sequential anaesthesia.

1 Mixed agonist-antagonist analgesics have analgesic action but also possess a range of side-effects. 2 Narcotic antagonists do not reverse the non-specific effects of opiates. 3 Under certain circumstances the effects of agonists and mixed agonist-antagonists can be additive. 4 Chronic dosage of mixed agonist-antagonists leads to a lower level of dependence than that observed with the standard narcotics. 5 Mixed agonist-antagonists may not antagonize the respiratory effects of narcotics and may result in potentiation of such depression.

[Experience of labor and obstetrical analgesia]. / Vécu de l'accouchement et analgésie obstétricale.

A prospective study was undertaken at Strasbourg of the assessment of the patients of the techniques used by the obstetric team and of the general atmosphere in which labour and delivery took place. A questionnair of 115 items was analysed by computer using a Pastis-Pascal programme (see attached). The first results, concerning the analysis of 100 cases and taking into account approximately ten variables, gave the following findings: -the intolerable pain factor is related to the period of dilatation; -the analgesic or amnesic factor in the mother influences the satisfaction she experiences in relation to her child; -demand for epidural anaesthesia appeared the same, whether the woman had been prepared by a psychoprophylactic method or not; -psychoprophylactic preparation would not appear to influence the assessment of pain; -women having an epidural anaesthetic never considered their labour to have been intolerable. Discriminant analysis with study of correlations is not possible at present. Given the number of variables to be considered, the population analysed is inadequate. A multicentre study would improve the performance of this research. Our questionnaire is available to any teams who might wish to use it.

[A comparative study of the cardiovascular effect of dobutamine. Preliminary results obtained in a surgical resuscitation unit]. / Etude comparative des effets cardio-vasculaires de la dobutamine. Résultats préliminaires obtenus dans un service de réanimation chirurgicale

Dobutamine (dobutamin hydrochloride, Lilly) is a new inotropic catecholamine; it is presented in lyophilized ampoules for I.V. use, each containing 250 mg of dobutamine to be reconstituted with 5 per cent glucose or sterile water for injection. In the first part of this study, animal pharmacology is reported as described in medical literature: inotropic activity with minimal chronotropic effects, direct action, no vasconstriction, minimal arrhythmogenic activity and minimal diversion of blood flow to skeletal muscles are the main experimental features. The authors report afterwards their own experience with dobutamine in 8 patients (cranial traumas) without cardiac failure, and in 9 patients presenting with a cardio-circulatory failure in a toxi-infectious condition. In all patients tested, hemodynamics parameters (heart rate, mean A.P., central venous pressure) and cardiac output measurement (dye dilution method) were performed. Cardiac index and systolic index, total systemic resistances, left ventricular performance were also calculated. Dobutamine dosage ranged from 2.5 to 10 mcg/kg/mn except in patients with low output syndrom (2.5 and 5 mcg/kg/mn). Dobutamine offers new possibilities by its constant and indisputable inotropic activity contrasting with its minimal chronotropic effect.