[Propofol and thoracic surgery]. / Propofol et chirurgie thoracique.

20 patients undergoing thoracic surgery were studied. Before anaesthesia either a catheter was placed in the intercostal space, at the same level as the thoracotomy (16 patients) or an epidural catheter was inserted if there was a contraindication of intercostal blockade (4 patients). Marcaine 0.5--was injected. Anaesthesia was induced with propofol 2.5 mg.kg-1, vecuronium 0.1 mg.kg-1, dextromoramide 50 mcg.kg-1. It was maintained with propofol 9 mg.kg-1.h-1 for 30 mn, then 4.5 mg.kg-1.h-1 for following hours (by a syringe pump) and vecuronium 0.1 mg.kg-1.h-1. Cardio vascular effects were studied only in the 16 patients with intercostal blockade: during induction bradycardia in 3 patients, and systolic arterial pressure (S.A.P.) decrease of 30% in 8 patients were observed. After the incision, heart rate and S.A.P. became steady. The average duration of anaesthesia was 214 min +/- 74. The time from the end of propofol infusion to the moment of extubation was 15.4 min +/- 33 and the time to recover all mental faculties was 46 mn +/- 11. 30 min after the end of anaesthesia the maxima minute ventilation was equal to the post operative value at 48 H. Propofol anaesthesia allows a fast awakening, without cumulative effects.

[Epidemiologic characteristics of 21 peranesthetic anaphylactoid accidents observed in a population of 12,855 surgically treated patients]. / Caractéristiques épidémiologiques de 21 accidents anaphylactoïdes peranesthésiques observés dans une population de 12 855 sujets opérés.

A study of anaphylactoid reactions (AR) observed between September 1982 and September 1983 was carried out in the surgical departments of a French regional hospital. The patients who had presented clinical symptoms suggesting an AR (bronchospasm, collapse, tachycardia, with or without skin rash) during a general anaesthesia were included in this study. A precise history of previous anaesthesias and allergy was taken; allergological testing was carried out six to eight weeks after the AR. It included intradermal skin tests (ST) and a human basophil degranulation test (HBDT) with the suspected drugs. Out of 12,855 patients operated on under general anaesthesia in the hospital, 21 AR were seen during the year under study, in 18 women and 3 men, of median age 27 years (extreme values: 11 and 62). The median number of previous anaesthesias was 2 (extreme values: 0--in 4 cases- and 22). Cardiocirculatory abnormalities were the most frequent clinical symptoms of the AR: they consisted of decreased arterial pressure in 13 cases, with 8 cases of vascular collapse. Respiratory symptoms were less frequent but severe bronchospasm was observed in 5 cases. Skin rashes were seen simultaneously in 13 out of the 21 observations. A history of allergy was found in 11 patients. Total IgE serum concentration averaged 134 kU X 1(-1) (extreme values: 32-378). Results of histamine-sensitivity skin tests were not significantly different from those observed in a control group. Calcemia and magnesemia were in the normal range. One to four drugs were tested in each patient: 41 tests combining ST and HBDT were carried out.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anesthesia programmed by enflurane]. / Anesthésie programmée à l'enflurane.

A microcomputer type 6502 is the central unity of a volatile anaesthetic injector for use in a closed circuit breathing system. Estimated calculations for quantity of anaesthetic liquid are done in agreement with the formula of J.W. Severinghaus and H. Lowe. Clinical assay is realised with enflurane. The syringe efficacy is controlled by permanent recorder of halogenate concentration in upper airways Fi-FA: infrared analysor cosma Rubis 3000).

[Comparison of halothane and enflurane on the pulmonary compliance (author's transl)]. / La compliance pulmonaire en cours d'anesthésie en circuit fermé. Effets comparés de l'halothane et de l'enflurane sur celle-ci.

The peroperative pulmonary compliance in spontaneous ventilation is studied in two series of ten anesthetized patients with halothane and enflurane, in closed system. The tidal volumes (inspiratory and expiratory at noflow point) are recorded by pneumotachograph (Godard 17212). The intrathoracic to mouth differential pressure is recorded by pressograph (Godard 17300). The measurements are simultaneously realized by linear recorder (Brush gould 2500) or by XY recorder (Bryans 26000 A4). At the second hour of anaesthesia with enflurane pulmonary compliance is not modified (non significant increase to 11,5 p. cent: 0,3 less than P less than 0,2) while with halothane it shows a very significant 25 p. cent decrease (0,001 less than P less than 0,01). The authors relate this difference to the specific feature of breathing in the course of such an anaesthesia with enflurane.

[The adaptation of the Bennett PR2 to intermittent mandatory ventilation (author's transl)]. / Adaptation du Bennett PR2 à la ventilation intermittente commandée.

This adaptation presents the following advantages over and above those already acknowledged for continuous IPP ventilation: conservation of respiratory muscle functions, autoregulation of ventilatory frequence, reduction of mean endothoracic pressure, thus dispensing with the necessity for negative-end-expiratory pressure. In addition: easy, effortless assembly, abolishes the defects of the Bennett PR2, gives the machine a good volumetric performance.

[Prevention of tracheal lesions by rhythmic insufflation of the intubation catheter ballone]. / Prévention des lésions trachéales par insufflation rythmée du ballonnet de sonde d'intubation

The prevention of tracheal lesions due to the ballons of the intubation catheters depends on the correction of several factors concerning: -the material used (polyvinyl is better tolerated than rubber); -the shape (the sleeve-shape balloons are less traumatic); -the pressure of use, which should remain moderate; -the permanence of the compression (one should use intermittent filling of the ballon). A device designed by the authors and which is described here, permits intermittent insufflation of the ballons of the endotracheal catheters, by adaptation of certain apparatus of artificial ventilation, type LOGIC and SF4, has given excellent results.