[Epidural analgesia after thoracic surgery: morphine versus buprenorphine]. / Analgésie péridurale après chirurgie thoracique: morphine versus buprénorphine.

A double-blind study was carried out to assess the efficiency and possible side-effects of a single epidural injection of either morphine or buprenorphine at equipotent doses after elective thoracic surgery. The series included 24 patients aged 53.7 +/- 11.4 years; 13 underwent a lobectomy and 11 a pneumonectomy. 6 h after the last intravenous injection of fentanyl, the patients were randomly allocated to one of three equal groups. They received an epidural injection at T8-9 or T9-10 level of either 100 micrograms.kg-1 morphine (group M) or 6.6 micrograms.kg-1 buprenorphine (group B) or a subcutaneous injection of 0.1 ml.kg-1 normal saline placebo at the same level (group T). The following parameters were measured 20 and 60 min, and every 6 h up to 48 h after the injection: patient wakefulness, respiratory rate, blood gases, pain (according to a verbal scale), FVC and FEV1, adverse effects (euphoria, hallucinations, sweating, facial pruritus, nausea) and atelectasis. The duration of surgery, the anaesthetic protocol, the age, weight and height, as well as all the parameters before injection were similar in all three groups. There was a fall in pain intensity from the 20th min to the 24th hour in group M and from the 20th min to the 36th hour in group B, significant for both groups when compared with group T. Similarly, there was a prolonged increase in FEV1 in both groups M and B. There was no case of severe respiratory depression; PaCO2 was increased at the 1st hour (+0.3 +/- 0.6 kPa) in group B and at the 6th hour (+0.5 +/- 0.7 kPa) in group M.(ABSTRACT TRUNCATED AT 250 WORDS)

Tunnelling of two central venous catheters inserted via a single venipuncture.

Two central venous catheters were inserted into the subclavian or internal jugular vein using a single puncture and tunnelled with two different subcutaneous pathways in 32 critically ill patients; 15 of them underwent this procedure immediately after a tracheostomy. The procedure was carried out without significant technical difficulties. Separate removal of one of the catheters was performed easily in 5 cases. Cultures were positive in 21% of 42 catheters from 21 patients; Staphylococcus epidermidis was isolated from 7 catheters. Separate tunnelling of two central venous lines inserted via a single venipuncture can be used in critically ill patients needing multiple central venous access.

[Effects of intravenous naloxone on the secondary effects and analgesia after epidural injection of fentanyl]. / Influence de la naloxone intraveineuse sur les effets secondaires et l'analgésie après injection péridurale de fentanyl.

On demand intravenous naloxone reverses respiratory depression following epidural morphine but does not have any effect on analgesia. This study aimed to assess the action of a preventive naloxone infusion on the side-effects and analgesia induced by epidural fentanyl. Sixteen patients were studied. Three had isolated uncomplicated flail chest. The thirteen others had undergone thoracotomy, and were included in the protocol at least 6 h after extubation. All patients had two epidural injections, they received an intravenous infusion of either 10 micrograms.kg-1.h-1 naloxone after a 400 micrograms bolus (group F + N) or 5% dextrose (group F), which was randomly allocated. In group F, but not in group F + N PaCO2 increased from the 15th min to the 4th, and sedation occurred from the 15th min to the 6th h. A significant and similar pain relief was noted in both groups. Duration of analgesia was not statistically different in the two groups. This preventive action of intravenous naloxone on the supraspinal adverse effects of epidural fentanyl was not accompanied by a reduction in analgesia. This could lead to widespread use of this analgesic technique.

Pharmacology of vecuronium in patients with end-stage renal failure.

Vecuronium was administered as an intravenous bolus (50 micrograms kg-1) to 10 normal and 10 anephric patients. The elimination half-life was 50.7 +/- 20.3 min in normal patients and 67.826.3 min in anephric patients. The plasma clearance was 3.6 +/- 1.5 ml min-1 for normal patients and 4.5 +/- 2.6 ml min-1 kg-1 for anephric patients. Only the volume of the second compartment was statistically increased (+90%, P less than 0.05) in anephric patients. The duration of action in normal patients (25.3 +/- 9.8 min) was comparable to the duration of action in patients with renal failure (32.8 +/- 10.7 min), but the recovery index was prolonged (+45%, P less than 0.05) in anephric patients.