Clonidine does not delay recovery from anaesthesia.

Clonidine is known to reduce anaesthetic requirements and improve haemodynamic stability when given as premedication. This study, of 46 ASA I-II patients undergoing thyroid surgery, was designed to assess if clonidine interferes with recovery from anaesthesia. Patients were allocated randomly to three groups to receive, 2 h before surgery, flunitrazepam 1 mg, clonidine 150 micrograms, or both drugs. Anaesthesia comprised thiopentone, alfentanil, isoflurane and 70% nitrous oxide in oxygen. Recovery from anaesthesia was assessed using a clinical score, electro-oculographic measurements and reaction times to auditory stimuli. Psychomotor tests were performed the day before surgery and 30, 60, 120 and 240 min after arrival of the patient in the recovery room. Psychomotor performance was decreased significantly after operation in the three groups (P less than 0.05) and returned to baseline at 240 min. There was no significant difference between the three groups. This study indicates that clonidine 150 micrograms orally before surgery does not delay recovery from anaesthesia.

[Monitoring of cerebral function. Limits and values]. / Le moniteur de fonction cérébrale. Limites et intérêts.

The Cerebral Function Monitor registers EEG amplitude and frequency variations. The C.F.M.A. described in 1979 produces a more detailed analysis of the EEG amplitude and analyses the frequency of the waveforms into standard bands. The device has many indications in anaesthesia and intensive cares for continuous monitoring of cerebral electrical activity over long periods. Unfortunately it is not as well diffused as it might be.

[Carotid endarterectomy under cervical epidural anesthesia. Analysis of neurologic manifestations]. / Endartériectomie carotidienne sous anesthésie péridurale cervicale. Analyse des événements neurologiques.

Carotid endarterectomy can be complicated by neurological events due to different mechanisms. Monitoring cerebral function is difficult under general anaesthesia. By contrast, the monitoring of awareness and neurological deficit is very easy under regional anaesthesia. The aim of this study was to assess the requirement for arterial shunting during endarterectomy performed under cervical epidural anaesthesia, to analyse the neurological events and to compare the value of clinical and electroencephalographic monitoring. Sixty-four patients were included in this study. Cervical epidural anesthesia was performed with 0.375% bupivacaine and 100-150 micrograms fentanyl. In 19 high risk patients, a one-channel electroencephalographic filter processor (Cerebral function monitor, Critikon) was placed over the affected hemisphere. Before surgery, it was estimated, on angiographic and Doppler data, that 18 patients needed an arterial shunt for carotid clamping. An arterial shunt was in fact inserted during surgery in only four patients, because of cerebral ischaemia after carotid clamping. Transient obnubilation was observed during carotid clamping in three other patients; it disappeared on unclamping in two, and on increasing blood pressure in the third. An additional patient suffered from a very short loss of awareness after declamping, due to cerebral embolism. The cerebral function monitor never documented false positive results, but failed to detect one out of every five neurological events. Controlateral carotid occlusion and preoperative stroke were documented to correlate with peroperative neurological events. Cervical epidural anaesthesia, which maintains consciousness during surgery, reduced in high-risk patients the need for arterial shunting as well as that for the analysis of neurological events.

Treatment in serious lower limb injuries: amputation versus preservation.

A study of patients with serious lower limb injuries is presented. With these injuries it is important to decide whether the limb should be salvaged at the risk of losing a life. Seventy-six patients are described and compared with a group of patients with similar injury severity scores but without serious lower limb injury. It is concluded that it is often preferable to amputate the limb rather than to risk the patient's life. Attempts at preservation of a limb were unsuccessful in 20 of the 54 patients in whom this was attempted. Secondary amputation was often performed in unsatisfactory conditions because of general complications that had resulted from the delay.

Alcoholism in polytrauma.

Alcoholism is a blight which implicates numerous areas. Polytrauma requires a sometimes long and expensive hospitalization, with a mortality of approximately one in three. In 250 patients (the mean ISS is the same for patients who died, whether nonalcoholics, chronic alcoholics, or occasional drinkers), there was a significant difference between the mortality rate of two-wheeled vehicle drivers and the mortality rate of the light vehicle drivers (p less than 0.05). The risks of morbidity and mortality amongst alcoholics increased for chronic alcoholics (60%) regardless of sex or age differences. Mortality of occasional drinkers was 13.3%, 51% of the offenders were chronic alcoholics. Chronic alcoholism in polytraumatology appears to be a serious element since 59% of multiple injured patients had blood alcohol concentration greater than 1.20 gm/L, 65% greater than 0.80 gm/L, and 70% greater than 0.50 gm/L. Thus chronic alcoholism is a serious index in traumatology.

[Treatment of severe injuries of the lower limbs. Identification of clinical criteria of severity]. / Traitement des traumatismes graves des membres inférieurs. Individualisation de critères cliniques de gravité.

The choice and timing of therapeutic methods for injuries of the lower limbs were evaluated in 60 patients. Primary amputation had to be performed in 18 of them, and conservative treatment was attempted in the others. Sixteen secondary amputations were necessary, mostly for arterial lesions. These results were not in agreement with the general severity of injury, as evaluated by the Injurity Severity Score. There was a significant difference in mortality depending on whether it was decided to amputate secondarily or to preserve the limb. When local signs of complication were present, this difference was highly significant. Age over 50 and arterial lesions were aggravating factors. When present together with an already high severity score, these factors should suggest immediate amputation as a life-saving measure.

[Deliveries outside maternity hospitals. 5-year prospective study apropos of 150 cases]. / Les accouchements hors maternité. Etude prospective sur 5 ans à propos de 150 cas.

Deliveries outside of maternity hospitals in 1983 resulted in many high risk newborns. In 40% of cases it occurred in lower socio-economic groups and in 60% was due to lack of information with regards to recent progress in obstetrical care. The presence of regional emergency services (SAMU) and competent pediatric care, has allowed for rapid transport and medical intervention. One hundred and fifty newborns weighing between 850 and 3,790 gms were thus transported: 50% were of low birth weight, 63% born after 38 weeks gestation and 37% were premature. Hypothermia was common and details of labour were unknown. Despite rapid intervention, there were 9 deaths including 6 with severe neonatal asphyxia. Morbidity was related to socio-economic and intellectual parental levels.

[Continuous monitoring of temperature in anesthesia and intensive care]. / La surveillance continue des températures en anesthésie-réanimation.

Continuous surveillance of both regional and general temperatures is of great interest in anaesthesia and intensive care. After a brief review of temperature regulation and the value of temperature control, the authors suggest a simple and reliable method of surveillance. This uses Chromel/Alumel thermocouples connected to a central device used to store the information. An experimental clinical study involved the assessment of 3 different anaesthetic protocols: Taractan-Palfium; Droleptan-Phenoperidine, Fentanyl only. These measurements were made in 30 young subjects undergoing a maxillofacial surgical procedure under identical conditions. The parameters studied were central temperature (rectal) and skin temperature of the index finger. With regard to peripheral temperature curves the results showed a first phase consisting of fall followed by a second phase characterised by a sudden increase up to a plateau. This plateau (3rd phase) persisted as long as the subject slept. The 4th phase, when peripheral temperature fell suddenly to a level sometimes lower than the initial temperature represented one of the first signs of awakening. As far as central temperature was concerned it fell in a linear fashion for all curves. Comparing the different curves obtained, the authors conclude by noting that the more vasoplegic the anaesthetic protocol, the higher the induction peak of the second phase of peripheral temperature pattern, but also that the fall in central temperature was marked. The authors feel that an anaesthetic which is biologically satisfactory and at the same time produces an overall fall in the production of heat without causing chills avoids the development of vasoconstrictor reactions between the care and the surface which are reflected by a decrease in the gradient between central and peripheral temperatures.

[Case history of a gassed patient]. / Histoire d'un "gazé".

Ricardo T., aged 20 years, was a passenger in a Varig air-craft which suffered an accident on July 11th 1973. A fire developed on board whilst the plane was in the air, at about 3 p.m. After emergency landing, rescue workers (firemen and emergency ambulance teams) discovered only two survivors amongst the 122 passengers. One was in his forties and died a few moments later. The other (Ricardo) was rapidly transported to the surgical and traumatological intensive care unit of the Henri Mondor Hospital. At the time of arrival, he was in stage 1 coma with skin burns (3rd degree), burns of the airway and a high carbon monoxide blood level. Treatment consisted of assisted ventilation for 24 hours, with intermittent bronchial lavage used to eliminate ashes and calcinated debris, then for 10 days, spontaneous ventilation without intubation, with a tele-expiratory counter-pressure of 4 milibar in a mini-chamber (globe) enriched in oxygen. Intravenous hyperalimentation was started during the first few hours, continued on the 24th day by enteral alimentation. Initial chest XRays showed heavy flaky appearances, predominantly in the hilar region, and more marked on the right. At about the 15th day, XRay showed fibrous with predominance of signs of the apex. These sequellae were confirmed by respiratory function tests which gave objective evidence of a diffusion disturbance with decrease in membrane permeability coefficient. Repetition of RFT indicated a decrease in mechanical problems. On August 31st (on the 51st day) Ricardo was able to return to Rio in a good general condition, dorso-lumbar burns having healed. There was a dysphonia of mixed origin: scarred infiltrate of the vocal cords, but with normal mobility, and a decrease in vital capacity of --30%. Seen again in September 1978, Ricardo was found to be well with normal activity and slight effort dyspnea. Chest XRays showed signs of residual fibrosis.

[The Cerebral Function Monitor. Description, functioning and interpretation principles]. / Le Moniteur de Fonction Cérébrale. Description - principe de fonctionnement et d'interprétation.

The Monitor of Cerebral Function enables continuous monitoring of the cerebral electrical activity and this over long periods due to the slow recording speeds. The cerebral electrical signals picked up by the electrodes attached to the scalp are registered in the form of a curve which fluctuates to a greater or lesser extent depending on the recording speed. The examination of the height of the curve with respect to zero and its amplitude indicates the voltage of the cerebral activity and yields information regarding polymorphism. It is thus possible to monitor variations in cerebral activity over a prolonged period during anaesthesia as well as during the revival phase with the Monitor of Cerebral Function, the electroencephalogram being reserved as an aid to precise diagnosis and for localization and close scruting of the anomalies.

[Cerebral Function Monitor (CFM) and electroencephalography (EEG). Experimental study]. / Moniteur de Fonction Cérébrale (MFC) et électro-encéphalogramme (EEG). Etude expérimentale.

This work is an attempt to connect the electro-encephalogram (EEG) and monitor of cerebral function (MCF) recordings during the experimental stimulation of the rabbit brain whether this is in the from of direct central stimulation, by stereotaxic location, or in the form of indirect stimulation via a peripheral nerve. These stimulations, performed under alfadione anaesthesia or under the neuroleptanalgesic sedative effect of chlorprothixine, are compared for every animal with the results of the control stimulations. The cardiovascular responses are recorded simultaneously. It has been found that, in simple narcosis induced by alfadione, there is much variation in the EEG recording and even more so in the MCF recording according to the quantity used and the block of responses to stimuli does not appear until there is deep anaesthesia. However, when chlorprothixine is used, the MCF trace is found to be very closely related to the trace of mild anaesthesia with accompanying block to all of the nociceptive stimulations. It would seem, therefore, if we accept the concept of levels of cerebral activity, that the use of the MCF could well open the way to a better understanding of the pure narcotic phenomena and of the neurovegetative response block to aggression.

[Cerebral Function Monitor and anesthesia]. / Moniteur de Fonction Cérébrale et anesthésie.

The Monitor of Cerebral Function was employed in anaesthesia for a double purpose: as a monitor of anaesthesia, of possible complications and of overdosage that might lead to cerebral damage; a bringing up to date of the comparative data on the various anaesthetic protocols. In this manner, we were able to demonstrate the during anaesthesia application of a cerebral monitor that is well designed and easy to handle. A comparative study of hypnotic anaesthetics and those that induce neuroleptanalgesia demonstrated that, in certain cases, the same anaesthetic stability is achieved when there is an early appearance of the electric silences as when the cerebral electrical activity is only slightly modified.

[Hemodynamic effects of etomidate]. / Etudes des effets hémodynamiques de l'étomidate.

A study of the haemodynamic effects of an injection of 0.3 mg/kg of Etomidate was carried out in 11 multiple trauma patients under constant controlled ventilation. At the 3 rd minute after injection there was a slight, but significant, increase in cardiac output and in the systolic index of the left ventricle, persisting at the 20th minute. It may be concluded that the injection of a dose of 0.3 mg/kg has no harmful haemodynamic effects in this type of patient.