[Peroperative circulatory arrest caused by tumoral pulmonary embolism after hepatectomy for tumor. Apropos of a case].
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Biomedical subjects
Publications and source records attributed to B Dixneuf.
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The authors encountered technical difficulties for the endotracheal intubation but neither laryngeal damage nor serious oropharyngeal lesions occurred after this intubation. The general evolution was favourable without specific trouble (cutaneous or infectious). The risk of intubation was reexamined from the recent literature. It is generally believed that there is a tendency for the skin to become more resistant to the formation of bullae as the afflicted children grow older. So, when another disease sets vital prognosis in action, major surgical operations can be performed and more especially as the average length of life is now increasing for these patients.
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One hundred and six cases of myocardial revascularisation ECC performed during 1976 and 1977 were reviewed in order to assess the accidents and complications seen in surgery of this type. The course of the operation, and above all during the pre-ECC phase, was felt to be marked above all by hypertensive crises. During the immediate postoperative phase the picture was dominated by haemodynamic problems. Moderate left ventricular failure was common and responded rapidly to restoration of water and electrolyte and blood volume balance. Sympathomimetic amines were also used as necessary. Severe low output states were seen in only 8.5 per cent of cases. Analysis of factors interfering with the operation showed that the prior myocardial state had the most influence on the postoperative course.
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There is an important fistula rate associated with the cervical anastomosis of oesophagoplasties. The authors report their experience with reinforcement of these anastomoses by adhesion using a fibrinogen based biological tissue glue. They propose that this technique be used in all high risk anastomoses, in particular, for those affecting a non peritonealized section of the digestive tract.
Studies concerning the hemodynamic effects of this new antidepolarizing agent are scarce and difficult to interpret because of drug interactions, and of an accentuation of vagal tonus related to the use of morphinomimetic analgesics. For a better approach of the effects proper to fazadinium, we have tried to perform a study freed, to a maximum, from any drug interference. We studied the hemodynamic effects to a single dose of 1 mg.kg-1 of fazadinium bromide during 35 minutes in coronary patients normal hemodynamically or rhythmically, non-premedicated, ventilated with 50 p. 100 nitrous oxide in oxygen, and bebore any surgical procedure. All hemodynamic modifications are moderate and maximal 10 minutes after injection. The stroke index decreases 16 p. 100, heart rate increases 6 p. 100 and cardiac index falls 10 p. 100. Total peripheral resistance remains unchanged and mean arterial pressure drops 10 p. 100. Finally pulmonary wedge pressure decreases slightly. None of these modifications are statistically significant. One may, therefore, conclude that fazadinium tolerance, when the drug is freed from any drug interference, in coronary patients normal hemodynamically and free from rhythm disorders is excellent from a hemodynamic and rhythmic point of view. However, other isolated observations of hypovolemic subjects, or patients with atrial fibrillation receiving fazadinium and studied hemodynamically suggest a poorer tolerance in these cases.
The initial period of postoperative rewarming is frequently marked by rapid increases in metabolic rate and myocardial work leading to haemodynamic instability. In order to test the beneficial effect of mechanical respiratory support with sedation in the postoperative period, 18 patients with coronary artery disease operated upon for abdominal or orthopedic surgery were submitted to a hemodynamic study. The patients were divided in two groups. In group II intravenous nitrates were administered perioperatively. Postoperative hemodynamic profiles were similar in both group. No perioperative signs of myocardial ischemia were detected. Prolonged ventilation with sedation can prevent the hemodynamic stress of recovery.