Biomedical subjects
Publications and source records attributed to F Barale.
During aorto-biiliac by-pass, patients with heart disease are exposed at many haemodynamic problems. Mixed venous oxygen saturation monitoring help anesthetist along clamping and unclamping periods. This study concerning 13 patients with pre-operative NYHA class II and III congestive heart disease, discusses therapeutic algorithm especially for choosing inotropic or vasodilatator drugs.
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Morphine at very low dose gives a good post-operatory analgesia without major secondary effects. This study analyses retrospectively 285 spinal anaesthesia with hyperbaric 0.5% bupivacaine 0.2 mg.kg-1 and morphine 0.25 mg in adult urologic surgery. The analysis of enquiry in analgesic during the post-operatory period shows that in most cases (72%) the patients have supported the first 24 hours without any complementary analgesia; 28% of patients needs a complementary analgesia realized with 1 g of paracetamol. Intravenous morphinics have never been necessary in post-operative period. The analgesia was adequate for the patient's comfort, and it never mask a surgery complication. No respiratory complication appeared, even in 13 patients who needed intravenous morphinics in per-operative.
A retrospective study was carried out on anaesthetic records concerning spinal anaesthesia with hyperbaric bupivacaine 0.5% in urologic surgery. Three doses were utilised: slight (< 0.19 mg.kg-1), mean (0.19-0.21 mg.kg-1) or important (> 0.21 mg.kg-1) for two different levels: T12 or T10. Important doses may be involved excessive extension. Failures are perhaps more frequent with slight doses. Mean doses, 0.20 mg.kg1, seems to be recommended.
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This study was designed to assess in vitro the effects of Thiopental alone and Thiopental--Dobutamine association on control and on Diltiazem pretreated papillary muscle. The Diltiazem treatment do not increase the negative inotropic effect of Thiopental but the effect of Dobutamine is less important in pretreated group. The Diltiazem treatment protect to arrhythmogenic action of Thiopental and Thiopental-Dobutamine association.
This study included 20 children (average 8.5 years) undergoing surgery of the upper limb under brachial plexus block. A method of blocking the brachial plexus using an infraclavicular approach is described. Eighteen brachial plexus block were performed under general anesthesia. No complication was observed. Post-operative analgesia was satisfactory in all cases. In 10 cases a nerve stimulator was used. It is not necessary for the realization of a brachial plexus block, but the punction is easier under general anesthesia with this instrument.
There is no etiologic treatment for acute necrotizing pancreatitis. Advances in intensive care resulted in a reduction in early death rate by a better control of systemic complications. Delayed death rate from infection is high (20-60%). Diagnostic problems are an important cause, in spite of the aid of computed tomography and echography. The prognosis will further be improved by earlier diagnosis, a better definition of surgical treatment when complications arise, and constant medicosurgical collaboration.
Standard artificial feeding is not suitable for patients with acute respiratory failure due to the increase in CO2 production it entails, effect of carbohydrate metabolism. Randomized use of an enteral diet comprising 55% of fats in 10 patients with chronic pulmonary disease during an acute phase, receiving mechanical ventilatory support, achieved a rapid decrease of VCO2 value, 243 to 215 ml.min-1, while it increased to 250 ml.min-1 with the control diet. These variations are metabolic and not ventilatory in origin for they are not accompanied by changes in plasmatic total CO2 rate.
The pharmacokinetic properties of propofol given at a constant rate, were studied in 10 children. Propofol was administered at a dose according to I.C.I. Pharma advices. For minor surgery, a low quality of general anesthesia was observed in correlation with low plasma levels of propofol. An increase in dosage would be necessary in children above 8 years old.
Continuous epidural anesthesia was carried out in 30 children aged from 2 months to 15 years (12 are less than 5 years old) and scheduled for long surgical procedure (thoracic, abdominal or urologic procedures). The epidural space was punctured under general anesthesia on a midline approach with a saline filled syringe. The catheter is easily inserted and fixed. 28 are inserted before surgery; 2 at the end of procedure. The local anesthesia used was lidocaine 1% (with 1/200,000 epinephrine) and/or bupivacaine 0.5 alone or mixed; bupivacaine wasn't used for children aged less than 6 months. During surgery, complete sensory blockade was obtained in 26 cases; insufficient analgesia or lateralization of the block in the 2 other cases. Complete muscle paralysis, researched for 17 children, was altered for 11 patients. The insufficient was observed in upper abdominal surgery for which etidocaine was used unless the patient is aged less than 6 months (in this case lidocaine 2% was preferred). As complications, a dural penetration was observed in a child aged 2 months, and an hemodynamic instability for another patient for which 100 ml albumin was used. In the post operative period, the catheter remained in situ from 24 to 48 hours, provide safe and effective analgesia and therefore eased the management of the children.
Three hundred children were anaesthetized for E.N.T. operations. The anaesthetic consultation took place one week prior to operation. The anaesthetic comprises premedication, inhalation of halothane for infants, or propofol drip for the others with tracheal tubing for 10% of them. Recovery in every case is supervised in the recovery room. There are few setbacks with this method. Eleven children were not accepted for operation for sociological or medical reasons (Willebrand diseases) and only 3 had to remain in hospital until the following day due to slow recovery from anaesthetic.
Anesthesia of patients suffering from one of the various types of myopathy and with a view to orthopedic operation, cannot be univocal. Operating indications, preparation, results, vary according to the type of suffering. The absence of associated cardiopathy allows surgery even with severe respiratory failures. The experiment of an orthopedic surgery department over a 10 years period shows that these patients may be effectively taken charge of by a multidisciplinary group, thus restricting to a maximum their hospital stay for the benefit of at home hospitalization techniques.
A post-operative follow-up in 21 cases of Congenital diaphragmatic hernia (C.D.H.) was carried out on 2 groups of patients. The first consisted in patient treated a long time ago by different anaesthetic methods which were not very precise. The other sample was recent, and a strict anesthetic procedure was used, analgesia and curarization with mechanical ventilation. Post-operative complications decreased on the ratio of 1/7, the intensive care stay being halved. The overwhelming importance of the correct anaesthetic procedure was underlined. An overall survival rate of 76% gives hopes for a better future for patients suffering from this malformation.
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Acexamic acid is currently used to avoid pulmonary fibrosis in patients treated with bleomycim. It seems to be equally effective to prevent pulmonary fibrosis in adult respiratory distress syndrome. The complications of this therapy are hypercalcemia and hypernatremia.
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