Biomedical subjects
Publications and source records attributed to E Tapounie.
This report describes a case of fatal peroperative cardiac tamponade in a 5-year-old boy. It was the consequence of myocardial perforation by a polyethylene central venous catheter and intrapericardial infusion. In case of peroperative unexplained cardiovascular collapse, repeat check of the position of the central venous catheter is mandatory.
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In five years 14 children aged 1 to 15 underwent long lasting anesthesia (9,6 +/- 1,7 hours), excluding cardiac and neuro-surgery. These anesthesias, which are seldom performed are essentially used for the correction of congenital malformations of the cephalic pole (9 patients). Two types of anesthesia were used: neuroleptanalgesia (11 patients), enflurane and narcotic (3 patients). In addition to the usual monitoring in pediatric anesthesiology the insertion of a catheter in the radial artery proved essential. Temperature never went below 35 degrees C. In 8 cases blood loss was higher than the patient blood volume. The average preoperative perfusion was 9,4 +/- 5,4 ml/kg/heure.
Droperidol premedication for children (0.3 to 0.5 mg/kg) was compared with pentobarbital and Dolosal--promethazine). Results are analyzed using criteria proposed by Burken and Nisbet. Droperidol compared very favourably with the order drugs. However a decrease in efficacy was noted with infants and neuw-born children, even with higher doses. The possible incidence it hypertonic seizures renders this drug unsuitable for ambulatory surgery.
Intra-thoracic gaseous collections, pneumodiastinum and pneumothorax, have become more common since the use of positive expiratory pressure, either with spontaneous ventilation or in association with artificial ventilation. In our experience, the occurence rate of such collections has increased from 7 p. 100 in 1970 to 19 p. 100 in 1974, related to the use of continuous positive pressure of long duration in the treatment of idiopathic respiratory distress or hyaline membrane disease. These gaseous collections were initially associated with a high mortality (50 p. 100) which is now practically nil. Improved knowledge of the clinical and radiological signs and the insertion of thoracic drains in the presence of the slightest doubt represent the explanation of this reduced mortality.
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