[Effects of sodium nitroprusside and its metabolites on erythrocyte function. Study in humans].
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Acid-Base Equilibrium↗
Biomedical subjects
J Deschodt
Publications and source records attributed to J Deschodt.
[Plasma level of the thiocyanate ion in sodium nitroprusside perfusion].
24 subjects were selected at random out of a group of 80 patients undergoing surgery under a hypotensive anaesthetic technique by means of nitroprusside perfusion; the variation of one of the metabolites, the thiocyanide ion, were assayed. Hypotension was of 30 to 380 minutes duration and mean dosage of 12,44 mg (1,99 mug/kg/min). SCN- assays were performed by means of an original technique, which is described in this publication, before any perfusion of nitroprusside, every 30 minutes during perfusion and 30 and 60 minutes after ending the perfusion. Results show that SCN- concentration is increasing during perfusion but not as much as compared with the toxic concentration. Major increase takes place 30 minutes after starting the perfusion (1,27 10(-4) M/l). Increase slows down then and remains on a plateau level until the end of the perfusion where it decreases. Those results allow to reject a toxicity risk related to an increase of SCN- during nitroprusside perfusion. However, the accidents reported after high dosage of NPS and probably related to cyanogenic ion accumulation combined with lactic acidosis as shown in this publication, led the authors to advise a dosage not over 10 mug/kg/min in a maximum of 2 hours time.
Adolescent↗
[Constant outflow anesthesia with the combination of alfatesine and fentanyl].
In a previous work, the authors showed the value of administering Alfatesine, in interventions of long duration, at a constant rate by using an automatic syringe, and by combining it with destromoramide. In this new work the authors present an analagous study carried out in 47 subjects, in which dextromoramide was replaced by fentanyl. The automatic syringe used was the Braun Perfusor IV equipped with a 50 ml syringe containing 0.3 ml. of CT 13.41 and 0.006 mg. of fentanyl per ml. Induction was achieved at graduation 10, 14 ml of the mixture having been injected in approximately 60 seconds. Maintenance of anesthesia was ensured at graduation 6 corresponding to an hourly administration of 27 to 30 ml of the mixture (9 ml of CT 13.41 and 0.18 mg of fentanyl). The patients were adults of average weight 64 kg., who had undergone sometimes major orthopedic surgery, of an average duration of 161 mn. The results are looked at from the angle of quality of the anesthesia and of the awakening and of the side effects. They confirm the non-accumulation under these conditions of use and these doses of CT 13.41 used and reveals an analagous behaviour of fentanyl. Reserves are however made owing to the mode of elimination of fentanyl, on the use of such a technique in anuric patients or in renal insufficiency.
Adolescent↗
[Tracheal stenosis after tracheotomy. Apropos of 12 cases in 227 observations].
Out of 543 tracheotomized patients, 227 survived and 12 of them developed a tracheal stenosis syndrome (5,28 p. 100) including: 3 supra-ostial stenosis, 1 ostial and supra-ostial stenosis, 1 ostial stenosis, 3 intermediate stenosis and 4 distal stenosis. In two cases, the stenosis was found out during the removal of the cannula and in the other cases from 3 days to 8 months after the decannulation. The deffered treatment consisted in an anti-inflammatory medical treatment treatment (one case), in a permanent dilation with an Albouker tube (two cases), and in a resection of the stenosed tracheal part plus an anastomosis. Good results were obtained in 9 cases including the recovery of a satisfactory tracheal diameter. Because of a recurrence of the stenosis after resection and anastomosis, it was necessary, in two cases, to resort to another resection and, upon another occasion, to place a permanent cannulation. Finally, in one case, 2 Rethi operations were necessary to get a sub-normal tracheal diameter. From these facts, it emerges that tracheal stenosis are less important if, during the tracheotomy, a partial resection of the tracheal wall is effected (rather than an inverted U flap folded back at the bottom) together with the putting in of a cannula equipped with an elongated cylindrical cuff requiring a less important filing-up pressure (although just as efficient as far as tightness is concerned).
Adolescent↗
[Is total arthroplasty of the hip justified in cirrhotics?].
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Aged↗
Hemodynamic effects of 0.375% versus 0.25% bupivacaine during cervical epidural anesthesia for hand surgery.
BACKGROUND AND OBJECTIVES: Cervical epidural anesthesia with 0.375% or 0.25% bupivacaine plus fentanyl is a reliable technique for surgical restoration of digital motion-after tourniquet release and rehabilitation. The study was designed to assess the hemodynamic effects of this technique in 11 ASA 1 patients. METHODS: The epidural catheter was introduced at the C7-T1 interspace on the day of operation. The volume of 0.375% bupivacaine necessary to block the brachial dermatomes was determined. The day after (day 1), every patient received epidurally the determined volume of 0.375% bupivacaine plus 1 microgram/kg fentanyl (group A). On day 2 the same volume of 0.25% bupivacaine plus 1 microgram/kg fentanyl (group B) was injected. For each patient one or several pairs of injection (A + B) were performed in relation with duration of rehabilitation. Cardiac index, stroke volume index, end diastolic index, ejection fraction, and systemic vascular resistance were studied by thoracic electrical bioimpedance. These parameters, mean arterial pressure and heart rate were recorded before and after injection. Sensory level was assessed by loss of cold sensation. RESULTS: Nineteen paired injections were performed. Mean volume of bupivacaine was 7.1 +/- 2 mL. The caudad sensory level was lower in group A: T7 (T3-L1) versus T6 (T2-T11) in group B. Hemodynamic variables were not different between the 2 groups. Mean arterial pressure cardiac index, heart rate, stroke volume index, and ejection fracture decreased slightly as end diastolic index remained unchanged and systemic vascular resistance increased slightly. No correlation was found between hemodynamic changes and spread of analgesia. CONCLUSIONS: Hemodynamic effects, in ASA 1 patients, are moderate and not dependent on the studied concentration of bupivacaine, indicating that a similar degree of sympathetic block is achieved with 0.375% and 0.25% bupivacaine.
Adult↗
Continuous spinal anesthesia: does low-dose plain or hyperbaric bupivacaine allow the performance of hip surgery in the elderly?
OBJECTIVES: This study was designed to assess the predictability of 5 mg bupivacaine to give a T10 sensory level when injected subarachnoid in elderly patients. METHODS: Sixty-five patients aged 75 years or more, scheduled to undergo elective hip surgery, participated in the study. Patients were randomized to receive either 5 mg plain bupivacaine without epinephrine (isobaric group), or 5 mg hyperbaric bupivacaine (hyperbaric group). A 19-gauge catheter was inserted at the L3-4 interspace and threaded 4 cm cephalad in the subarachnoid space. Patients were placed in supine horizontal position and sensory level was assessed every 5 minutes over 20 minutes. Increments of 2.5 mg bupivacaine were given when sensory level did not reach T10 at the 20th minute. RESULTS: After 20 minutes, the mean sensory level was T8.8 +/- 3.2 in the isobaric group and T7.2 +/- 4.3 in the hyperbaric group without significant difference. Hypotension, defined as greater than a 25% drop in mean arterial pressure, was not significantly different in the two groups: 37.5% and 42.4%, respectively. However, patients who developed hypotension were older (84.3 +/- 7.8 years) than the others (80.3 +/- 5.9 years), and cephalad spread of sensory anesthesia was higher in patients who developed a hypotension (T5.3 +/- 1.4 versus T9.5 +/- 4). In each group, sensory levels did not reach T10 in five patients after initial dose. Five had a sensory block that was too low in spite of incremental doses with the patient in the horizontal position. For the last three, an unintentional sacral placement of the catheter was proved radiologically. CONCLUSIONS: The authors conclude that 5 mg bupivacaine is too high a dose in the elderly to limit the sensory blockade at T10 and avoid hypotension. In elderly patients, this dose allowed surgery to be performed, provided that the sensory level reached T10. When the initial dose only affects lumbar dermatomes, a caudal direction of the catheter must be evoked, and changing position must be preferred to incremental injections to reach thoracic levels.
Aged↗