[Apropos of vascular filling. Interview with Prof. J.F. Baron].
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Adolescent↗
Biomedical subjects
J F Baron
Publications and source records attributed to J F Baron.
[The risk of general anesthesia in surgery of the veins of the lower limbs].
Venous surgery on the lower limbs does not involve specific problems for the anaesthetist. General anaesthetic is still indicated in particular cases, even though techniques of locoregional anaesthetic are being more and more widely used in venous surgery of the lower limbs. Certain authors have found that the indications for general anaesthetic are limited to the counterindications or failures of local anaesthetic; others give general anaesthetic a wider application when surgery is to be carried out on a patient in the ventral decubitus position. The aim of general anaesthetic for venous surgery of the lower limbs is simply to facilitate a purely functional surgery. In this context, injury or fatality directly connected with the anaesthetic seems unacceptable. However, the accident rate is far from being low, as various inquiries have revealed. In France, the inquiry set up by INSERM found that serious accident related wholly or partially to the anaesthetic occurs once in every 3,000 operations. Of course, the accident rate increases with age and depends on the previous pathological condition. But, quite apart from cardio-vascular accidents, which have multiple causes and usually involve high-risk patients, these studies show that respiratory accidents involve every type of patient, whatever their medical history. Moreover, the majority of such accidents could have been avoided had there been adequate monitoring to detect any anomaly before the occurrence of the accident. It is thus appropriate to recall the recommendations of the American Society of Anesthiologists for standard pre-operative monitoring: monitoring of ventilation (spirometry, capnometry, debrancher alarm), monitoring of oxygenation, circulation (continuous ECG and pulse assessment) and monitoring of temperature.(ABSTRACT TRUNCATED AT 250 WORDS)
Accidents↗
Incidence of myocardial ischemia during carotid endarterectomy.
Since patients undergoing carotid endarterectomy often suffer from coronary artery disease, the detection, adequate treatment and prevention of intra and postoperative myocardial ischemia are a major concern. Effectively, the deleterious effects of intraoperative ischemic episodes have been largely documented. They may lead to arrhythmia, left ventricular dysfunction lasting several hours or myocardial infarction. Anesthesia induced by fentanyl, flunitrazepam and pancuronium and maintained with N20 and volatile anesthetics when warranted, has the advantage of preventing cardiovascular stimulation during endotracheal intubation and surgery, and of significantly decreasing the incidence of intraoperative myocardial ischemia in patients suffering from mild angina pectoris. However, with this approach, the incidence of intraoperative ischemic episodes remains high in patients suffering from disabling angina pectoris. In such cases, prophylactic i.v. nitroglycerin, administered continuously at the dose of 0.7 microgram/kg-1/min-1, optimizes myocardial oxygenation during surgery and minimizes the risk of intraoperative myocardial ischemia.
Anesthesia, General↗
Cardiac effects of phytic acid induced high P50 with free and limited coronary blood flow.
A blood preparation with a large increase in P50, obtained by a new technique to encapsulate inositol hexaphosphate (IHP) in erythrocytes was evaluated on an isolated heart model. Each heart was alternatively perfused with control stored human blood (P50 = 2.12.+/- 0.9 mmHg) and IHP-treated human blood (P50 = 42.5 +/- 9.33 mmHg). Changes of perfusates were performed when coronary blood flow (CBF) was free and adapted to a constant perfusion pressure (FREE CBF). Changes of perfusates were also performed at a constant but restricted CBF corresponding to 55% of basal value (RESTRICTED CBF). Both bloods were oxygenated and equilibrated to achieve the same acid-base balance, arterial PO2 and O2 content. When CBF was not restricted, switching from control blood to IHP-treated blood, induced a decrease in CBF (-23%), an increase in coronary sinus PO2 (57%) and a decrease in coronary sinus O2 content associated with an increase in myocardial O2 consumption (14%). These metabolic changes were associated with a decrease in left ventricular developed pressure (LVDevP) (-15%) and its maximal positive derivative (-12%). When CBF was restricted, switching from control blood to IHP-treated blood, induced an increase in perfusion pressure (59%). This vasoconstriction was associated with the same changes in the blood gas measurements as those observed when CBF was not restricted, while LVDevP increased significantly (7%). It is concluded that the beneficial effects on myocardial metabolism from the increase in P50 with IHP, are lessened by the cardiodepressive effect of the blood preparation which is predominant when CBF is not restricted.
Animals↗
[Aphthoid stomatitis induced by labetalol].
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Aged↗
[Unilateral hematocolpos, blind vagina and agenesis of the homolateral urinary tract].
Hematocolpos with homolateral renal agenesis is a rare condition. Dysmenorrhea and paroxysmal abdominal pain are common symptoms in adolescent girls. Following a review of the literature, this article considers those procedures and investigations which can be used to help these patients before arriving at the stage of reconstructive surgery.
Abdominal Pain↗