[Heparin release in patients after infusion of lipid suspensions. Measurement of heparinemia (author's transl)].
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Biomedical subjects
Publications and source records attributed to P Viars.
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Bupivacaine (Marcaine) is being used increasingly in obstetrics for epidural analgesia, by virtue of the good sensory block obtained and the minimum of side-effects on the mother and newborn infant. At a concentration of less than 0.5 p. 100, analgesia is excellent with a minimal effect on motor fibres. Side-effects and toxicity are limited by the use of fractionated doses from the beginning of labour or of a single dose during or at the end of labour calculated in relation to the effect sought. Any action on the newborn infant would appear to be exceptional, if dose recommendations are respected, the high percentage of Marcaine bound to proteins limiting its transplacental passage.
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To determine the reliability of central venous pressure (CVP) as a guide to fluid therapy during an operation, repeated and simultaneous CVP and pulmonary wedge pressure (PWP) measurements were made with a Swan-Ganz catheter in 13 relatively elderly patients without obvious cardiac or respiratory disease- Overall correlation between CVP and PWP was highly significant (P less than .001); there was, however, an important variation of the correlation for each patient. For values of CVP greater than or equal to 8 mm Hg, the correlation was not significant. The disparity between right and left ventricular filling pressures was confirmed by the relationship between serial changes in CVP and PWP. These data strongly suggest that in relatively elderly patients undergoing surgery without evidence of cardiac or respiratory disease, CVP may be misleading index for appreciating PWP.
Severe facial injuries are becoming more and more common, -either facial injuries alone or associated with other injuries, -or facial deformities due to cancer which has required radical surgical operation. The authors analyse the cases of 26 patients with trauma and 24 with neoplastic radical surgical modifications. In the first group, pre-operative resuscitation is often an emergency, e.g. tracheotomy to restore or maintain vital respiratory functions. In the second group, the patients are often elderly and undernourished and they require intensive care before operation. In both groups there are common problems: -feeding by gastric catheter is generally required, -many re-operations with their problems: -avoid nutritional disorders, -and avoid morphine addiction.
The difficulties of tracheal intubation are mainly encountered in facial surgery and E.N.T. surgery, but they may nevertheless, occur in any form of surgery. The indications for nasal intubation, without visible glottis, the problems raised and the means of solving them, whilst respecting safety precautions, are briefly recalled.
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In a previous study, performed in patients undergoing gastrointestinal surgery receiving antibiotics intravenously we pointed out that the gastric aspiration was an additional route of elimination for some drugs. In order to estimate the extra-dose required to replace losses in patients receiving ornidazole, a study was set up. 8 patients entered the trial; the patients were infused 500 mg of ornidazole for 3 days every 12 hours. Blood was sampled at 0-2-4-8-24 h after the last infusion. Urines and gastric aspirate were collected. The results indicate that the amount aspirated through the tubings is 69.1 +/- 37.5 mg per 24 hours (24.8 - 116.8) with a very high variability; the half-life was not different of what is known for ornidazole: 10.5 +/- 1.7 h. The results confirm that for the molecules weakly bound to protein which "concentrate" in the gastric secretion, the aspiration is an important route of elimination.