Operative care and surveillance in severe trauma patients. Interference between resuscitation treatments and anaesthesiology, and consequence on immunity.

Major trauma remains a worldwide cause of morbi-mortality. Early mortality is the consequence of hemorrhagic shock and traumatic brain injury. During early resuscitation, anaesthesia is often mandatory to perform surgery. It is mandatory to master the hemodynamic effects of hypnotic drugs in order to anticipate their potential deleterious effects in the setting of hemorrhagic shock. After early resuscitation, trauma patients present a high prevalence of nosocomial pneumonia, which sustains major morbidity. Nosocomial pneumonia are the consequence of an overwhelming systemic inflammatory response syndrome (SIRS) as well as a trauma-related immunosuppression. The administration of hemisuccinate of hydrocortisone modulates the SIRS and reduces the risk of nosocomial pneumonia as well as the length of mechanical ventilation. Finally in the operating theatre, fighting against hypothermia and un-anatomical positions, which can aggravate rhabdomyolysis, are both mandatory.

[Postoperative analgesia using propacetamol]. / Analgésie postopératoire par le propacetamol.

Postoperative analgesia using propacetamol was studied in 50 patients, 42 +/- 16 years old, after little or moderate surgery. Two grams of propacetamol in intravenous perfusion were administered every six hours. Three scales were utilized to note the intensity of the pain (simple verbal, behavioral and visual analogue scales), before the first injection and, one, four, six hours after. From this study, satisfactory analgesic efficiency and good tolerance of propacetamol were established.

[Role of invasive technics in the occurrence of nosocomial infections. At an intensive care unit]. / Place des techniques vulnérantes dans la survenue des infections nosocomiales. En réanimation.

A prospective study was carried out in a polyvalent medical intensive care unit to determine the role played by diagnostic and therapeutic invasive techniques in the development of four nosocomial infections. Over a 6-month period, 206 patients admitted for more than 48 hours were studied; all had undergone one or several invasive techniques: 76 patients (37 per cent) developed a total of 117 nosocomial infections including urinary tract infection (41.8 per cent), purulent bronchitis (37.5 per cent) septicaemia (11.6 per cent) and pneumonia (7.6 per cent). The risk factors were: duration of urinary or vascular catheterization, tracheal intubation, tracheotomy and artificial ventilation. Gram-negative bacilli (59 per cent) predominated over Gram-positive cocci (39.6 per cent).

[Continuous propofol infusion versus enflurane in children operated on for strabismus. Comparison of the quality of anesthesia and recovery conditions]. / Propofol en perfusion à débit continu versus enflurane chez l'enfant opéré de strabisme. Comparaison de la qualité de l'anesthésie et du réveil.

In children, the use of a continuous infusion of propofol has not yet been reported. A study was therefore designed to compare the characteristics of anaesthesia and recovery when either propofol or enflurance was used as the main anaesthetic agent. All 42 children (14 girls, 28 boys), ASA I and scheduled for corrective squint surgery under general anaesthesia, received 350 micrograms.kg-1 midazolam and 40 micrograms.kg-1 atropine intrarectally 20 min before induction, which was carried out with 3 mg.kg-1 propofol intravenously in 20 s. The patients were then randomly assigned to two groups, according to the drug used for maintenance: group P (n = 21) received a continuous intravenous infusion of propofol, 18 mg.kg-1.h-1 for the first 30 min and 15 mg.kg-1.h-1 thereafter; group E (n = 21) received 2.5%, then, after 30 min, 2% enflurane. Both groups were given 15 micrograms.kg-1 dextromoramide and 0.09 mg.kg-1 vecuronium. During anaesthesia, the following parameters were monitored: systolic (Pasys), diastolic (Padia) and mean arterial (Pa) pressures, heart rate (fc), the presence or not of an oculocardiac reflex with or without a 20% fall in fc which responded to 10-15 micrograms.kg-1 atropine, the appearance of a cardiac dysrhythmia, duration of anaesthesia and the delay before extubation. Recovery was assessed 1, 2, 4 and 6 h postoperatively by using both clinical and psychomotor criteria, the latter being adapted to children having one or both eyes occluded.(ABSTRACT TRUNCATED AT 250 WORDS)