Production and manipulation of elevated temperatures in pig abdomen with a three-electrode capacitive heating device.

The ability of a three-electrode capacitive heating device operating at 13.56 MHz to produce and effect spatial redistribution of hyperthermic temperatures is demonstrated through abdominal heating studies conducted with 80 kg female and 65 kg male pigs. Temperature-time profiles over the respective heating periods were obtained in anterior and posterior superficial tissue and in selected abdominal organs. At selected times during heating, spatial redistribution of elevated temperatures was effected through adjustment of power settings for one or more of the three electrodes, i.e. through manipulation of the specific absorption rate (SAR) in-vivo.

[Video-assisted pneumonectomies: lessons learned from an experimental study on an animal model]. / Pneumonectomies vidéo-assistées: enseignements tirés d'une étude expérimentale sur un modèle animal.

In order to test the feasibility of video-assisted pneumonectomy, we conducted an experimental study in an animal model. We performed 12 attempts of video-assisted pneumonectomy (7 on the right side and 5 on the left side) in pigs with an average weight of 43.5 kg. We used a combined technique of conventional and endoscopic dissection. A complication-free pneumonectomy was possible in 7 animals. Among the remaining 5 animals, 6 vascular injuries occurred, one of which was lethal. Two other animals died during the procedure for unknown reasons. We conclude that: 1) the vascular risk of video-assisted pneumonectomy appears to be prohibitive; 2) the value of animal models for vats feasibility studies is questionable because of the major differences in anatomical conditions.

Laparoscopic splenectomy: initial laboratory experience.

An experimental study was conducted in an animal model to test the feasibility of laparoscopic splenectomy. Twelve pigs were operated on. The splenectomy was feasible in 10 cases. However, a splenic injury occurred in five cases and the average blood loss was 80 ccm. We concluded that laparoscopy is feasible in an experimental model but is not a safe and easy procedure. Clinical applications should probably be limited to selected cases.

Thoracoscopic dissection of the esophagus: an experimental study.

In order to reduce the respiratory morbidity of thoracotomy in esophageal surgery, several methods have been used, such as blunt dissection and endoscopic dissection through mediastinoscopy. It seems that the latter reduces drastically the morbidity but does not allow full visualization of the esophageal wall, a disadvantage in some circumstances. We describe a thoracoscopic dissection of the esophagus which gives a large and magnified view of the pleural cavity, of the mediastinum, and of the esophagus.

[Surgery of the esophagus under thoracoscopy. Study of feasibility]. / Chirurgie de l'oesophage par thoracoscopie. Etude de faisabilité.

An experimental study of thoracoscopic surgery on the esophagus was conducted in 11 animals. Complete dissection of the esophagus was carried out in the ten last cases. Other procedures performed included mode picking, truncal vagotomies, and myotomies. The thoracoscopic esophageal surgery might allow to decrease the morbidity of thoracotomy. Its interest, compared with other methods of dissection without thoracotomy, has to be evaluated.

[CDP-choline improves the postoperative rehabilitation of patients with cerebral risk]. / Amélioration par la CDP-choline de la récupération post-opératoire de sujets à risque cérébral.

To evaluate the efficacy of CDP-choline to prevent from brain damages after surgery for high risk patients, 210 patients receiving pre and post operative parenteral CDP-choline were compared to 204 controls (mean age 73 years) in a multicenter open randomised study. Quality and delay of anesthetic recovery were assessed. Cognitive screening test and self-control scale (simplified Mini Mental Status test and Barthel Index) were performed the day before and the first and fourth day after surgery. CDP-choline does not enhance quality or delay of anesthetic recovery but increases the percentage of subjects with a better fourth post-operative than preoperative cognitive and self-control test (p less than 0.05).

[Estimation of blood sugar levels with dipsticks]. / Estimation de la glycémie par bandelettes réactives.

The purpose of the study was to compare the blood glucose measurement by spectrophotometry with blood glucose estimation by reflectometry. The results show that reflectometry is a quite, simple, rapid and reliable method, which can be used by anaesthesiologist in operating theatre, recovery room and intensive care units especially in paediatric practice.

[Prevention of pulmonary collapse during bronchography under general anesthesia in children]. / Prophylaxie du collapsus pulmonaire lors des bronchographies sous anesthésie générale chez l'enfant.

The inhalation of halothane with oxygen and air facilitates bronchography without pulmonary collapse or alveolar obstruction by contrast medium. This anaesthetic technic used in 15 paediatric investigations is more secure under transcutaneous PO2 and PCO2 monitoring.

[EEG recordings in prolonged hypercapnia during surgery of a cervico-mediastinal tumor in a 3-year-old child]. / Enregistrement EEG pendant une hypercapnie prolongée au cours d'une intervention pour tumeur cervico-mediastinale chez un enfant de 3 ans.

An EEG has been recorded during surgery for a cervico-mediastinal desmoid fibroma in a 3-year-old child. Soon after anesthetic induction a bronchospasm occurred, followed by major respiratory difficulties. During more than 3 h, hypercapnia reaching 15-24 kpa was noted without hypoxia. Meanwhile the EEG recording was inactive. The respiratory difficulties subsided only with the surgical liberation of the trachea. As the hypercapnia decreased, the EEG began to show "burst suppressive" activity. Progressively the tracing was more and more continuous with slow waves until complete recovery. The following day the EEG was quite normal. The mechanisms of these EEG features are discussed with regards to anesthetic drugs and to brain hypercapnic edema.

[Therapeutic testing. Procedure in pediatric anaesthesia (author's transl)]. / L'essai thérapeutique. Conditions en anesthésie pédiatrique.

In pediatric anaesthesia, the therapeutic research raises ethical, moral and legal problems. The reexamination of three personal experimental procedures: ketamine (1970), propanidide (1971), etomidate (1978) yields suggestions concerning the use of new anesthetic drug in children. The experimental procedures in pediatric anesthesia need: --a great number of experimental results in "adults" animals but also in "growing" animals, --sufficient experiments in human adults, --an anesthetic medical staff especially trained in practice of pediatric anesthesia, --a special care for th convenient protocol. Moral and ethical problems concern: --the direct benefit, --the discernible risk, --the inclusion of non critically ill minor children in the procedure and the legal right of "informed consent". The approval of the design, details and ethical criteria of the research by a medical ethics committee seems the only judicious way.

[Blood pressure during pediatric anesthesia. Four methods of peroperative indirect measurement. Comparison (author's transl)]. / Pression artérielle en anesthésie pédiatrique. Comparaison de quatre méthodes indirectes de mesure peropératoire.

During general anesthesia blood pressure levels have been recorded for 35 children (10 aged 1-12 months, 15 aged 12-24 months, 10 more than 24 months). Four different methods of indirect measurement were used: pulse palpation, flush technique, ausculatory determination by mean of a conventional sphygmomanometer, Doppler ultrasonic technique by mean of arteriosonde. The pulse palpation is the easiest method at any age, during pediatric anesthesia but does not give values of diastolic blood pressure. The flush technique quite convenient for infants less than 24 months gives values lying midway between systolic and diastolic blood pressure. Ausculatory determination in operating room is difficult especially with small infants less than 12 months. During anesthesia longer than thirty minutes, monitoring blood pressure by Doppler ultrasound sphygmomanometer can be fairly available. Even in case of difficulties to detect clear signals of systolic and diastolic blood pressure the sphygmomanometer can be used to obtain blod pressure determination by flush technique or pulse palpation.

[The tracheal intubation of children suffering from congenital cranio-facial anomalies. Pre-operative anticipation of its technical problems (author's transl)]. / L'intubation trachéale chez les enfants atteints de dysmorphies cranio-faciales congénitales. Détection pré-opératoire des difficultés.

In order to anticipate the technical problems of the tracheal intubation of children suffering from congenital cranio-facial anomalies, the authors suggest, in addition to the routine examination of the nasal and buccal cavities, different clinical and radiological measurements such as mandible angle, maxillo-pharyngeal angle and the mouth opening. These parameters explore the extent of the mandibular asymmetry and hypoplasia, the limits of the mouth opening and the cervical spine extension. Three data are reported, showing the interest of the scheme of examination proposed.

[Siamese twins: anesthesia, pre-per- and post-operative care (author's transl)]. / L'anesthésie et la réanimation des monstres doubles.

The authors relate the anesthetic and pre-, per- and post-operative care problems they had to meet with six pairs of siamese twins separated at the Hôpital des Enfants Malades (Paris), between 1960 and 1978. 77 cases of such anomalies have been reported since the beginning of the XXth century. The authors point out the importance of: 1) a precise pre-operative assessment of the anatomo- and physiopathological status of the conjoined twins, 2) an outstanding technical organization, 3) a medical and nursing team specialized in pediatric anesthesia and intensive care to face with the predictable and unpredictable problems which may occur, specially those which the clinical and paraclinical investigations have not been able to discover before the operation.