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1.
Ann Fr Anesth Reanim ; 15(8): 1162-7, 1996.
Artigo em Francês | MEDLINE | ID: mdl-9636788

RESUMO

OBJECTIVE: To determine the quality of blood salvaged and processed during Caesarean section with a cell-saver. STUDY DESIGN: Laboratory study. PATIENTS: The study included 20 patients of ASA physical class 1 or 2 undergoing a scheduled Caesarean section. METHODS: A separate suction device was used from the beginning surgery until the delivery of the fetus, to remove most of the amniotic fluid coming from the surgical field. Thereafter using an Haemolite 2Plus (Haemonetics), the blood was separated and washed with 2 L of normal saline solution. Blood quality was assessed through detection of fetal cells and measuring out of alpha-fetal-protein, tissue factor. A Kleihauer test was also performed. RESULTS: Cell-saver processing removed most of alpha-fetal-protein and tissue factor while fetal cells were rarely seen. The Kleihauer test could not be performed because of haemolized blood samples. However, the results were very heterogeneous and after washing some salvaged units contained very high concentrations of alpha-fetal-protein or tissue factor. CONCLUSIONS: These preliminary results show that intra-operative autologous transfusion is not fully safe during Caesarean sections. In addition, there is an immunological risk if a significant part of fetal red blood cells are reinfused into maternal circulation. Therefore, additional studies are needed to better assess this risk.


Assuntos
Transfusão de Sangue Autóloga/métodos , Cesárea , Adulto , Transfusão de Sangue Autóloga/instrumentação , Feminino , Feto/citologia , Humanos , Período Intraoperatório , Troca Materno-Fetal , Gravidez , alfa-Fetoproteínas/análise
2.
Ann Fr Anesth Reanim ; 15(2): 128-34, 1996.
Artigo em Francês | MEDLINE | ID: mdl-8734231

RESUMO

OBJECTIVES: The aims of this study were to assess the analgesic effect of the intraperitoneal topical administration of 0.375% bupivacaine in patients undergoing laparoscopic cholecystectomy and to carry out a pharmacokinetic study of bupivacaine administered topically by intraperitoneal route. STUDY DESIGN: Randomized, double-blind controlled trial. PATIENTS AND METHODS: Twenty-four patients of ASA physical status 1 or 2, undergoing elective laparoscopic cholecystectomy, were included. Anaesthesia technique was the same for all patients. At the end of surgery, they were randomly assigned to one of two groups. Patients in group bupivacaine were administered 0.375% bupivacaine, 0.6 mL.kg-1 intraperitoneally in both subdiaphragmatic areas and the cholecystectomy wound, those of the control group were given the same volume of NaCl 0.9%. Analgesia was provided by morphine PCA. Postoperative pain, assessed on a 100 mm visual analogue pain scale (VAS), and administered morphine were recorded 30 min after extubation, and 0.5, 1, 2, 3, 6, 12, 24, 36 and 48 hours later. Blood samples were collected 2, 5, 15, 30, 60, 90, 120, 180, 300 and 480 min after the intraperitoneal administration of bupivacaine to measure bupivacaine plasma concentration. Statistics included Student t test and Chi square test. P < 0.05 was considered significant. RESULTS: There was no significant difference between the two groups with regard to VAS scores during the first 48 postoperative hours. Morphine requirements (total and at each point) were also similar. Plasma bupivacaine concentrations reached a plateau at 10-20 min, and then decreased slowly. The median plasma peak concentration was 0.94 +/- 0.47 microgram.mL-1. In one patient toxic concentrations (> 1.6 micrograms.mL-1) during the first 60 min after intraperitoneal administration were obtained, while in another patient a concentration of 1.58 micrograms.mL-1 was reached twice. CONCLUSIONS: Intraperitoneal administration of 0.6 mL.kg-1 of 0.375% bupivacaine is ineffective in reducing postoperative pain after laparoscopic cholecystectomy. Furthermore these high doses of bupivacaine may result in toxic plasma concentrations. This technique is not safe and cannot be recommended.


Assuntos
Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Colecistectomia Laparoscópica , Dor Pós-Operatória/tratamento farmacológico , Adulto , Idoso , Analgesia Controlada pelo Paciente/métodos , Anestésicos Locais/efeitos adversos , Anestésicos Locais/farmacocinética , Bupivacaína/efeitos adversos , Bupivacaína/farmacocinética , Feminino , Humanos , Injeções Intraperitoneais , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Falha de Tratamento
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