[Atheromatous stenosis of the left coronary trunk. 28 surgical cases]. / Sténoses athéromateuses du tronc de la coronaire gauche. Vingt-deux cas opérés

22 patients with atheromatous narrowing of the left coronary trunk underwent surgery between 1969 and 1974. Most of these patients had severe and incapacitating angina pectoris. The clinical features are readily explained by the size of the diffuse anatomical lesions, which are to be found on the left coronary trunk as well as on the three coronary vessels themselves. This series has not confirmed the serious risk of surgery in such cases, as there were no operative deaths. Secondary mortality was low (9%), and the 20 survivors (average length of follow-up: 26 months) were mostly (18/20) in an excellent condition functionally. These facts have lead us to advise surgery whenever possible.

[Anantomical aspects and surgical treatment of pulmonary stenoses and atresias with intact interventricular septum in the newborn and the infant under 6 months]. / Aspects anatomiques et traitement chirurgical des sténoses et atrésies pulmonaires á septum interventriculaire intact du nouveau-né et du nourrisson de moins de 6 mois

The series presented consists of 25 babies (18 of which were neonates), seen between 1972 and 1974. The anatomical and angiographic study revealed 5 anatomical types, according to whether the pulmonary orifice was patent or atretic, and according to the size of cavity of the right ventricle, which may be normal or reduced (perhaps almost totally). The diagnostic clinical features and findings on angiography are recalled. The operative procedure in all 25 cases was pulmonary valvotomy carried out with a brief normothermic period of cirulatory arrest. The technique is described briefly. The results, which vary widely with the anatomical type, were as follows: out of the 25 operated cases there were 12 deaths during or immediately after surgery. The figures are none-the-less encouraging, given the grave natural history of this condition in the baby. The best results were seen in cases in which there was a right ventricular cavity of normal or at least acceptable size. The maximum postoperative follow-up period was 3 years. Most of these children have a persistant pulmonary stenosis and hypertrophic right ventricle, and require a second operation in early infancy.

[A study of 11 ventilators for anesthesia: laboratory testing]. / Etude de 11 ventilateurs d'anesthésie: banc d'essai.

Eleven anaesthesia ventilators were instrumentally tested under various conditions. They included: Excel and Modulus II Plus (Ohmeda); 710 and Servo anaesthesia circle 985 (Siemens); Jollytronic (Soxil) and Elsa (Engström); SA2 and Cicero (Dräger); ABT 4,300 (Kontron); Monnal A and the prototype Alys (Taema). The test circuit comprised a two compartment model lung, a pneumotachograph, a pressure gauge in the "airway". The volume was calculated as the integral of flow rate. Each machine was calibrated by the firms' technicians. Before each test, the pneumotachograph was calibrated using a 11 air syringe and the pressure gauge with a 5 cm water column. Each machine ventilated the model lung for 30 min before starting the tests. There were five tests: 1) reliability of the machine's spirometer, 2) reliability of the ventilation rate, 3) reliability of pressure measurements, 4) effect of increasing fresh gas flow on spirometry, 5) effect of increasing downstream resistances. In usual simulated ventilatory conditions, all the machines accurately delivered the setted ventilation and spirometric measurements were with minimal error only. Several ventilators (SA2, Excel, 710, Elsa, ABT 4,300) did not succeed in maintaining their performances when compliance was strongly decreased or resistance of the test lung notably increased. Resistance in the circuit during simulated spontaneous ventilation was < 3.6 cmH2O.l-1.s-1. Increasing fresh gas flow raised the minute volume delivered in six ventilators. It is concluded that, during extreme ventilatory conditions, the inspired volume must be adjusted so as to maintain the inspired tidal volume. However, ventilators which increase inspiratory time in response to an increased mechanical load cannot be adjusted by this way.

[Spinal anesthesia and prevention of thrombosis by heparin]. / Anesthésie intra rachidienne et prévention des thromboses par l'héparine.

Non traumatic spinal hematomas are a rare pathology, anticoagulant treatments are one of their most frequent etiology. Therefore, the association of spinal anesthesia and a preventive treatment which has antithrombotic aim by the use of subcutaneous heparin (non fragmented or low molecular weight) is being discussed by many authors. It is lawful to associate spinal anesthesia with a soft dose of non fragmented subcutaneous heparin (Kakkar method) if the protocols are strictly respected. It is certainly possible to use low molecular weight subcutaneous heparin as well. However a slight decline in their use urges anyone to be very cautious.

[Technics of anesthesia and hypothermia for the infant. Choice of replacement fluid for the circuit]. / Techniques d'anesthésie et d'hypothermie chez le nourrisson. Choix du liquide de remplissage du circuit

Sixty-five infants were submitted to complete repairment of a congenital cardiopathy under profound hypothermia and ECC. Description of the preparation of the young surgical patient, of the anesthesia, of the technique of ECC. The overall mortality was 35.5 p. 100. The hypothermia induced by ECC, does not introduce any supplementary risks as long as strict technical rules are respected.

[Anesthesia for resections-anastomoses of the trachea and the tracheal bifurcation]. / Anesthésie pour les résections-anastomoses de la trachée et de la bifurcation trachéale

Resection and anastomosis of the trachea or the tracheal bifurcation, raises numerous problems, which will be discussed in a series of 81 patients: -there is more or less marked ventilatory insufficiency related to the degree of the stenosis, and difficulties of expectoration responsible for retention of sputum; -per-operative ventilation. One must choose between an intubation catheter of small caliber in order to overcome the stenosis, or a large catheter to remain above it. The problem is all the more delicate to solve when the stenosis is tighter and higher; -during the period when the trachea is open, the surgeon must intubate the central part of the trachea with a sterile catheter. If the division is low, it is necessary to intubate the main bronchi or one only, and then create a marked shunt effect which would be ill-supported by the patient; -It is advisable to remove the catheter at the end of the operation. Awakening should be perfect in order to cough to be immediately efficacious in a patient who often has to remain with his head flexed forwards.

[Congenital cardiopathies appearing during the neonatal period. The view points of the cardiologist, the hemodynamics specialist, the surgeon, and the anesthetist]. / Cardiopathies congénitales à révélation néo-natale. Point de vue du cardiologue, de l'hémodynamicien, du chirurgien et de l'anesthésiste réanimateur

The best chances of survival for a new-born depend on the following factors: the possibility of clinical and haemodynamic diagnosis of the malformation, adequate reanimation and surgery. All this must be carried out as early as possible. Although catheterization is very risky it should be complete and as fast as possible, under monitoring of ventilation and haemodynamies. Reanimation is very important before, during and after surgery; it should be more preventive than curative. Very often, surgery is only palliative at this age. Taking into account progress in surgical techniques, the authors report their experience in anaesthesia and ressuscitation of 100 patients under 10 days old. They were all operated on in Laennec in Professor MATHEY's department but only some of them were catheterized there.

Transcutaneous cranial electrical stimulation increases the potency of nitrous oxide in humans.

The potency, amnesic, and postanesthetic analgesic effects of transcutaneous cranial electrical stimulation (TCES) were evaluated during N2O anesthesia in 120 unpremedicated patients, prior to urologic or general surgical operations. The patients were divided into six groups of 20 each with respect to what concentration of N2O in oxygen they were allowed to breathe (75, 62.5, and 50%), and whether they were or were not stimulated with TCES. Recordings of heart and respiratory rates, systolic arterial blood pressure, and minute ventilation were made prior to and after 20 min of N2O, and one minute later following application of a Kocker clamp to the upper inner thigh for one minute. The presence or absence of movement during the painful stimulus, memory of the painful stimulus, and postanesthetic pain at the clamp site (20 min after anesthesia) were also evaluated. Patients who received TCES had significantly lower incidences of movement, memory of the painful stimulus, and postanesthetic pain at the stimulation site at each N2O concentration than patients not getting TCES. TCES did not alter circulatory and respiratory dynamics prior to painful stimulation and prevented an increase in arterial blood pressure during painful stimulation in patients receiving 50% N2O. These data indicate that TCES significantly increases the analgesic potency of N2O and probably also the depth of anesthesia.

[Transurethral resection of the prostate (turp syndrome), myth or reality? Analytic studies using a radioactive isotope method (author's transl)]. / Le syndrome de résection transurétral de la prostate (turp syndrome), mythe ou réalité? Essais analytiques à l'aide d'une méthode radio-isotope.

It is accepted that the laboratory and clinical so-called "transurethral resection syndrome" reflects passage into the body of a large fraction of the water used to perfuse the field of endoscopic resection. The major complete syndrome (dyspnoea, nausea, hypertension, raised central venous pressure, bradycardia then pulmonary oedema, cerebral oedema, cardiovascular shock and renal insufficiency) is rare: 1.5 per cent of cases of transurethral resection of the prostate in the literature, 0.6% in a series of the last 300 resections performed by the authors (2/300). Also was it not possible to hope for a complete physiological study of sufferers from this complication. Nevertheless, it may be considered that all transurethral resections of the prostate may be associated with similar movements of water to a minimal extent. In order to attempt to demonstrate this, the authors studied in a series of 19 patients pre- and postoperative blood volumes by a radio-immunological technique using pre- and postoperative serum albumin haematocrits. In this short series, patients who had undergone a short endoscopic resection (35 minutes on average) of a small adenoma (13 grams on average) with a mean irrigation of 10 litres of water rendered isotonic by the addition of glycocolle, without any transfusion or infusion being necessary during the course of the resection, the conclusion was simple: no variation in blood volume was demonstrated. Is the physiopathological hypothesis advanced to explain this phenomenon false? And is the problem in fact one of peroperative septicaemia?

Transcutaneous cranial electrical stimulation decreases narcotic requirements during neurolept anesthesia and operation in man.

The influence of transcutaneous cranial electrical stimulation (TCES) on fentanyl requirements was evaluated in 50 patients undergoing urologic operations with pure neuroleptanesthesia (droperidol, diazepam, fentanyl, and air oxygen) with (group I) or without (group II) simultaneous TCES. All patients had silver electrodes (three) applied between the eyebrows and behind each mastoid process and attached to a 167-kHz current generator. Current was delivered only to group I. The wave form was a complex nonsinusoidal, nonsquare wave pattern which was applied intermittently in a 3-msec-on 10-msec-off sequence. All patients had anesthesia induced with droperidol (0.20 mg/kg IV), diazepam (0.2 mg/kg IV), and pancuronium (0.08 mg/kg IV), and, after tracheal intubation, had anesthesia maintained with fentanyl in 100-microgram intravenous increments every 3 minutes whenever and as long as systolic arterial blood pressure and/or heart rate were greater than 20% of control (preanesthetic induction) values. Fentanyl requirements averaged 6.1 +/- 0.5 and 7.9 +/- 0.4 microgram/kg/min for a mean total dosage of 9.0 +/- 0.9 and 12.5 +/- 0.8 microgram/kg for the entire operation in groups I and II, respectively. These differences between groups were statistically significant (p less than 0.05). The data demonstrate that TCES augments the analgesic effects of fentanyl and thus reduces fentanyl requirements during urologic operations with neuroleptanesthesia.