[Immuno-allergologic evaluation in case of anaphylactoid incidents during anesthesia].

In case of an anaphylactoid accident, immunological and allergological investigation is to be performed in two parts: immediately after the accident (plasma histamine determination, C3 immunoelectrophoresis, basophil count) and four to eight weeks afterwards, investigating for anaphylaxis (intradermal tests, human basophil degranulation test, Prausnitz-Küstner test) and for risk factors (anomalies of histamine release and hyperreactivity to histamine, atopy, spasmophilia, drug allergies, previous administration of the involved substances). The investigation allows the involved mechanism as well as the responsible drug to be ascertained, thus allowing to manage the anaesthetic procedure in the light of the findings.

[Anaphylactic shock induced by suxamethonium].

The authors have studied 18 cases of anaphylactic shock due to suxamethonium which occurred in eastern France during the period 1972-1980. The drug responsible was succinyl iodide in 15 cases and succinyl chloride in 3. Significant contributing factors were previous drug allergy, spasmophilia and skin hypersensitivity to histamine.

Square-wave endurance exercise test (SWEET) for training and assessment in trained and untrained subjects. III. Effect on VO2 max and maximal ventilation.

The effect of training on VO2 max, endurance capacity (EC) and ventilation during maximal exercise (VE max) were studied in 17 normal subjects aged 21--51 years. At the beginning of the study 11 of the subjects (eight women and three men) were untrained (U) and six others (three women and three men) trained regulatory (T). A maximal intensity exercise (on a cycle ergometer) which could be sustained for 45 min (MIE45) was performed three times per week for 6 weeks; the total mechanical work (TMW) corresponding to the MIE45 per session varied between 3.

Anaphylaxis due to succinylcholine. Immunoallergological study of thirteen cases.

The antigen non-specific release of histamine by synthetic neuromuscular blocking agents is well known, though our review of thirty-two cases reported in the literature of anaphylactoid reactions to succinylcholine, shows that there is insufficient evidence to determine whether the signs are due to anaphylactic or to anaphylactoid reactions. We have examined thirteen cases in whom evidence of anaphylactic sensitization was examined by direct skin tests (in eleven cases) Prausnitz--Küstner tests (in five), rabbit basophil degranulation, Shelley test (in twelve) and human basophil degranulation (in seven). These tests were done on two to four occasions, and the optimal period for the first test ascertained to be 6 to 12 weeks after the episode.

[The respiratory effects of small dose fentanyl associated with controlled hypotension during spontaneous ventilation in anesthetized man (author's transl)].

Deliberately lowering blood pressure facilitates middle ear surgery. However, bleeding can persist in spite of hypotension in some tachypneic patients. Fentanyl is a powerful morphinomimetic which decreases ventilatory frequency.

[Changes in skin reactivity to phytohemagglutinin caused by general anesthesia].

Cellular immunity is studied by intradermal reaction to phytohaemagglutinin (four concentrations: 1, 2, 5 and 10 infinity g), the response to which at the 24th hour gives information concerning macrophage power and at the 48th hour the functional value of the T lymphocytes. Such a study was carried out in three groups of patients: 1st group (n = 20): general anaesthesia without surgery, duration less than 30 minutes; 2nd group (n = 10): general anaesthesia without surgery, duration greater than 2 hours; 3rd group (n = 20): general anaesthesia with surgical procedure, duration greater than 2 hours. In all groups, the results showed highly significant immune depression at the 24th hour, certainly linked to a depression of macrophage power.

[Anesthesia and postoperative care in reconstructive surgery of cranio-facial dysmorphias in children (about 100 cases) (author's transl)].

Hundred cases of anesthesia for surgery in craniofacial dysmorphias in children are reported. 40 children were below 2 years of age, 14 were 2-5 years old and 46 were 5 to 15 years old. Surgery was of 3-12 hours duration (mean: 5 h 30).

[Effects of a respiratory analeptic with peripheral action-almitrine on ventilation immediately after surgery].

After a brief review of the advantages and disadvantages of the postoperative administration of a respiratory analeptic with a central action, the authors study the effects of almitrine (respiratory analeptic with a peripheral action) on alveolar ventilation following thoracic surgery. Two groups of 10 patients were distinguished: the patients of the first group received almitrine (1.5 mg/kg-1 over a period of one hour) thirty minutes after their return from the operating room, whilst those of the second group received no respiratory analeptic.

[Indications for normovolemic hemodilution].

So long as normovolaemic conditions are respected and the haematocrit is not reduced to less than 30 per cent, there are a large number of surgical and even medical indications for deliberate haemodilution. Amongst the several contraindications, coronary insufficiency must be considered as being formal.

[Hemodynamic effects of normovolemic hemodilution].

After reviewing data from the literature concerning the effects of normovolaemic haemodilution on cardiac output and regional flow rates, the authors illustrate these concepts by a personal study involving the haemodynamics of 10 subjects undergoing operation in normovolaemic haemodilution. Removal of blood was compensated simultaneously by modified liquid gelatin in electrolytic solution (Plasmion) until the haematocrit was 0.30.

[Epidemiology of infections on a thoracic surgery service].

The aim of the present work is to discover the origin of the post-operative infections presented by certain patients following surgery for pulmonary exeresis in a surgical unit that deals both with thoracic and general surgical patients (most commonly cancer surgery). A prospective epidaemiological investigation of 54 pulmonary cases was thus undertaken, lasting for a period of 6 months. This consisted in obtaining multiple microbiological specimens from the patient himself, but also from the patient's environment and from the hospital staff (more than 1000 specimens were examined).

[Harmful interference between preoperative prophylactic cardiac pacemaker and cutting diathermy. Case report].

The authors report the case of a patient suffering the consequences of harmful preoperative between a prophylactic cardiac pacemaker system and cutting diathermy, resulting in irreversible ventricular fibrillation. After reviewing the different mechanisms responsible for this accident, they attribute the blame to a phenomenon of capture of electromagnetic currents with the pacemaker catheter playing the role of an aerial. They reconsider the indications for the use of prophylactic pacing and recall the safety precautions which must be respected at the time of simultaneous use of an external pacemaker and cutting diathermy.