Comparative trial of propofol and ketamine in anesthesia for the baths of severely burnt patients

Ketamine was the normal anaesthetic drug for carrying out the baths of severely burnt patients. It was compared with propofol in a study of 50 patients (greater than 50 UBS) randomly assigned to two groups: 2.5 mg . kg-1 propofol and 2 mg . kg-1 ketamine. The speed of induction was the same for both groups, surgery beginning within the same time intervals. In the propofol group, however, apnoea was seen more often and lasted longer (p less than 0.05) than in the ketamine group. The times between repeat injections were short (about 5 min) and constant with propofol, whereas they were larger and irregular with ketamine; this was due to the shorter distribution half-life and lack of accumulation of propofol. During anaesthesia with propofol, haemodynamic parameters remained steady after an initial period of cardiovascular depression. Respiratory rate increased, because of the lack of analgesia. Recovery was very quick, complete and with no bothersome adverse effects in the propofol group. These hypercatabolic patients could therefore be fed early postoperatively; also, there was no deleterious psychological interference in these deeply disturbed patients.     

Atherosclerosis and cerebral ischemic attacks: intakes of cerebrography with xenon133 inhaled and platelet tests in the diagnosis, clinical and therapeutic monitoring; the preventive role of dipyridamole

A study of patients to develop the significance of the role of the blood platelets in the recurrence of transient cerebral ischemic attacks in patients with cerebral atheromatous, develop the effectiveness of dipyridamole in the prophylactic therapeutic regimen. In the group treated with dipyridamole, a 76.3% clinical improvement was recorded (mean increases of 11.2 ml/min. and 11.4 ml/min. of the cerebral hemispheric flows), 15.8% of cases stabilized (mean increases of 1.7 ml/min. and 1.2 ml/min.) and 7.9% failures (mean decreases of 10.4 ml/min. and 14.3 ml/min.) of these same flows. The cerebrography with xenon133 inhaled as well as the platelet tests used, constitute unfailing means of diagnosing and monitoring the clinical development.     

Postsurgical follow-up by MRI of anterior cervical discectomy without fusion.

Postoperative magnetic resonance imaging (MRI) findings are described in selected patients with cervical radiculopathy and a cervical soft disc herniation, treated by anterior cervical discectomy (ACD) without fusion. Six months postoperatively, 45 patients underwent MRI examination using a 0.5 T superconductive unit. T1- and T2-weighted spin echo sequences were acquired on sagittal and axial planes. A low signal intensity on T2-weighted images was visualized at the ACD level in all patients. Five patients were found to have a slight kyphosis at the discectomy level. There was no residual disc material at any ACD level. In 5 patients, areas of diminished signal intensity on T1- and T2-weighted images on adjacent vertebrae was noticed, indicating sclerosis of the cortical bone adjacent to the ACD level. In 3 patients, cervical disc protrusions without impression on the dura were visualized postoperatively: 2 below and 1 above the ACD level. One patient developed a cervical disc herniation without complaints one level above the operated one. No patient developed infolding or degenerative swelling of the ligamenta flava and no intrinsic cord abnormalities were present. MRI provided useful information on pathology, allowing a non-invasive evaluation following ACD and enabling a better understanding of surgical consequences.     

Fiberoptic intracranial pressure monitoring in rats

An adaptation of a fiberoptic intracranial pressure monitoring system for clinical use is described. The method allows easy and reliable acute and chronic intracranial pressure registration in anesthetized as well as conscious rats. The disposable fiberoptic probes, originally designed for human use, can be re-used limitlessly. The fiberoptic method is compared with conventional monitoring procedures under different experimental conditions. The validity of intraparenchymal and epidural measurements is discussed. The importance of chronic intracranial pressure registration in conscious laboratory animals is stressed.     

Photochemically-induced cerebral infarction in the rat: Comparison of NMR imaging and histologic changes

Summary The evolution of a photochemically induced cerebral thrombotic infarction was followed in rats during the first week after the insult by means of NMR imaging and histology. Heavily T2-weighted images provided an excellent lesion detection and a high specificity for the discrimination of different histological abnormalities. The T2-weighted images showed a brain lesion evolving during the first 24h from a homogeneous hyperintense area, histologically corresponding to diffuse vasogenic and cytotoxic oedema with concomitant neuronal necrosis, to an iso-intense area with a hyperintense seam, which microscopically correlated with increased vascular permeability at the periphery of the lesion. The hyperintense seam was observed up to day 7, but at that time coincided with gliomesodermal repair reaction which could be verified histochemically and ultrastructurally. It may be concluded that NMR-micro-imaging at a moderately high field, enables early detection and adequate followup of small cerebral infarctions in rats.     

Gadolinium-DOTA enhanced MR imaging of intracranial lesions

Gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N",N"'-tetraacetic acid (Gd-DOTA) is the first of a new class of macrocyclic paramagnetic magnetic resonance (MR) contrast agents (gadolinium cryptelates) to be used in clinical practice. Gadolinium-DOTA possesses relaxation properties similar to those of gadolinium diethylene triamine pentaacetic acid (Gd-DTPA). We report our initial clinical experience in 38 patients with intracranial lesions studied with MR before and after injection of Gd-DOTA. Diseases included primary and metastatic brain tumor, cerebral infarct, vascular malformation, meningioma, hemangiopericytoma, schwannoma, and pituitary macroadenoma. Gadolinium-DOTA was administered intravenously in a dosage of 0.1 mmol/kg body weight. All studies were performed on a superconductive 0.5 T system. As compared to noncontrast T1- and T2-weighted images (WI), Gd-DOTA enhanced T1 WI were useful in defining the anatomy of malignant intraaxial tumors (high-grade glioma, metastasis) and in tumor versus edema differentiation. Low-grade gliomas did not enhance; in these cases the precontrast T2-weighted sequence was found to be more informative. In post-operative patients, Gd-DOTA allowed us to demonstrate residual tumor or tumor recurrence. Extraaxial tumors (meningioma, hemangiopericytoma, neuroma) enhanced markedly, presumably reflecting tumor vascularity. In our experience, the use of Gd-DOTA improves the anatomic definition of cerebral lesions and in some cases increases both MR sensitivity and specificity. We found Gd-DOTA to be a well tolerated and effective paramagnetic contrast agent. Gadolinium-DOTA can be considered as an alternative water-soluble MR contrast agent to Gd-DTPA.     

Craniostenosis: the importance of the anesthesiologist

Based on the experience with 15 patients operated for craniostenosis in our hospital, guidelines were determined for the anesthetic and postoperative management with optimal maintenance of vital parameters. Subgaleal accumulation of blood may cause a spectacular drop of hemoglobin level during the first postoperative days. Since it is better to prevent than to cure, systematic anti-convulsive and antibiotic prophylaxis must be considered.