La mise sur le marché de nouveaux médicaments comme l'érythropoïétine recombinante (rHu EPO) modifie les stratégies transfusionnelles habituelles. Ainsi, les besoins transfusionnels peuvent être réduits par la prescription préopératoire de rHu EPO dans des conditions précises: patients insuffisants rénaux, cancéreux anémiques, cardiopathes anémiques. La rHu EPO peut également être associée à la transfusion autologue programmée, à condition de sélectionner les patients anémiques avant les prélèvements, qu'ils aient des besoins transfusionnels élevés ou des programmes de prélèvements écourtés. En période postopératoire, la rHu EPO n'est efficace que sur une période de prescription prolongée, ce qui limite ses indications et son utilité, étant donné son coût élevé.

New agents such as recombinant human erythropoietin (rHu EPO) modify conventional transfusionnal strategies. For accurate indications, such as, anaemia associated with chronic renal failure, cancer or cardiac disease, the preoperative prescription of rHu EPO may reduce transfusion requirements. rHu EPO may also be associated with pre-deposit transfusion in patients with anaemia before blood donation, when the transfusion needs are high, or the period for blood pre-deposit donation shortened. Postoperatively rHu EPO is only efficient if it is administered for a prolonged period; this condition limits its indications and value because of its high cost.

Comparative mitochondrial ultrastructural changes during myocardial ischaemic periods have been assessed when using four different solutions: Bretschneider's solution (BS) (K+ = 10 mEq/l) at 4°C; St Thomas's hospital solution (STS) (K+ = 20 mEq/l) at 4°C; standard Ringer's solution (SRS) (K+ = 2.7 mEq/l) at 4°C; blood potassium cardioplegic solution (BPS) (K+ = 21 mEq/l) at 15°C. BS (n = 8), STS (n = 10), SRS (n = 8) and BPS (n = 8) were infused in 34 patients undergoing aortic valve replacement (n = 17) or aortocoronary bypass grafting (n = 17), after aortic crossclamping, either in the aorta or in both coronary ostia, until the septal myocardial temperature reached 10-13°C for crystalloid solutions or 15°C for blood cardioplegia. Myocardial biopsies were taken from the left ventricular apex, on a beating heart, at the beginning and end of bypass. To assess the degree of ischaemic injury, an ultrastructural evaluation of the mitochondria was done and four histological classes have been defined: class I- dense matrix and cristae; class II — occasional mitochondrial swelling; class III — decrease in matrix density with extensive swelling; class IV — severe swelling and/or rupture of matrix. This study showed that: (1) only the St Thomas's and Bretschneider's solutions provide a rapid electromechanical asystole; (2) isolated hypothermic crystalloid solution with low potassium concentration (standard Ringer) is not sufficient either to induce cardiac arrest or to prevent detrimental mitochondrial changes; (3) Bretschneider's solution appears to provide the best ultrastructural mitochondrial preservation during myocardial ischaemia.

27 malades: 17 lesions de la crosse de l'aorte, 10 cas de lesions a risque hemorragique majeur, 3 indications medicales (CEC d'assistance pour vasoplegie refractaire). Ces interventions font appel a un arret circulatoire et une hypothermie profonde

After open-heart surgery using extracorporeal circulation, residual blood from the heart-lung machine was collected, treated by plasmaphaeresis and washed using a Haemonetics Cell Saver. Qualitative, quantitative and bacteriological aspects of the concentrated red cells were studied. In 13 patients, an average of 500 ml of concentrated washed red cells (CWRC) was obtained with an average haematocrit of 62·3 %; bacteriological cultures were negative in all cases. As far as qualitative aspects were concerned (intraglobular ATP, 2, 3 DPG, deformability, filtrability and resistance to hypotonic solutions), these red cells were always compatible with immediate transfusion. However, the small volume of blood retrieved and the relatively high cost of this technique suggest that its use be restricted to cases of total haemodilution or for patients with rare blood groups, in whom homologous transfusion blood is scarce.

Carotid endarterectomy with clamping is performed in 50 patients. Internal carotid artery stump pressure is measured in all cases after clamping at the beginning of the operation. In 35 patients, an increase of systolic pressure is observed which allows a stump pressure more than 70 mmHg in 29 patients. In 15 patients, systolic pressure decreases and a stump pressure more than 70 mmHg is observed in two patients. When the stump pressure is more than 70 mmHg, the clamping is maintained. When the stump pressure is low, the clamping is stopped. A perfusion of Metaraminol increases systolic pressure in all cases: stump pressure is measured again after a second clamping. In 17 cases out of 19, stump pressure increases more than 70 mmHg and the clamping is maintained. In the two cases with a low stump pressure, a shunt is used during intervention.

Les auteurs analysent 50 interventions de chirurgie carotidienne avec clampage. La méthode anesthésique associant diazepam, fentanyl et curare décrite en neuroanesthésiologie est rappelée. L'appréciation de la qualité de la suppléance hémodynamique cérébrale repose sur la mesure de la pression résiduelle carotidienne lors d'un test de clampage. La mesure concomitante de la pression systémique rend compte de son aspect contingent quant à l'appréciation de la suppléance hémodynamique.