1 School of Physiotherapy, Curtin University of Technology, Western Australia, Australia; E-mail: a.burnett@curtin.edu.au 2 School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Western Australia, Australia 3 School of Science and Primary Industries, Charles Darwin University, Darwin, Northern Territory, Australia 4 Princess Margaret Hospital for Children, Western Australia, Australia

The very first reported instance when vigorous preventative measures were taken because of a transfusion related accident occurred in the seventeenth cen-tury, in France [3-5]. This was a time when animal-to-man transfusions were

The most frequent type of complication in patients undergoing aortic surgery is respiratory. Preoperative lung function (PFT) and arterial blood gas measurement (ABG) are often carried out to assess the risk more precisely. The aim of the present retrospective study was to determine which value of lung function test could identify patients who developed such complications. "Receiver Operating Characteristic" (ROC) curves and the area beneath the curve for the diagnosis of respiratory complications were calculated for each variable of PFT and ABG. The greatest Youden index for each variable was chosen as indicative pulmonary function criterion of increased risk of pulmonary complications. One hundred and ninety-five patients (age: 65 +/- 10 years) were included. Respiratory complications occurred in 15% of patients. Respiratory complications increased from 12% if the vital capacity (VC) was > or = 77% of the predicted value to 35% if the VC was < 77% (P = 0.002), and from 10% if the FEV1 was > 76% to 34% if the FEV1 was > or = 76% (P = 0.0005). A decreased PaO2 or increased PaCO2 was not correlated with an increased incidence of respiratory complications. Length of stay in ICU or in hospital were increased when VC or FEV1 were low. Frequency of pulmonary complications was 9% in patients without PFT abnormalities, 16% in patients with either diminished VC or FEV1 and 35% in patients with both lowered VC and FEV1. However, all the areas under the ROC curves were < 0.7 and the sensitivity of the different variables was low. It is concluded that routine preoperative PFT and ABG cannot predict respiratory complications after abdominal aortic surgery.

Les complications respiratoires sont les complications les plus fréquentes après chirurgie de l’aorte abdominale. Les épreuves fonctionnelles respiratoires (EFR) et les gaz du sang artériel (GDS) sont fréquemment réalisés en préopératoire dans le but d’évaluer plus précisément ce risque. Le but de cette étude rétrospective était de déterminer pour chaque paramètre des EFR (exprimé en % de la valeur prédite) et des GDS, des valeurs permettant de définir les patients à haut risque de complications respiratoires postopératoires en construisant des courbes “Receiver Operating Characteristic” (ROC) et en calculant l’indice de Youden (sensibilité + spécificité −1). La valeur maximale de l’indice a été choisie comme valeur seuil. Cent quatre-vingt-quinze patients âgés de 65 ± 10 ans ont été étudiés rétrospectivement. La fréquence des complications respiratoires était à 15%, en moyenne, de 35% lorsque la capacité vitale (CV) était < à 77%, et de 12% (P = 0,002) pour une CV≥ à 77%, de 34% lorsque le volume expiré en 1 seconde (VEMS) était < à 76% contre 10% pour un VEMS ≥ à 76% (P = 0,0005), de 28% un débit expiratoire maximal à 75% de la CV(DEM75) < à 56% contre 10% chez les patients ayant un DEM75 ≥ à 56% Une hypoxémie ou une hypercapnie n’étaient pas prédictives d’une augmentation des complications respiratoires. La durée de séjour en réanimation et en postopératoire augmentait significativement chez les patients ayant une diminution de la CV ou du VEMS. La fréquence des complications respiratoires était de 9% chez les patients n’ayant aucune anomalie spirographique, de 16% chez ceux ayant une diminution isolée de la CV ou du VEMS et de 35% chez les patients ayant à la fois une diminution de VEMS et de la CV. Cependant, toutes les surfaces mesurées sous les courbes ROC étaient inférieures à 0,7. La réalisation préopératoire systématique des EFR et des GDS ne permet pas de prédire avec une sensibilité suffisante le risque de complication respiratoire postopératoire après chirurgie de l’aorte abdominale.

The European study group, SANGUIS, tried to understand the transfusion behaviour of 158 teaching hospital surgical teams between october 1990 and september 1991. A partial series of 649 patients, from 20 teaching hospitals from 7 countries, having undergone a first elective total hip replacement is discussed. 15% were not transfused any blood at all. The number of patients transfused varied with the hospital, from 44% to 100%. Those patients transfused homologous blood only were exposed to a mean of 3 donors each. The teams who tended to transfuse more patients also tended to transfuse each of them with a greater number of blood units. There were great variations in each team in the use of blood products as well as blood derivatives and substitutes. Work must be done to obtain convergent practice by reviewing the indications for transfusion in elective surgery, and to increase the use of autotransfusion techniques.

The association of verapamil with halothane causes ischaemic-like myocardial dysfunction. Using an isolated rat heart model perfused with a radiolabelled fatty acid (123I-labelled iodohexadecenoic acid) as a sensitive marker of ischaemia this study investigated whether or not this dysfunction is of ischaemic origin. Hearts were perfused with a control solution or with solutions containing either 1% of halothane or 150 ng ml-1 of verapamil or the association of 0.75% halothane + 120 ng ml-1 verapamil. The ischaemic group was perfused at a reduced perfusion rate (-50%). Intracellular fate of IHA was assessed, and its esterification ratio computed. Ischaemia and the drugs induced a similar depression of haemodynamics. The esterification ratio in the ischaemic group was significantly higher (0.723 +/- 0.04) than in controls (0.0526 +/- 0.03) and than in the treated groups: halothane (0.533 +/- 0.06), verapamil (0.411 +/- 0.027) or the association halothane+verapamil (0.408 +/- 0.05), suggesting a non-ischaemic origin for the dysfunction caused by halothane-verapamil.

Hereditary angioneurotic oedema is an autosomal dominant disorder associated with serum deficiency of functionally active C1 inhibitor protein (type 1) or normal serum level of functionally deficient C1-inhibitor (type 2). These biochemical abnormalities induce a complement activation which leads to episodic swelling of interstitial tissues usually of the abdominal viscera and of the upper airway with resultant asphyxia. Vasoactive peptides from the degradation of component C2 of the complement along with an activation of basophils by chemotactic substances from the degradation of C3 and C5 are the main mechanisms involved in vasodilatation and swelling. Attacks of angioneurotic oedema, sometimes fatal when involving the upper airway, can occur during any but usually during ear-throat-nose, dental or facial surgery. This article describes the pathophysiology and the main features of the disease in children. It reviews the different treatments used to avoid attacks or to cure an attack of angio-oedema once it has begun, both during planed surgery and during emergency surgery.

Recent advances in neurophysiology and neurochemical management of pain has lead to a new concept in pain relief in the post-operative period. After a review of the pain perception mechanism and of the effects of antinociceptive drugs, the authors present simplified protocols for the management of post operative pain in pediatric surgery.

Respiratory analeptics have been shown to give important increases in pulmonary vascular resistance and pulmonary arterial pressure in hypoxaemic respiratory failure patients, but no studies have been carried out in the post-operative recovery period. The aim of this study was to compare the haemodynamic and respiratory effects of doxapram and almitrine infusion given over 1 h in patients who had just undergone pneumonectomy. Two hours after the end of anaesthesia, three groups of randomly selected patients were therefore given 3 mg kg-1 doxapram (n = 10), 1 mg kg-1 almitrine (n = 10) or placebo (n = 10). Measurements were made before and 15, 30, 60, 90, 120 and 180 min after the beginning of the infusion. There was an immediate 15-20% fall (P less than 0.01) in PaCO2 and a 20% rise in PaO2 (P less than 0.005), identical for both drugs; the variations in the placebo group became significant only after 60 min. Heart rate and cardiac index did not change. Mean arterial pressure did not change with doxapram, but decreased by 20% during the infusion of almitrine (P less than 0.01), remaining low until the 90th min (P less than 0.05). This hypotension was due to a decrease in peripheral arterial resistance (P less than 0.05) and a small decrease in right atrial pressure (P less than 0.05). The mean pulmonary arterial and wedge pressures were increased before starting the infusion, and did not vary significantly. Pulmonary arterial resistance increased with both analeptics but only significantly with the doxapram (P less than 0.05) at 5, 60 and 90 min; however, there was no significant difference between doxapram and almitrine. The post-operative respiratory efficiency of these drugs has been confirmed, there being no difference between almitrine and doxapram. The haemodynamic effects were moderate, especially with almitrine. Both of these drugs, therefore, may be recommended for use after lung surgery.