Summary
Experience with 50 poor-risk surgical patients has been presented, in whom neuroleptanaesthesia was used. The drugs employed were diazepam and morphine supplemented with nitrous oxide, d-tubocurare, and hyperventilation. The induction period was prolonged up to 3–5 minutes, with remarkably stable cardiovascular function. There was a progressive decrease in respiration, so that assisted and controlled ventilation was utilized. The blood gas values showed adequate arterial oxygenation, and a mild respiratory alkalosis. Routine curare-reversal was carried out at the termination of anaesthesia, with rapid return of consciousness and orientation, tranquility, amnesia, and analgesia persisted well into the recovery period, making this pleasant for the patient.
It is recommended that in the poor-risk surgical patient, neuroleptanaesthesia with diazepam-morphine be administered with hyperventilation, but that provision be made to maintain normocarbia and normal acid-base balance.
Résumé
On présente cinquante cas de mauvais risques chirurgicaux chez qui on a utilisé la neuroleptanesthésie. Les produits utilisés furent le diazépam et la morphine complétés par le protoxyde d'azote, la d-tubocurarine et l'hyperventilation. La période d'induction a duré de 3 à 5 minutes, sans trouble de la fonction cardiovas-culaire. Il y a eu une diminution graduelle de la respiration, de sorte qu'on a utilisé la ventilation assistée ou contrôlée. L'analyse des gaz sanguins a montré une oxygénation artérielle suffisante et une légère alcalose respiratoire. A la fin de l'anesthésie on a pratiqué le renversement habituel du curare, ce qui a amené un retour rapide à la conscience et à l'orientation; le calme, l'amnésie et l'analgésie se sont prolongés durant la période de réveil, ce qui est très agréable pour le malade.
On recommande, pour les mauvais risques chirurgicaux, que la neuroleptanesthésie au diazépam-morphine soit administrée avec l'hyperventilation, mais qu'on ait la précaution de maintenir la normocarbie et un équilibre acide-base normal.
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Eisenberg, L., Kwan, A.M. Neuroleptanaesthesia with diazepam-morphine in poor-risk surgical patients. Canad. Anaesth. Soc. J. 18, 465–472 (1971). https://doi.org/10.1007/BF03025698
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DOI: https://doi.org/10.1007/BF03025698