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ETUDE CRITIQUE DE ĽEXPLORATION HEMODYNAMIQUE PER-ANESTHESIQUE

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Résumé

Le praticien qui doit choisir des méthodes ďanesthésie et de surveillance hémodynamique adaptées à ľétat de ses patients, cherche dans la littérature réponses à ses questions. Il n’y trouve pas toujours des notions utilisables dans son exercice courant.

En effet, la réaction circulatoire à un agent phaimaco-dynamique est diffuse et non spécifique, comme le rappelent divers exemples théoriques et pratiques. En particulier, il n’est pas sûr que diminuer la perfusion coronaire soit “mauvais“ si la Vo2 myocardique diminue en proportion.

D’autre part, les indices hémodynamiques (PA, PV, dP/dt) sont composés à partir de données élémentaires interdépendantes; il en résulte qu’ils sont eux aussi interdépendants.

Un dernier fait est troublant: les agents anesthésiques dépresseurs peuvent déclencher des crises hémodynamiques sévères mal supportées par les viscères en général mais, semble-t-il mieux par le myocarde qui ne souffre pas irrémédiablement si Panoxie ischémique infligée ac compagne une diminution brutale du travail cardique externe. Ceci explique la bonne tolérance cardiaque à un surdosage anesthésique passager.

Il est difficile de déterminer quelles sont les premières modifications hémodynamiques duês à ľanesthésie que ľon doit traiter. La biochimie du sang veineux coronaire elle-même n’apporte pas aujourďhui la solution.

Summary

Physicians must choose the anaesthetics for their patients and select the methods to check their haemodynamic status. Experimental works do not always bring sufficient information to help them in their daily practice.

Circulatory reaction to a pharmacodynamic agent is diffuse and non-specific. Some examples drawn from theoretical considerations and practical situations support this view. The difficulty of assessing the actual damage caused by one apparent variation still remains. On the other hand, haemodynamic indices such as PA, CVP, dP/dt are composed of elementary data that are interdependent; so indices are interdependent, too.

A puzzling fact is that depressing anaesthetics can initiate severe haemodynamic crisis, generally badly tolerated by tissues, but better tolerated by myocardium which is not definitely altered if the anoxia inflicted is accompanied by a real decrease in cardiac work. This explains the often slight effect of short anesthetic overdosage.

Previous haemodynamic variations to be countered relative to anaesthesia are not really known. Biochemistry of the venous coronary blood does not yet bring striking features in this field.

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Correspondence to P. Girardet.

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Stieglitz, P., Girardet, P. ETUDE CRITIQUE DE ĽEXPLORATION HEMODYNAMIQUE PER-ANESTHESIQUE. Can. Anaesth. Soc. J. 25, 191–197 (1978). https://doi.org/10.1007/BF03004878

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