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Deliberate hypocapnia during the anaesthetic management of the patient undergoing craniotomy has become an accepted standard of care. However there has been a resurgence of interest, in how hypocapnia should be applied in intra- and extra-operative settings. There are three possible therapeutic effects of hypocapnia, namely, (a) reduction of brain bulk through a reduction in cerebral blood volume, with a decrease cerebral blood flow; (b) developing an "inverse steal" by redistribution of blood from normal to ischaemic regions and (c) acting to offset cerebral acidosis by increasing pH in the extracellular space. In anaesthetic intraoperative practice, hypocapnia is used as a specific treatment of, or prophylaxis against, intracranial hypertension during induction of anaesthesia and the period before dural exposure. More commonly, hypocapnia is used for intraoperative brain relaxation (intracranial pressure = 0). Severe hypocapnia (20 mmHg) may result in cerebral production of lactate; however no studies have shown that a Paco2 in the range of 23-28 mmHg has deleterious effects. Recent studies in head-injured patients suggest that routine long-term hyperventilation, without an objective index of cerebral flow/metabolism coupling, may place the brain at risk for adverse outcome. The few data available for intraoperative management suggest that Paco2 figures of 30-35 mmHg result in acceptable operating conditions. Unless otherwise specifically indicated by surgical conditions or cerebral flow/metabolism coupling (e.g. jugular O2 saturation), routine application of profound (Paco228-30 mmHg) hyperventilation should probably be avoided and its use needs reevaluation.

Cette étude traite de la façon dont 52 entrepreneurs, à la tête d’entreprises d'âge et de secteurs d’industrie différents, ont choisi leurs premiers employés. Elle s’intéresse particulièrement aux cinq premiers employés et gestionnaires entrés en fonction et démontre que les entrepreneurs ont tendance à confier aux premiers arrivés un plus grand éventail de responsabilités qu'aux employés engagés ultérieurement. A l’embauche des directeurs, la priorité est donnée à la gestion des opérations, aux ventes et à l’administration; tandis que le poste de directeur du personnel et des ressources humaines est relégué au second plan et le dernier comblé. Il semble que le secteur de l'industrie, l’âge de l’entreprise et les antécédantsde l’entrepreneur influencent la gestion des ressources humaines de départ. L'étude traite également d'aspects tels le développement de l'«esprit d'entreprise», la délégation des responsabilités et la rémunération, ainsi que des changements de la structure organisationnelle entraînés par l'expansion de l’entreprise., The early hiring practices of 52 entrepreneurs in different industries and of different ages are examined. With an emphasis on the first five employees and the earliest managers hired, this study finds that earlier employees tend to be given a wider range of responsabilises than later hires. As managers are hired, the focus is on operations, administration and sales, with the manager of personnel and human resources being the least important and last hired. Issues of finding and motivating «entrepreneurial spririt», delegation, and compensation are discussed as are some of the changes in organizational structure that occur with increased size. Industry, age of firm, and background of the entrepreneur appear to influence early human resource practices., Este estudio trata sobre la manera por medio de la cual 52 empresarios, dirigentes de empresas antigüas y de diferentes sectores industriales, han seleccionado sus primeros empleados. Se acuerda asi entonces un interés particular a los cinco primeros empleados y gestionarlos que entraron en fundón y se demuestra que los empresarios tienen tendencia a confiar a los recien llegados un pliego mas grande de responsabilidades que al personal que se emplea ulteriormente. Se mentiona también que durante la selección de los de los directores, se da prioridad a la gestión de operaciones, a las ventas y a la administración, mientras que el cargo de director de personal se llena en ultimo lugar. Parece entonces que el sector industrial, la antigüedad de la empresa y los antecedentes del empresario influyen sobre la gestión de los recursos humanos desde un comienzo. Para terminar, el estudio trata iqualmente sobre aspectos tales como el desarrollo del «espíritu de empresa», la delegación de responsabilidades y la remuneración como también sobre los cambios de la estructura de organización ocasionados por la expansión de la empresa.