Annales françaises d'anesthèsie et de rèanimation
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In order to evaluate long-term intrathecal morphine therapy for cancer pain, whatever its location, 121 patients (80% were ambulatory patients) treated between April 1979 and April 1985 at the Cancer Institute of Montpellier (Centre Paul-Lamarque) were assessed. Morphine was stored in a presternal insulin syringe, protected by a sterile and waterproof dressing. A bolus administration of morphine via a subcutaneous lombo-epigastric subarachnoid catheter was scheduled every 12 h. ⋯ Nausea and vomiting were frequent but resolved spontaneously within a few days. Urine retention (33%) occurred mainly in men over 65 years, after pelvic surgery or radiotherapy. Because of the absence of a defined zone of analgesia, the small volumes required and the "ready for use" preparation, intrathecal isobaric morphine therapy will lead to easy self-administration via an implanted pump in the future.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1986
Randomized Controlled Trial Comparative Study Clinical Trial[Maintenance of obstetrical analgesia by continuous perfusion into the peridural space].
Two methods of epidural analgesia were compared in two randomized groups each of 16 normal women in labour, using bolus or continuous infusion. Analgesia was provided by a mixture of bupivacaine 0.25% and fentanyl. ⋯ There was no statistical difference between the two groups concerning length of labour, number of forceps, Apgar score and patient, obstetrician and anaesthetist satisfaction score. Although continuous epidural infusion was greatly appreciated by the obstetrical team, it would seem to be of interest only when labour is long enough to require larger doses, especially when labour is induced.
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Ann Fr Anesth Reanim · Jan 1986
Case Reports[Contracture test with ionophore A 23187 for the diagnosis of malignant hyperthermia].
The results are reported of the contracture test obtained by using the calcium ionophore A 23187 (Calcimycin) in two patients, the son (A) and the mother (B). The past history of patient A revealed the occurrence of an impending malignant hyperthermia crisis during induction of anaesthesia in 1975. ⋯ It is suggested the A 23187 contracture test be added to the contracture tests as defined by the European Malignant Hyperpyrexia Group. This test could be of great help in identifying the percentage of relatives of MHS ("malignant hyperthermia susceptible") patients found to be MHE ("malignant hyperthermia equivocal").
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Ann Fr Anesth Reanim · Jan 1986
Randomized Controlled Trial Clinical Trial[Effects of intermittent muscle stimulation on muscle catabolism in patients immobilized in the ICU].
Are muscular contractions obtained by electrical stimulation able to reduce muscle catabolism in immobilized patients? Ten patients (65 to 79 yr old), hospitalized in an intensive care unit for postoperative failure or cerebral infarction, were studied during nine days. Artificial nutrition was the same for each patient during the study. Two periods of four days where defined and randomized for each patient, separated by one day; during the stimulation period (S), intermittent electrical stimulation of the muscles of the legs (external electrodes) was performed daily 2 X 30 min; during the non-stimulation period (NS), muscular stimulation was not performed. ⋯ Results (X +/- SD) are as follows: the nitrogen balance (g/d) was -1.29 +/- 1.26 during the NS period and 1.43 +/- 1.10 during the S period (NS); 3-methylhistidine (mumol/kg/d) was 3.78 +/- 0.37 during the NS period and 3.15 +/- 0.32 during the S period (p less than 0.01); creatinine (mumol/kg/d) was 92.9 +/- 6.8 during the NS period and 72.9 +/- 25 during the S period (p less than 0.01). It is concluded that a significant decrease in 3-methylhistidine and creatinine excretions is observed during the S period. In intensive care unit patients, muscle protein breakdown may be influenced by intermittent electrical muscle stimulation.
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Ann Fr Anesth Reanim · Jan 1986
Case Reports[Heart arrest during general anesthesia in a child with unrecognized Duchenne's dystrophy].
A three-year old child was anaesthetized by halothane. Cardiac arrest occurred soon after the injection of suxamethonium. Signs of rhabdomyolysis associated with hyperkalemia were present. The diagnosis of Duchenne muscular dystrophy was obtained afterwards.