Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1989
Randomized Controlled Trial Comparative Study Clinical Trial[A combination of sufentanil and 0.25% bupivacaine administered epidurally for obstetrical analgesia. Comparison with fentanyl and placebo].
The study reported was designed to determine whether 15 micrograms sufentanil would provide analgesia comparable in duration and quality with that given by 75 micrograms fentanyl, when associated with plain 0.25% bupivacaine for extradural analgesia for labour. Patients (n = 124) in labour and at full term were randomly divided into 3 groups. Group 1 (n = 41) were given 12 ml of 0.25% plain bupivacaine with saline, group 2 (n = 41) 12 ml of 0.25% plain bupivacaine with 75 micrograms fentanyl and group 3 (n = 42) 12 ml of 0.25% plain bupivacaine with 15 micrograms sufentanil. 11 cases were excluded from the study (8 Caesarean sections, 3 technical failures). ⋯ The only side-effect seen with sufentanil and fentanyl was pruritus (group 2: 21.9%, p less than 0.05; group 3: 21.4%, p less than 0.05; group 1: 2.4%). These results showed that 15 micrograms sufentanil could replace 75 micrograms fentanyl for extradural pain relief of labour with plain 0.25% bupivacaine. However, the use of opioids with local anaesthetics would seem to be of interest only if labour is likely to be prolonged.
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The discovery of opiate receptors and naturally occurring opiate-like substances in the central nervous system started a new era in pain control. Epidural and spinal opiates have been increasingly used since 1979. However, applying these analgesic techniques in obstetrics has been criticized because of possible side-effects on the mother and foetus. ⋯ The choice of a lipid-soluble opiate like fentanyl is safe. However, when considering new drugs, great care must be taken to avoid unforeseen problems. A good knowledge of the problem and a cautious approach combined with careful monitoring of the respiratory rate and adequacy of ventilation are the keys to the safe use of spinal and epidural opiates.
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Ann Fr Anesth Reanim · Jan 1989
Review[Management of a patient with malignant hyperthermia susceptibility during anesthesia and daily living].
Death from malignant hyperthermia (MH) still occurs in France. However, anaesthesia of the MH susceptible (MhS) patient is quite possible without any more risk than for patients who are not MhS. Guidelines have been worked out: "trigger" drugs such as volatile anaesthetics (halothane, enflurane, isoflurane) and depolarizing muscle relaxants must be imperatively avoided; "non-trigger" drugs should be used, such as nitrous oxide, barbiturates, benzodiazepines, propofol, opiates, non-depolarizing muscle relaxants, amide or ester local anaesthetics at the usual doses without adrenaline. ⋯ MhS patients must also be given counselling. This includes explanations about MH, its genetic features, the main laboratory tests used to detect susceptibility, as well as advice about lifestyle, the use of drugs other than general and local anaesthetics, and a discussion concerning the association of MH with other diseases. This counselling is not always easy to provide, because many answers are not, as yet, definitive.