Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1992
Review Randomized Controlled Trial Comparative Study Clinical Trial[Clonidine premedication and isoflurane anesthesia to reduce bleeding in otologic surgery].
Seventy-seven ASA 1 patients scheduled for ear surgery were premedicated orally, 90 min before anaesthesia. They were randomly assigned to two groups, according to the drug used: hydroxyzine alone (group T, n = 39) or combined with clonidine (4.9 +/- 0.3 micrograms.kg-1) (group C, n = 38). Anaesthesia was induced with midazolam (0.3 mg.kg-1) and alfentanil (30 micrograms.kg-1). ⋯ There were more periods of sinus bradycardia (heart rate less than or equal to 50 b.min-1), mostly seen before the beginning of surgery, in group C patients (p less than 0.01); atropine was also required more often (when the heart rate was less than or equal to 40 b.min-1) in this group of patients (NS). The comparative assessment of surgical field quality was in favour of group C (no troublesome bleeding) as opposed to the control group (16% troublesome bleeding); there were also more bloodless surgical fields in the former group (73.7% vs. 48.7% in group T, p less than 0.05). This study therefore demonstrated that clonidine premedication before anaesthesia with isoflurane was helpful in decreasing bleeding during ear surgery.
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The anatomy of the posterior lumbar epidural space (PLES) has been extensively studied. Besides the anatomists, surgeons, radiologists and anaesthetists have taken an interest in this. However, because each one has considered the PLES from his own specialist field, descriptions are not always concordant. ⋯ The fatty tissue could therefore be compressed and take any of the shapes which have been described on epidurography. On the other hand, should it be torn, it seems this fatty tissue could make up these haphazard fibrous tracts tensed between the dura and the vertebral arch, such as described in classical anatomy, as Bonica recalled. These can be clearly seen during surgical and anatomical dissections, and during endoscopies carried out on cadavers with sufficient optical means, as opposed to the medial fibrous band fixing the dura to the vertebral arch.(ABSTRACT TRUNCATED AT 400 WORDS)
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Ann Fr Anesth Reanim · Jan 1992
Review Randomized Controlled Trial Clinical Trial[Prevention of postoperative nausea and vomiting by ondansetron].
This study was carried out to assess the efficacy of oral ondansetron, a new 5HT3 receptor antagonist, in patients undergoing thyroid surgery. It included 60 patients, randomly assigned to two groups, and receiving orally, 1 h before induction of anaesthesia, either 8 mg of ondansetron (n = 29) or a placebo (n = 30). One patient was excluded. ⋯ The differences between the groups were statistically significant: p = 0.025 for nausea and p = 0.042 for vomiting. It is concluded that oral ondansetron, 8 mg taken orally 1 h before surgery, significantly reduces the incidence of nausea and vomiting during the first twelve postoperative hours. As it is easy to use and has no side-effects, it might be of interest in day-case surgery patients, despite its high cost.
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Ann Fr Anesth Reanim · Jan 1992
Review Case Reports[Tracheal intubation in patients with cervical spine injuries using a fiber optic laryngoscope].
Eleven patients, with a cervical spine injury and scheduled for elective cervical spine fusion at least 48 h after their initial trauma, were intubated using a new fiberoptic laryngoscope (Bullard). This technique uses either a semi-rigid guide independent of the laryngoscope blade, or a rigid one attached to the blade. The cervical spine was immobilized with either a collar or a halo. ⋯ This is confirmed by the time required, 44 +/- 22 sec for the rigid guide, and 97 +/- 92 sec for the semi-rigid one. In the patient in whom this technique failed at the first attempt, endotracheal intubation was carried out by the nasal route and controlled by the fiberoptic laryngoscope. This technique enables a rapid and easy orotracheal intubation in trauma patients with an immobilized cervical spine, but careful training is necessary.
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Ann Fr Anesth Reanim · Jan 1992
Review[Consequences and prevention methods of hemodynamic changes during laryngoscopy and intratracheal intubation].
In patients ranked ASA 1, laryngoscopy and intubation lead to an average increase in blood pressure of 40 to 50%, and a 20% increase in heart rate. These changes, which are greatest one minute after intubation, last for 5 to 10 min. They are due to sympathetic and adrenal stimulation, which may also result in some arrhythmias. ⋯ In clinical practice, prevention will first rely on a sufficient dose of narcotics. In some cases, nitroglycerin or beta blockers may be used so as to decrease the doses of narcotics, without altering their efficacy; however, the risk of hypotension should be constantly borne in mind. If preventing measures have not been taken, short-acting antihypertensive agents (beta blockers, calcium blockers) should be used in patients who develop major hypertension during laryngoscopy and intubation.