Annales françaises d'anesthèsie et de rèanimation
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Pain at the site of propofol injection is a real problem which requires particular attention in children. In adults, undergoing planned surgery, premedication or opioid administration prior to propofol seem to sufficiently reduce the frequency and severity of the pain induced by the injection of the agent into a distal arm vein. Adding lidocaine to propofol just before the injection is debatable in day-case procedures, especially if the injection is carried out on the dorsum of the hand. In children, intravenous administration of lidocaine seems to be more routinely performed, whatever the type of surgery.
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Ann Fr Anesth Reanim · Jan 1994
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of the analgesic efficacy of nalbuphine and its combination with propacetamol during the immediate postoperative period in gynecologic-obstetric surgery].
This prospective randomized single-blind study compared the efficacy of a combination of propacetamol (2 g) and a low dose of nalbuphine hydrochloride (10 mg) with nalbuphine hydrochloride (20 mg) alone, in a population of 152 white female patients after gynaecologic or obstetrical surgery, for alleviation of postoperative pain in recovery room. The drugs were administered intravenously in case of pain. The population was divided into two groups: group 1 received 20 mg of nalbuphine hydrochloride and group 2 received 2 g of propacetamol combined with 10 mg of nalbuphine hydrochloride. ⋯ Side effects were minimal and similar in both groups (nausea, drowsiness). It is concluded that a propacetamol-nalbuphine hydrochloride 10 mg association provides better analgesia than single dose of 20 mg of nalbuphine. This association convenient analgesia with a decreased dose of nalbuphine.
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Ann Fr Anesth Reanim · Jan 1994
[In vitro effects of the alkalinization of 0.25% bupivacaine and 2% lidocaine].
Recent clinical studies have suggested that alkalinization of local anaesthetic agents may shorten the onset time and lengthen their duration of action. In clinical practice, sodium bicarbonate 1.4 and 4.2% are often added to local anaesthetic agents to obtain these effects. We evaluated pH changes of 4 local anaesthetic solutions commonly used for obstetrical epidural anaesthesia, in order to develop titration curves with sodium bicarbonate 1.4 and 4.2%. ⋯ Increasing volumes of sodium bicarbonate, buffered the acidic effect of sodium bisulfite present in solutions containing epinephrine, and increased the percentage of the free form of local anaesthetic to the level of epinephrine free solutions. From this pH point upwards, the gain is poor and precipitates are generated. This study suggests that 1 mL of 4.2% sodium bicarbonate for 10 mL of local anaesthetic solution is the best theorical choice for alkalinization of a local anaesthetic associated with epinephrine.
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Although the importance of continuing medical education (CME) is a recognized fact, its modalities are still a controversial matter. In order to obtain informations on the demands and the difficulties to which French anaesthetist (AN) are faced with, the Committee for Education of the French Society of Anaesthesia (SFAR) carried out an inquiry with a questionnaire circulated to 7000 AN. ⋯ The inquiry seems to demonstrate a strong motivation for CME, as well as demands for training courses, courses extending over two days or more, and a self-assessment. The funding of the expenses as well as the difficulties to obtain a locum tenens were the two main obstacles which limited the access to CME.
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1. Propofol as an induction agent At a dose of 2 to 2.5 mg.kg-1, as a bolus injection over 30 to 60 seconds, for gynaecological procedures of short duration (abortion, D and C), propofol can be characterized as follows when compared with other induction agents: ADVANTAGES OVER METHOHEXITONE AND ETOMIDATE: decreased incidence of hiccups and abnormal movements, increased quality of induction, similar to that obtained with thiopentone, decreased postoperative nausea and vomiting. ADVANTAGES OVER THIOPENTONE: shorter recovery period, more rapid recovery of consciousness and orientation. ⋯ COMPARED WITH DESFLURANE: shorter induction time than desflurane, less respiratory problems at induction, similar recovery period, same incidence of nausea and vomiting. The administration of propofol for maintenance of anaesthesia has the main advantage of reducing the incidence of postoperative nausea and vomiting when compared to conventional halogenated anaesthetics. Respective costs of the various techniques, using propofol or the new halogenated anaesthetics, may be a criterion for choice in the future.(ABSTRACT TRUNCATED AT 250 WORDS)