Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1996
Review[Three-in-one block or femoral nerve block. What should be done and how?].
The "3 in 1" block and the femoral nerve block are widely used for lower limb surgery and postoperative analgesia. Whether these blocks are in fact a same regional block with two different names or represent definitively two different blocks remains controversial. A large number of anatomical as well as functional variations of the lumbar plexus have been described and complicate a rational analysis of the spread of local anaesthetics following these blocks. ⋯ However, once the "3 in 1" block is well performed, a complete anaesthesia covering the territories of the femoral nerve, the lateral femoral cutaneous nerve, and the obturator nerve occurs. Specific indications of each technique are different: major knee surgery and postoperative analgesia for the "3-in-1" block and leg surgery for femoral nerve block. The best approach for knee arthroscopy remains open for discussion.
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Ann Fr Anesth Reanim · Jan 1996
Review[Indications and role of albumin for vascular loading in trauma patients and during preoperative period].
The use of albumin solutions for volume replacement remains controversial. The last American guidelines recommend the use of albumin for resuscitation in case of a contra-indication of artificial colloids or the requirement of sodium restriction. Recent trials did not show any beneficial effect of albumin on the mortality and morbidity rates. ⋯ For resuscitation, albumin could be used when the recommended upper limit of hydroxyethyl starch vol-ume has been reached and fresh frozen plasma not yet required. During preoperative haemodilution, low molecular weight hydroxyethyl starch has at least the same efficacy as albumin. When a rheological effect is required, albumin could be used.
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Ann Fr Anesth Reanim · Jan 1996
Review[Indications and role of albumin for vascular loading during postoperative intensive care].
Prospective clinical trials comparing human albumin to other plasma volume expanders during the three first postoperative days in adult patients were analysed. Fifteen studies were selected. Nine of them concerned the evaluation during the immediate postoperative period, after cardiac surgery with cardiopulmonary bypass (CPB). ⋯ After cardiac surgery, mainly uncomplicated coronary artery bypass graft or valve replacement, albumin can be substituted by HES. These conclusions are only valid for blood losses below 50% of blood volume. The place of isooncotic albumin for fluid resuscitation in case of blood loss exceeding 50% of blood volume cannot be specified.
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Chylothorax following blunt chest trauma is a rare event. The presence of a cloudy or milky persistent pleural effusion should suggest the possibility of its chylous origin. The diagnosis is made by analysis of the fluid obtained either from thoracentesis or tube thoracostomy. ⋯ An efficient control of the chylous effusion may be facilitated by using a fat-poor enteral nutrition and parenteral nutrition, which prevents malnutrition. Surgical ligation of the thoracic duct is relatively simple and efficient. It is indicated when the daily chylous flow is over 500 mL after 2 or 3 weeks of medical treatment or in case of weight loss.
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Ann Fr Anesth Reanim · Jan 1996
Review[Is albumin administration useful in critical care for burnt patients?].
The most typical reaction of the organism after a major burn consists in transcapillary shift from plasma into interstitial space. Capillary hyperpermeability, but also changes in colloid osmotic gradient and decrease in interstitial hydrostatic pressure, explain the fluid shift to burned and, at minor importance, non burned areas during the first post-burn day. The extent of capillary hyperpermeability results in inefficiency of colloid infusions in reducing fluid shift to burned areas. ⋯ However, for most groups, restoration of a functional interstitial space has priority during the 24 first post-burn hours, justifying crystalloid supply without colloids. Furthermore, colloid infusion could be responsible for delayed pulmonary oedema, in the first days following initial fluid replacement. After 24 post-burn hours, in patients experiencing severe albumin depletion, infusion of human albumin is justified, in order to favour oedema resorption.