Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1986
Randomized Controlled Trial Comparative Study Clinical Trial[Epidural anesthesia during labor: comparison of 3 combinations of fentanyl-bupivacaine and bupivacaine alone].
The association of bupivacaine and fentanyl appeared as the best method of inducing satisfactory obstetrical analgesia. But the various techniques of drug administration had to be detailed; this justified the present work, a single-blind controlled trial performed on 159 primipara women at term (except one of them), randomized in four groups, after informed consent. In each group, the number of patients, the age and the degree of uterine dilatation at the beginning of the epidural anaesthesia were comparable. ⋯ In the newborn, Apgar score was assessed at 1, 5 and 10 min after delivery. The degree of analgesia was statistically improved in the groups receiving fentanyl, without any differences between them. On the other hand, the length of labour was shorter with protocol II (lowest concentration of fentanyl).(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1986
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative study of general and spinal anesthesia in elderly women in hip surgery].
The choice between regional versus general anaesthesia for elderly patients undergoing hip surgery is debated. It is vitally important to see if the type of anaesthetic administered affects per- and postoperative morbidity and mortality. Seventy women more than 75 yr old suitable for spinal anaesthesia were included in this study. ⋯ In patients having general anaesthesia, 22.9% developed bronchopneumonia as opposed to 8.6% in the spinal anaesthesia group (p less than 0.05). The mortality rate at three months was rather similar in the two groups. It was concluded that, in order to reduce the incidence of postoperative central dysfunction and bronchopneumonia, spinal anaesthesia should be preferred in geriatric patients for lower limb surgery.
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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
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 1985
Randomized Controlled Trial Clinical Trial[Determination of the dose-response curve for atracurium dibesylate in the anesthetized adult].
The mechanical response of the adductor pollicis to a 0.15 Hz stimulation of the ulnar nerve was studied in 35 unpremedicated adult patients (mean age 38 yr) under general anaesthesia using thiopentone, fentanyl and a N2O/O2 mixture under mechanical ventilation. PaCO2, pH, K, Ca, Mg plasma levels and temperature were in the normal range. Each patient received a single bolus of atracurium dibesylate: 0.10 mg . kg-1 (n = 11), 0.15 mg . kg-1 (n = 10), 0.20 mg . kg-1 (n = 11) or 0.30 mg . kg-1 (n = 4). ⋯ The 0.3 mg . kg-1 dose resulted in onset time of 4.7 +/- 1.3 min, duration of 39.9 +/- 3.7 min and a recovery index of 10.7 +/- 1.8 min. Thus atracurium dibesylate seemed to be an agent of intermediate potency. Onset time was approximately the same as that for other non-depolarizing neuromuscular blocking drugs, but duration of action and recovery index were quite shorter, except for vecuronium bromide.