Annales françaises d'anesthèsie et de rèanimation
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A new type of airway has been widely used for two years, throughout hospitals in the United Kingdom. Designed and created since 1983 by Dr AIJ Brain, the Laryngeal Mask Airway (LMA) is a compromise between the endotracheal tube and the face-mask. Blindly inserted in an anaesthetized patient, without either a laryngoscope or neuromuscular blockade, it provides a good airway in almost all cases. ⋯ The spontaneously breathing patient, undergoing elective surgery for 15 to 60 minutes, in supine position, who would ordinarily be managed with a face-mask is the more likely candidate for the LMA. But, longer procedures, in lateral or prone position, with controlled ventilation can usually be carried out using the Brain's device. More effective and less demanding than the facial-mask, much less hurtful than the endotracheal tube, the Laryngeal Mask is potentially an important and valuable addition to anaesthetic care.
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Physiologic and pathologic changes due to ageing should be taken in account for the preoperative evaluation and peroperative management of geriatric patients. Pharmacokinetic changes ed to reduce the doses of intravenous agents by 50%. ⋯ Pharmacodynamic deleterious effects are limitative in the choice of some drugs. Cardiocirculatory and pulmonary functions need specific, if possible non invasive monitoring, during surgery, recovery and the early postoperative days.
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Ann Fr Anesth Reanim · Jan 1990
Comparative Study[Comparison of the pharmacokinetics of etomidate in children and in adults].
Etomidate pharmacokinetics were compared in 12 children (P group) (age 7 to 13 years, weight 22 to 48 kg) and in 4 adult women (A group) (age 28 to 52 years, weight 46 to 72 kg), A. S. A. 1, undergoing minor non abdominal surgery. ⋯ No age-related difference was found inside P group with regard to pharmacokinetic parameters. In conclusion, a 30% higher etomidate bolus dosage is required in children than in adults to achieve similar plasma concentrations, due to a higher volume of the initial compartment. In comparison to adults the higher clearance suggests higher maintenance dose requirements in children.
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The use of regional anaesthesia in ambulatory patients is discussed. Five criteria for discharge are described: the four 'A's (Awake, Ambulation, Alimentation, Analgesia) and micturition. Recommended agents for additional sedation with the regional block, if required, are midazolam and fentanyl. ⋯ However, urinary retention and orthostatic hypotension can occur. The risk of headache is not a contraindication for day-case surgery if some guidelines are followed. Penile blocks and caudal blocks are widely used in pediatric surgery.
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Ann Fr Anesth Reanim · Jan 1990
[Intrathecal and epidural administration of alpha adrenergic receptor agonists].
Alpha-agonists are frequently added to local anaesthetic agents to prolong the duration of spinal or extradural anaesthesia. Adrenaline and phenylephrine have been employed most commonly for this purpose. Recent controlled studies indicated that the alpha-adrenoceptor agonist clonidine, when administered spinally, has a dose-dependent antinociceptive effect. ⋯ However, spinally administered alpha-agonists have side effects, which include vasoconstriction in the spinal cord, hypotension, bradycardia or tachycardia, somnolence and respiratory depression. To minimize such complications, great care may be needed, which is described in this review, assessing the minimal required amount of alpha-agonists and effective clinical monitoring. The development of this technique in the management of subarachnoid and extradural anaesthesia and of chronic pain is discussed.