Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1994
Review[Epidemiology of complications of obstetrical epidural analgesia].
Epidural analgesia (EA) is the best technique to obtain pain relief during labour. But the needle, the catheter and the local anaesthetics (LA) are 3 reasons to cause maternal complications. In France we do not know the exact number of EA performed every year and it is very difficult to appreciate the incidence of maternal complications. ⋯ The overall incidence of serious complications was 1/4,005 EA. The most frequent are accidental dural puncture (1/156), massive subarachnoid injections (1/8,010) and convulsions (1/9,011). The incidence of these 3 complications must be reduced by better training, material or attention during bolus injection of LA.
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Cahiers d'anesthésiologie · Jan 1994
Review[Emergency cesarean section: role of locoregional anesthesia].
Emergency cesarean section is sometimes required for acute fetal distress but also for some maternal vital emergencies. In spite of its maternal (Mendelson's syndrome, difficult intubation) and fetal (neonatal depression) risks, general anaesthesia was classically used. The arguments in favor of regional anaesthesia techniques for emergency cesarean section and the respective advantages of spinal and epidural anaesthesia are developed in this text. ⋯ In case of patchy or unilateral analgesia, it is particularly important to resite the catheter to avoid the need for emergency general anaesthesia to solve an inadequate epidural anaesthesia for cesarean section. Spinal anaesthesia is the technique of choice for its rapidity of action but its hemodynamic risks need a prior careful evaluation of maternal hemodynamics. General anaesthesia will be always indispensable in some cases; therefore, every anaesthetist should maintain sufficient experience and skills in the management of some of its complications, especially intubation difficulties.
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Cahiers d'anesthésiologie · Jan 1994
Randomized Controlled Trial Clinical Trial[Effects of ondansetron and metoclopramide on postoperative nausea and vomiting after epidural anesthesia in children].
We studied the preventive effect on postoperative nausea and vomiting (PONV) of ondansetron, metoclopramide and placebo associated with epidural anaesthesia. Sixty children, ASA I or II, 4 to 12 yr old underwent surgery for inguinal hernia repair (n = 30) or orchidopexy (n = 30). Children were randomly assigned to a postinduction intravenous medication group, ondansetron (5 mg.m-2), metoclopramide (0,12 mg.kg-1) or a saline solution placebo. ⋯ The incidence of postoperative emesis in the metoclopramide group was 25%, whereas that of placebo group was 10%. The administration of ondansetron was associated with a lower (P = 0.017) incidence of postoperative vomiting if compared to the metoclopramide group. In conclusion ondansetron given preoperatively had proven to be an effective treatment for PONV after epidural block for lower abdominal surgery.
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The key-question, when dealing with preemptive analgesia, its to know whether an analgesic intervention coming before surgery is as efficient, more efficient or less efficient than the same intervention following surgery. Surgical tissular damaging leads to a dual phenomenon of peripheral and central sensitization. ⋯ Central mechanisms and neuroplasticity are analyzed, insisting on inter and intracellular biochemical events. The role of excitatory amino-acid is explained, especially of glutamic acid and the NMDA (N-methyl-D-aspartate) receptor at the spinal level.
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Epidural opiate administration is routinely used by many anaesthesiologists involved in obstetric anaesthesia. Epidural injection of a local anaesthetic combined with an opioid generates a more rapid onset of more profound analgesia with little motor blockade. Thus pain relief lasts longer than after either drug alone. ⋯ Sufentanil appears to induce a faster onset of more profound, long lasting analgesia with extremely low concentrations of bupivacaine than that with fentanyl. The reduction of the total amount of bupivacaine is correlated with a significant decrease in motor blockade and instrumental deliveries. There were no adverse maternal or fetal effects and umbilical cord levels were too low to be detected.