Cahiers d'anesthésiologie
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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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Cahiers d'anesthésiologie · Jan 1994
[Combined epidural and spinal anesthesia for cesarean section].
Combined spinal epidural block has proven its efficacy in skilled hands. This technique allies advantages of spinal anaesthesia, regarding its speed of action and intensity of motor blockade and advantages of postoperative epidural analgesia. ⋯ Local anaesthetics and additives are reviewed and commented. The two main complications, hypotension and post dural puncture headache can be contained in very low limits.
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Cahiers d'anesthésiologie · Jan 1994
[Indications of blood components and outcome of transfusion practices in hemorrhage of multiple trauma].
Bleeding occurring in a patient with multiple trauma has an unpredictable evolution; blood losses are often very important and their origins mostly unclear. These problems should not prevent the use of a strategy for optimal use of blood components. Indications for packed red cells, fresh frozen plasma, platelets and coagulation factors are discussed. ⋯ Considering its cost, the use of albumin must and can be reduced when fluid replacement is realized with long lasting colloids, like starch. Warming of transfused blood is necessary, especially if acceleration disposals are used to prevent or minimize hypothermia. Use of portable monitors for haemoglobin and coagulation parameters is recommended.
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Cahiers d'anesthésiologie · Jan 1994
[Mechanisms of the analgesic effect of alpha 2 adrenergic agonists].
Alpha 2 adrenergic agonists stimulate specific receptors in the dorsal horn of the spinal cord leading to blockade of potassium and calcium channels. Presynaptic alpha 2 receptors inhibit the release of substance P and other neuropeptides which stimulate transmission of nociceptive stimulations. Post-synaptic alpha 2 receptors hyperpolarize neurons membranes and decrease the activity of nociceptive neurons. In addition, alpha 2 adrenergic agonists have a synergistic action with opioid and cholinergic agonists.
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Sciatic nerve blocks were seldom used until recently. They apply to most surgical procedures on the lower limb and are often combined with a "3 in 1" block. ⋯ Sciatic nerve block can be obtained by different techniques. The choice of which being helped by some guidelines according to the patients characteristics and the surgical site.