Cahiers d'anesthésiologie
-
Cahiers d'anesthésiologie · Jan 1994
[Mechanical ventilation during MRI in children. Anesthetic constraints].
Early use of magnetic resonance imaging (MRI) excluded patients needing mechanical ventilation. However magnetic resonance imaging is an innocuous investigation and affords important elements to the diagnosis of many pathologies. Improvement of anaesthetic equipment have led to enlarge MRI applications considerably. ⋯ Although the ferromagnetic charge of presently used ventilators is greatly reduced, it is still necessary to keep them at some distance from the patient, with tubing of about 3 m, even in children. Therefore the compressible gas volumes are larger than the usual ones. For a tube length of 3 m, about 2-3 ml.kg-1 should be added to the standard tidal volume (10 ml.kg-1), so as to obtain safe normoventilation.
-
Unlike epidural anaesthesia for general surgery or caesarean section, épidural analgesia for labour leads to maternal hyperthermia. Its recent demonstration is probably related to the multiple influencing factors: site of measurement, ambient temperature, previous labour duration and dilatation at the time of epidural puncture, and occurrence of shivering. During the first 2 to 5 hours of epidural analgesia, there is a weak--if any--thermic increase. ⋯ This hyperthermia has been correlated with foetal tachycardia but never with any infectious process. A potential deleterious effect is still debated and may lead to propose an active cooling for the mother. This hyperthermia must also be recognized to avoid an inadequate obstetrical attitude (antibiotics, extractions).
-
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.
-
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.