Cahiers d'anesthésiologie
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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.
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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).
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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
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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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.