Cahiers d'anesthésiologie
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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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Cahiers d'anesthésiologie · Jan 1994
[Unusual obstetrical situations: role of locoregional anesthesia].
Breech or twin delivery is a difficult obstetric situation in which both maternal and neonatal risks are increased and where the incidence of caesarean section and instrumental extraction is high. Epidural anaesthesia may worsen the obstetric situation especially if high doses of local anaesthetics are used resulting in a dense motor blockade. ⋯ Extension of the sensory block may be rapid, allowing obstetric intervention while maintaining maternal safety and comfort. For similar reasons and by using low dose techniques, epidural anaesthesia should not be anymore considered contra-indicated in the trial of labor after previous caesarean section.
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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.
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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.