Cahiers d'anesthésiologie
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The advantages of regional over general anaesthesia have led to an increased use of peripheral nerve blocks. Among the few risks of regional anaesthesia are those of overdosage, systemic and neural toxicity. Techniques have been proposed to improve the success of peripheral nerve blocks and to avoid nerve damage or systemic toxicity. Nerve stimulator, anatomic landmarks, needles and anaesthetic solutions are discussed.
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Regional anaesthesia has been increasingly popular in paediatric patients of all ages, especially because some techniques afford excellent per and post-operative pain relief. However, side effects may occur. Particularly, systemic toxicity from bupivacaine administration is associated with intravascular injection or overdosage. ⋯ Management of the best method of block, doses and local anaesthetics or adjuvants according age, requires likely specific teaching in training team. An effort to provide appropriate guidelines and training to ward nurses is necessary to improve security when regional blockade is used for postoperative analgesia. In every cases, physician's experience is the best argument of choice.
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Cahiers d'anesthésiologie · Jan 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative study of sufentanil and fentanyl in urologic surgery in adults].
Sufentanil is compared with fentanyl as a supplement to N2O isoflurane anaesthesia in a double blind study of 30 elderly patients undergoing major urological surgery. Comparison is made with respect to 1) haemodynamic (heart rate, blood pressure) responses during surgery and recovery; 2) time to extubation after the end of surgery; 3) Postoperative analgesia. No difference is observed between the two groups with respect to demographic data, duration of surgery, and total doses of muscle relaxants. ⋯ Times between end of surgery and extubation are different: 77 +/- 13 min the sufentanil group versus 57 +/- 22 min the fentanyl group (p < 0.05). Use of analgesia is significantly delayed in the sufentanil group. It is suggested that sufentanil, in elderly patients, provides a better haemodynamic stability and a greater residual analgesia than fentanyl in the immediate postoperative period.
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Cahiers d'anesthésiologie · Jan 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Analgesia with intra-articular injection of buprenorphine after surgery of the shoulder].
The effect of 10 ml of intra-articular buprenorphine (0.30 mg) or normal saline on postoperative pain after shoulder surgery was studied in a randomized, prospective, double-blind study in 30 ASA I-II patients receiving general anaesthesia. The pain scores (Five Point Scale ranging from "no pain" to "unbearable pain" and Visual Analog Pain Scale) 1, 2, 3, 4, 6 and 24 hours after surgery, time to first analgesic use and total 6-hours and 24-hours analgesic requirements were recorded. VAPS was significantly lower in the buprenorphine group compared with placebo-treated patients one hour after surgery (p < 0.05). ⋯ No significant differences were detected in total 24-h analgesic requirements between the two groups. These results indicate that intra-articular injection of buprenorphine after shoulder surgery provides short analgesia. This effect may be mediated by systemic absorption.
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The occurrence of bleeding in trauma patients is a life-threatening problem which can be explained by different mechanisms. The infusion of cristalloids, colloids, packed red blood cells, or even fresh frozen plasma is very rarely responsible for bleeding but it can contribute to dilute the patient's platelet pool, and especially dilutional thrombocytopenia is the first cause of bleeding after massive transfusion. Blood coagulation factor activity is decreased after a massive fluid infusion is performed but it has to reach a dramatically low plasma level in order to induce troubles. ⋯ Hypothermia can also impair platelet function and worsen the bleeding. A simplified monitoring of haemostasis can be proposed with platelet count, whole blood coagulation clotting time, immediately available activated partial thromboplastin time and prothrombin time with bedside portable monitors and thromboelastography. Haematocrit and body temperature have to be monitored as well.