Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1996
[Intraosseous device of perfusion. Apropos of 3 cases before hospitalization].
A renewal of interest in the intraosseous route has appeared lately in France. It concerns pediatric patients. ⋯ Our modest experience enables us to present three observations where intraosseous route has been used outside hospital in children suffering a cardiopulmonary arrest on arrival of the practitioner belonging to the mobile emergency unit. This rapid and easy to place technique seems to be attractive as an alternative to the intravenous route in situations of utmost emergency, this all the more so since there are few reported contraindications and complications.
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The use of intraparenchymatous ICP sensor is becoming increasingly popular at the expense of the traditional intraventricular catheter method, in spite of the impossibility, with the former technic, to correct a possible zero drift. The decision to initiate or discontinue ICP monitoring is essentially based upon whether suggestive aspects of raised ICP are or not present on CT-scan. The degree of basal cisterns effacement is particularly informative. ⋯ Preceding the rise of ICP, there exists a compensation phase during which a progressive decrease of intracranial compliance is the important event. Even more earlier, posttraumatic cellular metabolic dysfunctions are to-day objectives for a neurochemical monitoring. Therefore a special technical and human environment has became mandatory to take a real benefit from ICP monitoring.
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Combined spinal-epidural anaesthesia (CSEA) is realized by one route immediately before the surgical procedure. It consists of: -a spinal anaesthesia for the operation itself. -followed by the installation of a catheter in the epidural space, so as to ensure postoperative analgesia. ⋯ Real contra-indications are few. Updated recent needles could certainly extend the field and general use of this technique.
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Cahiers d'anesthésiologie · Jan 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Evaluation of 2 dosages of fentanyl in caudal anesthesia. A prospective randomized double-blind study].
A caudal block is currently performed in children. A randomized and double blind study including two dosages of fentanyl: 0.5 microgram.kg-1 (group I) and 1 micrograms.kg-1 (group II) in association with bupivacaine 0.25% at a dosage of 1 mL.kg-1 was carried out. Two groups of 25 children undergoing urogenital or orthopaedic surgery participated in this study. ⋯ Furthermore, recovery of anaesthesia was rapid and calm. The frequency of nausea and vomiting was respectively 24% and 20% in groups I and II and did not require any specific therapy. Therefore it appears that caudal block with bupivacaine 0.25% and fentanyl 0.5 microgram.kg-1 is a very satisfactory technique in children when indicated.
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Cahiers d'anesthésiologie · Jan 1996
Case Reports[Modified technique of Waters for retrograde intubation. Apropos of a case of difficult intubation].
The authors describe a case of impossible intubation by classical means in an obese 37-yr old woman, affected with encephalopathy, hydrocephalus and severe psychomotor retardation. After failure of intubation by classical methods using a flexible introducer, the patient was intubated by Waters retrograde technique using an epidural catheter passed through the thyrocricoid membrane and recovered in the mouth. Following this guide the endotracheal tube passed the glottis fairly easily with the help of a flexible "mouse tail-ended" introducer (C-Mettro, Cook, 19.0.80) inserted into the same tube to facilitate alignment of distal tube and trachea. The authors conclude that the combination of epidural catheter and flexible introducer may facilitate the retrograde technique performance; they consider this technique to be an interesting alternative when endotracheal intubation is difficult or impossible by usual methods.