Cahiers d'anesthésiologie
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Combined spinal epidural (CSE) analgesia for labour is usually performed with sufentanil (or fentanyl) which provides powerful and fast onset pain relief (< or = 5 min). Dose reduction of sufentanil from 10 to 5 micrograms may be recommended and has little influence on the 1.5-2 hours of analgesia usually obtained. This mean duration of action may be prolonged by half an hour with the addition of a low dose of bupivacaine (< or = 2.5 mg). ⋯ Major improvement will be to prolong the excellent pain relief provided by intrathecal analgesia throughout the whole labour. This will require prolonging substantially the intrathecal analgesia duration and/ or influencing positively the epidural analgesia used afterwards. However, women prefer CSE technique to standard epidurals because of faster onset, less motor block, and feelings of greater self-control.
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Cahiers d'anesthésiologie · Jan 1996
[Study of a protocol of intra-articular analgesia after arthroscopy of the knee].
The purpose of this study was to assess the analgesic effects of intra-articular injection of a morphine-bupivacaine combination following knee arthroscopy. 47 patients were evaluated. Knee arthroscopies were all performed under general anaesthesia, using propofol, alfentanil, isoflurane and nitrous oxide. Analgesic effects were evaluated by a visual analogic pain scale. ⋯ Analgesia was good in the immediate postoperative period, with minimal side effects. The serum bupivacaine levels were low. However the analgesic efficacy of intra-articular injection of morphine-bupivacaine should be corroborated through a double blind study.
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Cahiers d'anesthésiologie · Jan 1996
[Neurological accidents after epidural anesthesia in obstetrics].
Several neurological complications have been described after epidural anaesthesia, including direct trauma to the spinal cord or nerve roots, epidural haematoma, meningitis, epidural abscess, spinal cord infarction. neurologic toxicity of injected agents. In obstetric practice, these complications are very uncommon. However, their real occurrence may be underrated, partly for medicolegal reasons. Different complication mechanisms are described; they should be kept in mind while evaluating post block neurological deficits so that prompt corrective measures can be taken whenever appropriate to prevent permanent damage.
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Cahiers d'anesthésiologie · Jan 1996
Case Reports[Anesthetic problems of epidermolysis bullosa dystrophica. Apropos of a case].
Epidermolysis bullosa is a group of hereditary diseases of the skin that may also involve mucous membranes, particularly of the oropharynx and oesophagus. The common primary feature is the formation of blisters following even trivial trauma. During the management of anaesthesia, it is critical that trauma to the skin and mucous membranes be avoided or minimized in these patients. We report the case of a 3-year-old child who had two surgeries and discuss the anaesthetic implications of this disease.
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Cahiers d'anesthésiologie · Jan 1996
[Inhalation anesthesia in unusual situations: the Eole 2 NA ventilator].
The volumetric ventilator Eole 2 NA has been adapted to work as an anaesthesia machine with low flow or closed system. This modified device is very easy to use in exceptional situations: because of its strength and reliability; its favorable quality/price ratio; versatile electrical supply: mains (220 volts) or 24 D. ⋯ V. from internal battery (2 hours autonomy) or external battery (8 hours autonomy); gas economy: less than 1 L.min-1 of fresh gas flow, whether O2/N2O = 0.5 L.min-1 of each gas or 1 L.min-1 delivered by an oxygen concentrator. Clinical trials are discussed.