Cahiers d'anesthésiologie
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This retrospective study concerns 1,373 adult patients who underwent forefoot surgery during 1988-95 under regional anaesthesia by ankle nerve blocks (of posterior tibial nerve systematically and other nerves according to the surgical site). As a rule, plain bupivacaine 0.5% (maximum 40 mL) was used, completed if necessary by lidocaine 1% (a few mL). A nerve stimulator is currently used for posterior tibial blocks. ⋯ No general anaesthesia was needed (except after one case of convulsions, likely from accidental injection of a few mL of local anaesthetic and without any sequelae). Five patients complained of temporary paraesthesias, with indication of a posterior tibial neurolysis in one case and complete recovery. Thus ankle blocks appear increasingly to be a satisfactory alternative to general anaesthesia for most surgical procedures on the forefoot, provided that all usual safety conditions are respected and the patient's acceptance of the procedure is obtained.
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Cahiers d'anesthésiologie · Jan 1996
Historical Article[History of anesthesia: the return of nitrous oxide].
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Since the last decade, lumbar epidural analgesia has gained widespread use in obstetrics. Approximately 80% of parturients receive epidural analgesia for labour and vaginal delivery as well as caesarean section in most centres. There is little doubt that the most successful application of epidural analgesia during labour, considered by more than 75% of primiparas as extremely painful. ⋯ Thus, epidural analgesia usually can be extended to relieve both uterine pain and pain related to distension of the lower birth canal, as well as providing analgesia for forceps delivery or caesarean section. Epidural analgesia allows the mother to be awake, minimizes or completely avoids the problems of maternal aspiration and avoids neonatal drug depression from general anaesthetics. If the most popular indication for epidural analgesia is the provision of pain relief, there are certain complications of pregnancy in which epidural analgesia appears to be indicated on therapeutic grounds such as pregnancy-induced hypertension, breech delivery, multiple pregnancy, incoordinate uterine action and fetal and/or maternal medical complications.
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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.
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Hepatic injuries account for about 45% of all abdominal traumas and for 30 to 40% of penetrating abdominal injuries. In 60% of the cases, they are associated with other lesions, especially life-threatening head injuries. ⋯ Surgical care, relying mainly on perihepatic packing and vascular exclusion techniques must remain as conservative as possible. Once haemodynamics have been stabilized in patients who do not present any other abdominal lesion requiring laparotomy, the non-interventional attitude is often successful and bears lower morbidity.