Cahiers d'anesthésiologie
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Unlike epidural anaesthesia for general surgery or caesarean section, épidural analgesia for labour leads to maternal hyperthermia. Its recent demonstration is probably related to the multiple influencing factors: site of measurement, ambient temperature, previous labour duration and dilatation at the time of epidural puncture, and occurrence of shivering. During the first 2 to 5 hours of epidural analgesia, there is a weak--if any--thermic increase. ⋯ This hyperthermia has been correlated with foetal tachycardia but never with any infectious process. A potential deleterious effect is still debated and may lead to propose an active cooling for the mother. This hyperthermia must also be recognized to avoid an inadequate obstetrical attitude (antibiotics, extractions).
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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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Anaesthesia for fetal distress is usually indicated for emergency caesarean section. General anaesthesia, which is the classical technique in these cases, remains the leading cause of anaesthesia-related maternal mortality. Difficult intubation and Mendelson's syndrome are mostly responsible for these fatalities. ⋯ For example, a "prophylactic" epidural instituted soon after the beginning of labor may be lifesaving in a patient with obvious signs of difficult intubation. A clear definition of safe standards of equipment and practices both to prevent Mendelson's syndrome or to cope with a failed intubation through a "failed intubation drill" is of paramount importance. Finally, a comprehensive communication between anesthetic and obstetrical teams is one of the most useful ways to allow a safer approach of the management of obstetric emergencies such as caesarean section for fetal distress.
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Cahiers d'anesthésiologie · Jan 1994
Comparative Study[Comparative study of propofol versus thiopental-halothane in the occurrence of oculocardiac reflex and postoperative vomiting after surgery for strabismus in children].
Strabismus surgery in children is associated with side-effects, intraoperative oculocardiac reflexes in relation with muscular tractions and postoperative vomiting. Studies with propofol anaesthesia in this surgery have shown a lower incidence of these side-effects. So, a prospective study compared these incidences with propofol (P) versus thiopental/halothane (T+H) anaesthesia. Propofol appears to be efficient in reducing postoperative vomiting but might be associated with more frequent OCR.
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Cahiers d'anesthésiologie · Jan 1994
Comparative Study[Effect of epidural analgesia on obstetrical mechanics].
Epidural analgesia is the most effective technique of pain relief during labour. However, there is an old suspicion that it modifies the course of labour. ⋯ The deleterious effect on the second stage is primarily due to motor blockade of the pelvic floor muscles which normally exert an important influence on fetal accommodation. It is possible to limit the negative effect of motor blockade by using either a combination of low-dose bupivacaine and opioid, or injection of a lipophilic opioid through a subarachnoid catheter, or by using the new amide local anaesthetic, ropivacaine, which is claimed to possess less motor blocking action.