Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1996
[Combination of propofol-ketamine-vecuronium for total intravenous anesthesia under hazardous conditions].
A total intravenous technique using propofol, ketamine and vecuronium was successfully used on 29 patients treated for elective surgery at the UNPROFOR French Medical Group (Sarajevo, Bosnia Herzegovina). Operative conditions were satisfactory for the surgeons. ⋯ No hypoxaemia was observed during the immediate postoperative period. The use of a propofol/ketamine/vecuronium combination is possible in field anaesthesia especially when opiates and inhalational agents are not available.
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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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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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Despite physiological advances and recent progress in pain relief, early analgesia for patients with acute abdominal pain is not a conventional endpoint. In clinical practice, priority is often given to diagnosis and management decisions. There are few controlled trials to settle the issue and opinions are still divided. recent studies suggest than early and effective analgesia in acute abdomen does not interfere with diagnosis, and even facilitates initial examination. Various modes of analgesia can be considered.