Cahiers d'anesthésiologie
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The intravascular administration and the high blood resorption of local anesthetic agents are known to induce neurotoxic accidents. However, the use of potent local anesthetic drugs such as bupivacaine is responsible for serious cardiotoxic accidents with a mortality of about 50%. Indeed, bupivacaine induces both electrophysiologic and haemodynamic disturbances with the occurrence of conduction blocks, arrhythmias and cardiovascular collapse. ⋯ We demonstrated that the combination of clonidine and dobutamine is efficient to reverse both haemodynamic and electrophysiologic impairments induced by a large dose of bupivacaine in anesthetized dogs. Whatever the efficiency of specific resuscitation, it must be emphasized that prevention of toxic accident must always include: the best choice of local anesthetic drug (e.g.: lidocaine+alpha-2 agonist vs bupivacaine), test dose, aspiration and slow administration. Finally, the monitoring of regional anaesthesia must be similar to that in use for general anaesthesia and drugs and devices for resuscitation must be ready.
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Regional anesthesia represents a selective approach in shoulder surgery. The following technics can be used: brachial plexus block, cervical epidural and intra-articular anesthesia. The advantages of each technique are discussed.
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Cahiers d'anesthésiologie · Jan 1993
Review Comparative Study[A comparative study of recovery following maintenance of anesthesia with propofol or isoflurane. An attempt to synthesize current data].
Quality of recovery is a means to improve anaesthetic safety during postoperative time, in post-anaesthesia recovery room and especially when the patient returns to his unity. The comparison of recovery after maintenance of anaesthesia with propofol or isoflurane shows that, for 50 to 60 min surgical procedures, results are significantly better with isoflurane. Review of literature shows that, for less than 30 min operations, propofol seems to give best recovery. For more than 30 min operations, isoflurane enables better quality recovery.
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Cahiers d'anesthésiologie · Jan 1993
Comparative Study[Shoulder surgery using a plexus block: for or against. Against].
Brachial plexus block is an alternative and elegant procedure for shoulder surgery. Three main concerns have to be considered when this technique is planed. ⋯ Thirdly, when nerve lesions of different mechanisms including plexus block itself occur, the origin of the lesion may be difficulty related to its cause. Indications of cervical block are therefore to be considered cautiously when shoulder surgery is performed.
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Cahiers d'anesthésiologie · Jan 1993
[Locoregional anesthesia of the upper limbs. Experience of the Centre de la Main].
The Hand Centre of Angers in France is entirely autonomous. 2,200 patients a year undergo hand or wrist surgery under regional anaesthesia exclusively. Authors insist on the importance of pre-selection among patients. Security rules and postoperative recommendations are mandatory.