Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1993
Review[Prevention and treatment of hypotension during spinal anesthesia].
Spinal and epidural anaesthesias alter self-regulation of arterial pressure as they lead to a sympathetic blockade. The extent and the speed of appearance of this blockade conditions the magnitude of the decrease of arterial pressure. ⋯ Correcting a deep arterial hypotension demands first of all the use of vasoconstricting agents the choice of which depends on the site of the anaesthesia and on the cardiovascular condition of the patient. The occurrence of bradycardia more often indicates a hypovolaemic state.
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Cahiers d'anesthésiologie · Jan 1993
Review[Treatment of algodystrophies. The point of view of an anesthetist].
Algodystrophy is a complex and heterogenous syndrome, better defined as a subtype of Reflex Sympathetic Dystrophy syndrome (RSD). The pathophysiological theory of RSD has been supported by basic studies and clinical efficacy of sympathetic blocks. Results may be good, but some of RSD are not responsive to sympathetic blocks, and distinction between sympathetic dependent and independent pain has been proposed as subtypes of RSD. ⋯ Some new treatments rise interesting fundamental questions and some of them are under evaluation. Psychological support is the third part of treatment of these chronic pain patients. Multidisciplinary organisation, as offered by pain centers, can help to understand this syndrome and to elaborate guidelines for diagnosis, treatment and research programs.
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Cahiers d'anesthésiologie · Jan 1993
[Trans-sacral caudal anesthesia in ambulatory practice in infants. Our experience].
Sacral epidural block (S2 S3 intervertebral space, P. Busoni's method) is as safe and easy as caudal block. 11 children ASA 1 undergoing ambulatory surgery are studied (inguinal herniorrhaphy, undescended testis). Bupivacaine 0.25%, 0.5 ml.kg-1 is unsatisfactory, but anaesthesia is excellent with 0.8 ml.kg-1.
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Cahiers d'anesthésiologie · Jan 1993
[Loco-regional anesthesia and orthopedic surgery of the shoulder].
Interscalene block can induce by itself anesthesia for shoulder surgery, if the opening does not reach the delto-pectoral site nor the shoulder-blade, but medical indications must be thoroughly talked over on account of the risk of phrenic paralysis with patients suffering from breezing trouble, and the surgical position that may disturb the anesthesiologist in case he has to increase anesthesia. A superficial cervical plexus block is required in anesthesia of the upper part of the shoulder. ⋯ Today we prefer set interscalene block before the patient is anaesthetized, searching for paresthesias with a thin needle: this process does not take long to install, it is relatively painless and provides excellent analgesia during the per and post-surgical period, until the next day with long acting local anesthetics. Not any complication happened in fifty patients for one year.