Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression
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This study included 20 children (average 8.5 years) undergoing surgery of the upper limb under brachial plexus block. A method of blocking the brachial plexus using an infraclavicular approach is described. Eighteen brachial plexus block were performed under general anesthesia. ⋯ Post-operative analgesia was satisfactory in all cases. In 10 cases a nerve stimulator was used. It is not necessary for the realization of a brachial plexus block, but the punction is easier under general anesthesia with this instrument.
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A new apparatus for anaesthesia has been developed for disaster situations. A turbine pushes room air through a halothane vaporizer to a modified D. Mapleson system. ⋯ Oxygen monitoring was performed with percutaneous PO2, SaO2, FiO2. Only one patient with cardiac disease needed oxygen adjonction (2 l.min-1) to raise his SaO2 level above 95%. Thus it is possible to have the optimum FiO2 with the lowest amount of halothane and oxygen.
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Since Althesin was withdrawn from the market, and since Ledingham's report on the inhibitory effect of etomidate on cortisol secretion, anaesthesia in intracranial surgery has lacked an intravenous agent with a pharmacokinetic-dynamic profile making it a suitable alternative to the classic thiopental-isoflurane sequence. Propofol has been used experimentally in neuroanaesthesia for 4 years, and is now ready to be used on a routine basis in neuroanaesthesia. An induction dose of propofol decreases cerebral blood flow (CBF), cerebral metabolic rate for oxygen (CMR02), and intracranial pressure (ICP). ⋯ Recovery can thus be rapid. Propofol is used with the same agents or manoeuvres as those used with the thiopental-isoflurane sequence, i.e. lidocaine, fentanyl, esmolol, mannitol, steroids, hyperventilation and lumbar drainage in order to obtain the most relaxed brain and reduce the mechanical pressure exerted on the brain. Propofol can be used for all intracranial pathologies with may be one exception, when a cerebral aneurysm has to be clipped and vasospasm is present.
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Celiac plexus block is a good alternative of pain treatment in upper abdominal pain. Neurolysis of the celiac plexus by the percutaneous posterior route used CT guidance in 8 patients. Pain relief was obtained in 5 of 7 patients (70 per cent); no complication occurred.