Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1989
Randomized Controlled Trial Comparative Study Clinical Trial[A combination of sufentanil and 0.25% bupivacaine administered epidurally for obstetrical analgesia. Comparison with fentanyl and placebo].
The study reported was designed to determine whether 15 micrograms sufentanil would provide analgesia comparable in duration and quality with that given by 75 micrograms fentanyl, when associated with plain 0.25% bupivacaine for extradural analgesia for labour. Patients (n = 124) in labour and at full term were randomly divided into 3 groups. Group 1 (n = 41) were given 12 ml of 0.25% plain bupivacaine with saline, group 2 (n = 41) 12 ml of 0.25% plain bupivacaine with 75 micrograms fentanyl and group 3 (n = 42) 12 ml of 0.25% plain bupivacaine with 15 micrograms sufentanil. 11 cases were excluded from the study (8 Caesarean sections, 3 technical failures). ⋯ The only side-effect seen with sufentanil and fentanyl was pruritus (group 2: 21.9%, p less than 0.05; group 3: 21.4%, p less than 0.05; group 1: 2.4%). These results showed that 15 micrograms sufentanil could replace 75 micrograms fentanyl for extradural pain relief of labour with plain 0.25% bupivacaine. However, the use of opioids with local anaesthetics would seem to be of interest only if labour is likely to be prolonged.
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Ann Fr Anesth Reanim · Jan 1989
Review[Treatment of malignant hyperthermia crisis during anesthesia].
Malignant hyperthermia (MH), triggered by anaesthesia, is a rare and potentially fatal condition. It requires immediate and specific treatment. This review focuses on anticipation and organisation of treatment. ⋯ A rational approach to the treatment of hyperkalaemia, circulatory and renal failure is discussed. After the crisis, dantrolene should be continued for a short time. Finally, the nonspecific signs which can give the earliest diagnosis possible of MH are discussed: an early diagnosis and early treatment with dantrolene are essential in reducing the mortality of malignant hyperthermia.
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Malignant hyperthermia (MH) is a pharmacogenetic disorder. It is classically described as a hypermetabolic state triggered by halogenated anaesthetics and/or depolarizing muscle relaxants. In fact, since Denborough and Lovel's case, it has been shown that MH has a great number of clinical forms. ⋯ In the latter case, major cardiac problems may occur at the time of anaesthetic induction. Even if there are no other signs of MH, all patients who have had a masseter spasm must be considered as open to doubt, and should be further explored. MH is often difficult to diagnose in medium severity types.(ABSTRACT TRUNCATED AT 250 WORDS)
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After having been virtually completely forgotten since the Second World War, paediatric regional anaesthesia has been undergoing a renewal in the last decade. This renewed interest in old techniques is due to several converging factors: a better knowledge of the pharmacology of local anaesthetic agents in the child, the availability of equipment adapted for children, the remarkable haemodynamic stability of the very young child during an epidural block, as well as the need to treat pain not just in the operative period. The child is not, or rather, is not only a small adult. ⋯ Its ideal indication is surgery below the umbilicus in the infant and young child. Lumbar epidural anaesthesia requires greater experience as well as proper equipment, especially in the very young child. Peripheral nerve blocks are less used than in adults.(ABSTRACT TRUNCATED AT 400 WORDS)
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Ann Fr Anesth Reanim · Jan 1989
Review[Management of a patient with malignant hyperthermia susceptibility during anesthesia and daily living].
Death from malignant hyperthermia (MH) still occurs in France. However, anaesthesia of the MH susceptible (MhS) patient is quite possible without any more risk than for patients who are not MhS. Guidelines have been worked out: "trigger" drugs such as volatile anaesthetics (halothane, enflurane, isoflurane) and depolarizing muscle relaxants must be imperatively avoided; "non-trigger" drugs should be used, such as nitrous oxide, barbiturates, benzodiazepines, propofol, opiates, non-depolarizing muscle relaxants, amide or ester local anaesthetics at the usual doses without adrenaline. ⋯ MhS patients must also be given counselling. This includes explanations about MH, its genetic features, the main laboratory tests used to detect susceptibility, as well as advice about lifestyle, the use of drugs other than general and local anaesthetics, and a discussion concerning the association of MH with other diseases. This counselling is not always easy to provide, because many answers are not, as yet, definitive.