Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1991
Randomized Controlled Trial Comparative Study Clinical Trial[Evaluation of obstetrical pain by a questionnaire of adjectives. Comparison of 2 epidural analgesia protocols].
A French version of the McGill pain questionnaire, the "Questionnaire Douleur Saint Antoine" (QDSA), was assessed prospectively by comparing two epidural analgesia protocols using bupivacaine. One hundred women in labour who asked for epidural analgesia were randomly allocated to two groups and received either 0.25% or 0.5% bupivacaine (mean initial doses 32.5 and 50 mg respectively) with adrenaline 1 in 200,000. All the patients were then instructed to trigger a patient controlled analgesia (PCA) device for top-up doses of 0.25% bupivacaine with adrenaline 1 in 400,000 once they became aware of pain returning. ⋯ On the other hand, the affective part of the score was only correlated with the level of anxiety and behaviour. The sensory part of this score was the only one to show a difference between the different initial doses given to the patients. The results obtained with this series of patients underline the value of a multidimensional assessment of labour pain.
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Ann Fr Anesth Reanim · Jan 1991
Randomized Controlled Trial Clinical Trial[Effects of intravenous clonidine on postoperative shivering].
A study was designed to assess the possible effects of intravenous clonidine on postoperative shivering. Fifty patients undergoing spinal fusion under isoflurane anaesthesia were randomly assigned to two groups (n = 25). Patients in one group were given intravenous clonidine (5 micrograms.kg-1 during the first hour, and 0.3 microgram.kg-1.h-1 thereafter) or placebo. ⋯ Clonidine significantly decreased blood pressure, heart rate, cardiac output and whole body oxygen consumption. The patients in these series were free from any cardiac disease. Further studies are required to assess the possible beneficial effects of clonidine on postoperative oxygen consumption in patients suffering from heart failure.
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Patient controlled analgesia (PCA) is a drug delivery system aimed to control acute pain using negative feedback technology in a closed loop system in which the patient plays an active role. It overcomes the inadequacies of traditional analgesic protocols due to marked differences in pharmacokinetic and dynamy of analgesis between patients. Moreover, doctors and nurses frequently underprescribe opioids in patients with severe pain for fear of dangerous side-effects. ⋯ The principles of demand analgesia are now being investigated using other agents, such as local anaesthetics, and other routes of administration, mainly epidural injection. In most patients, even in children, PCA can replace intramuscular injections, which are the standard route for opioid administration. Today PCA and spinal opioids are the two main methods of analgesia for postoperative pain management.
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Ann Fr Anesth Reanim · Jan 1991
Randomized Controlled Trial Comparative Study Clinical Trial[Controlled trial of a non-invasive continuous blood pressure monitor: Cortronic AMP 770].
The performances of a Cortronic AMP 770 monitor, a new apparatus for non invasive continuous blood pressure monitoring was assessed. Its working principle is derived from oscillometry. The blood pressure cuff is kept at a low pressure (about 20 mmHg), and the oscillations induced by the arterial pulse are converted into blood pressure. ⋯ There was no correlation between blood pressure levels and discrepancy in the measurements obtained with the two methods. The Cortronic AMP 770 was reliable under normal circumstances, when compared with a traditional oscillometer. However further studies are required to assess its reliability under pathological circumstances (severe hypotension or hypertension, arrhythmias and sudden changes in blood pressure).
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Single lung transplantation was performed in several steps: laparotomy to prepare an omentopexy, followed by pneumonectomy and implantation of a pulmonary graft, both by postero-lateral thoracotomy. The patients suffered from lymphangiomyomatosis (1), panacinar emphysema (2) and idiopathic pulmonary fibrosis (1). Immunosuppressive treatment was started before surgery. ⋯ Except in one patient with preoperative pulmonary hypertension, the increase in pulmonary vascular resistances remained moderate after clamping of the pulmonary artery. Sufficient oxygen delivery, with more than 50% venous oxygen saturation, was maintained at this time by the infusion of dopamine and dobutamine. Two other specific problems were encountered in the emphysematous patients: severe hypotension following the start of artificial ventilation and after placing the patient in lateral position; thoracic asymetry with overdistension of the emphysematous lung, and mediastinal shift.(ABSTRACT TRUNCATED AT 250 WORDS)