Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · Jan 1996
Multicenter Study Clinical Trial[Peroperative risks in cerebral aneurysm surgery].
The perioperative complications associated with cerebral aneurysm surgery require a specific anaesthetic management. Four major perioperative accidents are discussed in this review. The anaesthetic and surgical management in case of rebleeding subsequent to the re-rupture of the aneurysm is mainly prophylactic. ⋯ Its treatment is aggressive, with intravenous agents, mannitol, deep hypocapnia and/or lumbar drainage. Prophylaxis, according to the "brain homeostasis concept", is the preferred method to avoid these four peroperative accidents. It includes normal blood volume, normoglycaemia, moderate hypocapnia, normotension, soft manipulation of the brain and optimal brain relaxation.
-
Ann Fr Anesth Reanim · Jan 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Does oral ondansetron reduce the incidence of nausea and vomiting after surgery for strabismus in children?].
To compare the efficacy of oral ondansetron with oral metoclopramide for the prevention of postoperative vomiting and nausea in children undergoing strabismus surgery. ⋯ Unlike intravenous ondansetron, oral ondansetron is not superior to metoclopramide for the prevention of nausea and vomiting caused by strabismus surgery in children.
-
Ann Fr Anesth Reanim · Jan 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Gynecologic laparoscopy with or without curare].
To assess physiological changes and operating conditions during general anaesthesia with or without neuromuscular blockade in patients undergoing gynaecologic laparoscopy. ⋯ Neuromuscular blockade influences neither most of the clinical haemodynamic and respiratory changes induced by pneumoperitoneum for gynaecologic laparoscopy not the operating conditions.
-
Spinal anaesthetics can induce histopathologic lesions and regional haemodynamic alterations in the spinal cord. There are numerous causes of neurologic lesions, including direct trauma of the spinal cord and nerve roots during puncture or catheter insertion, compromised spinal cord perfusion and direct neurotoxic effect. Histopathologic lesions are localized either in meninges (meningitis or arachnoiditis) or in neuraxis (myelitis or axonal degeneration). ⋯ Incomplete blockade should not necessarily lead to a reinjection. Large volume of hyperbaric lidocaine or repeated injections of such solutions must be avoided as well as preservative-containing solutions. The administration of new compounds by the spinal route must be supported by data of spinal neuropharmacology and the lack of neurotoxicity must have been previously checked with animal studies.
-
Pneumatic tourniquets, often used to provide a bloodless operating field, carry a risk of adverse effects. Limb exsanguination by gravitation is less aggressive than by mechanical means. Skin, muscles, nerves and vessels suffer maximally under tourniquet because of mechanical pressure, with both a sagittal force, responsible for compression and an axial force responsible for stretchening. ⋯ In order to minimize its side effects, the tourniquet must be used within the frame of a strict procedure, with a well adapted and regularly checked equipment. Duration of ischaemia should be as short as possible and not continue for more than two hours, with a reperfusion of 15 minutes every hour. Local hypothermia seems to be a safe means for decreasing side effects.