Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · May 1999
Randomized Controlled Trial Comparative Study Clinical Trial[Obstetric analgesia: peridural analgesia versus combined spinal and peridural analgesia].
To compare the analgesic efficiency, side effects and obstetrical repercussions of epidural analgesia (EP) and combined spinal-epidural analgesia (CSE). ⋯ In the early phase of labour, the CSE technique using intrathecal sufentanil has no significant benefit when compared to the EP technique using bupivacaine and sufentanil. In the CSE group, technical incidents were more frequent and the length of the first stage of labour was increased.
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To analyze the current anaesthetic management of HIV/AIDS patients. ⋯ Twenty per cent of HIV-positive patients require surgery during their illness. Anaesthesia and surgery decrease cell mediated immunity and modify the activity of immune mediators. These changes are more pronounced under general anaesthesia compared to regional anaesthesia. They are transient and not clinically significant. Poor information is available concerning the perioperative management of HIV-positive patients and the effects of anesthesia on their immune status. Preoperative evaluation focuses on the following three important data: patient's status, surgery, and anaesthesia. In patients in good clinical conditions who comply with treatment, the anesthetist assesses the effects of the antiretroviral treatment and the risk of interactions between anaesthetic and antiretroviral agents. Etomidate, atracurium, cisatracurium, remifentanil and desflurane are not dependent on hepatic metabolism by the cytochrome P450 system. In patients in bad clinical conditions or in patients who do not comply with treatment, attention focuses on cardiovascular, pulmonary, neurologic and nutritional status. The specific antiretroviral treatment is not discontinued in the perioperative period, as far as compatible with the type of surgery and associated dysfunction of the digestive tract. Regional anaesthesia offers the benefits of not interfering with the immune system and antiretroviral agents. However, the viral infection can be enhanced by regional anaesthesia due to the cofactors' effect of local anaesthetic agents in cerebrospinal fluid. Homologous blood transfusion is not recommended as it increases postoperative infection and viral activation. Erythropoietin can be of benefit in selected cases. In the future, supportive immunotherapy will probably be the main tool for perioperative management of HIV and AIDS patients.
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During cerebral ischaemia, energetic failure of injured cells together with excessive release of glutamate the most common excitatory amino acid in the brain, lead to excitotoxicity and immediate or delayed neuronal death. There is strong experimental evidence to support the neuroprotective role played by anaesthetic agents. Hence, barbiturates, volatile anesthetics or ketamine exhibit significant protective effects against ischaemic injury in numerous experimental models of ischaemia in vitro or in vivo. ⋯ Reduction of cerebral metabolism by these agents seems not to be their primary neuroprotective mechanism. However, no data are available at the present time to support any clinical benefit of these actions in neurosurgical patients, head trauma in contrast to mild hypothermia or cerebrovascular disease. Future research should develop models as close as possible to the clinical situation to examine further pathophysiological hypotheses and clinical implications.
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Ann Fr Anesth Reanim · May 1999
Clinical Trial[Laryngoscope. Evaluation of a device for preventing blade contamination].
To evaluate the efficacy and the difficulty of use of a disposable sheath which prevents the contamination of blades. ⋯ The laryngoscope blade sheath is simple and easy to use, efficient and not expensive.