Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1992
Review Randomized Controlled Trial Comparative Study Clinical Trial[Clonidine premedication and isoflurane anesthesia to reduce bleeding in otologic surgery].
Seventy-seven ASA 1 patients scheduled for ear surgery were premedicated orally, 90 min before anaesthesia. They were randomly assigned to two groups, according to the drug used: hydroxyzine alone (group T, n = 39) or combined with clonidine (4.9 +/- 0.3 micrograms.kg-1) (group C, n = 38). Anaesthesia was induced with midazolam (0.3 mg.kg-1) and alfentanil (30 micrograms.kg-1). ⋯ There were more periods of sinus bradycardia (heart rate less than or equal to 50 b.min-1), mostly seen before the beginning of surgery, in group C patients (p less than 0.01); atropine was also required more often (when the heart rate was less than or equal to 40 b.min-1) in this group of patients (NS). The comparative assessment of surgical field quality was in favour of group C (no troublesome bleeding) as opposed to the control group (16% troublesome bleeding); there were also more bloodless surgical fields in the former group (73.7% vs. 48.7% in group T, p less than 0.05). This study therefore demonstrated that clonidine premedication before anaesthesia with isoflurane was helpful in decreasing bleeding during ear surgery.
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Ann Fr Anesth Reanim · Jan 1992
Randomized Controlled Trial Comparative Study Clinical Trial[Patient-controlled analgesia: effect of adding continuous infusion of morphine].
This double blind study aimed to assess the effects of a continuous intravenous (i.v.) infusion of morphine added to an intermittent bolus patient controlled analgesia on morphine demand and related side-effects. Patients scheduled for abdominal and thoracic surgery (ASA 2 or 3) were randomly allocated postoperatively to three groups (n = 10 each): group 1 were given i.v. boluses of 2 mg of morphine (lockout interval = 15 min); the other two groups were given the same boluses as well as a continuous i.v. infusion of either 1 mg.kg-1 of morphine (group 2) or 2 mg.kg-1 (group 3). Pain was assessed with a visual analog scale before starting analgesia, and after 1, 2, 3, 4, 8, 16, 24 and 36 h. ⋯ Total amounts of morphine were higher in groups 2 (56.8 +/- 23.8 mg) and 3 (116.2 +/- 41.8 mg) compared with group 1 (38.2 +/- 17.8 mg) (p < 0.05). Morphine administration was stopped in 5 patients in group 3 and in 1 in group 2 because PaCO2 had risen to more than 45 mmHg. Therefore, a continuous i.v. infusion is not required in patients receiving PCA, all the more so as this has deleterious respiratory effects.
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Ann Fr Anesth Reanim · Jan 1992
Randomized Controlled Trial Comparative Study Clinical Trial[Analgesic effect of ibuprofen in pain after episiotomy].
The relief of post-episiotomy pain was investigated in three groups of women, ranked ASA 1 or 2, using either a single dose of 400 mg of ibuprofen (n = 31), or 1 g of paracetamol (n = 28) or placebo (n = 31). Pain intensity was assessed with a visual analogic scale, a verbal scale and pain relief scores after half an hour, 1, 2, 3, 4, 5 and 6 h. The day after treatment, patients rated the quality of pain relief, and were asked whether they wished to take again the same drug for the same type of pain. ⋯ On the day after treatment, 22 patients from the ibuprofen group considered pain relief to have been good or excellent, versus 8 and 5 in the paracetamol and placebo groups respectively (p less than 0.001). Similarly, 24 patients from the ibuprofen group would accept the same drug again for the same type of pain, as opposed to 8 and 5 from the paracetamol and placebo groups respectively (p less than 0.01). The only side-effect reported was abdominal pain in one patient (placebo group).(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1992
Randomized Controlled Trial Comparative Study Clinical Trial[Propofol versus etomidate in short-time urologic surgery].
Thirty patients, scheduled for short urological surgical procedures and ranked ASA 1 or 2, were randomly assigned to two homogenous groups. In group P, they were given a 2 mg.kg-1 bolus of propofol and 10 micrograms.kg-1 of alfentanil, followed by a continuous infusion of propofol (5 mg.kg-1.h-1) and 5 micrograms.kg-1 doses of alfentanil. In group E, they were given a 0.3 mg.kg-1 bolus of etomidate, followed by an infusion (1.5 mg.kg-1.h-1). ⋯ On the other hand, in group E, there was little or no haemodynamic alteration, but there often was a trismus at induction. Hypoxia also occurred during induction with etomidate, being severe enough in one case to require tracheal intubation and artificial ventilation. The reasons for this hypoxia seemed to be the apnoea and the trismus, which tends to hinder assisted ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1992
Review Case Reports[Tracheal intubation in patients with cervical spine injuries using a fiber optic laryngoscope].
Eleven patients, with a cervical spine injury and scheduled for elective cervical spine fusion at least 48 h after their initial trauma, were intubated using a new fiberoptic laryngoscope (Bullard). This technique uses either a semi-rigid guide independent of the laryngoscope blade, or a rigid one attached to the blade. The cervical spine was immobilized with either a collar or a halo. ⋯ This is confirmed by the time required, 44 +/- 22 sec for the rigid guide, and 97 +/- 92 sec for the semi-rigid one. In the patient in whom this technique failed at the first attempt, endotracheal intubation was carried out by the nasal route and controlled by the fiberoptic laryngoscope. This technique enables a rapid and easy orotracheal intubation in trauma patients with an immobilized cervical spine, but careful training is necessary.