Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1986
[Plasma determination of lidocaine and bupivacaine after caudal anesthesia in children].
Serum concentrations of lidocaine and plasma concentrations of bupivacaine were measured so as to assess the risk of systemic toxicity following their administration by the caudal route in children, and study their pharmacokinetic profiles according to age. The serum concentrations of lidocaine were measured by immuno-enzymology in 37 children (23 +/- 13 kg) during the first hour after administration of 7 mg . kg-1. The plasma concentrations of bupivacaine were measured by high performance liquid chromatography in 40 children (18.03 +/- 8.90 kg) during the first hour after administration of 2.5 mg . kg-1. ⋯ Higher values were observed in infants weighing less than 12 kg where they reached 2.89 +/- 0.72 and 1.52 +/- 0.68 micrograms . ml-1 respectively. These results showed that caudal anaesthesia with lidocaine (7 ml . kg-1) and bupivacaine (2.5 ml . kg-1) was a safe technique for children, giving average plasma concentrations inferior to toxic values. However, it seemed prudent not to give more than the prescribed doses in the small infant.
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Ann Fr Anesth Reanim · Jan 1986
Randomized Controlled Trial Comparative Study Clinical Trial[Epidural anesthesia during labor: comparison of 3 combinations of fentanyl-bupivacaine and bupivacaine alone].
The association of bupivacaine and fentanyl appeared as the best method of inducing satisfactory obstetrical analgesia. But the various techniques of drug administration had to be detailed; this justified the present work, a single-blind controlled trial performed on 159 primipara women at term (except one of them), randomized in four groups, after informed consent. In each group, the number of patients, the age and the degree of uterine dilatation at the beginning of the epidural anaesthesia were comparable. ⋯ In the newborn, Apgar score was assessed at 1, 5 and 10 min after delivery. The degree of analgesia was statistically improved in the groups receiving fentanyl, without any differences between them. On the other hand, the length of labour was shorter with protocol II (lowest concentration of fentanyl).(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1986
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative study of general and spinal anesthesia in elderly women in hip surgery].
The choice between regional versus general anaesthesia for elderly patients undergoing hip surgery is debated. It is vitally important to see if the type of anaesthetic administered affects per- and postoperative morbidity and mortality. Seventy women more than 75 yr old suitable for spinal anaesthesia were included in this study. ⋯ In patients having general anaesthesia, 22.9% developed bronchopneumonia as opposed to 8.6% in the spinal anaesthesia group (p less than 0.05). The mortality rate at three months was rather similar in the two groups. It was concluded that, in order to reduce the incidence of postoperative central dysfunction and bronchopneumonia, spinal anaesthesia should be preferred in geriatric patients for lower limb surgery.
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Ann Fr Anesth Reanim · Jan 1986
Randomized Controlled Trial Clinical Trial[Effects of intermittent muscle stimulation on muscle catabolism in patients immobilized in the ICU].
Are muscular contractions obtained by electrical stimulation able to reduce muscle catabolism in immobilized patients? Ten patients (65 to 79 yr old), hospitalized in an intensive care unit for postoperative failure or cerebral infarction, were studied during nine days. Artificial nutrition was the same for each patient during the study. Two periods of four days where defined and randomized for each patient, separated by one day; during the stimulation period (S), intermittent electrical stimulation of the muscles of the legs (external electrodes) was performed daily 2 X 30 min; during the non-stimulation period (NS), muscular stimulation was not performed. ⋯ Results (X +/- SD) are as follows: the nitrogen balance (g/d) was -1.29 +/- 1.26 during the NS period and 1.43 +/- 1.10 during the S period (NS); 3-methylhistidine (mumol/kg/d) was 3.78 +/- 0.37 during the NS period and 3.15 +/- 0.32 during the S period (p less than 0.01); creatinine (mumol/kg/d) was 92.9 +/- 6.8 during the NS period and 72.9 +/- 25 during the S period (p less than 0.01). It is concluded that a significant decrease in 3-methylhistidine and creatinine excretions is observed during the S period. In intensive care unit patients, muscle protein breakdown may be influenced by intermittent electrical muscle stimulation.
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Ann Fr Anesth Reanim · Jan 1986
Case Reports[Contracture test with ionophore A 23187 for the diagnosis of malignant hyperthermia].
The results are reported of the contracture test obtained by using the calcium ionophore A 23187 (Calcimycin) in two patients, the son (A) and the mother (B). The past history of patient A revealed the occurrence of an impending malignant hyperthermia crisis during induction of anaesthesia in 1975. ⋯ It is suggested the A 23187 contracture test be added to the contracture tests as defined by the European Malignant Hyperpyrexia Group. This test could be of great help in identifying the percentage of relatives of MHS ("malignant hyperthermia susceptible") patients found to be MHE ("malignant hyperthermia equivocal").