Annales françaises d'anesthèsie et de rèanimation
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50 attempts of deep percutaneous antecubital catheterization are reported. A tourniquet was applied to the upper arm and the medial deep brachial vein was punctured in a point immediately medial to the brachial artery, in the antecubital fossa. Venepuncture was successful in 88% of the cases (44 cases), catheterization possible in 72% of the cases (36 cases). ⋯ The only benign complication was injury to the brachial artery in 6 cases. Mean duration of catheterization was 20 days. This very easy and safe technique can be used when superficial veins are unusable and use of the deep central veins dangerous or impossible.
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A technique of regional anaesthesia of the foot for forefoot surgery (ingrowing toe-nail, hallux valgus, amputation, etc.) is described. It consists of a block of the superficial peroneal nerve at the ankle combined with a block of the posterior tibial nerve behind the medial malleolus. ⋯ A pneumatic tourniquet was placed on the upper part of the thigh after the patient had been given an intramuscular premedication. The results of 52 such blocks carried out in 40 patients are discussed.
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Ann Fr Anesth Reanim · Jan 1985
Case Reports[Circulatory arrest in the operating room in a patient with a congenital long QT syndrome].
Reversible cardiocirculatory arrest was observed during orthopaedic treatment of a digital dislocation in a 37 year old female patient. Cardiological studies showed a prolonged QT interval (0.6 s) in the patient and her daughter, associated with hypokalemia (3.4 mmol) in the former. The diagnosis suggested was that of Romano-Ward's syndrome. Preparation and choice of anaesthesia are discussed.
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Ann Fr Anesth Reanim · Jan 1985
[Anaphylaxis to muscle relaxants. Predictive value of intradermal tests and study of crossed anaphylaxis].
37 patients were studied, all of whom presented with anaphylaxis to a muscle relaxant. The diagnosis was made after simultaneous intradermal testing (IDT), human basophil degranulation tests (HBDT) and Prausnitz-Küstner tests (PK) of passive cutaneous anaphylaxis. Three tests were positive in 6 patients, both IDT and PK in 9, and both IDT and HBDT in 8. ⋯ Pancuronium and vecuronium appeared to be the least likely drugs to cause crossed anaphylaxis. The predictive use of these tests is discussed. It is also suggested that muscle relaxants with only one quaternary ammonium group should be used, this chemical characteristic probably reducing the risks of sensitization.
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The histamine releasing potential of atracurium was assessed by testing skin reactivity in ten patients who had previously suffered from a preanaesthetic anaphylactoid accident, but in whom the diagnosis of anaphylaxis had not been confirmed. Atracurium was injected intradermally in increasing concentrations so as to determine the reactivity level, comparing it in the same patient with that due to d-tubocurarine and alcuronium given in the same way. Skin tests with histamine and 48/80 were also carried out at the same time. ⋯ All the commercial muscle relaxants together with atracurium were tested, even though none of the patients had ever received this last. Anaphylaxis was confirmed when the intradermal reaction was positive with a dilution of 1 in 1,000 and beyond. These tests showed that five patients out of the six had a crossed anaphylaxis, and one of these five was sensitive to all four muscle relaxants (atracurium included).(ABSTRACT TRUNCATED AT 250 WORDS)