Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1988
ReviewThe modifying effect of anesthetic technique on the metabolic and endocrine responses to anesthesia and surgery.
In spite of the fact that our knowledge on the release mechanisms of the surgical stress response is rather incomplete, several techniques are available to modulate the response. However, at present it appears that no technique is capable to effectively suppress all aspects of the injury response and the widespread use of the term "stress free anesthesia" in surgery is therefore not valid. However, continuous administration of local anesthetic agents in the epidural space is the most effective technique in so far as reduction of the stress response is concerned. ⋯ The cumulative experience from these studies have demonstrated an advantageous effect on postoperative morbidity parameters such as blood loss, postoperative thromboembolic complications, pulmonary infective complications, gastrointestinal motility, postoperative hospital stay, etc. The most pronounced effect on morbidity in these studies is in procedures where regional anesthesia has also been demonstrated to be most effective on the surgical stress response. However, whether this is a causal relationship or a coincidental event, has not been finally answered.(ABSTRACT TRUNCATED AT 250 WORDS)
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The development of a traumatic chylothorax is an uncommon but serious clinical entity. Two cases of traumatic chylothorax are reported. The anatomy and physiology of the thoracic duct and the etiology, diagnosis and management of traumatic chylothorax are discussed.
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Acta Anaesthesiol Belg · Jan 1988
ReviewIs there a place for regional anesthesia in pediatrics?--Yes!
Regional anesthesia has a central place in pediatrics. The neonate requires an analgesic, but not one which will produce respiratory depression. The older child undergoing intermediategrade surgery requires the best available analgesia, but without sedation and nausea. ⋯ Caudal block is particularly useful and, even when given in large doses, does not give rise to high plasma concentrations. Regional techniques are seen at their best when combined with light general anesthesia. The advantages of both these methods are then available for the benefit of the child, and the value of regional analgesia is further enhanced when supplementary intramuscular or oral analgesia is given regularly at specific times so that pain is prevented rather than relieved.
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Acta Anaesthesiol Belg · Jan 1988
ReviewIs there a need for chloroprocaine 3% and bupivacaine 0.75%?
Bupivacaine and chloroprocaine have proven to be valuable local anesthetics for a variety of surgical and obstetrical situations. Bupivacaine is particularly useful as a long acting agent which provides excellent sensory analgesia particularly during labor with minimal blockade of motor fibers. The 0.75% solution is useful for epidural surgical anesthesia since it does result in a decrease in onset time and a more marked motor blockade. ⋯ The local neural toxicity of chloroprocaine solutions is referably to the low pH and the inclusion of sodium bisulfite in these particular solutions. The toxicity of chloroprocaine solutions is related to total dosage rather than the concentration of solution employed. Careful administration of chloroprocaine epidurally in order to avoid accidental subarachnoid injection should preclude the possibility of local neural toxicity.