Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1996
Case Reports[Modified technique of Waters for retrograde intubation. Apropos of a case of difficult intubation].
The authors describe a case of impossible intubation by classical means in an obese 37-yr old woman, affected with encephalopathy, hydrocephalus and severe psychomotor retardation. After failure of intubation by classical methods using a flexible introducer, the patient was intubated by Waters retrograde technique using an epidural catheter passed through the thyrocricoid membrane and recovered in the mouth. Following this guide the endotracheal tube passed the glottis fairly easily with the help of a flexible "mouse tail-ended" introducer (C-Mettro, Cook, 19.0.80) inserted into the same tube to facilitate alignment of distal tube and trachea. The authors conclude that the combination of epidural catheter and flexible introducer may facilitate the retrograde technique performance; they consider this technique to be an interesting alternative when endotracheal intubation is difficult or impossible by usual methods.
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Isolated lower limb injuries are very common; difficulties for emergency anaesthesia may come from full stomach and drug interferences. The outcome of geriatric-fractured hip is influenced neither by a preoperative delay shorter than 48 hours, nor by the choice of anaesthetic technique; Nevertheless the use of acrylic cement is associated with an increased early mortality rate in hemiarthroplasties. ⋯ Spinal anaesthesia using 0.5% plain bupivacaine produces a block quickly achieved, not influenced by posture, allowing surgical installation and procedures. Postoperative analgesia using local anaesthetics may obscure symptoms of compartment syndrome which occasionally complicate tibial and femoral nailing.
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Cahiers d'anesthésiologie · Jan 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Evaluation of 2 dosages of fentanyl in caudal anesthesia. A prospective randomized double-blind study].
A caudal block is currently performed in children. A randomized and double blind study including two dosages of fentanyl: 0.5 microgram.kg-1 (group I) and 1 micrograms.kg-1 (group II) in association with bupivacaine 0.25% at a dosage of 1 mL.kg-1 was carried out. Two groups of 25 children undergoing urogenital or orthopaedic surgery participated in this study. ⋯ Furthermore, recovery of anaesthesia was rapid and calm. The frequency of nausea and vomiting was respectively 24% and 20% in groups I and II and did not require any specific therapy. Therefore it appears that caudal block with bupivacaine 0.25% and fentanyl 0.5 microgram.kg-1 is a very satisfactory technique in children when indicated.
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This retrospective study concerns 1,373 adult patients who underwent forefoot surgery during 1988-95 under regional anaesthesia by ankle nerve blocks (of posterior tibial nerve systematically and other nerves according to the surgical site). As a rule, plain bupivacaine 0.5% (maximum 40 mL) was used, completed if necessary by lidocaine 1% (a few mL). A nerve stimulator is currently used for posterior tibial blocks. ⋯ No general anaesthesia was needed (except after one case of convulsions, likely from accidental injection of a few mL of local anaesthetic and without any sequelae). Five patients complained of temporary paraesthesias, with indication of a posterior tibial neurolysis in one case and complete recovery. Thus ankle blocks appear increasingly to be a satisfactory alternative to general anaesthesia for most surgical procedures on the forefoot, provided that all usual safety conditions are respected and the patient's acceptance of the procedure is obtained.
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Despite physiological advances and recent progress in pain relief, early analgesia for patients with acute abdominal pain is not a conventional endpoint. In clinical practice, priority is often given to diagnosis and management decisions. There are few controlled trials to settle the issue and opinions are still divided. recent studies suggest than early and effective analgesia in acute abdomen does not interfere with diagnosis, and even facilitates initial examination. Various modes of analgesia can be considered.