Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1991
[Peridural obstetrical analgesia and the cicatricial uterus. A 4-year evaluation].
191 women with previous cesarean section in 291 indexed between October 1985 and September 1989 underwent a trial of labor. 146 patients received epidural analgesia in the course of labor. Vaginal delivery occurred in 126 patients (86.3%). Duration for epidural analgesia in labour was 163 +/- 110 min. ⋯ We report four uterine dehiscences and one rupture. In no case, epidural analgesia did not delay the diagnosis. The use of epidural analgesia for trial of labor in previous cesarean section did not increase maternal or fetal risk.
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Cahiers d'anesthésiologie · Jan 1991
Case Reports[A rare and serious complication of spinal anesthesia: bacterial meningitis].
Bacterial meningitis following spinal anaesthesia is a rare but serious complication. We describe a case in which an old woman received spinal anaesthesia for hip replacement. Diagnosing the aetiologic agent is a major medical challenge. The possible aetiological causes of this complication are discussed and the difficulty in differentiation between aseptic and bacterial meningitis noted.
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Cahiers d'anesthésiologie · Jan 1991
Review[Mechanism of action and clinical use of opioids administered by the peripheral perineural route].
Experimental studies have shown that opioids could produce two types of effect on neuronal excitability. The first one, aspecific, is a local anesthetic action on the nerve fiber with a diminution of sodium and potassium conductance. ⋯ Clinical studies have proved that opioid injection in peripheral nervous trunks and specially in the brachial plexus produce a prolonged analgesia status in the post operative period but also and mostly in the chronic pain. The more liposoluble opioids like fentanyl and buprenorphine are the more effective.
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Postoperative analgesia using propacetamol was studied in 50 patients, 42 +/- 16 years old, after little or moderate surgery. Two grams of propacetamol in intravenous perfusion were administered every six hours. Three scales were utilized to note the intensity of the pain (simple verbal, behavioral and visual analogue scales), before the first injection and, one, four, six hours after. From this study, satisfactory analgesic efficiency and good tolerance of propacetamol were established.
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A specialized unit in outpatient anaesthesia and surgery needs an adapted planning. During the preoperative period, it is particularly important to preserve the time of the patients. Different types of structures are possible for the intraoperative period depending on their degree of independence to a hospital. ⋯ During the postoperative period, a special medical organization must be planned to help the patient if necessary. The part of the secretarial work is important for the success of such a unit. Its efficiency may be improved by computerised treatment of part of the information.