Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1991
[Is it possible to avoid a penal offence in carrying out ambulatory anesthesia?].
French jurisprudence about outpatient anaesthesia is resolutely unfavorable. It is principally based on the June 22nd 1972 decision of the cessation court, the highest court of justice in France. Preoperative non hospitalisation has been considered as a fault by negligence/carelessness of the practitioners. ⋯ This decision is linked with the evolution of the fault and the responsibility share between surgeon and anaesthetist. The post-operative phase seems to involve "theory of missing luck" (causality linkage or the detriment in itself), excluding a penal condemnation but not a partial compensation. Though some new legal considerations could be put forward, a written contract between physicians and patients is necessary in outpatient surgery, whereas the medical files and the organisation of the unit can prove the quality of medical care.
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Cahiers d'anesthésiologie · Jan 1991
Randomized Controlled Trial Comparative Study Clinical Trial[A comparison of midazolam and diazepam in premedication using the intramuscular route].
A double blind study has been carried out on 60 women undergoing gynaecological surgery: they were divided into 2 groups who were given as premedication either midazolam: 10 mg, or diazepam: 15 mg intramuscularly. No significant differences between both groups concerning heart rate, blood pressure and respiratory rate were found. After 30 min sedation of anxiety was noted in 30 subjects (100%) after midazolam and in 20 subjects (67%) after diazepam (P less than 0.001). ⋯ Amnesia of the immediate postoperative period was 100% in both groups. Midazolam as compared with diazepam can be regarded as a superior intramuscular premedicant. This superiority can been explained by a rapid and good resorption.
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Cahiers d'anesthésiologie · Jan 1991
Randomized Controlled Trial Clinical Trial[The effect of alfentanil on pain caused by the injection of propofol during anesthesia induction in children].
Three modes of administration of alfentanil were assessed in order to reduce pain on injection with propofol. Forty healthy children scheduled for ENT surgery were included in this double-blind randomized study. All patients received intrarectal premedication with midazolam and atropine. ⋯ The children experience pain when alfentanil was administered a few seconds before or just after propofol. An bolus injection reduced significantly discomfort in patients. Dosages of alfentanil in plasma might determine the right moment of propofol injection to obtain analgesia.
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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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Cahiers d'anesthésiologie · Jan 1991
Review[Opioids by the perimedullary route: mechanisms of opioid analgesia].
The identification of multiple opioid receptors and opioid peptides in the 1970 was the starting point of an increasing knowledge on opioid physiology and pharmacology. The mechanisms of action of spinally supraspinal levels. At the spinal level, opioids act by a modulation of specific supraspinal effect is the consequence of the migration of opioids, other in the bloodstream or in the cerebrospinal fluid, towards the encephalon. ⋯ At the receptor level, opioid agonists act, hypothetically via the system of adenylcylase, more certainly via a modulation of membrane tonic channels. Thus, opioids modify sodium, calcium and potassium currents, and modify the successives phases of the membrane action potential. The result is an hyperpolarization which is responsible of an inhibition of the release of various neurotransmitters such as P substance.