Cahiers d'anesthésiologie
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The aim of the regional administration of opioids is to provide an efficient and prolonged analgesia. Then, opiates can be useful for postoperative analgesia and for the treatment of chronic pain of malignant origin. Analgesia is correlated with several adverse effects of which the most frequent are nausea and itching and the most severe is respiratory depression. ⋯ Opioids also act by a reduction of the motor functions of the bowel, which perhaps could reduce the incidence of anastomotic breakdowns. Finally, other effects have been reported, as anecdotes, such as the treatment of spasm after bilateral replantation of the ureters, neurologic bladder dysfunctions and enuresis. Spinal administration of opioids has also been used as a treatment of premature ejaculation.
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Cahiers d'anesthésiologie · Jan 1991
Review[Secondary effects of opioids administered by the regional route].
The administration of narcotics in the subarachnoid or the epidural space is gaining acceptance for postoperative pain relief. However, the potential side effects of intrathecal and epidural use of opioids are the following: early and late respiratory depression, pruritus, nausea and vomiting, urinary retention. ⋯ Naloxone can be used to reverse the depression. Pruritus can occur in 10 to 30% of patients receiving morphine; 10 to 30% nausea and vomiting, and urinary retention occurs in 20 to 50% of patients.
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Cahiers d'anesthésiologie · Jan 1991
[Complications of local and regional anesthesia. An analysis of closed files of insurance companies].
We report a review of closed insurance claims for local and regional anaesthesia mishaps in the main private professional insurance companies. Twenty eight cases with extensive written documentation were discovered, spanning a 6 years interval between 1983 and 1989, involving 21 epidural, 6 spinal and 1 caudal anaesthesias, half with surgical and half obstetrical indication, and excluding all other blocks. Twenty four out of the 28 patients were relatively healthy. ⋯ Twenty two had a poor outcome: 8 deaths, 7 severe neurological injuries, a baby was dead and another child had severe neurobehavioral sequellae. The author points out the limitation of this study--a biased sample of all adverse events and inability to derive an incidence. However some of these events reveal patterns of anaesthetic management which lead to poor outcomes.
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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.