Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1992
Review[Fetal and neonatal effects of perimedullary opioids used in obstetrical anesthesia].
The use of spinal or epidural narcotics is more and more frequent in obstetric patients since it enhances the analgesia induced by local anesthetics. However, specific information regarding their fetal and neonatal effects is rare. Fetal effects are mainly dependent on the respiratory and hemodynamic maternal effects, and thus usually limited when usual low dosages of intraspinal narcotics are used. ⋯ In contrast, the evaluation of Apgar and neurobehavioral scores, performed for all the narcotics used, shows little changes when low dosages are used. However, the use of larger dosages epidurally is associated with an increased frequency of low neurobehavioral scores. Therefore, the use of low dosages of epidural narcotics is recommended since there is little available information about the risk of neonatal respiratory depression and no clear maternal advantage of higher dosages.
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The laryngeal mask (LM) is a new concept developed by Brain. Easily inserted, the LM allows appropriate ventilation without the disadvantages of either the facial mask or the endotracheal intubation with its own complications. The limits of its use concern all the cases of reduction of thoracopulmonary compliance and full stomach. ⋯ Moreover, the LM is widely used for ENT and ophthalmic surgeries, in paediatric and adult procedures. Many cases of foreseeable or unforeseeable difficult intubation have been resolved by the insertion of a LM, allowing secondary intubation through the mask. Further investigations are required in order to evaluate the real limits and indications for its extended use.
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Five children with cancer pain were given continuous intrathecal morphine or fentanyl infusion associated with bupivacaine 0.25% without epinephrine. The morphine daily dose varied from 0.1 mg.kg-1 to 1 mg.kg-1, the maximum daily dose of fentanyl was 0.1 mg.kg-1 associated with the same dose of intravenous fentanyl, and the maximum daily dose of bupivacaine was 1 mg.kg-1. Intrathecal treatment was started after oral and epidural morphine treatment had failed. ⋯ A satisfactory analgesia was achieved until demise occurred. In all children, urinary retention was the only side effect of the therapy. Therefore, intrathecal opioid and bupivacaine may be indicated after oral morphine therapy has failed in children with advanced cancer refractory pain.