Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1993
Randomized Controlled Trial Comparative Study Clinical Trial[The use of antifibrinolytics in heart surgery. 3 prospective studies].
In order to assess the validity of antifibrinolytic treatments in cardiac surgery, three successive controlled randomized double-blind studies were carried out in patients undergoing a first (n = 60) or repeat surgical procedure because of a valvular or coronary disease. The first study aimed at stating the value of low doses of aprotinin compared with "classical" ones and a placebo. The second study was planned to compare tranexamic acid with low-dosed aprotinin and a placebo. ⋯ Tranexamic acid was found as effective as aprotinin on platelets function. No significant changes of seric creatinine was observed from preoperative to 4th postoperative day. A valvular non-obstructive thrombosis occurred on the second postoperative week in the tranexamic acid group.
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Cahiers d'anesthésiologie · Jan 1993
Randomized Controlled Trial Clinical Trial[Postoperative respiratory depression following ambulatory anesthesia for abortion. Evolution of the ventilatory response to CO2 following the use of propofol alone or in association with different opioids: comparison with midazolam in the same situation].
Sixty patients, undergoing minor gynaecologic procedures, were prospectively enrolled in this randomized study. They were anaesthetized with either propofol or midazolam supplemented or not with fentanyl or alfentanil. ⋯ No respiratory depression was observed when propofol was used alone. By contrast, midazolam alone induced a significant respiratory depression during the first postoperative hour.
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Cahiers d'anesthésiologie · Jan 1993
Review[The use of patient-controlled analgesia by the obstetrical patient].
Patient-controlled analgesia is a technique of analgesia recently developed for obstetrical pain. During labor, PCA using intravenous administration has already been used for more than a decade but meperidine may be conceivable replaced by fentanyl with which maternal and neonatal side-effect seem reduced. ⋯ After cesarean section, PCA using intravenous morphine has been shown to produce less pain relief than epidural morphine but is associated with a high degree of satisfaction. The wider use of PCA in obstetrics is however limited by its cost and will thus require evaluation of its cost/effectiveness ratio.
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Cahiers d'anesthésiologie · Jan 1993
[Loco-regional anesthesia and orthopedic surgery of the shoulder].
Interscalene block can induce by itself anesthesia for shoulder surgery, if the opening does not reach the delto-pectoral site nor the shoulder-blade, but medical indications must be thoroughly talked over on account of the risk of phrenic paralysis with patients suffering from breezing trouble, and the surgical position that may disturb the anesthesiologist in case he has to increase anesthesia. A superficial cervical plexus block is required in anesthesia of the upper part of the shoulder. ⋯ Today we prefer set interscalene block before the patient is anaesthetized, searching for paresthesias with a thin needle: this process does not take long to install, it is relatively painless and provides excellent analgesia during the per and post-surgical period, until the next day with long acting local anesthetics. Not any complication happened in fifty patients for one year.