Cahiers d'anesthésiologie
-
Cahiers d'anesthésiologie · Jan 1993
Review[Treatment of algodystrophies. The point of view of an anesthetist].
Algodystrophy is a complex and heterogenous syndrome, better defined as a subtype of Reflex Sympathetic Dystrophy syndrome (RSD). The pathophysiological theory of RSD has been supported by basic studies and clinical efficacy of sympathetic blocks. Results may be good, but some of RSD are not responsive to sympathetic blocks, and distinction between sympathetic dependent and independent pain has been proposed as subtypes of RSD. ⋯ Some new treatments rise interesting fundamental questions and some of them are under evaluation. Psychological support is the third part of treatment of these chronic pain patients. Multidisciplinary organisation, as offered by pain centers, can help to understand this syndrome and to elaborate guidelines for diagnosis, treatment and research programs.
-
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.
-
Anaesthesia for ambulatory surgery implies a strict selection of patients. Screening tests are non specific, compared to these ordered for in-patients. ⋯ The detection of an asymptomatic anomaly by routine testing is extremely infrequent and does not lead to changes in the operating schedule or in the outcome of anaesthesia. Clinical examination and patient history are the only predictive elements, so systematic complementary tests should be abandoned and replaced by judicious selective prescription.