Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1993
Randomized Controlled Trial Comparative Study Clinical Trial[Preventive treatment of hemodynamic disorders during conventional spinal anesthesia].
The prevention of blood pressure fall during a conventional spinal anaesthesia effected with 20 mg (4 ml) of isobaric 0.5 p. 100 bupivacaine relies on the use of vascular filling and/or a vasoconstrictor. A randomized prospective study was performed to evaluate the comparative efficacy of these two treatments. 148 patients were included and divided into three groups. Group I (n = 50): 2.5 mg IV bolus of etilefrine followed by continuous infusion (0.35 mg.kg-1.h-1). ⋯ Haemodynamic changes were fewer and less important in the etilefrine group compared with the saline infusion group. No failure and a better tolerance in the vasoconstrictor group were also to be noticed. These clinical data suggest that etilefrine could meet satisfactorily the therapeutic requirements.
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Cahiers d'anesthésiologie · Jan 1993
Comparative Study[A comparison of 3.5% dextran 40 and 4% albumin used as volume expansion solutions following heart surgery. Effects on the hemodynamic parameters and the oncotic colloidal pressure].
Dextran 40 (3.5%), a synthetic colloid solution used as a volaemic expander was compared to albumin 4% in 30 patients (15 in each group) during the first twenty hours after cardiac surgery. The patients were administered 500-600 ml.m-2 either dextran 40 or albumin at a rate of 10-12 ml.kg-1 x h-1 between 2nd and 4th postoperative hour. In the two groups, heart rate and mean arterial pressure did not change significantly but left and right filling pressures and cardiac index increased similarly. ⋯ Diuresis was not different in the two groups. No side effect was observed. Dextran 40 was efficient and could be used as a volaemic expander after cardiac surgery.
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The use of regional anaesthesia in day care practice is discussed. Five criteria of discharge are described: the four "A"s: awake, ambulation, alimentation, analgesia plus micturition. Complementary sedation with the regional block, if needed, should be midazolam and fentanyl. ⋯ However, urinary retention and orthostatic hypotension can occur. Furthermore the risk of headache is not a contraindication to an ambulatory practice if some guidelines are observed. In addition, penile blocks and caudal blocks are widely used in pediatrics.
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The intravascular administration and the high blood resorption of local anesthetic agents are known to induce neurotoxic accidents. However, the use of potent local anesthetic drugs such as bupivacaine is responsible for serious cardiotoxic accidents with a mortality of about 50%. Indeed, bupivacaine induces both electrophysiologic and haemodynamic disturbances with the occurrence of conduction blocks, arrhythmias and cardiovascular collapse. ⋯ We demonstrated that the combination of clonidine and dobutamine is efficient to reverse both haemodynamic and electrophysiologic impairments induced by a large dose of bupivacaine in anesthetized dogs. Whatever the efficiency of specific resuscitation, it must be emphasized that prevention of toxic accident must always include: the best choice of local anesthetic drug (e.g.: lidocaine+alpha-2 agonist vs bupivacaine), test dose, aspiration and slow administration. Finally, the monitoring of regional anaesthesia must be similar to that in use for general anaesthesia and drugs and devices for resuscitation must be ready.
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Cahiers d'anesthésiologie · Jan 1993
Review[Vascular filling and vasopressors: effects on the fetus and the newborn infant].
Epidural analgesia and anaesthesia are more and more commonly used in modern obstetrical anaesthesia practice leading to the frequent use of fluid infusion and vasopressors. Fetal and neonatal effects of these treatments are reviewed here and may be summarized as follows: 1) Prolonged and/or severe maternal arterial hypotension may induce fetal hypoxia and acidosis, especially when fetal status is already compromised (uteroplacental insufficiency). 2) Preventive fluid hydratation with crystalloids associated with left uterine displacement are always useful to avoid maternal hypotension. 3) Dextrose-containing solutions are undesirable for the prevention of treatment of maternal hypotension as they may induce delayed neonatal hypoglycemia. 4) When the parturient is correctly hydrated, the rapid use of intravenous ephedrine is efficient in restoring normal maternal arterial pressure and has no deleterious effect on the fetus and the newborn. Finally, rapid, repetitive and non-invasive monitoring of maternal arterial pressure is the prerequisite to a rapid management of maternal hypotension which is essential to avoid any deleterious effect to the fetus and the neonate.