Cahiers d'anesthésiologie
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Blocking the median, the radial, the ulnar and the musculo-cutaneous nerves, alone or all together provide sufficient anaesthesia for hand and forearm surgery. Because of frequent anatomical variations and the possibility of a double nerve supply in some territories, blockade must be extended to the adjacent nerves. Tourniquet over the elbow is the only limit for these blocks, but they are useful to provide per and postoperative analgesia during general anaesthesia, and in some cases to improve the efficiency of brachial plexus block.
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Regional anaesthesia involves its own risks of which five main categories appear to stand out: 1. Excessive indications, especially of epidural anaesthesia instead of nerve blocks or general anaesthesia. 2. ⋯ Neurological complications of traumatic punctures, such as nerve root or dura mater injury. 5. Excessive complementary sedation.
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PDPH are not the privilege of spinal anaesthesia, as they can occur in various circumstances including epidural anesthesia, surgical wound of the dura, spinal tap and/or myclography. Diagnosis PDPH can be discussed with four etiologies: cortical vein thrombosis, meningitis, intracranial haematomas (intracerebral, subdural) or migraine. PDPH result from the leakage of CSF via the dural hole, responsible of hypotension of CSF in the subarachnoid compartment. ⋯ After then, epidural blood patch allows 90% success rate. Other therapeutic proposals are discussed. Finally, prevention of PDPH appears to be the keypoint, paying particular attention to the choice of the needle and of the spinal puncture technique.
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Cahiers d'anesthésiologie · Jan 1993
Review[Prevention and treatment of hypotension during spinal anesthesia].
Spinal and epidural anaesthesias alter self-regulation of arterial pressure as they lead to a sympathetic blockade. The extent and the speed of appearance of this blockade conditions the magnitude of the decrease of arterial pressure. ⋯ Correcting a deep arterial hypotension demands first of all the use of vasoconstricting agents the choice of which depends on the site of the anaesthesia and on the cardiovascular condition of the patient. The occurrence of bradycardia more often indicates a hypovolaemic state.
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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.