Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1994
Comparative Study[Comparative study of propofol versus thiopental-halothane in the occurrence of oculocardiac reflex and postoperative vomiting after surgery for strabismus in children].
Strabismus surgery in children is associated with side-effects, intraoperative oculocardiac reflexes in relation with muscular tractions and postoperative vomiting. Studies with propofol anaesthesia in this surgery have shown a lower incidence of these side-effects. So, a prospective study compared these incidences with propofol (P) versus thiopental/halothane (T+H) anaesthesia. Propofol appears to be efficient in reducing postoperative vomiting but might be associated with more frequent OCR.
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Cahiers d'anesthésiologie · Jan 1994
Comparative Study[Effect of epidural analgesia on obstetrical mechanics].
Epidural analgesia is the most effective technique of pain relief during labour. However, there is an old suspicion that it modifies the course of labour. ⋯ The deleterious effect on the second stage is primarily due to motor blockade of the pelvic floor muscles which normally exert an important influence on fetal accommodation. It is possible to limit the negative effect of motor blockade by using either a combination of low-dose bupivacaine and opioid, or injection of a lipophilic opioid through a subarachnoid catheter, or by using the new amide local anaesthetic, ropivacaine, which is claimed to possess less motor blocking action.
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Giving a definition of analgesia in ICU needs to answer several questions: Why sedation? Which drugs can we use? How can we deal with sedation? (monitoring, continuous administration, weaning...)? Two different types of sedation must be considered: treatment-sedation (status epilepticus, tetanus, intracranial hypertension...) and comfort-sedation in anxious and/or restless and/or painful patients and in those necessitating mechanical ventilation. Analgesic consumptions vary widely with diseases and their outcome, background diseases and ICU environment. Several studies have shown that pain and analgesia are frequently neglected in ICU. ⋯ A particular place is reserved to regional techniques, often underused in ICU. Indications are then fully discussed, according to several specific pathological conditions. Monitoring and weaning of sedation are also discussed at the end of the review.
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Headache and low back pain are common minor complications after epidural anaesthesia. Headache is due to cerebrospinal leakage through the site of accidental dural puncture. ⋯ Different mechanisms are suggested: needle trauma, myotoxicity of local anaesthetic and postural problem. Large prospective randomized studies are yet necessary to clarify the role of epidural anaesthesia, the duration of symptoms and the therapeutic.
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Cahiers d'anesthésiologie · Jan 1994
[Laryngeal masks in pediatric anesthesia. Apropos of 251 cases].
A series of 251 anaesthesias with a laryngeal mask (LM) in a paediatric surgery unit is studied retrospectively. After some short training, using LM is most often easy and allows a good airway control without any frequent or severe complications. Therefore this technique should quickly supplant the facial mask and many endotracheal intubations.