Cahiers d'anesthésiologie
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Lumbar plexus block via the inguinal approach is indicated for analgesia following knee surgery. The technique consists in an injection of the anaesthetic solution through a catheter placed into the space limited by the fascia of the iliopsoas muscle. In this area are the different nervous roots which constitute the plexus. A good technique and a good knowledge of the anatomy of this region are necessary for a successful block and for the safety of the patient.
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Cahiers d'anesthésiologie · Jan 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Hemodynamic effect of intrathecal clonidine].
Intrathecal administration of bupivacaine and clonidine results in a significant prolongation of both motor and sensitive blocks but side effects-hypotension and bradycardia-are observed. We compared two groups of patients allocated randomly. ⋯ Some possible explanations are discussed. No complications due to clonidine were observed.
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Regional anaesthesia has been increasingly popular in paediatric patients of all ages, especially because some techniques afford excellent per and post-operative pain relief. However, side effects may occur. Particularly, systemic toxicity from bupivacaine administration is associated with intravascular injection or overdosage. ⋯ Management of the best method of block, doses and local anaesthetics or adjuvants according age, requires likely specific teaching in training team. An effort to provide appropriate guidelines and training to ward nurses is necessary to improve security when regional blockade is used for postoperative analgesia. In every cases, physician's experience is the best argument of choice.
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Caudal block is the most frequently epidural block performed in children. A better knowledge of the child anatomy, physiology and pharmacokinetics has increased the safety of regional anaesthesia in children. ⋯ The children, as well as adult, have benefited of new drugs (opioids, alpha 2 agonists) which increase the indications regarding time duration or pain intensity. If complications are still possible the respect of safety rules and the use of adapted equipment make caudal block a safe regional anaesthesia.
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Airway control and maintenance of effective assisted ventilation are an absolute priority in emergency medicine. Developed by Brain in 1988, the laryngeal mask offers a new means of ventilation management and is a reliable compromise between the face mask and endotracheal tubing. The laryngeal mask ensures no protection against gastric contents inhalation and its use is limited in patients with decreased thoracopulmonary compliance. ⋯ The laryngeal mask cannot and does not replace endotracheal tubing which remains the only technique that guarantees upper airway patency and protection as well as efficient ventilation control. However, in some situations tubing may prove difficult and even, at times, impossible to perform. This is when the laryngeal mask will come in handy, either as a temporary solution or as an alternative to difficult or impossible tubing techniques.