Cahiers d'anesthésiologie
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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.
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Regional anesthesia represents a selective approach in shoulder surgery. The following technics can be used: brachial plexus block, cervical epidural and intra-articular anesthesia. The advantages of each technique are discussed.
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Cahiers d'anesthésiologie · Jan 1993
Review[Is there an advantage to using opioid combinations by the peridural route?].
Epidural opioids provide a potent analgesia not devoided of side effects. In addition, epidural administration of lipid soluble opioids has no clear advantage over the IV route. Combination of epidural opioids with other analgesics may strengthen analgesia and may decrease the incidence of side effects because of a reduction in the amount of opioid administered. ⋯ Clonidine, which is a selective alpha-2-adrenergic agonist has been demonstrated to improve and to prolong analgesia produced by opioids in postoperative patients. Clonidine administration induces side effects, like sedation, bradycardia and hypotension, but allows to highly reduce the opioid dose. None of the combined techniques of analgesia implies that monitoring of the side effects of opioids has to be reduced.
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Cahiers d'anesthésiologie · Jan 1993
Review Comparative Study[A comparative study of recovery following maintenance of anesthesia with propofol or isoflurane. An attempt to synthesize current data].
Quality of recovery is a means to improve anaesthetic safety during postoperative time, in post-anaesthesia recovery room and especially when the patient returns to his unity. The comparison of recovery after maintenance of anaesthesia with propofol or isoflurane shows that, for 50 to 60 min surgical procedures, results are significantly better with isoflurane. Review of literature shows that, for less than 30 min operations, propofol seems to give best recovery. For more than 30 min operations, isoflurane enables better quality recovery.