Cahiers d'anesthésiologie
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The laryngeal mask (LM) is a new concept developed by Brain. Easily inserted, the LM allows appropriate ventilation without the disadvantages of either the facial mask or the endotracheal intubation with its own complications. The limits of its use concern all the cases of reduction of thoracopulmonary compliance and full stomach. ⋯ Moreover, the LM is widely used for ENT and ophthalmic surgeries, in paediatric and adult procedures. Many cases of foreseeable or unforeseeable difficult intubation have been resolved by the insertion of a LM, allowing secondary intubation through the mask. Further investigations are required in order to evaluate the real limits and indications for its extended use.
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Five children with cancer pain were given continuous intrathecal morphine or fentanyl infusion associated with bupivacaine 0.25% without epinephrine. The morphine daily dose varied from 0.1 mg.kg-1 to 1 mg.kg-1, the maximum daily dose of fentanyl was 0.1 mg.kg-1 associated with the same dose of intravenous fentanyl, and the maximum daily dose of bupivacaine was 1 mg.kg-1. Intrathecal treatment was started after oral and epidural morphine treatment had failed. ⋯ A satisfactory analgesia was achieved until demise occurred. In all children, urinary retention was the only side effect of the therapy. Therefore, intrathecal opioid and bupivacaine may be indicated after oral morphine therapy has failed in children with advanced cancer refractory pain.
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Cahiers d'anesthésiologie · Jan 1992
[Propofol anesthesia for ophthalmologic surgery in the elderly].
Fifty patients more than 70 years old, ASA I and II, NYHA I and II, were anaesthetized by propofol for cataract or retinal detachment surgery. Induction was carried out by a propofol slow injection (0.5-1 mg.s-1) until loss eyelash reflex (mean dose 0.728 mg.kg-1) and completed by fentanyl 2 micrograms.kg-1 and vecuronium 0.08 mg.kg-1. After intubation, anaesthesia was maintained with nitrous oxide and continued infusion of propofol (mean dose 4.48 mg.kg-1.h-1) according to haemodynamic parameters. ⋯ Recovery was as fast and good as in younger patients. It should be emphasized that propofol doses must be reduced in elderly patients so as to preserve a satisfactory haemodynamic stability. Reasons for increased sensitivity to propofol in elderly patients are briefly discussed.