Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1991
Review[The use of opioids by the regional route in obstetrics].
Epidural and spinal administration of opioids in obstetrics can be used during labour and for cesarean section. Although these routes of administration are of limited use when opiates are employed as sole agents, the association with local anesthetics may improve the characteristics of analgesia. The administration of a local anesthetic-opiate mixture allows a reduction of the total amount of local anesthetics, thus reducing the incidence of maternal hypotension and the percentage of instrumental extraction. ⋯ Opioids may also be used for postoperative analgesia after cesarean section. Since they could be responsible for an opioid-related respiratory depression in the mother and the neonate, a strict supervision is absolutely necessary following this particular mode of administration of opiates. If human and technical means of supervision failed to bring into operation, it would be better not to use opioids by the spinal route in such a context.
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Cahiers d'anesthésiologie · Jan 1991
Review[Secondary effects of opioids administered by the regional route].
The administration of narcotics in the subarachnoid or the epidural space is gaining acceptance for postoperative pain relief. However, the potential side effects of intrathecal and epidural use of opioids are the following: early and late respiratory depression, pruritus, nausea and vomiting, urinary retention. ⋯ Naloxone can be used to reverse the depression. Pruritus can occur in 10 to 30% of patients receiving morphine; 10 to 30% nausea and vomiting, and urinary retention occurs in 20 to 50% of patients.
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Postoperative analgesia using propacetamol was studied in 50 patients, 42 +/- 16 years old, after little or moderate surgery. Two grams of propacetamol in intravenous perfusion were administered every six hours. Three scales were utilized to note the intensity of the pain (simple verbal, behavioral and visual analogue scales), before the first injection and, one, four, six hours after. From this study, satisfactory analgesic efficiency and good tolerance of propacetamol were established.
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Cahiers d'anesthésiologie · Jan 1991
[Peridural obstetrical analgesia and the cicatricial uterus. A 4-year evaluation].
191 women with previous cesarean section in 291 indexed between October 1985 and September 1989 underwent a trial of labor. 146 patients received epidural analgesia in the course of labor. Vaginal delivery occurred in 126 patients (86.3%). Duration for epidural analgesia in labour was 163 +/- 110 min. ⋯ We report four uterine dehiscences and one rupture. In no case, epidural analgesia did not delay the diagnosis. The use of epidural analgesia for trial of labor in previous cesarean section did not increase maternal or fetal risk.
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Cahiers d'anesthésiologie · Jan 1991
Comparative Study[The importance of the preoperative measurement of hemoglobin concentration. Evaluation of a colorimetric method (Hemocue)].
The present study compares two methods of haemoglobin measurement during surgery in 40 patients aged 1 to 85 years. The reference method is the Coulter STKS based on red cell count and mean cellular content in haemoglobin measurement. The method tested (Hemocue-Diagnostics Transfusion) allows instantaneous determination of haemoglobin on a 10 mu sample by measuring infrared absorption by haemoglobin in the 565 and 880 nm wavelengths. ⋯ On capillary samples, there was a poor agreement between Hemocue and Coulter since the mean difference was -0.272 g/dl-1 with the following limits of agreement: -2.356 g/dl-1 and +1.812 g/dl-1. Only 92% of the observed differences were within the 95% confidence interval, with 17% of these being greater than the clinically accepted limit of 1 g/dl-1. The precision of Hemocue measurement of capillary blood haemoglobin was only +/- 16%.(ABSTRACT TRUNCATED AT 250 WORDS)