Anesthésie, analgésie, réanimation
-
Anesth Analg (Paris) · Jan 1981
[Percutaneous cordotomy. Actual situation in pain surgery (author's transl)].
A personal experience with 138 percutaneous cordotomies is presented. The results and complications are compared to those of 49 open cordotomies at C1-C2 level. ⋯ For this reason the author prefers in certain cases open cordotomy in a modified microsurgical technique which is described. It is outlined that in the authors opinion cordotomy should be restricted to cancer pain.
-
Anesth Analg (Paris) · Jan 1980
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison between the analgesic effects of buprenorphine and morphine in conscious man (author's transl)].
Morphine chlorhydrate and buprenorphine chlorhydrate are given intramuscularly at increasing doses to patients suffering from intense pain in the facial or trigeminal nerves territory. No other drugs are used. The diverses groups of ten patients received respectively: --morphine: 0.100, 0.150, 0.200 mg/kg; --buprenorphine: 0.0015, 0.003, 0.006 mg/kg. ⋯ Yet, concerning buprenorphine, the analgesia is not more intense with the 0.006 mg/kg dose, than with the 0.003 mg/kg dose. This phenomenon, if confirmed, would be an important limitation for the clinical use of this drug. For equianalgesic doses buprenorphine and morphine give an analgesia similar in time of initiation and in duration.
-
Anesth Analg (Paris) · Jan 1980
[Anesthetic management for delivery of 38 cardiac patients (author's transl)].
The choice of anesthesia is discussed in connection with a serie of 38 women cardiac and pregnant cared from 1976 to 1979, 32 of them having delivered a child. Peridural analgesia improves the labour and the delivery without inconveniene for either mother of child, but general anesthesia must be prefered for cesarean section. Anticoagulant therapy is a contra-indication for peridural analgesia.
-
Anesth Analg (Paris) · Jan 1980
[Testing of neuromuscular function during anaesthesia (author's transl)].
Traditionally clinical signs are used to evaluate neuromuscular blockade during anaesthesia. Recent research has shown that patients managed by clinical signs alone will often demonstrate postoperative residual curarization. The systematic use of nerve stimulator during and after anaesthesia can facilitate accurate evaluation and management of neuromuscular blockade. ⋯ To refine the evaluation of the muscular contraction it is possible to connect the thumb to a recorder. Use of a nerve stimulator facilitates more appropriate and individualized dosage of the neuromuscular blocking agents. In this way one may achieve an optimal level of surgical relaxation, avoid overdosage of the neuromuscular blocking agents and diminish the risk of post-operative residual curarization.
-
Our first care when anesthetizing a child having a head injury treated by neurosurgery is to preserve a correct blood perfusion pressure, by using anesthetic agents without vasodilator potency and to control cerebral oedema. The most suitable anesthetic agents are thiopentone, dextromoramide or fentanyl, diazepam and pancuronium. Artificial ventilation is used nearly systematically trying to obtain mild hypocapnia (PaCO2:30-35 Hg pH 7.45) inducing a benefic cerebral vasoconstriction. About the antiedematous agents, mannitol gives best results in case of emergency.