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SCOPUS: ar.j, info:eu-repo/semantics/published

SCOPUS: ar.j, info:eu-repo/semantics/published

In this study, we evaluated the effect of two doses of intrathecal sufentanil combined with bupivacaine and epinephrine on the incidence of pruritus and on the duration and quality of analgesia. One hundred five parturients were enrolled in this randomized, double-blinded, placebo- controlled study. They received either intrathecal 1.25 mg bupivacaine and 25 μg epinephrine (control group); 1.25 mg bupivacaine, 25 μg epinephrine, and 2.5 μg sufentanil (2.5-μg group); or 1.25 mg bupivacaine, 25 μg epinephrine, and 5 μg (5-μg group). Pain relief was assessed 10 min after injection, and pruritus was recorded at 30 min by a blinded observer. The study ended when the parturients requested further analgesia. There were no demographic differences among groups. Ninety of 103 parturients achieved complete pain relief with the initial dose, 11 patients in the control group (P < 0.004, control versus both sufentanil groups), and 2 patients in the 2.5-μg group needed a supplemental epidural bupivacaine. Pruritus was absent in the control group (P < 0.0001, control versus both sufentanil groups), whereas it was present in 36% of the 2.5-μg group and in 66% of the 5-μg group (P = 0.015, 2.5-μg versus 5-μg group). The mean duration of analgesia was similar in patients receiving sufentanil (2.5-μg group: 133 ± 55 min; 5-μg group: 142 ± 52 min) but was significantly higher than the control group (56 ± 32 min). Reducing the sufentanil dose from 5 μg to 2.5 μg when combined with bupivacaine and epinephrine, decreases the incidence of pruritus without impeding the quality or duration of analgesia. Implications: We evaluated two different doses of intrathecal sufentanil combined with bupivacaine and epinephrine for labor analgesia. Sufentanil 2.5 μg offered an advantage over sufentanil 5 μg because, while providing the same quality and duration of analgesia, it was associated with a reduced incidence of pruritus., SCOPUS: ar.j, info:eu-repo/semantics/published

SCOPUS: le.j, info:eu-repo/semantics/published

We report a case of surgical transsection of the naso-endotracheal tube during a Lefort I maxillary osteotomy, resulting in severe intra-operative ventilatory difficulties. The management of this problem and a brief review of the literature are presented., SCOPUS: ar.j, info:eu-repo/semantics/published

We report a case of surgical transsection of the naso-endotracheal tube during a Lefort I maxillary osteotomy, resulting in severe intra-operative ventilatory difficulties. The management of this problem and a brief review of the literature are presented., SCOPUS: ar.j, info:eu-repo/semantics/published

SCOPUS: le.j, info:eu-repo/semantics/published

Peritoneal insufflation with CO2 has been associated with profound cardiorespiratory disturbances, which may modify cerebral blood flow (CBF), particularly in hypertensive patients in whom CBF autoregulation is altered. We report a case of bilateral mydriasis durin laparoscopic gastrectomy in a patient with chronic hypertension followed by a coma lasting several hours and we shortly discuss the possible mechanisms involved., SCOPUS: ar.j, info:eu-repo/semantics/published

We report a case of a woman with carnitine palmityl deficiency (CPT) and idiopathic thrombocytopenic purpura, presenting in active labour at 38 weeks gestation. We discuss different anaesthetic factors involved with both diseases, and we propose an optimal management of such cases. Neuraxial analgesia with minimal motor blockade is indicated in early labour because it is necessary to alleviate stress in order to avoid rhabdomyolisis associated with CPT deficiency. Neuraxial analgesia is also needed because the theoretical risk of performing a caesarean section is higher than in a normal population, first because labour must be kept as short as possible and secondly because the possible thrombocytopenia in the baby precludes the use of instrumental delivery., SCOPUS: ar.j, info:eu-repo/semantics/published

Background and Objectives. During a combined spinal and epidural technique, extension of sensory block by epidural injection of saline or bupivacaine has been demonstrated and attributed to a volume effect or to the combination of a volume effect with a focal anesthetic effect. This two-part study was designed to evaluate the time dependency of the volume effect and the local anesthetic effect on the mechanism of spinal block extension Methods. We performed two prospective studies. Thirty patients were randomized in each study. A combined spinal and epidural was performed in a sitting position in all groups. The patients in the first study received 15 mg hyperbaric bupivacaine intrathecally and were placed supine 2 minutes after spinal injection. They received 10 mL epidural saline either 5 minutes after spinal (group A) or 20 minutes after spinal (group B) compared to a control group (group C). The patients in the second study received 12.5 mg hyperbaric bupivacaine intrathecally and were placed supine 5 minutes after spinal injection. They then received epidurally either 10 mL saline 7 minutes after spinal (group D) or 10 mL bupivacaine 7 minutes after spinal (group E) or noticing (group F). Sensory block levels were assessed by a loss of sensation to cold using other. Results. In the first portion of this study, in group A, area under the curve of sensory block levels by time from 10 to 40 minutes after spinal injection, and maximum sensory block levels were significantly higher (P < .05) compared to groups B and C. In the second portion of the study, sensory block levels were comparable at all times in the three groups. Conclusions. During a combined spinal and epidural technique with the use of hyperbaric bupivacaine, the volume effect is time dependent anti is seen when epidural top up is done soon after spinal injection. This volume effect is abolished when patients are left seated for 5 minutes after spinal injection. The local anesthetic effect is not demon, SCOPUS: ar.j, info:eu-repo/semantics/published

info:eu-repo/semantics/published

We report a case of a woman with carnitine palmityl deficiency (CPT) and idiopathic thrombocytopenic purpura, presenting in active labour at 38 weeks gestation. We discuss different anaesthetic factors involved with both diseases, and we propose an optimal management of such cases. Neuraxial analgesia with minimal motor blockade is indicated in early labour because it is necessary to alleviate stress in order to avoid rhabdomyolisis associated with CPT deficiency. Neuraxial analgesia is also needed because the theoretical risk of performing a caesarean section is higher than in a normal population, first because labour must be kept as short as possible and secondly because the possible thrombocytopenia in the baby precludes the use of instrumental delivery., SCOPUS: ar.j, info:eu-repo/semantics/published

info:eu-repo/semantics/published

Background and Objectives. During a combined spinal and epidural technique, extension of sensory block by epidural injection of saline or bupivacaine has been demonstrated and attributed to a volume effect or to the combination of a volume effect with a focal anesthetic effect. This two-part study was designed to evaluate the time dependency of the volume effect and the local anesthetic effect on the mechanism of spinal block extension Methods. We performed two prospective studies. Thirty patients were randomized in each study. A combined spinal and epidural was performed in a sitting position in all groups. The patients in the first study received 15 mg hyperbaric bupivacaine intrathecally and were placed supine 2 minutes after spinal injection. They received 10 mL epidural saline either 5 minutes after spinal (group A) or 20 minutes after spinal (group B) compared to a control group (group C). The patients in the second study received 12.5 mg hyperbaric bupivacaine intrathecally and were placed supine 5 minutes after spinal injection. They then received epidurally either 10 mL saline 7 minutes after spinal (group D) or 10 mL bupivacaine 7 minutes after spinal (group E) or noticing (group F). Sensory block levels were assessed by a loss of sensation to cold using other. Results. In the first portion of this study, in group A, area under the curve of sensory block levels by time from 10 to 40 minutes after spinal injection, and maximum sensory block levels were significantly higher (P < .05) compared to groups B and C. In the second portion of the study, sensory block levels were comparable at all times in the three groups. Conclusions. During a combined spinal and epidural technique with the use of hyperbaric bupivacaine, the volume effect is time dependent anti is seen when epidural top up is done soon after spinal injection. This volume effect is abolished when patients are left seated for 5 minutes after spinal injection. The local anesthetic effect is not demon, SCOPUS: ar.j, info:eu-repo/semantics/published

Peritoneal insufflation with CO2 has been associated with profound cardiorespiratory disturbances, which may modify cerebral blood flow (CBF), particularly in hypertensive patients in whom CBF autoregulation is altered. We report a case of bilateral mydriasis durin laparoscopic gastrectomy in a patient with chronic hypertension followed by a coma lasting several hours and we shortly discuss the possible mechanisms involved., SCOPUS: ar.j, info:eu-repo/semantics/published

Background: Obesity is an important respiratory risk factor after abdominal surgery. Laparoscopic surgical techniques seem beneficial in obese patients in terms of respiratory morbidity, with a faster return to normal respiratory function. However; there is little information about intraoperative respiratory mechanics and about patient tolerance to abdominal insufflation in the morbidly obese. Methods: We studied respiratory mechanics and arterial blood gases in 15 morbidly obese patients (mean BMI=45) undergoing laparoscopic gastroplasty under general anaesthesia and controlled ventilation. Respiratory mechanics were analysed using side-stream spirometry. Results: When compared to preinsufflation values, servocontrolled abdominal insufflation to 2.26 kPa caused a significant decrease in respiratory system compliance (31%), a significant increase in peak (17%) and plateau (32%) airway pressures at constant tidal volume with a significant hypercapnia but no change in arterial O2 saturation. Respiratory system compliance and pulmonary insufflation pressures returned to baseline values after abdominal deflation. Conclusion: These alterations in pulmonary mechanics are less than those observed with comparable degrees of abdominal inflation in non-obese patients, and were well tolerated. From the point of view of intraoperative respiratory mechanics, laparoscopic surgery is safe in morbidly obese patients., SCOPUS: ar.j, FLWIN, info:eu-repo/semantics/published

Background: In nonobese patients, peritoneal insufflation has consistently been shown to influence parameters of preload and afterload as well as cardiac output. Obese patients have an abnormal and particular cardiovascular status. The aim of this study was to investigate the hemodynamic changes induced by an increase of intra-abdominal pressure in morbidly obese patients (MOP). Methods: Standard general anesthetia was administered to 15 informed MOP (body mass index > 40 kg/m2) scheduled for laparoscopic gastroplasty. Hemodynamic parameters were measured by thermodilution through a pulmonary artery catheter and through invasive blood pressure monitoring. Results: CO2 insufflation with an intra-abdominal pressure of 17 mmHg caused a significant increase of mean arterial pressure (MAP) (33%, P = 0.005), mean pulmonary arterial pressure (MPAP) (40%, P = 0.001), pulmonary capillary wedge pressure (PCWP) (41%, P = 0.001), and central venous pressure (CVP) (55%, P = 0.001). The increase in diastolic filling pressures could be due to an increase in the filling volume or to a decrease in diastolic compliance. Ventricular volumes were not measured but we speculate that the rise in CVP, PCWP and MPAP is due to an increase in intrathoracic pressure as judged by the increase of pulmonary airway pressure. Stroke volume fell slightly (11%, P = 0.008), because of a reduction in transmural pressure and a fall in effective preload. Cardiac output rose slightly (16%, P = 0.005) because of an increase in heart rate (15%, P = 0.014) probably induced by sympathetic stimulation, which only became fully operative after 15 minutes. Conclusions: When compared to nonobese patients our obese patients tolerated the pneumoperitoneum surprisingly well, without experiencing fall in cardiac output. The hemodynamic consequences of peritoneal insufflation seem to be different in obese and nonobese patients., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction :The use of small gage pencil-point spinal needles may lead to sacral maldistribution of local anesthetics if the direction of the side - port opening is caudal and injection rate too slow (1). The purpose of this study was to observe if rapid injection of local anesthetics via a 27G Whitacre needle led to higher sensitive block levels compared to a 24G Sprotte needle. Methods :20 ASA I or II patients scheduled for elective orthopedic surgery of the lower limbs were randomized in two groups after 1KB approval and verbal consent. The two groups received a standard infusion line with 500ml lactate-Ringer solution. The first group received a combined spinal epidural anesthesia in a sitting position at L2 - L3 interspace via a 17G Tuohy-Weiss needle with loss of resistance to air after which a 27G long spinal needle with the side-port in a cephalad direction was inserted and 3ml heavy bupivacaine were injected in 10 seconds after obtaining free flow of CSF. The second group received spinal anesthesia in the same position with a 24G Sprotte needle with the side-port in a cephalad direction and received the same amount of heavy bupivacaine in 10 seconds. In the two groups, patients were placed supine four minutes after the spinal. All patients were monitored with one lead ECG, SpO2 and N1BP. Sensitive block levels were measured in the midline with ether every five minutes from 5 to 40 minutes after the spinal. Blood pressure was closely monitored and a 20% decrease or a blood pressure < 100 nunHg was treated by atropine or ephedrine or phenylephrine depending on the heart rate. Results :The two groups were demographically comparable. Sensitive block levels were significantly higher in the 27G group from 20 to the end of the measurements. At 20 minutes, mean levels in thoracic dermatomes were :5.6 in the 27G group and 7.8 in the 24G group ( p=0.024 / Mann-Whitney). At 25 minutes, mean levels in thoracic dermatomes were :5.1 in the 27G group and 7.1 in the 24G, SCOPUS: ar.j, info:eu-repo/semantics/published

Background: Obesity is an important respiratory risk factor after abdominal surgery. Laparoscopic surgical techniques seem beneficial in obese patients in terms of respiratory morbidity, with a faster return to normal respiratory function. However; there is little information about intraoperative respiratory mechanics and about patient tolerance to abdominal insufflation in the morbidly obese. Methods: We studied respiratory mechanics and arterial blood gases in 15 morbidly obese patients (mean BMI=45) undergoing laparoscopic gastroplasty under general anaesthesia and controlled ventilation. Respiratory mechanics were analysed using side-stream spirometry. Results: When compared to preinsufflation values, servocontrolled abdominal insufflation to 2.26 kPa caused a significant decrease in respiratory system compliance (31%), a significant increase in peak (17%) and plateau (32%) airway pressures at constant tidal volume with a significant hypercapnia but no change in arterial O2 saturation. Respiratory system compliance and pulmonary insufflation pressures returned to baseline values after abdominal deflation. Conclusion: These alterations in pulmonary mechanics are less than those observed with comparable degrees of abdominal inflation in non-obese patients, and were well tolerated. From the point of view of intraoperative respiratory mechanics, laparoscopic surgery is safe in morbidly obese patients., SCOPUS: ar.j, FLWIN, info:eu-repo/semantics/published

Introduction :The use of small gage pencil-point spinal needles may lead to sacral maldistribution of local anesthetics if the direction of the side - port opening is caudal and injection rate too slow (1). The purpose of this study was to observe if rapid injection of local anesthetics via a 27G Whitacre needle led to higher sensitive block levels compared to a 24G Sprotte needle. Methods :20 ASA I or II patients scheduled for elective orthopedic surgery of the lower limbs were randomized in two groups after 1KB approval and verbal consent. The two groups received a standard infusion line with 500ml lactate-Ringer solution. The first group received a combined spinal epidural anesthesia in a sitting position at L2 - L3 interspace via a 17G Tuohy-Weiss needle with loss of resistance to air after which a 27G long spinal needle with the side-port in a cephalad direction was inserted and 3ml heavy bupivacaine were injected in 10 seconds after obtaining free flow of CSF. The second group received spinal anesthesia in the same position with a 24G Sprotte needle with the side-port in a cephalad direction and received the same amount of heavy bupivacaine in 10 seconds. In the two groups, patients were placed supine four minutes after the spinal. All patients were monitored with one lead ECG, SpO2 and N1BP. Sensitive block levels were measured in the midline with ether every five minutes from 5 to 40 minutes after the spinal. Blood pressure was closely monitored and a 20% decrease or a blood pressure < 100 nunHg was treated by atropine or ephedrine or phenylephrine depending on the heart rate. Results :The two groups were demographically comparable. Sensitive block levels were significantly higher in the 27G group from 20 to the end of the measurements. At 20 minutes, mean levels in thoracic dermatomes were :5.6 in the 27G group and 7.8 in the 24G group ( p=0.024 / Mann-Whitney). At 25 minutes, mean levels in thoracic dermatomes were :5.1 in the 27G group and 7.1 in the 24G, SCOPUS: ar.j, info:eu-repo/semantics/published

Background: In nonobese patients, peritoneal insufflation has consistently been shown to influence parameters of preload and afterload as well as cardiac output. Obese patients have an abnormal and particular cardiovascular status. The aim of this study was to investigate the hemodynamic changes induced by an increase of intra-abdominal pressure in morbidly obese patients (MOP). Methods: Standard general anesthetia was administered to 15 informed MOP (body mass index > 40 kg/m2) scheduled for laparoscopic gastroplasty. Hemodynamic parameters were measured by thermodilution through a pulmonary artery catheter and through invasive blood pressure monitoring. Results: CO2 insufflation with an intra-abdominal pressure of 17 mmHg caused a significant increase of mean arterial pressure (MAP) (33%, P = 0.005), mean pulmonary arterial pressure (MPAP) (40%, P = 0.001), pulmonary capillary wedge pressure (PCWP) (41%, P = 0.001), and central venous pressure (CVP) (55%, P = 0.001). The increase in diastolic filling pressures could be due to an increase in the filling volume or to a decrease in diastolic compliance. Ventricular volumes were not measured but we speculate that the rise in CVP, PCWP and MPAP is due to an increase in intrathoracic pressure as judged by the increase of pulmonary airway pressure. Stroke volume fell slightly (11%, P = 0.008), because of a reduction in transmural pressure and a fall in effective preload. Cardiac output rose slightly (16%, P = 0.005) because of an increase in heart rate (15%, P = 0.014) probably induced by sympathetic stimulation, which only became fully operative after 15 minutes. Conclusions: When compared to nonobese patients our obese patients tolerated the pneumoperitoneum surprisingly well, without experiencing fall in cardiac output. The hemodynamic consequences of peritoneal insufflation seem to be different in obese and nonobese patients., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction: Combined Spinal Epidural technique is widely used in labour analgesia. It allows to start analgesia of the first stage of labour with low doses of local anesthetics or opiolds or a combination of both. Different regimens are used in the littérature. We performed a study to evaluate the best combination of intrathecal local anesthetics, epinephrin and opiolds in terms of duration of analgesia and pruritus. Methods: We randomized 72 labouring parturients requesting perimedullar analgesia in three groups. The first group ( I ) received 1.25mg plain bupivacaln with 25ug epinephrin and 25 g fentanyl. The secound group ( II ) received 2.5mg plain bupivacata with SOug epinephrin and 25ug fentanyl. The third group ( III ) received 1.25mg plain bupivacaln with 25jag epinephrin and Sug sufentanil. All solutions were given in a 2ml volume. We studied obstetric an demographic data along with duration of initial dose ( injection to next request ) and with incidence and severity of pruritus. Results: The three groups were obstetrically and demographically comparable. Mean durations of analgesia were not significantly different: 119.6 +/- 47.6 min. in group I, 127 +/- 24 min. in group II, 145 +/- 55.9 min. in group III. Incidence of pruritus in group I compared with group III was highly significant: 28 % and 77 % (P< 0.01); when we compared group I with group II, the difference was almost significant: 28% vs 54 % ( P= 0.06 ); when we compared group II with group III, the difference was not significant: 54 % vs 77 %. Pruritus was mild in all cases and did not require any treatment. Conclusion: Mean durations of analgesia were not significantly different. Using twice the dose of bupivacaln as in group II compared with group I did not prolong mean duration of analgesia. The addition of epinephrin did not have a positive effect on mean duration. Increasing the dose of epinephrin twofold seemed to increase the incidence of pruritus in group II (P=0.06). Sufentanil did not, SCOPUS: ar.j, info:eu-repo/semantics/published

Neurotoxicity of spinally administered hyperbaric 5% lidocaine is becoming a serious concern in view of the recent literature. We report a case of probable neurotoxicity of hyperbaric 5% lidocaine, followed by an aseptic meningitis. This case report emphasizes the danger of using hyperbaric 5% lidocaine in a too high dose while performing spinal anesthesia., SCOPUS: ar.j, info:eu-repo/semantics/published

info:eu-repo/semantics/published

info:eu-repo/semantics/published

Introduction: Combined Spinal Epidural technique is widely used in labour analgesia. It allows to start analgesia of the first stage of labour with low doses of local anesthetics or opiolds or a combination of both. Different regimens are used in the littérature. We performed a study to evaluate the best combination of intrathecal local anesthetics, epinephrin and opiolds in terms of duration of analgesia and pruritus. Methods: We randomized 72 labouring parturients requesting perimedullar analgesia in three groups. The first group ( I ) received 1.25mg plain bupivacaln with 25ug epinephrin and 25 g fentanyl. The secound group ( II ) received 2.5mg plain bupivacata with SOug epinephrin and 25ug fentanyl. The third group ( III ) received 1.25mg plain bupivacaln with 25jag epinephrin and Sug sufentanil. All solutions were given in a 2ml volume. We studied obstetric an demographic data along with duration of initial dose ( injection to next request ) and with incidence and severity of pruritus. Results: The three groups were obstetrically and demographically comparable. Mean durations of analgesia were not significantly different: 119.6 +/- 47.6 min. in group I, 127 +/- 24 min. in group II, 145 +/- 55.9 min. in group III. Incidence of pruritus in group I compared with group III was highly significant: 28 % and 77 % (P< 0.01); when we compared group I with group II, the difference was almost significant: 28% vs 54 % ( P= 0.06 ); when we compared group II with group III, the difference was not significant: 54 % vs 77 %. Pruritus was mild in all cases and did not require any treatment. Conclusion: Mean durations of analgesia were not significantly different. Using twice the dose of bupivacaln as in group II compared with group I did not prolong mean duration of analgesia. The addition of epinephrin did not have a positive effect on mean duration. Increasing the dose of epinephrin twofold seemed to increase the incidence of pruritus in group II (P=0.06). Sufentanil did not, SCOPUS: ar.j, info:eu-repo/semantics/published

Neurotoxicity of spinally administered hyperbaric 5% lidocaine is becoming a serious concern in view of the recent literature. We report a case of probable neurotoxicity of hyperbaric 5% lidocaine, followed by an aseptic meningitis. This case report emphasizes the danger of using hyperbaric 5% lidocaine in a too high dose while performing spinal anesthesia., SCOPUS: ar.j, info:eu-repo/semantics/published

Methaemoglobinemia is a rare but well known complication of the use of prilocaine in locoregional anaesthesia. We report a case of methaemoglobinemia following the administration of a low dose of prilocaine for an interscalenic bloc. We suggest some hypotheses to explain this phenomenon. This case illustrates the necessity of pulse oximetry monitoring in all patients receiving prilocaine during locoregional anaesthesia., SCOPUS: ar.j, info:eu-repo/semantics/published

Methaemoglobinemia is a rare but well known complication of the use of prilocaine in locoregional anaesthesia. We report a case of methaemoglobinemia following the administration of a low dose of prilocaine for an interscalenic bloc. We suggest some hypotheses to explain this phenomenon. This case illustrates the necessity of pulse oximetry monitoring in all patients receiving prilocaine during locoregional anaesthesia., SCOPUS: ar.j, info:eu-repo/semantics/published

info:eu-repo/semantics/published

info:eu-repo/semantics/published

info:eu-repo/semantics/published

info:eu-repo/semantics/published

info:eu-repo/semantics/published

info:eu-repo/semantics/published