Anesthésie locorégionale pour la chirurgie esthétique de la face et du cou

-La chirurgie plastique connaît un développement important, c’est un domaine d’application des blocs de la face. Les indications chirurgicales sont multiples, dont un nombre important peut être pratiqué en ambulatoire. Après quelques rappels anatomiques, les techniques d’anesthésie locorégionale appliquées à chaque type de chirurgie sont détaillées. La réalisation de ces blocs obéit aux règles générales de toute anesthésie, en particulier en ce qui concerne la surveillance clinique et l’asepsie.

Ambulatory hernia surgery under local anesthesia is feasible and safe in obese patients

– The authors conclude that ambulatory abdominal wall hernia repair under local anesthesia is feasible in obese patients. Because of the increased length of surgery in these patients, monitored sedation and prophylactic antibiotic cover should be used. The slight decrease in patient satisfaction is balanced by the lower risks and higher costs associated with full general anesthetic.

Spinal mepivacaine with fentanyl for outpatient knee arthroscopy surgery: a randomized controlled trial

– When compared with 45 mg isobaric mepivacaine 1.5%, an intrathecal dose of 30 mg isobaric mepivacaine 1.5% plus 10 microg fentanyl produces reliable anesthesia, hastens block regression, shortens stay in Phase I recovery, and enables earlier ambulation for patients undergoing unilateral knee arthroscopy.

Comparison of Local Anesthetic Effects of Tramadol With Prilocaine During Circumcision Procedure

– A combination of tramadol 5% plus adrenaline can provide a safe and effective local anesthesia during circumcision procedure and postoperative period in children.
Objectives

To compare the local anesthetic effects of tramadol hydrochloride with prilocaine for circumcision procedure.
Methods

This study included 40 patients with American Surgical Association-I scores. Patients were randomly allocated to receive either 5% tramadol (2 mg/kg) plus adrenaline (0.0125/mL) (group 1, n = 20) or 2% prilocaine plus adrenaline (0.0125/mL) (group 2, n = 20). The degree of burning sensation and pain at the injection site were documented. Sensory block was assessed 1 minute after injection and the patients were asked to grade touch and pinprick sensation. Five minutes after drug administration, incision was performed and intensity of pain, felt by the patient was evaluated on a 4-point scale (0-3). Pain at the injection site and local skin reactions were also recorded.
Results

Mean ages were 9.7 and 10.3 years for groups 1 and 2, respectively. Mean duration of surgery was 19.6 minutes. In control visit, 2 of 20 (10%) in group 1 and 10 of 20 (50%) children in group 2 reported extra need for oral ibuprofen (P <.05). First analgesic medication time was 9.5 (± 2.1) hours in group 1 and 8.7 (± 3.1) hours in group 2 (P >.05). Total postoperative ibuprofen consumptions were 10 and 50 mg for groups 1 and 2, respectively (P <.05).
Conclusions

A combination of tramadol 5% plus adrenaline can provide a safe and effective local anesthesia during circumcision procedure and postoperative period in children.

Transient neurological symptoms after spinal anaesthesia with levobupivacaine 5 mg/ml or lidocaine 20 mg/ml

– After spinal anaesthesia with levobupivacaine, the incidence of TNS was much less than after lidocaine. However, it appears that TNS may occur in association with levobupivacaine.
Transient neurological symptoms (TNS) after spinal anaesthesia have been reported most commonly in association with lidocaine, but have been observed with other local anaesthetics. The aim of this prospective, randomized, double-blind study was to investigate the incidence of TNS after spinal anaesthesia with either levobupivacaine or lidocaine.

Methods: Patients undergoing inguinal hernia, appendectomy, varicose vein or minor orthopaedic operations were included in the study (60 patients; 47 male, 13 female, overall mean age 30 years). All patients had an American Society of Anesthesiologists score of I or II. The patients were randomly assigned to receive spinal anaesthesia with either 20 mg isobaric levobupivacaine (5 mg/ml) or 80 mg isobaric lidocaine (20 mg/ml). Onset of sensory and motor block and side effects were recorded. On post-operative days 1, 2, and 3, patients were interviewed by an investigator blinded to the spinal anaesthetic used. The patients were classified as having TNS if, following recovery from anaesthesia, there was pain in the buttocks, thighs and/or lower limbs.

Results: In the levobupivacaine group, one patient (3.33%) experienced TNS, whereas in the lidocaine group, eight (26.6%) experienced TNS (P=0.002). Maximum times to arrival of sensory blocks were shorter with lidocaine (P<0.001). The levobupivacaine and lidocaine groups did not differ significantly in terms of the highest dermatome included in sensory block or motor block grade.

Conclusion: After spinal anaesthesia with levobupivacaine, the incidence of TNS was much less than after lidocaine. However, it appears that TNS may occur in association with levobupivacaine.

ANALGESIA Ropivacaine Spinal Anesthesia Is Not Antagonized by Ondansetron Pretreatment

– The authors investigated a possible effect of ondansetron on the duration of sensory and motor block produced by ropivacaine. Ondansetron had no effect on the subarachnoid sensory or motor block produced by ropivacaine.

Use of intra-articular lidocaine as analgesia in anterior shoulder dislocation: a review and meta-analysis of the literature

– Based on the current literature, it appears that the intra–articular lidocaine (IAL) method provides, at a minimum, the same level of pain control and reduction success as the procedural sedation method, while markedly reducing the time spent by the patient in the emergency department and the cost of treatment. The likelihood of complications is arguably less with the use of IAL. Although more research is this area is merited, physicians may consider IAL as an alternative to procedural sedation and analgesia (PSA) in the management of anterior shoulder dislocations.

A Randomized Comparison of Low Doses of Hyperbaric Bupivacaine in Combined Spinal-Epidural Anesthesia for Cesarean Delivery

– The lowest dose of hyperbaric bupivacaine (7 mg) provided equally rapid onset and effective anesthesia for cesarean delivery while reducing the incidence of hypotension compared with 8 and 9 mg. However, because of its shorter duration of anesthesia, it may be feasible only when the block can be reinforced using a functional epidural catheter.

A Comparison of Gabapentin and Ketamine in Acute and Chronic Pain After Hysterectomy

– Gabapentin and ketamine are similar in improving early pain control and in decreasing opioid consumption; however, gabapentin also prevented chronic pain in the first 6 postoperative months.

INNOVATIVE LIGHTED STYLET

– Intubation of trachea using lighted stylet is easy, safe, effective and rapid alternative method of airway management. The innovative lighted stylet has an added advantage that it can be used to intubate trachea with RAE tube where conventional lighted stylet fails.

Pediatric Pain After Ambulatory Surgery: Where's the Medication?

– A large proportion of children receive little analgesic medication after surgery and research efforts should be directed to the discrepancy between high ratings of postoperative pain provided by parents and the low dosing of analgesics they use for their children.

Three concentrations of levobupivacaine for ilioinguinal/iliohypogastric nerve block in ambulatory pediatric surgery

– The aim is to compare the postoperative analgesia of three different concentrations of levobupivacaine for ilioinguinal/iliohypogastric (II/IH) block in children undergoing inguinal hernia repair. II/IH nerve block using 0.4 mL kg^–1 of 0.25% levobupivacaine provided satisfactory postoperative pain relief after inguinal herniorraphy.

CT Scans Identify Patients With Severe H1N1 at Risk for Developing Pulmonary Emboli

LEESBURG, Va -- October 14, 2009 -- Utilising computed tomography (CT) scans, researchers have found that patients with severe cases of the influenza A(H1N1) are at risk for developing severe complications, including pulmonary emboli (PE).

The study is published online, ahead of print, in the American Journal of Roentgenology. The study will be published in the December print issue of the journal.

The study included 66 patients diagnosed with the H1N1. Two study groups were formed. Group 1 consisted of 14 patients who were severely ill and required admission to the intensive care unit (ICU) and group 2 consisted of 52 patients who were not severely ill and did not require ICU admission.

All 66 patients underwent chest x-rays for the detection of H1N1 abnormalities. Ten patients from the ICU group and 5 patients from the largely outpatient group, underwent CT scans.

"Pulmonary emboli were seen on CT in 5 of 14 ICU patients," said lead author Prachi P. Agarwal, MD, University of Michigan, Ann Arbor, Michigan.

"Our study suggests that patients who are severely ill with H1N1 are also at risk for developing PE, which should be carefully sought for on contrast-enhanced CT scans," she said.

"With the upcoming annual influenza season in the United States, knowledge of the radiologic features of H1N1 is important, as well as the virus's potential complications, said Dr. Agarwal.

"The majority of patients undergoing chest x-rays with H1N1 have normal radiographs. CT scans proved valuable in identifying those patients at risk of developing more serious complications as a possible result of the H1N1 virus, and for identifying a greater extent of disease than is appreciated on chest radiographs," she said.


SOURCE: American Roentgen Ray Society

Bispectral Index Monitoring of Midazolam Sedation During Flexible Bronchoscopy

– The authors suggest that the BIS value during flexible bronchoscopy is associated with the satisfaction of patients and they may be able to predict patients' satisfaction.

Perioperative Use of β-Blockers in the Elderly Patient

– This article examines common comorbidities in the elderly who may benefit from the chronic use of beta–blockers, prophylactic perioperative use of beta–blockers including timing, dosage, and choice of beta–blocker, the pharmacologic effects of aging, and recommendations on the use of beta–blockers.

THE ‘BEST FIT’ ENDOTRACHEAL TUBE IN CHILDREN

– The age–based and 5th fingernail width–based predictions of ETT size are more accurate than length–based and multivariate–based formulae in terms of mean value and case matching.

Obstructive Sleep Apnea Is Not a Risk Factor for Difficult Intubation in Morbidly Obese Patients

– In MO patients undergoing bariatric surgery in the "ramped position," there was no relationship between the presence and severity of OSA, BMI, or NC and difficulty of intubation or laryngoscopy grade. Only a Mallampati score of 3 or 4 or male gender predicted difficult intubation.

A prospective, randomised, cross-over trial comparing the EndoFlex® and standard tracheal tubes in patients with predicted easy intubation

– Patients with a grade 2 (19/50) or 3 (6/50) laryngoscopic view had shorter intubation times, easier intubation and reduced insertion attempts with the EndoFlex. The EndoFlex is a satisfactory alternative to a standard–type tracheal tube, even with an anterior larynx.

How do pediatric anesthesiologists define intraoperative hypotension?

– There is great variability in the BP parameters used and the threshold used for defining and treating IOH among pediatric anesthesiologists. The majority of respondents considered a 20–30% reduction from baseline in SBP as indicative of significant hypotension. Lack of a consensus definition for a common clinical condition like IOH could have implications for patient care as well as future clinical research.

Ultrasound guidance for peripheral nerve blockade

– The review authors searched the medical literature for controlled clinical trials comparing ultrasound with another nerve–locating technique in adult patients. They found 18 studies including a total of 1344 patients. Most of the studies compared ultrasound with electrical nerve stimulators. Most of the studies were of moderate quality. As the methods used in the included studies were very varied, the review authors were unable to pool the results using statistical tests. The findings of the review are based on the interpretation of individual studies. The use of ultrasound was not found to make a significant difference to whether a nerve block was successful or not. Using ultrasound reduced bruising. Ultrasound may reduce the time taken to do the block and also resulted in the block working more quickly. Two studies found ultrasound allowed a reduction in the amount of local anaesthetic. No differences were found in length of time the nerve block lasted. No serious complications were reported in any of the studies and there was no evidence of adverse effects from ultrasound itself.

Comparative Evaluation of Ketamine,Midazolam and Combinatin of Both as Oral Premedicants in chirldren

– Oral Midazolam and Ketamine alone and in combination were acceptable and effective premedication in children and their combination in lower dosage, 3 mg kg^–1 and 0.3 mg kg^–1 respectively was superior than their alone administration in higher dosage.

Single dose oral tiaprofenic acid for acute postoperative pain in adults

– Not one of eleven studies identified by the searches and examined in detail studied oral tiaprofenic acid against placebo in patients with established postoperative pain and therefore no results are available. In the absence of evidence of efficacy for oral tiaprofenic acid in acute postoperative pain, its use in this indication is not justified at present. Because trials clearly demonstrating analgesic efficacy in the most basic of acute pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this and similar classes which are effective, there is no urgent research agenda for this particular drug.

Single dose oral lornoxicam for acute postoperative pain in adults

– A high level of pain relief is experienced by about 45% of those with moderate to severe postoperative dental pain after a single dose of lornoxicam 8 mg, compared to about 10% with placebo. This is comparable to the proportion experiencing the same level of pain relief with ibuprofen 200 to 400 mg. Adverse events were generally mild and did not differ from placebo in these singe dose studies. There were insufficient data to assess duration of action, but it is likely to be similar to ibuprofen 200 mg.

Equipment for airway management

– The authors describe the ‘RAW’ approach (Ready, Able, Willing) and list five phases of airway management in which equipment is used. These are: facemask ventilation with adjuncts, airway clearance with suction or foreign body removal, use of supraglottic airway devices, tracheal intubation with a variety of laryngoscopes including the flexible fibre–optic bronchoscope and subglottic management using cricothyroidotomy or tracheostomy. Tracheal tubes and aids for placement are described.

Parent-assisted or nurse-assisted epidural analgesia: is this feasible in pediatric patients?

– Parent–assisted or nurse–assisted epidural analgesia (PNEA) can be safely administered to children undergoing surgery who are physically or cognitively unable or unwilling to self–activate a demand dose. Additional studies are needed to compare the efficacy of PNEA with other modalities for postoperative pain control in children.

Efficacy of a low-dose spinal morphine with bupivacaine for postoperative analgesia in children undergoing hypospadias repair

– Spinal anesthesia provided by hyperbaric bupivacaine is adequate for distal hypospadias repair in children, but adding 2 microg·kg^?1 intrathecal morphine provides better postoperative pain control when compared to placebo in these children.

Spinal Analgesia in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

– This analysis indicated that spinal analgesia does not improve clinically relevant outcomes in patients undergoing cardiac surgery, discouraging further randomized controlled trials on this topic even if changes in techniques, devices, and drugs could modify the outlook of the comparison between spinal and standard anesthesia in this setting.

"Tapentadol" A Novel Anagegic

– Tapentadol is a new analgesic drug with a dual mode of action, hence has efficacy in a broad spectrum of acute and chronic pain models and possibly an improved tolerability profile. It combines moderate mu–opioid agonist activity with NE reuptake inhibition in a single, nonracemic molecule. No metabolic activation of tapentadol is necessary for analgesia, and it has no active metabolites. Further RCTs are needed to establish its routine use in postoperative patients.

Effective anesthetic volumes in sciatic nerve block: comparison between the parasacral and infragluteal-parabiceps approaches with 0.5% bupivacaine wi

Effective anesthetic volumes in sciatic nerve block: comparison between the parasacral and infragluteal-parabiceps approaches with 0.5% bupivacaine with adrenaline and 0.5% ropivacaine
Effective anesthetic volumes in sciatic nerve block: comparison between the parasacral and infragluteal-parabiceps approaches with 0.5% bupivacaine with adrenaline and 0.5% ropivacaine. Rev. Bras. Anestesiol. [online]. 2009, vol.59, n.5, pp. 521-530. ISSN . doi: 10.1590/S0034-70942009000500001.

BACKGROUND AND OBJECTIVES: The volume and mass of local anesthetics (LA) affect the success rate of peripheral nerve blocks. Thus, the main objective of this study was to determine the volumes of local anesthetics in parasacral and infragluteal-parabiceps sciatic nerve block (SNB). METHODS: One hundred and one patients undergoing infragluteal-parabiceps or parasacral SNB with 0.5% ropivacaine or 0.5% bupivacaine with 5 �g.mL-1 of adrenaline were randomly divided into 4 groups. Success was defined as complete sensitive and motor blockades of the sciatic nerve 30 minutes after the administration of the LA. Volumes were calculated by the up-and-down method. RESULTS: In the parasacral approach, the mean effective volume of ropivacaine was 17.6 mL (95% CI: 14.9-20.8) and of bupivacaine it was 16.4 mL (95% CI: 12.3-21.9). In the infragluteal-parabiceps approach, the mean effective volume of ropivacaine was 21.8 mL (95% CI: 18.7-25.5), and that of bupivacaine was 20.4 mL (95% CI: 18.6-22.5). Volumes were significantly lower (p < 0.01) in the parasacral than in the infragluteal-parabiceps approach. In Probit regression, the estimated effective volume in 95% of the patients in the parasacral approach was 21.8 mL for ropivacaine, and 20.5 mL for bupivacaine; in the infragluteal-parabiceps approach the volumes were 27.2 mL for ropivacaine and 25.5 mL for bupivacaine. The effective volume in 99% of the patients in parasacral SNB was 24 mL for ropivacaine, and 24 mL for bupivacaine; and in the infragluteal-parabiceps approach, 29.9 mL for ropivacaine, and 28.0 mL for bupivacaine. CONCLUSIONS: In sciatic nerve block, significantly smaller volumes were necessary in the parasacral than in the infragluteal-parabiceps approach, but volumes did not differ between both LAs.

Keywords : ANESTHETIC, Local [bupivacaine]; ANESTHETIC, Local [ropivacaine]; ANESTHETIC TECHNIQUES, Regional [sciatic nerve block].

Pediatric Pain After Ambulatory Surgery: Where's the Medication?

– A large proportion of children receive little analgesic medication after surgery and research efforts should be directed to the discrepancy between high ratings of postoperative pain provided by parents and the low dosing of analgesics they use for their children.

Prevalence of Delirium with Dexmedetomidine Compared with Morphine Based Therapy after Cardiac Surgery: A Randomized Controlled Trial (DEXmedetomidine

– Dexmedetomidine reduced the duration but not the incidence of delirium after cardiac surgery with effective analgesia/sedation, less hypotension, less vasopressor requirement, and more bradycardia versus morphine regimen.