Prevention of hypotension after spinal anesthesia for cesarean section: 6% hydroxyethyl starch 130/0.4 [Voluven] versus lactated Ringer's solution

The aim of this study is to compare the efficacy of HES 130/0.4, a new hydroxyethyl starch, to lactated Ringer's solution [LR] in the prevention of hypotension after spinal anesthesia for cesarean section [CS]. One hundred and twenty nonlaboring ASA I and II women having non urgent CS were enrolled in this prospective and randomized study. Subjects were randomly assigned to receive prior to anesthesia either 1 liter of LR [Gr I: n = 59] or 500 ml of HES 130/0.4 [Gr II: n = 61] Blood pressure was measured until discharge from the post anesthesia care unit. Hypotension was treated with IV boluses of 3 mg of ephedrine. The nausea scale was recorded. Arterial and venous umbilical blood gazes were obtained. Data were compared using Mann-Whitney U-test and Student's t-test [p < 0.05 was significant]. Thirty-nine patients in Gr II while 48 pts in Gr I experienced hypotension [p = .033]. The total dose of ephedrine was statistically smaller in Gr II compared with Gr I [p = .001]. Nausea after induction of spinal anesthesia occurred with similar frequency in both groups. Neonatal outcome was excellent and similar in both groups. HES 130/0.4 is more effective than LR to prevent hypotension following spinal anesthesia for CS; its routine use in this purpose should be considered

Addition of small doses of clonidine to bupivacaine in ilioinguinal and iliohypogastric nerve block following spinal anesthesia for inguinal herniorraphy

Addition of clonidine to bupivacaine improves and prolongs analgesia following central blocks. In peripheral nerve blocks, divergent results have been reported. The aim of this study was to determine the efficacy of clonidine mixed with bupivacaine on postoperative analgesia provided by an ilioinguinal and iliohypogastric nerve block following herniorrhaphy in adult patients. After institutional approval and informed consent, 60 adult patients scheduled for unilateral inguinal herniorrhaphy under spinal anaesthesia were included in this prospective and randomized study. At the end of surgery, patients received an ilioinguinal and iliohypogastric block with 20 ml of 0.25% bupivacaine mixed with 1 mcg/kg of clonidine [group I] or mixed with 1 ml of 0.9% saline [group II]. Visual Analogue Scores [0-10 cm] at rest and during mobilization, sedation, hemodynamic variation and first analgesic request were recorded at 2, 6, 12, 18 and 24 postoperative hours. Statistical analysis was performed by two-way ANOVA, Fisher, Student and Mann-Whitney tests. P

Anesthesie locoregionale pour cure microchirurgicale des hernies discales lombaires

Goal of the study: Lumbar micro discectomy surgery is already performed under spinal anesthesia [SA] in many institutions. The aim of this study is to compare the quality of analgesia and recovery after SA when compared to general anesthesia [GA] after lumbar microdiscectomy surgery. methods: Following light sedation, SA is performed with the patient in the left lateral decubitus position, one to two levels above the herniated disc level. Isobaric 0.5% bupivacaine 3-3.5 ml was injected intrathecally followed by wound infiltration with 15 ml of bupivacaine with 1/200 000 epinephrine prior to surgical incision. Despite randomization, we found significantly more females in the GA group. Pain scores at 4 and 8h postoperatively were lower in SA group as well as total analgesic consumption during the first 24 h. Postoperative recovery including time to drinking, eating and walking were more rapid after SA when compared to GA. During the postoperative period, the incidence of urinary retention was comparable between groups but the occurrence of postoperative nausea and vomiting was significantly higher in the GA group. Moreover, the overall patient's and surgeon's satisfaction were significantly better in the SA group. SA associated to wound infiltration using bupivacaine is an interesting alternative to general anesthesia for outpatient lumbar microdiscectomy surgery

Pediatric renal biopsy. Ambulatory versus overnight hospitalization

Renal biopsy may be safely performed on selected pediatric patients in an ambulatory care setting. In order to verify the safety of this new procedure, we performed 51 renal biopsies on an ambulatory care basis over a five-year period [from December 1993 to December 1998]: twenty-eight biopsies on transplanted kidneys and twenty-three of native kidneys During the same period, 56 renal biopsies were performed during a regular hospitalization of a minimum of 24 hours. We compared the two groups Ambulatory procedure group and overnight hospitalization group. There were no significant differences between the two groups in mean age, adequacy of renal samples and complications such as post-biopsy pain or hematuria.After this encouraging experience, we are proposing the ambulatory procedure to all pediatric patients in our unit.Parents will be informed that if macroscopic hematuria is noted in the immediate post-biopsy period, hospitalization might be necessary

Utilisation des chambres implantables en chimiotherapie: experience de L'Hotel-Dieu de France

We are presenting our experience with 70 deep venous catheters for long term chemotherapy. Despite the well known complications of these procedures, the implantation of subcutaneous injection sites has facilitated the management and brought much more comfort to cancer patients. Strict measures of survey and meticulous nursing care are essential for optimal use of the injection sites