Philippe Carre

Axillary block in children: single or multiple injection?

The goal of this double‐blind prospective study was to compare the effect of a single injection versus multiple fractionated doses on the onset time and quality of motor and sensory block, obtained in 70 children anaesthetized with axillary block alone. The brachial plexus was identified with a peripheral nerve stimulator, and blocked with 0.5 ml·kg−1 of 1.5% lignocaine with adrenaline. In Group S (single injection), the total volume was injected after location of one nerve. In Group M (multiple fractionated doses), two nerves were located, including necessarily one nerve implicated in the surgical territory. Motor and sensory blocks were assessed according to Lanzs scale before surgery by a blinded observer. A block was considered complete if there was no feeling in at least three nerve territories at 30 min. No difference was found between groups for motor and sensory block quality. However the onset time of the block was faster after multiple fractionated doses (Group M, 25±7 min vs Group S, 29±4 min) and was faster in younger children (5–9 years: M=23±7 min vs S=28±5 min, 10–15 years: no difference). There was a significant difference in the quality of the sensory blockade of the musculocutaneous nerve: 18 versus 8 complete blocks, 10 versus 14 incomplete blocks, respectively for Group M versus Group S. No adverse effect was observed and analgesia was prolonged for more than 4 h. We can conclude that, unlike adults, fractionated doses in chilren bring no benefit to the quality of sensory and motor block. Selective block of the musculocutaneous nerve is recommended when a surgical procedure takes place in this territory.

The effect of preoperative epidural morphine on postoperative analgesia in children

IMPLICATIONS We examined the effects of preoperative epidural morphine associated with general anesthesia on postoperative morphine requirements. Twenty-one children older than 6 yr scheduled for major surgery were randomly assigned to two groups, a control group and an epidural group that received a single epidural morphine injection.

Comparison of recovery after intermediate duration of anaesthesia with sevoflurane and isoflurane

Background: The purpose of this study was to compare recovery from anaesthesia after sevoflurane and isoflurane were administered to children for more than 90 min.

Découverte d’une syringomyélie au décours d’une anesthésie péridurale

Resume L’apparition de signes neurologiques au decours d’une anesthesie peridurale oriente vers une complication liee a la technique anesthesique. Nous rapportons le cas d’une enfant operee d’une chirurgie perineale en position gynecologique sous anesthesie generale associee a une anesthesie peridurale, qui a presente 24 heures apres l’intervention une hypoesthesie superficielle de l’ensemble du membre inferieur gauche, sans deficit moteur patent. L’imagerie par resonance magnetique (IRM) a permis d’eliminer une compression medullaire, mais a revele l’existence d’une cavite syringomyelique etendue au niveau des 9 e et 11 e vertebres thoraciques. Il n’y avait aucune alteration des vitesses de conduction motrice et sensitive a l’electromyogramme. Les signes cliniques ont disparu totalement en 24 heures. Cette observation souligne que la survenue de signes neurologiques au decours d’une anesthesie perimedullaire n’est pas exclusivement une complication de l’anesthesie locoregionale, mais peut reveler une neuropathie meconnue, ou etre secondaire a la position operatoire ou a l’intervention chirurgicale. Un examen neurologique precis, une IRM et un electromyogramme s’imposent des l’apparition des signes.

Comparative Hemodynamic Depression of Sevoflurane Versus Halothane in Infants: An Echocardiographic Study

Background: The cardiovascular side effects of volatile anesthetics are one of the chief causes of postoperative complications in children, and infants seem to be at the greatest risk for this. This study compared cardiovascular changes at equipotent concentrations of sevoflurane and halothane in infants. Methods: Thirty infants classified as American Society of Anesthesiologists physical status I or II who required elective surgery were randomized to receive either halothane or sevoflurane for inhalation induction. Cardiovascular and echo‐cardiographic data were recorded in both groups at baseline and at end‐tidal concentrations of 1 and 1.5 minimum alveolar concentration (MAC). Results: Sevoflurane did not alter heart rate or cardiac index at all concentrations compared with awake values. Sevoflurane significantly decreased blood pressure and systemic vascular resistance compared with awake values at all concentrations. Shortening fraction and rate‐corrected velocity of circumferential fiber shortening decreased at 1.5 but not at 1 MAC. Myocardial contractility assessed by stress‐velocity index and stress‐shortening index decreased significantly at all concentrations, but did not fall into the abnormal range at any concentration. Halothane caused a greater decrease in heart rate, shortening fraction, stress‐shortening index, velocity of circumferential fiber shortening, stress‐velocity index, and cardiac index at all concentrations than did sevoflurane. Conclusion: Sevoflurane causes a lesser decrease in cardiac output than does halothane in infants.