Combined use of crystalloid preload and low dose spinal anesthesia for preventing hypotension in spinal anesthesia for cesarean delivery: a randomized controlled trial

Spinal anaesthesia for caesarean section is commonly associated with hypotension and crystalloid preload is widely recommended. Low-dose spinal appears to cause less hypotension. The aim of this study was to investigate whether the combined use of crystalloid preload and low dose spinal anaesthesia might further reduce the rates of hypotension. Sixty-two patients were randomly assigned to two groups: crystalloid preload anaesthesia [P]: received a rapid infusion of 20 mL/kg lactated Ringer's solution [LR], and no preload anaesthesia [N]. The incidence of hypotension and the amount of ephedrine used to treat it were compared. Spinal anaesthesia was performed with 0.5% isobaric bupivacaine 7.5 mg and fentanyl 10 micro g and morphine 100 micro g. The incidence of hypotension was similar in the P and N groups. Same doses of ephedrine were required to treat hypotension in the two groups. Crystalloid preload combined with low-dose spinal anaesthesia do not reduce the incidence of hypotension nor its severity

Reduction of bupivacaine dose in spinal anaesthesia for caesarean section may improve maternal satisfaction by reducing incidence of low blood pressure episodes

Spinal anaesthesia for caesarean section exposes to high incidence of arterial hypotension which can result in maternal and neonatal morbidity. We hypothesized that the reduction of this dose from 10 mg to 7.5 mg would minimize hypotension without altering pain relief. In this double-blind prospective study, 80 ASA1 women scheduled for elective caesarean section were randomized into two groups A and B receiving respectively 10 and 7.5 mg of isobaric bupivacaine both with 25 micro g of fentanyl and 100 micro g of morphine in spinal anaesthesia. Intravenous ephedrine was administered for each episode of hypotension. We recorded sensory and motor block, intraoperative pain, nausea and vomiting. In postanaesthesia care unit, sensory and motor recoveries were measured and maternal satisfaction rate was assessed. In group A, a larger dose of ephedrine was needed [32 +/- 23 vs 19 +/- 16 mg; p=0.004]. Incidence of sensory block above T4 [52 vs 10%; p<0.001], nausea [52 vs 22%; p=0.005] and vomiting [25 vs 8%; p=0.03] were all higher than in group B. Arterial hypotension was less frequent in group B [68 vs 88%; p=0.03]. The time required for recovery to T10 sensory level and motor regression were shorter than in group A [p<0.001] and the satisfaction rate was higher than in group A [excellent and good in 90% vs 67%; p=0.03]. There was no difference in pain relief. A dose of 7.5 mg of isobaric bupivacaine reduced incidence of hypotension, nausea and vomiting and improved patient satisfaction

[Protein profile - concept and clinical interest]

The protein profile consists in a simultaneous assay of many proteins in serum that explores many physiopathological axes. The results are expressed in percentage of the median value [100%] related to the patient's age and sex. There are two types of protein profiles: a directed profile and a targeted profile. This exam which is based on the study of the correlation between proteins, has ameliorated the screening, the diagnosis and the survey of many biologic syndromes. The aim of this article is to review the concept of protein profile in the different biological syndromes

Combined spinal-epidural analgesia in labor comparison of sufentanil vs tramadol

Combined spinal-epidural [CSE] analgesia is becoming increasingly used to provide pain relief during labor. It combines both the rapid onset of the spinal analgesia and the flexibility of the epidural catheter. Intrathecal sufentanil provides rapid-onset and profound analgesia during the first stage of labor. The dose required to produce this effect can be associated with maternal respiratory depression, hypotension, nausea, or pruritos. The major concern of the anesthesiologist is to limit these side effects sources of discomfort to a parturient, by choosing the optimal dose of sufentanil or searching for an alternative. The purpose of this study is to compare tramadol and sufentanil used in CSE analgesia in terms of duration of analgesia and frequency of adverse maternal or fetal effects. Forty parturients requesting labor analgesia were included in this prospective study. In a combined spinal- epidural technique, at 3 to 4 cm cervical dilation, patients were randomly assigned to receive either one of the following intrathecal solutions: 2.5 mg sufentanil [n = 20] and 2.5 mg bupivacaine, or 25 mg tramadol [n = 20] and 2.5 mg bupivacaine. Visual analog scores for pain, blood pressure, heart rate, sensory levels, incidence of nausea and pruritus, motor blockade, and maternal satisfaction, were recorded. Patients receiving 25 mg intrathecal tramadol with 2.5 mg bupivacaine had significantly longer-lasting analgesia [114 +/- 7 min]. than those receiving 2.5 mg intrathecal sufentanil and 2.5 mg bupivacaine [54 +/- 11 min]. No adverse maternal or fetal effects were noted in the group sufentanil. Five parturients of the tramadol group presented vomiting 10 min after induction. There was no difference in the time from analgesia to delivery, incidence of operative or assisted delivery or cervical dilation. During labor, maternal satisfaction was good. 2.5 micrograms of intrathecal sufentanil combined with 2.5 mg bupivacaine provides rapid-onset and profound analgesia during the first stage of labor without adverse maternal or fetal effects. 25 mg intrathecal tramadol with 2.5 mg bupivacaine had longer-lasting analgesia. The major side effect was vomiting

Importance comparative respective de l'analyse infra rouge et de l'analyse chimique classique dans le diagnostic etiologique de la lithiase urinaire

Analysis of the nature of calculi provides a valuable mean for the differential diagnosis of urinary lithiasis. In this work, we report a comparative study of the nature of 31 calculi performed by infra red and the classical chemical techniques. Our results showed that the chemical techniques give false positives for the struvite, whewellite and false negatives for the weddellite, the amorphus calcium phosphate, the whitlockite, the ammonium urate, the uric acid and the proteins 83,9% of the cases assessed clinically were not confirmed by the infra red analysis. We concluded that the chimical techniques are not inacurate and not adapted to the study of the chemical nature of urinary calculi

Valeur actuelle du dosage de la gamma glutamyltransfrase

The authors remind the general properties of the Enzyme and discuss the different indications of measure of its seric activity and the exploration of its multiple molecular forms

Discordance entre les chiffres d'uree et de creatinine: a propos de quelques malades

To show that it is possible to find a discordance between urea and creatinine concentration the authors report 8 pathological cases where they found the ratio [Blood urea / Blood creatinine] [U/C] is increased. They are blood samples of: 5 diabetics with degenerative complications - 2 lupus erythematosus [L.E.D] - 1 nephrotic syndrome. All of them have chronic renal disease and values of urea are higher than the creatinine's ones. The elevated ratio of U/C could be the fact of unrelated factors: - rise of blood urea [diabetic patients particulary] - rise of creatinine secretion which has been proved in L.E.D. cases and has to be demonstrated in the other cases