Effect of injection rate on hypotension associated with spinal anesthesia for cesarean section.

Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated in a prospective observational study the influence of injection speed on maternal hypotension. Hyperbaric bupivacaine 10 mg, sufentanil 2 microg and morphine 200 microg (total volume 4 mL) were injected either quickly (<15 s) or slowly (=120 s) in 50 women scheduled for elective cesarean section. Hypotension (systolic arterial pressure (SAP) <100 mmHg or <70% of baseline) was promptly treated with 5 mg ephedrine boluses. Slow injection significantly reduced the incidence of hypotension (68% in the 120 s group and 92% in the other, P =0.03). In addition, onset of hypotension was delayed, had a shorter duration and required less ephedrine for hypotension in the 120 s group (11.6 mg vs. 19.6 mg, P =0.019). Anesthesia was satisfactory for all women. We conclude that a 2 mL/min injection rate may be a simple and effective way to reduce the incidence and severity of hypotension during cesarean section under spinal anesthesia.

[Evaluation of hemostasis before obstetrical epidural anesthesia: a survey in 435 French obstetric departments]. / Evaluation de l'hémostase avant anesthésie péridurale obstétricale: enquête dans 435 maternités françaises.

OBJECTIVES: To specify by which means French anaesthesiologists evaluate the haemostasis profile of pregnant women before epidural analgesia. STUDY DESIGN: Nationwide retrospective survey. MATERIAL: Questionnaire sent of 847 French obstetrical units. METHODS: Comparison of categorical qualitative parameters using a chi 2 test. RESULTS: Answers from 435 centres, including 1,834 anaesthesiologists, performing 227 x 10(3) epidurals for 411 x 10(3) deliveries/year were obtained. A preanaesthetic clinical assessment was performed systematically in two out of three units, and blood samples for PT, aPTT and platelet count were taken in more than 90% of the centres. These laboratory examinations were often made during the 9th month of pregnancy (74%). For more than one-third of the anaesthesiologists, biological data are not essential before epidural puncture. In addition, the lower limits considered as being safe before epidural puncture were highly variable between the teams. CONCLUSIONS: Coagulation laboratory tests are almost always ordered before epidural obstetrical analgesia in France. The rationale to perform them is not always related to pregnancy induced haemostatic changes. Therefore, this problem should be clarified by a consensus conference for both practical and economical reasons.

[The advantages and limits of the use of desmopressin (Minirin) in stomatology. Apropos 2 young female patients presenting with von Willebrand's disease]. / Intérêts et limites de l'utilisation de la desmopressine (Minirin) en stomatologie. A propos de deux jeunes patientes présentant une maladie de Willebrand.

The authors describe two cases of wisdom tooth germ removal in female adolescents presenting with von Willebrand's disease. The effect of the Minirin injection was studied during a preoperative test and allowed carrying out the operation with normalized hemostasis, without using substitution factors and with no postoperative complications. The authors specify the indications and limitations of the use of desmopressin before surgery.

Pharmacokinetics of tiaprofenic acid in children after a single oral dose.

Twelve healthy children in three age groups anaesthetized for minor surgery were given a single oral dose of tiaprofenic acid (3 mg.kg-1) (TA). Seven blood samples and zero to 8 and 8 to 24 h urines were collected. TA concentrations in plasma and urine were measured by HPLC. No significant difference was found between the age groups in the kinetic parameters of TA and no correlation was found between these parameters and age: tmax = 2.12 h, Cmax = 8.78 mg.l-1, AUC(0----8 h) 33.9 mg.h.l-1, AUC = 39.3 mg.h.l-1, t1/2 = 2.35 h, Vt = 0.319 l.kg-1, CL = 0.094 l.h-1.kg-1. Renal clearance was 14 ml.h-1.kg-1.33% of the TA dose was recovered in the 24 h urine, 48% of which was conjugated, whereas in adults, TA is only found in urine as conjugates. The apparent plasma clearance was significantly higher (56%) than in 12 healthy adults given 1.5 mg.kg-1 TA. Volume of distribution and t1/2 did not significantly differ between children and adults. Since no relationship has been established between plasma TA and either efficacy or toxicity, a different dose regimen cannot be recommended in 3-11 year-old children from that in adults.