Analgésie péridurale obstétricale et lombalgie du post-partum: un lien de cause à effet?

in Revue Médicale de Liège (2012), 67(1), 16-20

backache is a common problem in the general population. the prevalence of backpain is increased during pregnancy and after delivery. early studies have suggested that labor epidural analgesia might be ... [more ▼]

backache is a common problem in the general population. the prevalence of backpain is increased during pregnancy and after delivery. early studies have suggested that labor epidural analgesia might be associated with an increased incidence of backache in the postpartum period. However, these initial studies were retrospective and their design included several methodological deficiencies. All the prospective studies published afterwards (prospective cohort studies and 3 ran- domized controlled trials) yield the same result : there is no relationship between labor epidural analgesia and long-term postpartum backpain. pregnant women must be aware of this in order to make an informed and appropriate choice about labor epidural analgesia, the most effective technique for intra- partum pain relief. [less ▲]

Analgésie épidurale obstétricale et pseudoxanthome élastique : à propos d’un cas

in Annales Françaises d'Anesthésie et de Réanimation (2011), 30(9), 685-7

Pseudoxanthoma elasticum is a rare inherited disorder of the elastic tissue characterised by multisystem manifestations. Skin, eyes, gastro-intestinal system and cardiovascular system are the major ... [more ▼]

Pseudoxanthoma elasticum is a rare inherited disorder of the elastic tissue characterised by multisystem manifestations. Skin, eyes, gastro-intestinal system and cardiovascular system are the major affected systems. We describe the anaesthetic management of a parturient affected by this disease. [less ▲]

Side effects of the addition of clonidine 75 microg or sufentanil 5 microg to 0.2% ropivacaine for labour epidural analgesia.

in International Journal of Obstetric Anesthesia (2010), 19(2), 149-54

BACKGROUND: Sufentanil 5 microg and clonidine 75 microg produce a similar reduction in minimum local anaesthetic concentration of ropivacaine. The aim of the present study was to compare the side effects ... [more ▼]

BACKGROUND: Sufentanil 5 microg and clonidine 75 microg produce a similar reduction in minimum local anaesthetic concentration of ropivacaine. The aim of the present study was to compare the side effects of two equianalgesic solutions by combining 0.2% ropivacaine with either sufentanil 5 microg or clonidine 75 microg for labour epidural analgesia. METHODS: In a prospective double-blind study, 60 women at 5 cm cervical dilatation were randomly allocated to receive 0.2% ropivacaine with either sufentanil 5 microg or clonidine 75 microg to initiate labour analgesia. The analgesic efficacy and side effects of the two mixtures were compared. RESULTS: Onset, duration and quality of analgesia and subsequent ropivacaine consumption were similar in the two groups. Hypotension was significantly more frequent and severe with clonidine than with sufentanil (systolic blood pressure <100 mmHg: 17/26 vs. 6/24, P <0.05; systolic blood pressure <90 mmHg: 5/26 vs. 0/24, P <0.05) resulting in more frequent ephedrine administration (11/26 vs. 2/24, P <0.05) and larger fluid requirements (1696 +/- 583 mL vs. 1264 +/- 407 mL, P < 0.05). Conversely, pruritus was more frequent with sufentanil than with clonidine (6/26 vs. 1/24, P <0.05). CONCLUSIONS: Hypotension occurs more frequently when clonidine is added to epidural ropivacaine instead of an equianalgesic dose of sufentanil. Therefore, clonidine cannot be recommended for routine administration for labour epidural analgesia. [less ▲]

Manifestations hemodynamiques et respiratoires de la preeclampsie.

in Annales Françaises d'Anesthésie et de Réanimation (2010), 29

The hemodynamic and cardiovascular changes seen during PE vary according to the natural history of the disease, its severity and eventual therapeutic measures taken. In the early stages of pregnancy ... [more ▼]

The hemodynamic and cardiovascular changes seen during PE vary according to the natural history of the disease, its severity and eventual therapeutic measures taken. In the early stages of pregnancy, patients who will eventually develop PE, present with a blood pressure which even though within normal limits, is higher than in other women. Similarly, their cardiac output is higher with a normal or decreased peripheral vascular resistance. As soon as the clinical signs of the disease appear, the hemodynamic picture usually shifts toward that of a high peripheral resistance with low cardiac output. Sometimes however, a clinically hyperkinetic circulation may be demonstrated. In PE patients, cardiac preload pressures are usually normal even though the circulatory volumes are lower by 600 to 800ml when compared to those found in normal pregnancy. The cardiac function is however usually preserved during PE. PE induces an exaggerated capillary permeability. This results in the worsening of the airway edema which may render the intubation very difficult. The increased capillary permeability contributes, among other factors, to the heightened risk of acute pulmonary edema. It is not justified to administer an anti-hypertensive treatment to PE women presenting with only moderate hypertension. An anti-hypertensive treatment must only be initiated whenever the hypertension is severe (i.e. SBP>/=160mmHg and/or DBP>/=110mmHg) in order to reduce the risk of maternal complications. In the absence of objective comparative data assessing anti-hypertensive agents for the PE patient, the choice of therapy relies predominantly on the practitioners' own experience. Systematic circulatory volume expansion has not been proven to improve the maternal nor the neonatal prognosis. Such treatment is to be reserved solely for situations in which correcting a hypo-volemia is absolutely necessary. The treatment of acute pulmonary edema in a PE patient is symptomatic and includes the administration of vasodilating agents and of diuretics. A benefit in setting-up an invasive monitoring of the pulmonary artery occlusive pressure has not been demonstrated. The sonographic surveillance of the hemodynamic state can however be useful in these circumstances. [less ▲]

Traitement de la prééclampsie sévère: jusqu'où, et pour quels risques/bénéfices?

in Revue Médicale de Liège (2009), 64(12), 620-625

Analgésie péridurale pour le travail et l'accouchement

in Gauthier-Lafaye, Pierre; Muller, André; Gaertner, Elisabeth (Eds.) Anesthésie locorégionale et traitement de la douleur (2009)

Impact of the addition of sufentanil 5ug or clonidine 75ug on the minimum local analgesic concentration of ropivacaine for epidural analgesia in labour: a randomized comparison

in International Journal of Obstetric Anesthesia (2008), 17

Réanimation cardiopulmonaire chez la femme enceinte

in Praticien en Anesthésie Réanimation (Le) (2002), 6

Mécanismes de l'action hypnotique des agents anesthésiques

in Praticien en Anesthésie Réanimation (Le) (1999), 3