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Biomedical subjects

B Dalens

Publications and source records attributed to B Dalens.

At least 19 recordsLinked to original sources
PubMed1994

[Diprivan and locoregional anesthesia in children over 3 years of age].

Preparation for anaesthesia (at least 1 hour prior to surgery): Topical anaesthesia at venepuncture sites and at the site of the block. Possible premedication (rectal midazolam: 0.3 mg.kg-1). Anaesthetic induction: Insertion of venous cannula; i.v. injection of 3-4 mg.kg-1 propofol, mixed with 0.05% lidocaine; Control of child's ventilation conditions: tolerance of the face mask, Guedel airway, laryngeal mask; tracheal intubation would be easy if necessary and would not require muscle relaxants; In cases where the child is distressed or where venous access cannot be obtained, it is sometimes preferable to resort to inhalational induction with halogenated anaesthetics prior to venepuncture. Initial maintenance anaesthesia (performing the block): Propofol given as a continuous infusion of 13 mg.kg-1.h-1, after a bolus injection of 1.3 mg.kg-1 (alternative solution: maintaining anaesthesia using halogenated agents); Positioning of the patient and performing the block technique with relatively concentrated local anaesthetic solutions (to avoid differential blocks). Maintenance anaesthesia during the procedure: Propofol given as a continuous infusion in reduced doses: 2 to 5 mg.kg-1.h-1; Alternatively: halogenated anaesthesia at low concentrations (equivalent to 0.25 to 0.5 vol % of halothane). Recovery: Particularly rapid and pleasant recovery, with a minimum of side effects; In cases of day-case surgery, patient discharge has virtually never to be postponed.

Ambulatory Surgical Procedures↗
PubMed1992

Severe farm machinery injuries to children--a report on 15 cases.

Fifteen children with 24 farm injuries were admitted to our institution during a 12 years period. Ten accidents occurred in boys and five in girls. They ranged in age from 1 to 15. The cause of fatal and non-fatal injury was farm machinery and especially tractor in 9/15. Fractures, lacerations and amputations were the most common injuries requiring multiple reconstructive surgical procedures. The magnitude of the problem requires emergency management in rural areas. However, educational programs with an emphasis on prevention by physicians, family members, educators and legislators is necessary to reduce the incidence of farm accidents.

Adolescent↗
PubMed1991

[Acute pain in children and its treatment].

Pain in paediatrics has long been underestimated. The numerous scientific studies carried out during the last decade show that its existence can no longer be doubted: in fact, pain already exists during the neonatal period, and probably throughout the last trimester of gestation as well. Pain pathways mature during the embryonic period and peripheral receptors develop between the 7th and 20th week. A-delta and C fibers, as well as spinal roots and nerves, are completely differentiated before the end of the second month. The development of specific neurotransmitters and thalamic and cortical dendritic branching occurs later on; it is well enough developed to allow perception of painful stimuli (slow or protopathic component) from the beginning of the foetal period onwards. The discriminative rapid component develops in parallel to myelinisation, and the psycho-affective component, which requires a long and complex learning process, will not be fully operative until the end of puberty. Assessing pain, already a difficult task in the adult, is all the more so in children because of lesser verbal communicative capabilities, difficulty in handling abstract concepts, lack of experience of painful stimuli to make comparisons, and ignorance of their body image. In the very young child, diagnosing pain relies on suggestive circumstances, and an altered behaviour, knowing that no one symptom in pathognomonic. As the child grows up, methods for self-assessment of pain become usable, such as coloured scales and simplified verbal scales. However, behavioural tests remain the mainstay until the prepubertal period. The treatment of acute pain requires a reasoned approach which takes into account the state of the child, that of the aetiological investigations, the likely course of the lesions, as well as the patient's analgesic requirements. Therapeutic means do not differ from those for adult patients; however, the differences of distribution of body water, the small possibilities of linking with plasma proteins, and limited conjugation with glucuronate must be taken into account, especially during the first months of life. Local and regional anaesthetic block techniques are of great interest in elective and emergency surgery, as well as in trauma: they can provide complete pain relief, mostly without having any effect on the patient's physiological state (haemodynamics and consciousness). Peripherally acting analgesic agents, which are well supported on the whole, as well as co-analgesics, have a great part to play, although there are less drugs available than for adults. The most useful ones are paracetamol, followed by the salicylates, propionic acid derivatives and non steroid anti-inflammatory drugs.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗
PubMed1990

Sciatic nerve blocks in children: comparison of the posterior, anterior, and lateral approaches in 180 pediatric patients.

Three techniques for blocking the sciatic nerve, differing in approach (posterior in group P; lateral in group L; and anterior in group A), were prospectively evaluated in 180 children who were also given light general anesthesia for surgery below the knee. Four anesthetic solutions with epinephrine (1% lidocaine, 0.5% bupivacaine, and two mixtures of 0.5% bupivacaine with either 1% lidocaine or 1% etidocaine) were administered to 15 patients in each group. The sciatic nerve was located by electrical stimulation or, when muscle twitches were not elicited, using a loss-of-resistance technique. Twitches were "typical" in 154 patients of whom 153 developed sciatic nerve block. In 26 patients twitches were atypical (eight patients) or absent (18 patients) and a sciatic block developed in only 13 patients (50%). The depth to which the needle was inserted was measured in each procedure; it varied according to patient's age and weight and was significantly less with the posterior approach than with either the lateral or anterior routes. The overall success rate exceeded 90% in the three groups but significantly fewer difficulties were encountered in group P than in group A. Although the spread of the anesthetic was different in the three groups, the distribution of anesthesia in the lower extremity was similar, including not only dermatomes supplied by the sciatic nerve, but also those supplied by the posterior femoral cutaneous nerve. No neurological sequelae were observed. It is concluded that the posterior and lateral approaches are the most suitable in children for blocking the sciatic nerve proximally.

Adolescent↗
PubMed1990

[Continuous epidural anesthesia in children under 1 year of age].

Thirty one epidural analgesias were performed in 23 ASA 1 or 2 infants ranged in age from 2 days to 1 year for orthopedic operation; 20 G needles were used for epidural puncture (25 with Potts-Cournand needles, 6 with Tuohy needles). A mixture of 0.5 mg.kg-1 0.5% bupivacaine, 0.5 mg.kg-1 1% etidocaine and 0.05 mg.kg-1 of morphine was administered. The same anesthetic mixture (without morphine) was injected by a catheter during the first 30 hours after the procedure to provide post-operative analgesia. Adequate, complete sensory blockade was obtained in every case (mean level T6). Five accidental dural punctures occurred with Potts-Cournand needles, none were observed with Tuohy needles. Hemodynamic and respiratory parameters did not show significant variations.

Analgesia, Epidural↗
PubMed1989

[Regional anesthesia in pediatrics].

After having been virtually completely forgotten since the Second World War, paediatric regional anaesthesia has been undergoing a renewal in the last decade. This renewed interest in old techniques is due to several converging factors: a better knowledge of the pharmacology of local anaesthetic agents in the child, the availability of equipment adapted for children, the remarkable haemodynamic stability of the very young child during an epidural block, as well as the need to treat pain not just in the operative period. The child is not, or rather, is not only a small adult. Embryological development is not finished at birth. The incompletely myelinized nervous system as well as the incomplete skeletal ossification will influence local anaesthetic pharmacodynamics and the choice of anaesthetic technique and anatomical landmarks. Aponeurotic sheaths are only poorly attached to anatomical structures, especially nerves. This, together with the fact that epidural fat in the young child is very fluid, explains why some techniques are very efficient, but also why the volumes of required anaesthetic solution are proportionately much more important than in adults. The general pharmacology of local anaesthetic drugs is very close to adults. However, the very important regional blood flow rates, the different body water distribution, the immature neurovegetative system, the weak activity of some enzymes, and the relatively greater importance of the liver and brain by weight explain the differences found in pharmacokinetics, which are differences in degree and not in nature. The choice of the appropriate local anaesthetic agent depends on these factors. In France, the chosen drug will almost exclusively be an amide, mostly lignocaine and bupivacaine. The psychological immaturity of children makes any assessment of pain quite difficult. Moreover, body image has not yet been completely acquired in most cases, so reducing the possibility of conceptualization. The usefulness of techniques requiring an active patient participation, in particular the search for paraesthesia, is therefore rather reduced. Light general anaesthesia and peripheral nerve stimulators (for nerve blocks) are essential, and desirable at least, if not wished by most patients. Caudal anaesthesia is an important technique in the child. It is easy to perform, efficient, with small risk. Its ideal indication is surgery below the umbilicus in the infant and young child. Lumbar epidural anaesthesia requires greater experience as well as proper equipment, especially in the very young child. Peripheral nerve blocks are less used than in adults.(ABSTRACT TRUNCATED AT 400 WORDS)

Anesthesia, Conduction↗
PubMed1989

Comparison of the fascia iliaca compartment block with the 3-in-1 block in children.

A new single injection procedure, the fascia iliaca compartment block, is described for blocking the femoral, lateral cutaneous, and obturator nerves. The technique consists of injecting a local anesthetic immediately behind the fascia iliaca at the union of the lateral with the two medial thirds of the inguinal ligament, and forcing it upward by finger compression. This block was prospectively evaluated in 60 pediatric patients aged 0.7 to 17 years undergoing surgery of the lower limb, and then compared with a similar group of 60 children given a 3-in-1 block. Adequate analgesia was only obtained in 20% of the patients given 3-in-1 blocks (group 1), whereas the fascia iliaca compartment block proved to be easy, free of complications, and effective in more than 90% of patients (group 2). Such a high failure rate in group 1 was not due to misplacement of the needle since a femoral nerve block developed in all patients. Therefore it is unlikely that the local anesthetic can spread rostrally towards the lumbar plexus then return peripherally along the issuing nerves, and this was, indeed, not confirmed by radiological findings. In the authors' opinion, a multieffective block can only develop when the local anesthetic is introduced behind the fascia iliaca, which circumscribes a potential space where the femoral, lateral cutaneous, and obturator nerves run for a considerable part of their course. This report shows that deliberately injecting this space almost always results in an easy and effective block of these three nerves. The fascia iliaca compartment block can be recommended for use in children.

Adolescent↗
PubMed1989

[Long term complications of splenic artery ligation for haematologic problems in the child. A study of 7 cases].

Since 1983, the authors have performed a surgical ligation of the splenic artery in 7 patients suffering hypersplenism due to hematological diseases (4 Minkowski-Chauffard, 2 Betathalassemia Major, 1 Idiopathic Thrombocytopenic purpura). The immediate post operative course and long-term outcome of the patients were evaluated on clinical and biological grounds. The early post operative period was not influenced by the underlying hematological disorder. In all patients the hemoglobin, erythrocyte and platelet counts significantly increased and were related to functional hyposplenism. Delayed outcome depended on the underlying disease. Patients with Betathalassemia returned to preoperative status within months; thus, the only advantage of the arterial ligation was to transiently decrease the requirements in blood transfusion. Two patients with Minkowski-Chauffard disease did not present further episodes of acute hemolysis and did not required additional blood transfusion. On the other hand, the other two patients with Minkowski-Chauffard disease progressively returned to preoperative status, including severe episodes of hemolysis, and required a splenectomy be performed. Since the arterial supply to the spleen remains inchanged after the operation, it may be expected that the results (i.e. long-duration hyposplenism) could be improved by performing extensively devascularization of the spleen to complete the ligation of the splenic artery.

Adolescent↗
PubMed1989

Penile block via the subpubic space in 100 children.

A technique for blocking the dorsal nerves of the penis was designed after reevaluation of the gross anatomy of the subpubic space and penis in children. The technique consists of inserting a short bevel needle in the two compartments of the subpubic space, where the nerves run before entering the base of the penis, and of injecting a small volume (0.1 mL/kg of body weight) of local anesthetic. This two-puncture procedure was prospectively evaluated in 100 children undergoing surgery of the penis under light general anesthesia. The local anesthetic was a solution of 1% lidocaine (Group A) or 0.5% bupivacaine (Group B). The technique did not require any special skill and was successful in all patients. In four cases, the block needle was withdrawn and reinserted due to venous blood reflux. No complications occurred and anesthesia was satisfactory for completion of surgery. The duration of postoperative pain relief was significantly longer in patients given bupivacaine than in those given lidocaine. It is concluded that the subpubic approach to the dorsal nerves of the penis is easy, safe, and reliable, and that 0.5% plain bupivacaine provides long-lasting postoperative pain relief.

Adolescent↗
PubMed1989

Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients.

The success rate and occurrence of adverse effects are reported in a retrospective study of 750 caudal analgesias in children. In 94% of the patients, the blocks were performed under light general anesthesia. Standard IM or short-beveled needles were used in all. Four anesthetic solutions of lidocaine and/or bupivacaine with 1:200,000 epinephrine were injected in volumes ranging from 0.5 to 1.25 ml/kg. The overall success rate of caudal blocks was 96%, but several attempts were necessary in 25% of patients. Most failures occurred in children more than 7 years old. The use of short-beveled needles considerably decreased the number of traumatic punctures. The upper limit of analgesia varied widely and appropriate distribution of anesthesia was reliably obtained only after the injection of 0.75 to 1.0 ml/kg of local anesthetic solution. Conscious children tolerated surgery poorly (from a psychological point of view) although they were free of pain. Conversely, breathing difficulties occurred in 12% of lightly anesthetized patients. Hemodynamic disturbances were infrequent, as were adverse effects except for postoperative vomiting (17%). Motor block, present in 54% of patients, was poorly tolerated postoperatively by 10% of patients. Long-lasting postoperative pain relief was usually obtained. There were no major complications or neurological sequelae and good patient and parental acceptance of caudal anesthesia. Caudal anesthesia is a reliable and safe technique in young children.

Adolescent↗
PubMed1988

Intrathecal morphine for spinal fusion in children.

Intrathecal morphine (0.025 mg/kg) was administered preoperatively to 20 children undergoing major surgery of the rachis, ie, either posterior (16 cases) or anterior (4 cases) spinal fusions. During the surgical procedure, hemodynamic control was easily maintained. Blood loss was slightly less than 50% of blood volume and the mean infusion rate of blood was 6.3 +/- 4.5 ml/kg/hour for the duration of surgery. The technique did not significantly interfere with wake-up tests, and memory of awakening was only observed in one case. The postoperative course was also positively affected. The children could be extubated within the 30 minutes following completion of surgery, and they could perform effective breathing exercises early on. High degree and long duration (36 to 72 hours) of pain relief were obtained in every case. No major adverse effect was observed. Thus, the administration of intrathecal morphine prior to spinal fusion appears to be safe, easy, and reliable. We think it should be recommended for major surgery of the rachis.

Adolescent↗