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E Chevaleraud

Publications and source records attributed to E Chevaleraud.

8 recordsLinked to original sources
PubMed1995

[Anesthesia for hand surgery in patients with epidermolysis bullosa].

OBJECTIVE: To report on the anaesthetic management with axillary block of patients suffering from recessive dystrophic epidermolysis bullosa (RDEB), undergoing repetitive surgery of the hand. STUDY DESIGN: Retrospective analysis of a case series. PATIENTS: Twenty-two patients, including 11 children less than 8-year-old and with a body weight under 20 kg, treated since 1988, were considered. METHODS: For surgery, including usually three stages at a 7-day interval, an axillary block was placed when feasible, after oral premedication midazolam (0.1-0.2 mg.kg-1) with a 25 gauge needle in patients of less than 30 kg of body weight and 22 gauge beyond. The local anaesthetic mixture included 2% lidocaine (5-10 mg.kg-1) and 0.5% bupivacaine (2-3 mg.kg-1). A catheter for repetitive injections had not been inserted. For children less than 10-year-old a parent was present in the theater during all the course of operation. RESULTS: Between 1988 and 1995, 22 patients underwent 160 operative interventions on 54 hands. Regional anaesthesia was used in 142 cases, including 140 axillary and 2 interscalene blocks. General anaesthesia was only required in 20 cases, either alone or associated with regional anaesthesia. The success rate of axillary blocks was 98%. DISCUSSION: For surgery of the hand in patients with RDEB, we switched in 1988 from general anaesthesia with ketamine to axillary block, even in young children, as it is closer to the no-touch principle, which is essential to prevent from blistering. In comparison to general anaesthesia, regional anaesthesia raises neither the problems of airway and vascular access, nor those of instrumental monitoring. The main factors of success with regional anaesthesia are technical skills, expertise in the management of patients with RDEB and parental presence in the operating room which makes the procedure less stressful for children.

Adolescent↗
PubMed1995

[Anesthesia for hand surgery in patients with bullous epidermolysis].

Epidermolysis bullosa is a rare genetic disease, characterized by the formation of bullae in the skin and squamous epithelium following minimal trauma. The majority of surgical indications specific to this disease concern autosomal recessive dystrophic epidermolysis bullosa (RDEB). Hand surgery is one of the fields of surgery involved. The cicatricial course of the lesions results in retraction and pseudosyndactylization of the fingers, sometimes leading to complete destruction of the hand. Since 1988, we have treated 23 patients, including 11 children under the age of 8 years and weighing less than 20 kg. 185 procedures were performed by two anaesthetists, using regional plexus blocks in 157 cases and general anaesthesia in only 28 cases. This series is comparable in number, to that reported by the London team, which prefers general anaesthesia. Regional anaesthesia has been previously used, but only following general anaesthetic induction. Our approach, based on the experience of a hand surgery center, is in marked opposition with this standard paediatric approach. Regional anaesthetic techniques, particularly in the upper limb, present many advantages in addition to their feasibility in small children: efficacy, simplicity, postoperative analgesia, and outpatient comfort. In the context of the specificities and difficulties encountered in the management of these patients suffering from epidermolysis bullosa, the authors demonstrate the value of first-line regional anaesthesia, even in very young children (less than 3 years). The presence of a parent in the operating room is a valuable aid, which is still insufficiently used, but which should be used with conviction for the benefit of all concerned.

Adolescent↗
PubMed1994

[Simplified locoregional anesthetic technique for the surgery of the thumb].

Finger surgery is a frequent procedure, of short duration unless in case of major trauma, and often performed in emergency circumstances. In order to improve this type of treatment, we have developed distal blockade techniques. The double innervation in the thumb requires two punctures; a) dorsal, in order to block the superficial branch of the radial nerve; b) palmar, through the flexor tendon sheath, allowing the blockade of the digital nerves, outing from the median nerve. We use bupivacaine 0.5% without adrenaline, which offers high quality anaesthesia and analgesia. This technique can be used outside the operating room, in emergency or X-ray rooms. It allows thumb anaesthesia, either alone for short duration or in an addition to a plexus blockade whose effect in the radial nerve area would be insufficient.

Adolescent↗
PubMed1994

[Simplified anesthesia for the surgical treatment of severe sprains of the metacarpophalangeal joint of the thumb].

A series a 40 patients with severe sprain of the medial collateral ligament of the metacarpophalangeal joint of the thumb is reported. Anesthesia was performed by infiltration of the superficial branch of the radial nerve and the palmar collateral nerves of the thumb via of the flexor tendon sheath, with 0.5% bupivacaine without adrenaline, 3-4 ml each. This technique, easy and reliable (complete success) with a prolonged analgesia, is useful in the operating room and for stress examination or dynamic X rays.

Analgesia↗
PubMed1993

[Local anesthesia of the finger through the flexor tendon sheath].

A series of 350 cases of local anaesthesia of the finger using the flexor tendon sheath is reported. The patients were ranked ASA 1 or 2 and the youngest was 12 months old. This technique was used for day case surgery, such as nail trauma and tumours, wound exploration, tumour and cyst removal, tenolysis and neurolysis. The needle was inserted on the palmar aspect of the metacarpophalangeal joint, into the digital flexor tendon of the corresponding finger. Thereafter the needle was withdrawn very slightly in order to inject the local anaesthesia solution within the sheath, and not the tendon. The volumes were respectively 1 ml in children and 3 to 4 ml in adults of either 2% lignocaine or 0.5% bupivacaine without adrenaline. As palmar injections are painful a freezing spray solution was used prior to insertion of the needle. There was no anaesthesia of the dorsal digital nerves, as opposed to the findings of the author of the first series. This technique, which can be qualified as being easy and reliable, could be a valuable alternative for the ring or interdigital blocks, which carry a significant risk of vascular and neurological complications.

Adolescent↗