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H Visseaux

Publications and source records attributed to H Visseaux.

9 recordsLinked to original sources
PubMed2006

[Request of epidural analgesia by women and obstetrical teams in four French areas. Part I: Request for analgesia].

OBJECTIVE: Epidural analgesia (EA) is widely used in France to treat the labour pain. The aim of this study was to evaluate and analyse the reasons of EA requirements by parturients and obstetricians. STUDY DESIGN: An epidemiological survey was sent in all maternity units of four French areas. PATIENTS AND METHODS: Forty-eight of the 84 maternity units entered the study. In each centre, 25 patients fulfilled the questionnaire and the medical team fulfilled a questionnaire about the organisation of the ward. Demands of EA by parturients during pregnancy, labour and for the next delivery were recorded, and also the offer of EA by midwives and the possibility to move in an other town to obtain an EA. Student t-test, chi2 test and logistic regression model were used as requested. p<0.05 was considered as significant. RESULTS: One thousand one hundred forty-two women entered the study. During pregnancy 79% of women asked for an EA, they were 72% during labour. Factors influencing the request of an EA were parity, educational level, pain, preanaesthetic evaluation and the size and the kind of maternity unit (university, public or private hospital). During labour, the request of an EA was more frequent when anaesthesiologists were on call in the hospital (77.7 vs 66.7%, p<0.001). Midwives offered EA to 69% of women. For the next delivery 79.9% of women hoped an EA, the factors of this new request were parity, pain during this labour and EA during this labour; 42.8% would be ready to move in an other town to obtain an EA. The medical indications for EA occurred in 1.8% of patients. DISCUSSION: The request for EA mainly comes from women. Probably, in France, the request for EA will not diminish in the future. Analgesia networks could be considered.

Adult↗
PubMed2006

[Request of epidural analgesia by women and obstetrical teams in four French areas. Part II: Management of epidural analgesia].

OBJECTIVE: Epidural analgesia (EA) is widely used in France to treat the labour pain. The aim of this study was to evaluate and analyse the rate of EA and the ratio between EA required by parturients and total EA realised (performance ratio). STUDY DESIGN: An epidemiological survey was sent in all maternity units of 4 French areas. Patients and methods. - 48 of the 84 maternity units were participating to the study. In each centre, 25 patients fulfilled the questionnaire and the medical team fulfilled a questionnaire about the organisation of the ward. Rate of EA and performance ratio were calculated. Student t test, chi2 test and logistic regression model were used as requested; p<0.05 was considered as significant. RESULTS: The mean rate of epidural analgesia (EA) rate, in the French areas studied, was 61.6%. It was significantly higher in university (79+/-13.7%) and private hospital (73.1+/-20.4%) than in general hospitals (54.6+/-19.6%, p<0.01), and also in those where anaesthesiologists are dedicated to the maternity unit (71.3+/-17.8 vs 54.6+/-22.1%, p<0.01) and in hospitals where anaesthesiologists were on duty in the hospital versus on call at home (69.8+/-21.4 vs 56.1+/-19%, p<0.02). Median duration of EA was 180 minutes, and 21.3% of them lasted more than five hours. Most of EA was performed between 8 AM and 6 PM. Patients' request was the major reason of EA insertion (OR=11.81), then the midwife request (OR=9.01). Other significant factors were the type of the hospital, the anaesthesiologist on duty and parity of women. The ratio between the number of EA requested by parturients and the total number of EA performed was significantly better in university hospitals (100.3+/-13%) and private hospitals (92.2+/-15.7%) than in general hospitals (79.4+/-17.3%, p<0.02). For the patients who had requested EA and did not have EA, the main reason was that labour was too fast (122/167) and then that there was a fail in anaesthesiological organization (59/167). The contraindications were rare (14/167). CONCLUSION: To correctly answer to the request of EA, it seems necessary that one or more anaesthesiologists were dedicated to the maternity units, and that they were on duty into the hospital. So it seems important to have large maternities with adequate number of anaesthesiologists.

Analgesia, Epidural↗
PubMed2005

[Smoking and anesthesia].

There is no specific study about consequences of smoking in anesthetized pregnant women. General anesthesia is mainly involved in adverse effects of smoking. Among smoking patients, there is a significant increase in the incidence of cardiac and respiratory complications during and after anaesthesia. Post operative anxiety increases in smokers patients. But smoking decreases the incidence of nausea and vomiting after surgery. It would be better if smoking cessation took place 2 months before surgery, it is necessary to stop smoking 12 hours before anaesthesia. For general anaesthesia, propofol and sevoflurane provide less respiratory complications than other drugs. If possible, regional anaesthesia is the best choice for smoking patients.

Anesthesia↗
PubMed1996

[Indications of albumin for vascular loading during pregnancy].

Albumin infusion is used during pregnancy for volume loading in preeclampsia and/or intra-uterine growth retardation, before regional anaesthesia for Caesarean section, compensation of blood loss during haemorrhages of parturition, as well as prevention and treatment of ovarian hyperstimulation syndrome after in vitro fertilization. In preeclampsia, albumin is used for volume loading before initiating antihypertensive therapy. However it neither decreases blood pressure, nor increases uterine blood flow. Before regional anaesthesia for Caesarean section, an infusion of albumin 5% at a rate of 15 mL.kg-1 prevents hypotension in mothers (P < 0.05 versus Ringer lactate) and provides better Apgar scores in neonates (P < 0.05). Albumin is used to treat hypovolaemia in severe ovarian hyperstimulation syndrome. Recent studies have shown that in patients at high risk of ovarian hyperstimulation syndrome, 500 mL albumin 5% administered after ovocytes retrieval diminished the incidence of this syndrome (P < 0.05 versus normal saline).

Adult↗
PubMed1995

[Low back pain and headache during immediate postpartum. Role of obstetrical epidural analgesia].

The rate of low back pain and headache following parturition seems to be higher in patients delivered under epidural analgesia. The aim of this study, performed in the immediate postpartum (up to 3rd day) and including 200 patients delivered vaginally, was to assess the incidence and the risk factors of low back pain and headache. A total of 31.5% of them complained of low back pain (LBP+) after parturition. They were significantly younger than those without low back pain (LBP-) (p < 0.03) and have had significantly more often epidural analgesia (p < 0.05). However, there were no statistically significant differences concerning weight, weight gain, parity, duration of labour and duration of epidural analgesia. The LBP+ patients complained significantly more often of cervical (p < 0.04) and low back pain (p < 0.02) during pregnancy, than the LBP-. In the immediate postpartum period, cervical and dorsal pain as well as headache occurred significantly more often in LBP+ than in LBP+ (p < 0.001). The intensity of low back pain during pregnancy (p < 0.006). Risk factors for postpartum LBP were epidural analgesia (OR = odds ratio = 6.59), LBP (OR = 6.50) and cervical pain (OR = 2.75) during pregnancy. The influence of epidural analgesia is questionable, as there was no difference between duration of labour and duration of epidural analgesia, if used, between the two groups. Patients for whom epidural analgesia was required are probably more susceptible to pain during pregnancy. Patients who suffered from postpartum headache (PPHDA+) were comparable to those who did not (PPDHA-).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Conduction anesthesia and the newborn infant].

The placental transfer of local anaesthetics (LA) depends on maternal, placental and fetal factors. The assessment of effects of LA and epidural anaesthesia (EA) on the fetus is based on the monitoring of fetal heart rate (FHR) and the measurement of the fetal pH. Apgar score and neurobehavioral tests allow an evaluation of the neonatal effects of the drugs used. Direct effects of LA: a diminution of variability of FHR was observed shortly after the beginning of an EA using lidocaine but there was no modification of FHR after EA using bupivacaine or lidocaine with epinephrine. Fetal neurological toxicity is rare and there are very few alterations of neurobehavioral scores after EA. Indirect effects on uteroplacental blood flow (UBF): in high concentration, LA can induce vasoconstriction of uterine arteries but maternal arterial hypotension that impedes directly uteroplacental blood flow is the main effect. Prevention of aortocaval compression is essential because it allows better Apgar scores and arterial pH at birth. Use of colloids has not a better preventive efficacy than an equal volume of cristalloids while dextrans are formally contra-indicated because of serious fetal accidents. Large iv infusion of dextrose solutions are responsible for maternal and fetal hyperglycemia and hyperinsulinemia leading to neonatal hypoglycemia. The utilization of IM prophylactic ephedrine is not useful while the therapeutic administration of ephedrine to treat maternal arterial hypotension is efficient. Phenylephrine used in case of maternal arterial hypotension seems as efficient as is ephedrine. Epidural narcotics: the use of morphine by epidural route can induce neonatal respiratory depression and low neurobehavioral scores. The epidural administration of fentanyl does not alter the variability of the FHR and does not modify neither Apgar or neurobehavioral scores, nor respiratory adaptation of the newborn. Use of epidural alfentanil or sufentanil does not lead to low neurobehavioral scores unless very high doses are used. For elective caesarean section, newborns present a lower Apgar score at 1 min and necessitate respiratory assistance more frequently after general anaesthesia (GA) than after EA. Neurobehavioral scores are better after EA than after GA. For emergency caesarean section, the percentage of newborns with an Apgar score < 4 or necessitating a respiratory assistance is more important after GA than after EA. However, the perinatal mortality is not more important after GA than after EA.

Adult↗
PubMed1994

[Epidemiology of complications of obstetrical epidural analgesia].

Epidural analgesia (EA) is the best technique to obtain pain relief during labour. But the needle, the catheter and the local anaesthetics (LA) are 3 reasons to cause maternal complications. In France we do not know the exact number of EA performed every year and it is very difficult to appreciate the incidence of maternal complications. Therefore, it is necessary to know it and try to reduce the incidence of some of them. Maternal complications after EA are classically: 1. caused by catheter or needle: massive subarachnoid injection, toxic intravenous injection with convulsions and/or cardiac arrest; 2. secondary to infectious problems: meningitis or epidural abscess; 3. due to LA with the very rare anaphylactoid reactions; 4. due to prolonged neurologic complications with epidural and subdural haematomas, subarachnoid cysts or arachnoiditis. These complications are rare: 1/4,700 in the largest series of literature, involving more than 500,000 EA. In France, we tried to quantify maternal complications among nearly 300,000 EA performed over a period of 5 years. The overall incidence of serious complications was 1/4,005 EA. The most frequent are accidental dural puncture (1/156), massive subarachnoid injections (1/8,010) and convulsions (1/9,011). The incidence of these 3 complications must be reduced by better training, material or attention during bolus injection of LA.

Abscess↗