Near-infrared spectrometry in pregnancy: progress and perspectives, a review of literature

Near-infrared spectroscopy (NIRS) allows continuous noninvasive monitoring of in vivo oxygenation in selected tissues. It has been used primarily as a research tool for several years, but it is seeing wider application in the clinical arena all over the world. It was recently used to monitor brain circulation in cardiac surgery, carotid endarteriectomy, neurosurgery and robotic surgery. According to the few studies used NIRS in pregnancy, it may be helpful to assess the impact of severe forms of preeclampsia on brain circulation, to evaluate the  efficacy of different treatments. It may also be used during cesarean section to detect earlier sudden  complications. The evaluation of placental function via abdominal maternal approach to detect fetal growth restriction is a new field of application of NIRS.Key words: Near-Infrared Spectrometry, pregnancy, preeclamsia, cesarean sectio

Réhabilitation précoce post césarienne: enquête de pratique auprès des maternités de la région de Sfax en Tunisie

Introduction: Bien que la plupart des principes de réhabilitation précoce post césarienne paraissent applicable dans nos structures de soins, il semble que la mise en oeuvre reste limitée. Méthodes: Il s'agit d'une enquête structurée par courrier électronique auprès des médecins anesthésistes de la région de Sfax décrivant leurs pratiques habituelles dans les maternités étatiques et privées de la région de Sfax. Nous avons utilisé un questionnaire dans le cadre de prise en charge de la césarienne programmée. Résultats: Le taux de réponse des médecins était de 68% (30/44). L'analgésie orale a été débutée au cours des 24 premières heures par 13% des anesthésistes. La perfusion post opératoire a été arrêtée avant 24h dans 27% des cas. Le Retrait de la sonde < H6, la reprise des boissons < H6, la reprise de l'alimentation < H12 ont été observé respectivement dans 57%, 63% et 30% des cas. L'emploi d'ocytocine limité à H6 est la conduite de 60% des médecins interrogés. La carbétocine est encore non utilisée. Conclusion: Les différents composants de la réhabilitation précoce post césarienne sont encore insuffisamment mis en oeuvre.Pan African Medical Journal 2016; 2

Postoperative analgesia in children when using clonidine in addition to fentanyl with bupivacaine given caudally

The aim of the study was to evaluate the efficacy of clonidine in association with fentanyl as an additive to bupivacaine 0.25% given via single shot caudal epidural in pediatric patients for postoperative pain relief. In the present prospective randomized double blind study, 40 children of ASA-I-II aged 1-5 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg and clonidine 1μg/kg (group I) or bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg (group II). Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamic parameters, and side effects or complications.Both the groups were similar with respect to patient and various block characteristics. Heart rate and blood pressure were not different in 2 groups. Significantly prolonged duration of post-operative analgesia was observed in group I (P<0.05). Side effects such as respiratory depression, vomiting and bradycardia were similar in both groups. The adjunction of clonidine to fentanyl as additives to bupivacaine in single shot caudal epidural in children may provide better and longer analgesia after infraumblical surgical procedures. The Pan African Medical Journal 2016;2