Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1996
Review[Prevention of respiratory complications after abdominal surgery].
Abdominal surgery, especially upper abdominal surgical procedures are known to adversely affect pulmonary function. Pulmonary complications are the most frequent cause of postoperative morbidity and mortality. This review article aimed to analyse the incidence and risk factors for postoperative pulmonary morbidity and their prevention. ⋯ The various techniques of physiotherapy (chest physiotherapy, incentive spirometry, continuous positive airway pressure breathing) seem to be equivalent in efficacy; but intermittent positive pressure breathing has no advantages, compared with the other treatments and could even be deleterious. Chest physiotherapy and incentive spirometry are the most practical methods available for decreasing secretion contents of airways, whereas continuous positive airway pressure breathing is efficient on atelectasis. In stage II or III COPD patients, admission in a intensive therapy unit and prolonged mechanical ventilation may be required.
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Chylothorax following blunt chest trauma is a rare event. The presence of a cloudy or milky persistent pleural effusion should suggest the possibility of its chylous origin. The diagnosis is made by analysis of the fluid obtained either from thoracentesis or tube thoracostomy. ⋯ An efficient control of the chylous effusion may be facilitated by using a fat-poor enteral nutrition and parenteral nutrition, which prevents malnutrition. Surgical ligation of the thoracic duct is relatively simple and efficient. It is indicated when the daily chylous flow is over 500 mL after 2 or 3 weeks of medical treatment or in case of weight loss.
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Ann Fr Anesth Reanim · Jan 1996
Comparative Study Clinical Trial[Combined spinal and epidural analgesia for labor. Prolongation by addition of a minidose of clonidine to sufentanil. An initial study].
The effect of adding a minidose of clonidine to intrathecal sufentanil during the early first stage of a painful labour was evaluated in this preliminary open-label, non-randomised trial. Group 1 received sufentanil 5 micrograms + clonidine 30 micrograms intrathecally (n = 10) and group 2 only intrathecal sufentanil 5 micrograms (n = 11). The two groups were not statistically different regard-ing age, weight, height, primiparity (67 vs 50%), oxytocin use (37 vs 60%), initial cervical dilation (m +/- DS: 2.9 +/- 1.1 vs 2.9 +/- 1 cm) and VAS pain scores (70 +/- 14 vs 68 +/- 19 mm). ⋯ Side effects, such as hypotension, pruritus and sedation, were not statistically different between groups. Nausea and motor blockade did not occur. In conclusion, the addition of a minidose (30 micrograms) of clonidine to sufentanil 5 micrograms given intrathecally seems to potentiate markedly the analgesia obtained during the early first stage of labour.
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Ann Fr Anesth Reanim · Jan 1996
Clinical Trial[A study of pneumatic performances of 2 new anesthesia ventilators: a trial].
To assess the pneumatic performance of two new anaesthesia ventilators. ⋯ These two new machines with pneumatic compensation overcome the main drawback seen with conventional "bellows-in-box" ventilators.