Annales françaises d'anesthèsie et de rèanimation
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Early and efficient management of severely burned patients facilitates outcome improvement. Pre-hospital care includes fluid loading with 2 mL.kg-1/% burn over the first six hours, sedation and analgesia, prevention of hypothermia and ventilatory support for either critically burned patients or facial, cervical or pulmonary burn injury. The transient stay in a general hospital before transfer to a burn centre allows extension of initial care, the critical investigation for associated injuries (intoxication, multiple trauma) and to perform initial local treatment with sterile coverage or vaseline gauze after a revised assessment of the burned skin area, and possibly escharotomies. ⋯ Finally, chemical or electrical burn, radiation, associated CO intoxication or multiple trauma, as well as burn injury in infants, raise specific problems. With improvement in early intensive care, the survival rate of the most severely burned patients is obviously improving. New techniques in skin substitution will probably further improve the final outcome.
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Ann Fr Anesth Reanim · Jan 1997
Case Reports[A low dose of nalbuphine reverses respiratory depression but not analgesia induced by intraspinal morphine].
Postoperative pain management after scoliosis surgery is based in our institution on intrathecal morphine administration. This case report describes an immediate and major postoperative respiratory depression that occurred in the recovery room, requiring the maintenance of the endotracheal tube. This respiratory depression was reversed by i.v. administration of a low dose of nalbuphine, which allowed tracheal extubation without suppression of morphine-induced analgesia.
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Ann Fr Anesth Reanim · Jan 1997
Randomized Controlled Trial Comparative Study Clinical Trial[Prevention of arterial hypotension during spinal anesthesia using intramuscular ephedrine in older people].
To assess the efficacy of intramuscular ephedrine for prevention of hypotension following subarachnoid block (SB) in the elderly. ⋯ Prophylactic intramuscular ephedrine is effective to prevent hypotension associated with SB in the elderly.
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Ann Fr Anesth Reanim · Jan 1997
Multicenter Study Comparative Study[Headaches after spinal anesthesia: prospective multicenter study of a young adult population].
We assessed the occurrence of post-dural puncture headache (PDPH) in a group of young adults following spinal anaesthesia using a 24-gauge Sprotte needle. ⋯ The indications of spinal anaesthesia could be extended to young patients, whatever their gender, using a non-traumatic 24-gauge Sprotte needle.
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The occurrence of a fat embolism syndrome (FES) can be explained by two hypothetic mechanisms. In the mechanical hypothesis, bone marrow enters into the cardiovascular system during an intramedullary peak pressure. This peak could occur during either long bone fracture and/or intramedullary nailing or cemented or noncemented arthroplasty. ⋯ Aprotinin and heparin are beneficial in counteracting blood cell aggregation. A prophylactic use of vena cava filters has been advocated. Prevention or early treatment of hypovolaemia and hypoxaemia are essential.