Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1997
[Decision to limit or practise maximum therapeutic support in a neurosurgical intensive care unit].
To assess the respective rates of intensive care maximalization, limitation and withdrawal practice in a neurosurgical intensive care unit. ⋯ This prospective study confirmed the results of several previous surveys. The medical decision to limit or to discontinue treatments is rather frequent in intensive care units. This is an illegal practice in French legislation and code of professional ethics. Recommendations by representative French medical associations on the modalities of decision making on limitation of therapy would be welcome.
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Ann Fr Anesth Reanim · Jan 1997
[Block of the lateral perforant branches of the subcostal and iliohypogastric nerves for proximal femur surgery].
We describe an original method to block the lateral cutaneous rami of the subcostal and iliohypogastric nerves or'iliac crest point block'to complete plexular block of the lower limb for hip surgery. The local anaesthetic is injected in front of an osterofibrous orifice of the iliac crest. In nine cases out of ten, the lateral cutaneous rami of the iliohypogastric nerve pass through this orifice and in one case out of ten, it is the one arising from the subcostal nerve. This complementary block allows the surgical incision at the level of the great trochanter.
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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.
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Ann Fr Anesth Reanim · Jan 1997
Randomized Controlled Trial Comparative Study Clinical Trial[Combination of Emla cream and nitrous oxide for venous cannulation in children].