Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Analgesia using continuous axillary block after surgery of severe hand injuries: self-administration versus continuous injection].
To compare analgesia produced after surgery for severe hand trauma, by a continuous axillary block obtained either with a continuous injection (CA) or controlled by the patient (PCA). ⋯ Continuous axillary plexus blockade provides safe and effective postoperative analgesia. With the PCA technique results a lower quantity of bupivacaine is required and patient's satisfaction better.
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Pain is a subjective feeling; its assessment is therefore difficult, and no "gold standard" method exists for humans. Major improvements have, however, been made in the last decade by widespread acceptation of the concept of pain evaluation and widespread use on surgical wards. Evaluation by the patient himself is the rule (unless communication is impaired), as assessment of pain by nurses or doctors systematically leads to underestimation (which also occurs with observational scales). ⋯ Although scientific validation is difficult, VAS seems the most accurate and reproducible scale. Post-operative pain should be assessed several times a day in every patient, at rest and in dynamic conditions (cough, movement) and should focus on present pain rather than on pain in the previous hours. Assessment of pain is essential before quality-assurance programmes can be implemented.
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Ann Fr Anesth Reanim · Jan 1998
Historical Article[The first death due to inhalation anesthesia in France. An example of the absence of verification of bibliographic references].
The reporting of the first death attributed to anaesthesia is commonly placed in 1848. The present work indicates that, in France, anaesthesia was recognized as being responsible for deaths as early as February, 1847.
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The assessment of postoperative pain and analgesic efficacy is essential as pain levels and morphine requirements are not predictable. Self-assessment with unidimensional methods (such as the visual analogue pain scale, the numerical rating scale and the verbal rating scale) is the rule for adults and children more than 5 years of age. The former is a validated method and the most accurate and reproducible scale. ⋯ Finally, morphine consumption with PCA is also an indirect pain assessment method. Postoperative pain should be assessed several times a day in every patient, starting in the recovery room and prolonged during hospital stay. Pain should be measured at rest and in dynamic conditions by the medical and paramedical team.
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Ann Fr Anesth Reanim · Jan 1998
Clinical Trial[Pressure exerted on tracheal cuffs in intubation in the presence of nitrous oxide].
To compare the time course of endotracheal tube cuff pressures in presence of nitrous oxide (N2O), obtained in a tracheal model with those measured during clinical anaesthesia. ⋯ The results obtained in vitro were correlated with those measured in the patients. Therefore the tracheal model is a helpful guide for the choice of endotracheal tubes.