Annales françaises d'anesthèsie et de rèanimation
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Pain management in paediatric neurosurgery must be a daily concern for surgeons and anaesthetists. Pain assessment in infants and small children is difficult to perform because of limitations associated with these patients. The association of safe and effective analgesics allows good pain relief together with good safety conditions. However, neuropathic pain, which may occur following neurosurgical procedures, will require further studies.
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Ann Fr Anesth Reanim · Feb 2002
Review[Infections of cerebrospinal fluid shunts in the child: prevention and treatment].
Cerebrospinal fluid (CSF) shunting has developed into the mean method of treatment in children with hydrocephalus. Until the last decade, shunt infection was the most important cause of morbidity with a mean rate of 10%. Most of shunt infection (> 90%) are diagnosed within six months after surgery supporting a basic premise of direct contamination at the time of surgery. ⋯ The small sample sizes of prospective controlled clinical trials precluded sufficient statistical power. The conclusions of the meta-analyses are not sufficiently robust to resolve the controversy and it is not possible to make recommendations either for or against the use of prophylaxis in shunt surgery. The management of shunt infection is examined with emphasis on antibiotic therapy.
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Craniosynostoses are a group of diseases, the presentation of which differs markedly on account of the cranial suture involved. Their impact is cosmetic, cerebral, and ophthalmologic. ⋯ This surgery requires a perfect collaboration between neurosurgeon, plastic surgeon, and anaesthesiologist. Surgical correction allows in large measures the preservation of intellect, sight, and body image.
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Ann Fr Anesth Reanim · Feb 2002
Review[Perioperative management of blood loss during surgical treatment for craniosynostosis].
Blood saving is the major challenge during the surgical repair of craniofacial deformities. Treated patients have a low reserve volume and the techniques available to lower homologous blood transfusions are limited or insufficiently evaluated in this particular case. The most important factor determining blood loss is the quality of the surgical haemostasis. ⋯ The haematocrit threshold allowing homologous blood transfusion should be set at 21%, provided that any other source of autologous blood is exhausted. Postoperative monitoring should also include precise evaluation of blood losses and haematocrit measurements. The 21% threshold should remain the reference during that period.
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Ann Fr Anesth Reanim · Feb 2002
Review[Anesthesia-resuscitation for intracranial expansive processes in children].
The most frequent space-occupying cerebral lesions in children are brain tumors, mostly posterior fossa tumors and haematoma resulting from arteriovenous malformation rupture. They result in intracranial hypertension, directly or by compression of the cerebrospinal fluid pathway resulting in hydrocephalus. Their localization and compressive effects are responsible for specific neurological deficits and general problems. ⋯ Surgical positioning is complex for these long lasting procedures and carries specific risks. The most common is venous air embolism in the sitting position that must be prevented by the use of specific measures. In the postoperative period, the risk of neurological and general complications commands close surveillance, fast track extubation must be adapted on an individual basis.