Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Apr 2006
Review[What are the changes in paediatric anaesthesia practice afforded by new anaesthetic ventilators?].
Because of specific paediatric respiratory physiology (mainly decreased compliance and functional residual capacity, increased O2 demand and CO2 production), ventilators for paediatric anaesthesia need to be powerful and able to deliver small volumes at a high rate without compression volume loss. The compensation of compliance now available on every anaesthesia machine, compensates for the volume of gas lost by compression in the circuit tubing allowing the tidal volume to reach preset commands, even for bellow in box respirators. Preset tidal volume is then totally delivered to the lung by volume-controlled ventilation because it becomes independent of total pulmonary compliance and fresh gas flow. ⋯ Increased accuracy and security of the mode "pressure assist" might increase the use of spontaneous ventilation in paediatric anaesthesia even for low weight children. However tidal volume remains variable with compliance and depth of anaesthesia, which may require several adjustments of ventilator's settings. The clinical conditions (mainly airway control) of pressure assist use for children less than 10 kg should be elucidated before recommending its use.
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Ann Fr Anesth Reanim · Apr 2006
Review[Inhalation induction with sevoflurane in paediatrics: what is new?].
The delay for loss of consciousness can be shortened by using high concentration sevoflurane > 6% and by adding N2O during inhalation induction with sevoflurane in paediatrics. Mean time for tracheal tube insertion is lower than 5 min in the majority of studies. This shorter delay is not associated with any significant increase in clinical side effects. ⋯ Inhalation induction with high alveolar sevoflurane concentration is questionable mainly when it is associated with hyperventilation. Positive pressure ventilation or pressure support ventilation make it possible to maintain normocapnia and to monitor FeSevo. Adding a narcotic decreases the target cerebral concentration required to perform tracheal intubation and consequently the risk of spike wave occurrence.
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Ann Fr Anesth Reanim · Apr 2006
Review[Regional organization for intensive care in children, need for maintenance of competence in paediatric anaesthesia and intensive care].
The recent French text concerning the medical care both of the child and the teenager classifies the establishments either in specialized centers or in proximity centers according to their level in the management of children and teenagers, the competences of their medical teams, their organization in permanence of care and the volume of acts they carry out and pathologies they treat by class of age. This grid of the paediatric activities implies a new organization both in paediatric surgery and in paediatric ENT and consequently in the anaesthetic organization. Anaesthetic competences necessary to the achievement of this mission and the means of maintaining these later are analyzed and compared with some foreign experiments.
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The malignant bone tumours in children are rare, concerning 5% of the all paediatric tumours. Among all paediatric bone tumours, 15% of them are malignant. ⋯ It is essential in front of potential clinical or radiological signs, to perform quickly the specific medical exams and biopsy. The treatment needs a paediatric medical and surgical staff.
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Ann Fr Anesth Reanim · Apr 2006
Review[Preoperative information for paediatric patients. The anaesthesiologist's point of view].
Medical information is mandatory before any medical procedure, including pediatric anesthesia. Preoperative information covers many aspects, including medico-psychologic and judicial aspects. When the patient is a child, information must be delivered to the parents in priority. ⋯ Preoperative preparation programs have been developed, but controversial results have been observed. The great majority of the studies on preoperative programs were performed in the USA, where the demand for preoperative information is very important. It is far from sure that the results of all these studies may be extrapolated to French parents, and French studies are needed.