Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1998
Review[Postoperative pain. Particularities in the child of less than 5 years, neonatology excluded].
For many years, postoperative pain has been undertreated in children less than 5 years old in comparison to adults. The assessment of pain is indeed difficult in this range of age, and only the scales of hetero-evaluation are used. The guidelines for treatment are similar as in adults: systematic administration, balanced analgesia, evaluation of pain and potential adverse effects. ⋯ Morphine remains the drug of choice among opioids; however the risk of respiratory depression in higher in infants less than 3 months old. Nalbuphine is also widely used in paediatrics. In addition, regional anaesthesia, either in single shot for minor surgery, or in continuous administration through epidural catheter for major surgery, has changed the management of postoperative pain in paediatrics.
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The pre-emptive analgesia concept suggests that pre-administration of analgesics may enhance the efficacy of these drugs. This review has selected the data from the literature according to two types of methodological criteria: Sackett's criteria, and those specific of pre-emptive analgesia studies. Infiltration, spinal and peripheral nerve blocks using local anaesthetic drugs do not seem to produce pre-emptive analgesia. ⋯ In other cases (NSAIDs, ketamine), pre-administration represents a change in usual practice. This is not justified for NSAIDs; NMDA receptor antagonists may offer an interesting research area. Data concerning pre-emptive analgesia for chronic pain syndrome such as phantom limb pain are quite limited.
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Ann Fr Anesth Reanim · Jan 1998
Case Reports-A difficult intubation of an infant with McKusick-Kaufman syndrome. Failure of the laryngeal mask-fibroscope sequence-.
Fibreoptic intubation through the laryngeal mask airway is a recommended technique for the management of a restricted airway. We report the failure of this technique in a 20-month-old infant presenting with McKusick-Kaufman syndrome.
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Ann Fr Anesth Reanim · Jan 1998
Comparative Study[Principles of tests of hypotheses in statistics: alpha, beta and P].
Modern clinical research requires control of statistical methods. We reviewed 120 original manuscripts which were submitted to the Annales françaises d'anesthésie et de reanimation and analyzed their statistical methodology. Most of them contained errors (inappropriate numerical expression of the data, uncontrolled alpha risk, lack of power, use of inadequate statistical tests) and only 9 (7%) were considered as adequate. ⋯ The following items should be checked to choose the appropriate test: assess the kind of variable, verify the requirements for application of the test (type of the variable distribution, sample size, particular conditions such as equality of variance, dependence or independence of the variables), determine if data come from paired samples or if multiple comparisons are performed. Statistical analysis has become more easy with computers, however a precise knowledge of statistics remains essential. Advice from a statistician is often useful especially when obtained a priori and not a posteriori.
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Ann Fr Anesth Reanim · Jan 1998
Comparative Study-Anesthesia and analgesia practice patterns in French obstetrical patients-.
To assess the rate of epidural analgesia (EA) for parturition and the techniques of anaesthesia for Caesarean section (CS). ⋯ In France in 1991, the average rate of 37.2% for EA for obstetrics was high when compared to the rate in United Kingdom. It was equivalent to those in United States and Ontario, Canada. The discrepancies between hospitals were mainly related to structural and organizational factors. The influence of the size of the maternity hospital, the 24-hour service of EA was also shown in other studies. However, the difference between GA and UH and PH is a French particularity. The high rate of GA for CS differs largely with those in the UK or the USA. The time saving aspect of GA was probably an important factor for the choice of this technique. This study must be reactualized and enlarged to determine the demand of EA for labour by parturients and obstetricians.