Revue médicale de Liège
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Revue médicale de Liège · Jan 2011
[Anesthesia and safety of procedures outside the operating room: "everyone's responsibility"].
Due to important technological improvements, anesthesiological activity outside the operating theatre is increasing. Most of these procedures are performed for gastroenterology procedures; other procedures include medical imaging, electroconvulsive therapy or cardioversion. ⋯ Anesthesia will be requested if the procedure is likely to be unpleasant or painful, if the patient is not cooperative, or if the patient's hemodynamic condition is unstable. The pre-anesthesia assessment, an adequate monitoring and an appropriate choice of the anesthetic technique and drugs will be helpful in managing an anesthetic procedure too frequently neglected despite it is associated with risks similar to procedures performed in the operating theatre.
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Synthesized as anesthetic agent about fifty years ago, ketamine (Ketalar) has been supplanted by more attractive anesthetic agents with less adverse effects. Nevertheless, the potential of this drug, although often unknown by many practitioners, remains significant. ⋯ Moreover, its efficacy to treat acute pain resistant to classic analgesics makes ketamine a very interesting and clinically-relevant drug for all practitioners facing this type of pain. This article reviews the clinical benefits of ketamine which has sometimes suffered from a negative reputation, but which possesses recently reconsidered wonderful pharmacological properties.
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Revue médicale de Liège · Jan 2010
[Extracorporeal membrane oxygenation (ECMO) in ICU patients suffering from cardiogenic shock, refractory hypoxemia or cardiac arrest].
ExtraCorporeal Membrane Oxygenation (ECMO) is a cardiopulmonary assistance device able to support patients in cardiac arrest, refractory cardiogenic shock or refractory hypoxemia otherwise sentenced to death. Recent technical progresses, early indication decision, bedside multidisciplinary implant, specific complications screening and echocardiographic weaning testing are crucial points to allow success of this exceptional technique.
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Revue médicale de Liège · Jan 2010
[Is a coagulation blood test compulsory before neuraxial blockade for labor analgesia?].
Neuraxial blockade such as epidural, spinal or combined spinal-epidural analgesia is considered to be the best technique for labour analgesia. Even if epidural hematoma is a very rare complication of neuraxial blockade, it may result in severe and definitive neurological injuries. This rare complication is usually associated with coagulation abnormalities. ⋯ This practice is questionable from the evidence-based medicine and the economic point of view. According to the guidelines published by several scientific societies, no routine coagulation screening tests are required in the absence of any history or clinical suspicion of coagulation impairment. The aim of the present article is to delineate the appropriate attitude in this context.
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Revue médicale de Liège · Dec 2009
Review[Regional analgesia after lower limb orthopaedic surgery].
To provide postoperative analgesia, the anaesthesist has at his disposal a panel of different medications and also regional techniques of neural blockade. Loco-Regional analgesia (epidural or peripheral nerve block), by the use of local anaesthetics, blocks conduction of the painful influx to th central nervous system. Pain relief using peripheral nerve blocks after lower limb surgery represents as good alternative to the epidural analgesia and is superior to controlled analgesia with morphine. ⋯ Analgesia after total knee prosthesis and hallux valgus surgery has considerably evolved. Postoperative analgesia is important in these cases: it facilitates physical therapy and improves patient's rehabilitation and satisfaction, it also shortens hospital stay. The aim of this review is to explain the different techniques of peripheral neural blockade and assess the value of this technique for the postoperative period after these two surgeries.