Cahiers d'anesthésiologie
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Patient controlled analgesia improves titration of analgesic drugs, minimizing individual pharmacodynamic differences between patients, during the postoperative period. We describe the efficacy and the safety of intravenous PCA, based on the follow-up of 300 patients, recovering from upper and lower abdominal surgery. Successful use of PCA requires the choice of two important parameters: the PCA bolus and the lock-out period. ⋯ Patient's acceptance proved to be excellent and only 4 patients were not satisfied with PCA therapy. The incidence of respiratory depression was low (0.02%) and only one patient required naloxone. The side effects were dysphoria, nausea, pruritus and urinary retention; their incidence was low.
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Cahiers d'anesthésiologie · Jan 1994
[Mechanical ventilation during MRI in children. Anesthetic constraints].
Early use of magnetic resonance imaging (MRI) excluded patients needing mechanical ventilation. However magnetic resonance imaging is an innocuous investigation and affords important elements to the diagnosis of many pathologies. Improvement of anaesthetic equipment have led to enlarge MRI applications considerably. ⋯ Although the ferromagnetic charge of presently used ventilators is greatly reduced, it is still necessary to keep them at some distance from the patient, with tubing of about 3 m, even in children. Therefore the compressible gas volumes are larger than the usual ones. For a tube length of 3 m, about 2-3 ml.kg-1 should be added to the standard tidal volume (10 ml.kg-1), so as to obtain safe normoventilation.
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Sciatic nerve blocks were seldom used until recently. They apply to most surgical procedures on the lower limb and are often combined with a "3 in 1" block. ⋯ Sciatic nerve block can be obtained by different techniques. The choice of which being helped by some guidelines according to the patients characteristics and the surgical site.
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Cahiers d'anesthésiologie · Jan 1994
[Indications of the different components of blood and outcome of transfusion practices in postpartum hemorrhage].
Despite a high incidence of mortality associated with post-partum haemorrhage, indications for transfusion of blood and its components in obstetrics remain ill defined. Transfusion is often massive if needed. ⋯ Treatment of DIC calls for fresh frozen safely screened plasma, fibrinogen or platelets concentrates. Indications for autologous transfusion are very limited in these circumstances.
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Cahiers d'anesthésiologie · Jan 1994
Comparative Study[Peridural morphine or intravenous patient-controlled (PCA) morphine: which is the best choice?].
Postoperative analgesia must be adapted to each case. When postoperative course is moderately painful, as in day case surgery, non opioid analgesics are sufficient. ⋯ Morphine by intravenous PCA is the technique of choice for it provides an optimal comfort in most cases. Nevertheless, when an intensive analgesia is needed, as for active physiotherapy in a risk patient after an important surgery, an epidural combination of opioids and local anaesthetics is much more suitable.