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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The author introduces the modernization program for field medical facilities of the French military health service. It depends mainly on the manufacturing of containerized hospitals, the main features of which are: mobility, modularity and fast setup.
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Cahiers d'anesthésiologie · Jan 1994
[Ambulatory anesthesia in ORL. Indication, limits and techniques].
Patients undergoing ENT surgery, mainly children, are excellent candidates for outpatient anaesthesia. Most surgical procedures are simple and do not require complicated techniques. Patient selection criteria have been defined by the "Société Française d'Anesthésie et de Réanimation" e.g. ⋯ Myringotomy and adenoidectomy and simple nasal or otologic surgery can be performed on an outpatient basis. Indications can be extended to other procedures that do not require hypotension and that meet selection criteria. Tonsillectomy and direct laryngoscopy could be performed on an outpatient basis in definite circumstances which have to be discussed for each patient.
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Cahiers d'anesthésiologie · Jan 1994
[How can we improve the efficacy of morphine analgesia without increasing adverse effects?].
The use of opioids for postoperative pain relief is associated with the occurrence of side effects whatever the technique of administration. One may consider different solutions to reduce these side effects, while maintaining an adequate analgesia level. Combination of different pharmacological types of analgesic agents is defined as "balanced analgesia". ⋯ Alpha 2 adrenergic agonists, acting at the level of the dorsal horn of the spinal cord, also strengthen and prolong analgesia induced by epidural or spinal opioids. Finally, local anaesthetic solutions in low concentration may potentiate the analgesic effect of opioids, also improving the quality of analgesia. These different combinations have to be considered in view of the surgical procedure performed, the patient condition and the possibilities of monitoring in any given care unit.