Cahiers d'anesthésiologie
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The occurrence of bleeding in trauma patients is a life-threatening problem which can be explained by different mechanisms. The infusion of cristalloids, colloids, packed red blood cells, or even fresh frozen plasma is very rarely responsible for bleeding but it can contribute to dilute the patient's platelet pool, and especially dilutional thrombocytopenia is the first cause of bleeding after massive transfusion. Blood coagulation factor activity is decreased after a massive fluid infusion is performed but it has to reach a dramatically low plasma level in order to induce troubles. ⋯ Hypothermia can also impair platelet function and worsen the bleeding. A simplified monitoring of haemostasis can be proposed with platelet count, whole blood coagulation clotting time, immediately available activated partial thromboplastin time and prothrombin time with bedside portable monitors and thromboelastography. Haematocrit and body temperature have to be monitored as well.
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The advantages of regional over general anaesthesia have led to an increased use of peripheral nerve blocks. Among the few risks of regional anaesthesia are those of overdosage, systemic and neural toxicity. Techniques have been proposed to improve the success of peripheral nerve blocks and to avoid nerve damage or systemic toxicity. Nerve stimulator, anatomic landmarks, needles and anaesthetic solutions are discussed.
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Cahiers d'anesthésiologie · Jan 1995
Review[Optimal use of the administration of morphine derivatives].
During the postoperative period, the efficacy of opioid treatment is different among patients. Indeed, an extreme variability exists between patients, concerning their analgesic requirement and their sensibility to opioids. ⋯ The combination of different analgesics must be prescribed systematically, if there is no contraindication. 3) Opoid side effects must be appropriately treated, in order to improve the quality of analgesia. These simple measures require regular evaluation of opioid analgesia, and treatment of the side effects.
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Cahiers d'anesthésiologie · Jan 1995
Review[Analgesia after surgery of the spine in adults and adolescents].
Postoperative pain after spinal surgeries is highly dependent on the number of vertebrae included in the operation and on its invasiveness, opposing two extremes, discectomies and cyphoscoliosis corrections. Opiates by intravenous route remain the reference, either continuously given in predetermined doses, or better using a patient-controlled device. Nonsteroidal and steroidal anti-inflammatory drugs are widely popular for medical approach of sciatalgia and it is quite logical to use them for reducing, even to suppress, opiates after spinal surgeries. ⋯ Also, epidural clonidine results in excellent pain relief, but is associated with hypotension and marked sedation. In discectomy, injection of dexamethasone into the operative field has been proposed. Whatever the technique used, early diagnosis of neurological complications of spinal surgery should be not ruled out by postoperative analgesia.