Cahiers d'anesthésiologie
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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.
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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
[HELLP syndrome and pregnancy hypertension: severity? Anesthetic management].
Four cases of HELLP Syndrome (Haemolysis, Elevated liver enzymes, Low Platelet count) (HS) have given the authors an opportunity for this brief review. HS should be evoked in any pregnant woman with high blood pressure during the last term, for it is a real emergency. Symptomatic treatment and rapid extraction constitute the commonly accepted therapy, by which maternal and foetal morbidity and mortality can be considerably reduced.
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Cahiers d'anesthésiologie · Jan 1994
[Convulsions and cardiac arrest after epidural anesthesia. Prevention and treatment].
Seizures followed by cardiac arrest after obstetrical epidural anaesthesia are induced by either low cerebral perfusion due to cardiovascular collapse after too excessive sympathetic blockade or after accidental total spinal anaesthesia, or by toxic accident due to accidental intravascular administration of local anaesthetic drugs. In case of toxic accident, convulsions usually occur before haemodynamic changes. ⋯ In contrast, when bupivacaine is used, in case of toxic accident, there are dysrhythmias or bradycardia but QRS complexes are widened. The treatment is firstly to oxygenate, to stop convulsions and then to intubate the trachea and to ventilate the lungs.