Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression
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A rebreathing closed-circuit (Dräger) has been modified adjoining an automated device to inject volatile anaesthetics, thus replacing the usual vaporizer. The input of anaesthetic drug is separated from that of fresh gases: its rate of administration can thus be maintained precisely. ⋯ In our experiences, this device allows for a very satisfactory regulation of the alveolar concentration of the volatile anaesthetic. In addition, this apparatus is able to measure the injected volume of liquid anaesthetic and includes several devices aimed at increasing both safety and versatility.
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A post-operative follow-up in 21 cases of Congenital diaphragmatic hernia (C. D. H.) was carried out on 2 groups of patients. ⋯ Post-operative complications decreased on the ratio of 1/7, the intensive care stay being halved. The overwhelming importance of the correct anaesthetic procedure was underlined. An overall survival rate of 76% gives hopes for a better future for patients suffering from this malformation.
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Postoperative analgesia remains frequently insufficient in children. This is in part due to the difficult assessment of pain in the different age groups. ⋯ The different analgesic drugs and techniques available allow to establish guidelines for postoperative analgesia in different age groups of children, under different surgical and postoperative conditions. On the basis of such guidelines, ordered analgesics have a greater chance to be really administered at the proper time to each child.
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Thirty one epidural analgesias were performed in 23 ASA 1 or 2 infants ranged in age from 2 days to 1 year for orthopedic operation; 20 G needles were used for epidural puncture (25 with Potts-Cournand needles, 6 with Tuohy needles). A mixture of 0.5 mg.kg-1 0.5% bupivacaine, 0.5 mg.kg-1 1% etidocaine and 0.05 mg.kg-1 of morphine was administered. ⋯ Five accidental dural punctures occurred with Potts-Cournand needles, none were observed with Tuohy needles. Hemodynamic and respiratory parameters did not show significant variations.
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Bioethics always has been a great part of medicine, particularly actually in anaesthesiology. From either neonatal distress resuscitation of polymalformated babies or negative vital prognostic babies enduring numerous anaesthesia, to euthanasia for condemned and often suffering patients, there are numerous medical situations in anaesthesiology needing ethical thinking. ⋯ Then, what a singular relation. The patient confinding the anaesthetist all his vital functions without knowing him.