Chirurgie; mémoires de l'Académie de chirurgie
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A special emergency ward for paediatric patients was established at the University Hospital in Nantes on November 7, 1990. Both medical and surgical patients less than 15 years, 3 months of age are admitted. The initial organization of the ward (facilities personnel, on call duty) are described for the emergency paediatric surgery unit. ⋯ During this period, 4,438 children were referred to the emergency ward and 2,905 (64.8%) involved a surgical pathology. The epidemiological characteristics of the patients (age, geographic origin, day and hour of admission), the causal pathology, the examinations and procedures performed, and outcome (length of stay in the ward long-term outcome) were studied. Based on these results, the authors analyzed the factors leading to dysfunction and proposed improvements in the organization of this emergency ward.
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After being neglected for a long time, postoperative analgesia is developing considerably at present. A wide range of resources, including antipyretics, nonsteroid anti-inflammatories, agonist-antagonists and morphinic agents allow to great variations of sensibility between individuals. New techniques such as patient-controlled analgesia and spinal morphine therapy are becoming essential for intense pain. New concepts are appearing, such as treatment units for acute pain, while others are gaining new momentum, like the prophylaxis of postoperative pain.
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Recent surveys, especially in Britain and in Finland, have completed and updated a survey on anaesthesia-related morbidity and mortality that was carried out under the auspices of the French institute for health and medical research a decade ago. Severity of the patient's condition remains the key factor, along with the extent of surgery, while the improvement of safety conditions in anaesthesia through standards and recommendations is beginning to produce results.