Annales françaises d'anesthèsie et de rèanimation
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Physiologic and pathologic changes due to ageing should be taken in account for the preoperative evaluation and peroperative management of geriatric patients. Pharmacokinetic changes ed to reduce the doses of intravenous agents by 50%. ⋯ Pharmacodynamic deleterious effects are limitative in the choice of some drugs. Cardiocirculatory and pulmonary functions need specific, if possible non invasive monitoring, during surgery, recovery and the early postoperative days.
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Numerous anaesthetic techniques exist for a patient who presents with a difficult endotracheal intubation. They all require an anaesthetic protocol which cannot be improvised. ⋯ When a fiberoptic bronchoscope is not available, several alternatives can be suggested: local anaesthesia of the glottis, retro-molar and retrograde intubation, or the use of a guide threaded over a lighted stylet; these techniques can be used in an anaesthetized patient breathing spontaneously. In the paralyzed patient impossible to intubate, various trans-laryngeal techniques of ventilation can be used in emergency: jet ventilation via the trans-crico-thyroid route, the use of a cricotomy cannula, or a minitracheotomy set.
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Ann Fr Anesth Reanim · Jan 1990
Comparative Study[Comparison of the pharmacokinetics of etomidate in children and in adults].
Etomidate pharmacokinetics were compared in 12 children (P group) (age 7 to 13 years, weight 22 to 48 kg) and in 4 adult women (A group) (age 28 to 52 years, weight 46 to 72 kg), A. S. A. 1, undergoing minor non abdominal surgery. ⋯ No age-related difference was found inside P group with regard to pharmacokinetic parameters. In conclusion, a 30% higher etomidate bolus dosage is required in children than in adults to achieve similar plasma concentrations, due to a higher volume of the initial compartment. In comparison to adults the higher clearance suggests higher maintenance dose requirements in children.
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The use of regional anaesthesia in ambulatory patients is discussed. Five criteria for discharge are described: the four 'A's (Awake, Ambulation, Alimentation, Analgesia) and micturition. Recommended agents for additional sedation with the regional block, if required, are midazolam and fentanyl. ⋯ However, urinary retention and orthostatic hypotension can occur. The risk of headache is not a contraindication for day-case surgery if some guidelines are followed. Penile blocks and caudal blocks are widely used in pediatric surgery.