Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Analgesia using continuous axillary block after surgery of severe hand injuries: self-administration versus continuous injection].
To compare analgesia produced after surgery for severe hand trauma, by a continuous axillary block obtained either with a continuous injection (CA) or controlled by the patient (PCA). ⋯ Continuous axillary plexus blockade provides safe and effective postoperative analgesia. With the PCA technique results a lower quantity of bupivacaine is required and patient's satisfaction better.
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Ann Fr Anesth Reanim · Jan 1998
Randomized Controlled Trial Comparative Study Clinical Trial-The effect of ondansetron on intracranial pressure and cerebral perfusion pressure in neurosurgical patients-.
To determine the effect of ondansetron on intracranial pressure (ICP), mean arterial pressure (MAP) and cerebral perfusion pressure (CPP). ⋯ Intravenous administration of 8 mg ondansetron affects neither cerebral hemodynamics nor ICP.
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Ann Fr Anesth Reanim · Jan 1998
Review[Benefit-risk and monitoring modalities of different techniques and methods of postoperative analgesia].
This review aimed to determine the benefits-risks ratio of postoperative analgesia. The various agents usually used for intravenous postoperative analgesia (paracetamol, NSAID's, opioids), and the techniques for postoperative analgesia (PCA, epidural, perinervous block) are analysed. The rules proposed for the monitoring of postoperative analgesia are considered.
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The question as to whether the head and trunk of neurosurgery patients should be elevated remains controversial. This question is particularly important when intracranial hypertension is present. Head up position may have beneficial effects on intracranial pressure (ICP) via changes in mean arterial pressure (MAP), airway pressure, central venous pressure and cerebro spinal fluid displacement. ⋯ In most patients with intracranial hypertension, head and trunk elevation up to 30 degrees is useful in helping to decrease ICP, providing that a safe CPP of at least 70 mmHg or even 80 mmHg is maintained. Patients in poor haemodynamic conditions are best nursed flat. CPP is thus the most important factor in assessment and monitoring when considering head elevation in patients with increased ICP.
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The necessity of an adapted, optimal postoperative analgesia in the elderly is widely recognised. Reduced physiological capacities must be taken into consideration during the perioperative period. Class I analgesics, such as paracetamol, are both safe and efficient, and can be used for basic analgesia. ⋯ Pulse oximetry can be of value. After orthopaedic surgery, perineural or peripheral analgesia should be favoured considering the excellent benefit-risk ratio. Close clinical monitoring is essential for providing safe and efficient analgesia in the elderly using the techniques currently at our disposal.