Annales françaises d'anesthèsie et de rèanimation
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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.
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Ann Fr Anesth Reanim · Jan 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative hemodynamic effects of sevoflurane and halothane at tele-expiratory concentration in intubation of infants].
To compare the cardiovascular changes at the end-tidal concentrations of sevoflurane versus halothane required for tracheal intubation in infants (intubation MAC). ⋯ Sevoflurane decreases cardiac output less than halothane in infants at the intubation MAC, due to a lower end-tidal concentration at intubation MAC and to less effects on haemodynamic variables.
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Ann Fr Anesth Reanim · Jan 1998
Review[Repercussion of postoperative pain, benefits attending to treatment].
Physiological responses to postoperative acute pain may impede organ functions (cardiovascular, pulmonary, coagulation, endocrine, gastrointestinal, central nervous system, etc). Pain alleviation improves patient's comfort, but also may minimise perioperative stress response, physiological responses and postoperative organ dysfunction, assist postoperative nursing and physiotherapy, enhance clinical outcome, and potentially shorten the hospital stay. Potent postoperative analgesia, especially by epidural route, may be associated with reduction in incidence and severity of many perioperative dysfunctions. ⋯ On balance, the mode of acute pain relief decreases adverse physiological responses and many intermediate outcome variables; however, there is inconclusive evidence that it affects clinical outcome. Major advances in postoperative recovery can be achieved by early aggressive perioperative care, including potent analgesia, early mobilisation and oral nutrition. As a result, the hospital stay may be shortened.
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The assessment of postoperative pain and analgesic efficacy is essential as pain levels and morphine requirements are not predictable. Self-assessment with unidimensional methods (such as the visual analogue pain scale, the numerical rating scale and the verbal rating scale) is the rule for adults and children more than 5 years of age. The former is a validated method and the most accurate and reproducible scale. ⋯ Finally, morphine consumption with PCA is also an indirect pain assessment method. Postoperative pain should be assessed several times a day in every patient, starting in the recovery room and prolonged during hospital stay. Pain should be measured at rest and in dynamic conditions by the medical and paramedical team.