Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1998
Review[Rapid sequence anesthetic induction via prehospital tracheal intubation].
The choice of sedation for emergency intubation remains controversial. This lack of consensus has led to various sedation protocols used in French prehospital care setting. ⋯ Its benefits include protection against myocardial and cerebral ischaemia, decreased risk of pulmonary aspiration, and a stable haemodynamic profile. Randomized studies are needed to substantiate the advantages of the association etomidate-suxamethonium for rapid sequences intubation in the prehospital setting.
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Beta2-mimetics represent the primary treatment for acute severe asthma. Their route of administration are nebulizer inhalation and inhalation chamber, or direct intratracheal route in patients receiving artificial ventilation. The subcutaneous route remains useful while awaiting implementation of nebulizer routine. The intravenous route is indicated in cases of non-rapid improvement in patients' receiving inhaled treatment.
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Ann Fr Anesth Reanim · Jan 1998
Review[The sitting position in neurosurgery: the viewpoint of the anesthetist].
The sitting position can be used safely in neurosurgery, if meticulous attention is given to the positioning and the monitoring of the patient during surgery. Venous air embolism remains the most frequent complication. Hypotension is the second complication. A rigorous patient selection of patients, the experience of the anesthesiologist and the neurosurgeon remain the main factors for the choice of the sitting position.
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We analysed the data on the risk of infection during practice of locoregional anaesthesia (LRA) and propose recommendations for its prevention. The epidemiologic data show that the incidence is very low. ⋯ The benefit-risk ratio must be considered, specifically in obstetrics. Precautions which must be followed during the practice of LRA are discussed.
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Ann Fr Anesth Reanim · Jan 1998
Review[Postoperative pain. Particularities in the child of less than 5 years, neonatology excluded].
For many years, postoperative pain has been undertreated in children less than 5 years old in comparison to adults. The assessment of pain is indeed difficult in this range of age, and only the scales of hetero-evaluation are used. The guidelines for treatment are similar as in adults: systematic administration, balanced analgesia, evaluation of pain and potential adverse effects. ⋯ Morphine remains the drug of choice among opioids; however the risk of respiratory depression in higher in infants less than 3 months old. Nalbuphine is also widely used in paediatrics. In addition, regional anaesthesia, either in single shot for minor surgery, or in continuous administration through epidural catheter for major surgery, has changed the management of postoperative pain in paediatrics.