Annales françaises d'anesthèsie et de rèanimation
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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.
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The pre-emptive analgesia concept suggests that pre-administration of analgesics may enhance the efficacy of these drugs. This review has selected the data from the literature according to two types of methodological criteria: Sackett's criteria, and those specific of pre-emptive analgesia studies. Infiltration, spinal and peripheral nerve blocks using local anaesthetic drugs do not seem to produce pre-emptive analgesia. ⋯ In other cases (NSAIDs, ketamine), pre-administration represents a change in usual practice. This is not justified for NSAIDs; NMDA receptor antagonists may offer an interesting research area. Data concerning pre-emptive analgesia for chronic pain syndrome such as phantom limb pain are quite limited.
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Ann Fr Anesth Reanim · Jan 1998
Case Reports-A difficult intubation of an infant with McKusick-Kaufman syndrome. Failure of the laryngeal mask-fibroscope sequence-.
Fibreoptic intubation through the laryngeal mask airway is a recommended technique for the management of a restricted airway. We report the failure of this technique in a 20-month-old infant presenting with McKusick-Kaufman syndrome.