Annales françaises d'anesthèsie et de rèanimation
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In 2003 were promulgated the texts regulating rest and safety, in the USA (approved by the ACGME) and in France (January 9th, 2001 and September 14th, 2001). The institution of the "rest for safety", an eleven hours duration interruption of activity, immediately after a night-call, can be viewed as a progress in the search for safety. Several studies showed a link between excessive work hours and occurrence of medical incidents related to tiredness. ⋯ The idea that taking the necessary rest would be synonymous with a decrease of efficiency in patient care is not demonstrated, but the danger of a poorer information transmission should be handed with an optimization of our manpower and organization. Aging is accompanied by a progressive disorganization of sleep. The foreseeable shortage of manpower, synonymous with aging of the medical actors and increased vulnerability to tiredness, is a posteriori the justification of the institution of the rest for safety.
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Ann Fr Anesth Reanim · Jul 2007
Case Reports[Hypertriglyceridemia-induced pancreatitis in pregnancy. A case report].
We report the case of a 31-year-old pregnant patient in the 33rd week of gestation, with no history of dyslipidaemia, admitted for sub-acute epigastric pain. The milky aspect of blood samples was remarkable. Blood analysis showed a moderate increase in pancreatic enzymes but a major hyperlipaemia: triglyceridaemia 113 g/l and total cholesterolaemia 25 g/l. ⋯ Rapid clinical improvement allowed discharge from intensive care at day 3. This case report illustrates lipid decrease with undertaken treatments. We discuss the management of hypertriglyceridemia-induced pancreatitis in pregnancy.
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Ann Fr Anesth Reanim · Jul 2007
Review[Is a biological assessment necessary to realize an obstetrical epidural anaesthesia in a patient whose interrogation and clinical examination are strictly normal?].
In France, coagulation blood tests are usually ordered before performing an epidural anaesthesia. This French habit obeys to the fear of triggering an epidural haematoma induced by neuraxial anaesthesia. This analysis of literature shows that these practices do not protect anaesthesiologists against this clinical risk or its medico-legal consequences. ⋯ This recommendation is valid only for normal pregnancy. The clinician must ensure that pregnancy is still normal by seeking for symptoms of pregnancy-induced pathology such as preeclampsia or HELLP syndrome before setting an epidural anaesthesia. The possibly late occurrence of these complications during the per- or post-partum explain why a coagulation test performed even a few days before anaesthesia may not allow to detect any coagulation defect favouring the risk of epidural haematoma.
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In France, the total hospital stay after colorectal resection by laparoscopy or laparotomy varies between 10 and 20 days. For several years, the concept of fast track rehabilitation in colonic surgery has been developed. In addition to a specific surgical and anaesthetic management, this concept relies on postoperative measures, particularly an early food intake and ambulation, which allow a spectacular reduction of the hospital stay to only 2 days. Two remarks temper initial optimism: all patients do not wish a short hospital stay and the wards do not always have the available resources necessary to set up this concept.
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The application and documentation of foetal surveillance in labour that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention remains discussed. The occurrence of abnormal foetal heart rate is a frequent indication for urgent Caesarean section and subsequent associated risks. ⋯ Definitions of safe standards of equipment and practices to prevent Mendelson's syndrome and to cope with a failed intubation drill are of major importance. Comprehensive communication between well-coordinated anaesthetic and obstetrical teams is one of the most important elements in the care of a compromised foetus.