Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 2012
[Caudal block and light sevoflurane mask anesthesia in high-risk infants: an audit of 98 cases].
In order to reduce the risk of postoperative apnoea, awake spinal anaesthesia or awake caudal anaesthesia are recommended for hernia surgery in newborn babies and former premature infants aged less than 60 weeks of amenorrhoea. However, additional sedation is sometimes necessary. Our working hypothesis was that a general anaesthesia with a face mask (sevoflurane) with no opiates nor neuromuscular blocking agents, maintaining the infant's spontaneous breathing and combined with a caudal anaesthesia, could provide a safe and effective alternative. ⋯ The technique proposed is an effective alternative to the awake locoregional anaesthesia techniques: it provides excellent conditions for surgery and presents similar perioperative morbidity and risk of postoperative apnoea.
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The sensory innervation of the face is provided by the three major nerves, emerging from trigeminal nerve: the ophthalmic, maxillary and mandibular nerve. Nerve blocks of the face or head are not widely used in practice in France. ⋯ The performance of these blocks is simple provided the usual safety rules are followed. As for other peripheral nerve blocks, ultrasound guidance has shown its interest for the realization of facial nerve blocks to identify anatomical structure and to locate the spread of the injected local anaesthetic.
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Ann Fr Anesth Reanim · Jan 2012
Review[The surgeon's viewpoint concerning Complex Regional Pain Syndrome 1].
The complex regional pain syndrome type 1 from the surgeon's point of view: description of the symptoms, imaging (nuclear medicine, MRI) and of the associated psychological context. Importance of the need for a multi-disciplinary organization from the diagnostic to the therapeutic care.
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Ann Fr Anesth Reanim · Jan 2012
Review[What should we do and what should we not do after an anaesthetic accident. The point of view of a medical expert].
Lawsuits following an anaesthetic accident are fortunately infrequent. Anaesthesiologists are mainly sued by parents when the accident led to death or permanent brain damage. The aims of this short review are to explain how the medical expert is chosen by the court, what are the goals of the mission given by the judge, and how to prepare the medical expertise.
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Ann Fr Anesth Reanim · Jan 2012
Review[What to do or not, after an anaesthetic accident? The point of view of the medical advisor].
The objectives of this review are (1) to explain the goals of a medico-legal appraisement and describe the various jurisdictions able to order it; (2) to analyze the actions to be taken from the medico-legal point of view during and after the accident; (3) to give advise concerning communication with the patient, its family and the colleagues involved in the case; (4) to describe of the role of the medical advisor before (constitution of the file to communicate), during (assistance to the blamed practitioner) and after the expertise (to learn the practical lessons); (5) to recall the importance of the quality of the anaesthetic file, the keystone of the expertise, and the rules governing the responsibility for the doctor.