Annales françaises d'anesthèsie et de rèanimation
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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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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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Ann Fr Anesth Reanim · Jan 1998
Review[How is the management of postoperative pain in organized in surgical wards?].
Many studies have demonstrated that the management of pain after surgery was unsatisfactory. New pain management techniques have been developed in recent years (patient-controlled analgesia, epidural analgesia). To extend the number of patients who may benefit from these recent techniques and/or to obtain the best efficacy from existing methods of pain relief, re-organisation should take place on surgical wards. ⋯ Surveys and audits should be carried out regularly to check their efficacy. Moreover, patients should be fully informed of the range of treatments available and their adverse effects. Finally, all staff involved in providing acute pain relief should undergo training.
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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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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.