Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 2012
Review[Peroperative anaphylactic shock in children: management and evaluation].
Anaphylactic shock is the most severe manifestation of hypersensitivity, whether of allergic origin or not. In the operating theatre, anaphylactic shock is rare in paediatric patients and latex allergy is still the major cause of allergy. ⋯ Symptomatic treatment is well codified. The results of blood sampling at the time of the reaction and of allergic tests performed a few weeks later will enable a definitive diagnosis to be made and appropriate recommendations (medical alert card) to be given to the patients and its parents.
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The activity of a paediatric chronic pain clinic is described. The author highlight the importance of the first visit of the child with its parents, and of a multidisciplinary approach adapted to the child's individual needs.
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Three types of hyperalgesia can occur during the postoperative period: primary hyperalgesia, which disappears with wound healing, secondary or central hyperalgesia, which can lead to chronic pain, and opiate-induced hyperalgesia. Different drugs, most of which are NMDA receptors antagonists, are used to decrease or prevent the risk of central or opiate-induced hyperalgesia. However, it is difficult to determine whether they are really effective and at which dosage: the results of most published studies are difficult to interpret because of methodological problems. The two most frequent of those are: absence of objective measurement of secondary hyperalgesia and difficulties targeting an at risk population.