Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Feb 2013
Review[Management of penetrating abdominal trauma: what we need to know?].
Penetrating traumas are rare in France and mainly due to stabbing. Knives are less lethal than firearms. The initial clinical assessment is the cornerstone of hospital care. ⋯ Mortality remains high, initially due to bleeding complications and secondarily to infectious complications. Early and appropriate surgery can reduce morbidity and mortality. Non-operative strategy is only possible in selected patients in trained trauma centers and with intensive supervision by experienced staff.
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Malignant hyperthermia (MH) is a pharmacogenetic disorder of anesthesia. Recent advances dealing with epidemiology of MH and the safe anesthetic course of MH susceptible patients are shortly presented here with a special insight into the preparation of modern anesthesia workstations, which they will share in operating room.
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Even with unfractionated heparin or derivates, the reversal of pharmacologic anticoagulation is crucial in anticoagulated patients developing a life-threatening bleeding or scheduled for an emergency procedure. The antagonisation of unfractionated heparin is well codified: each milligram of protamine sulfate antagonizes 100 IU of heparin. Measurement of thrombin time reflects the anti-IIa effect of heparin and has to be monitored immediately and 1hour after the injection of protamine. ⋯ To date, there is no effective antidote for new anticoagulants (fondaparinux and other pentasaccharides, direct thrombin inhibitors, direct anti-Xa inhibitors). Some preliminary studies suggest the effectiveness of recombinant activated factor VII for pentasaccharides and activated or not Prothrombin Complex Concentrates and recombinant activated factor VII for oral anti-Xa and anti-IIa agents. Therefore, while the characteristics of these new anticoagulants could increase the comfort and improve the compliance, their development needs to ascertain the lack of increase in bleeding complications and the need for a safe and effective antidote.
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Ann Fr Anesth Reanim · Jan 2013
Review[Systemic analgesia at home after pediatric day-case surgery].
Currently, day-case surgery has a significant development. In pediatrics, a big part of interventions can be performed as a day-case surgery. However, postoperative pain, often wrongly regarded as minor, should not be underestimated or undertreated. The aim of this paper is to review the available systemic analgesics and to propose a way to use them in order to improve children's comfort and experiences in their own families.
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Ann Fr Anesth Reanim · Jan 2013
Review[Organization of anaesthesia for children in a non-paediatric hospital].
The author reviews the guidelines and the possible organization of anaesthesia and surgery in a non-paediatric hospital.