Annales françaises d'anesthèsie et de rèanimation
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To describe the effects of anaesthetic techniques and agents on the risk of fetal distress during labour pain relief and anaesthesia for caesarean section. ⋯ All obstetric anaesthesia and analgesia techniques are associated with a theoretical risk of fetal distress, but given the fact that regional anaesthesia techniques are also associated with well-demonstrated benefits for the mother and the newborn, the latter remain the preferred choice in obstetric practice.
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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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Ann Fr Anesth Reanim · Jul 2007
Review[Spinal anaesthesia for caesarean section: fluid loading, vasopressors and hypotension].
To analyze the different preventive and curative strategies for the management of hypotension during spinal anaesthesia for caesarean section. ⋯ Hypotension during spinal anesthesia for caesarean section must be systematically detected, prevented and treated without delay. The association of vasopressor(s) (phenylephrine with or without ephedrine) with a rapid crystalloid loading at the time of spinal injection represents the most interesting strategy nowadays.
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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.