Annales françaises d'anesthèsie et de rèanimation
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Continuous peripheral nerve blocks (CPNB) have important role in the therapeutic arsenal, anaesthetic or analgesic in children. Indications for CPNB depend on benefits/risks analysis for each patient. ⋯ Nevertheless, CPNB may mask compartment syndrome in trauma or certain surgical procedure. Finally, ropivacaine, and perhaps levobupivacaine, appears to be the best local anaesthetic for continuous peripheral nerve blocks in children, requiring low flow rate with low concentration.
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Ann Fr Anesth Reanim · Jun 2007
[Mortality and prognostic factors of the cirrhotic patients with hepatic encephalopathy admitted to medical intensive care unit].
To assess mortality and to identify variables that could predict it in cirrhotic patients hospitalized to the medical intensive care unit (MICU) for hepatic encephalopathy (HE). ⋯ The MICU mortality of cirrhotic patients with HE was high and significantly associated with haemodynamic instability, hyperleucocytosis and mechanical ventilation.
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Ann Fr Anesth Reanim · Jun 2007
Review[Nociceptive cancer pain in adult patients: statement about guidelines related to the use of antinociceptive medicine].
The World Health Organization (WHO) published guidelines to improve cancer pain control which allow to relieve noceptive cancer pain in 80% of adult patients. Nevertheless WHO recommendations do not include: various ways to start morphine treatment, how to manage opioids adverse effects, severe cancer pain management, postoperative pain and procedure-relatived pain. The goal of this review is to discuss these issues. ⋯ Oral immediate or controlled release morphine is the most common and effective pain treatment for most patients with nociceptive cancer pain but rotation with other opioids or alternative routes of administration must be discussed quickly if pain persits or if adverse effects occur.
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Ann Fr Anesth Reanim · Jun 2007
Review[Steroids in the critical care children with septic shock and other conditions].
Steroids are indicated in paediatric intensive care as anti-inflammatory drugs or for substitutive treatment. During septic shock, the incidence of adrenal insufficiency (AI) varies between 18 à 52%, depending on the relative or absolute nature of the AI. Contrary to adults, for whom long courses of low doses of corticosteroids were shown to reduce mortality and increased shock reversibility, particularly in those with a negative synacthene test, no study provided sufficient evidence to show a benefit of steroids in terms of outcome in children with septic shock. ⋯ However the high incidence of side effects, particularly on the central nervous system, makes steroids currently not recommended for bronchopulmonary dysplasia. At last, steroids are indicated for severe asthma and for bacterial meningitis. In this latter indication, dexamethasone was shown to improve neurological outcome, indeed mortality in Haemophilus influenzae and Streptococcus pneumoniae meningitis.
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The real place of tramadol in the armatarium of postoperative analgesics in children remains to be defined. This paper presents a synthetic review of the present knowledge regarding the efficacy, dosage and possible routes of administration of tramadol to children in the postoperative period. ⋯ The perinervous routes (epidural, around peripheral nerves, skin infiltration) are controversial. Tramadol is a good alternative to NSAIDs and to morphine for moderate pain but its efficacy is variable due to the genetic polymorphism of its metabolism and possible drug interactions.