Annales françaises d'anesthèsie et de rèanimation
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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.
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Ann Fr Anesth Reanim · Jan 2012
Review[What is new regarding anaesthetic monitoring in the operating room?].
This paper critically reviews the new devices that can be used on the operating room to monitor the oxygenation and the haemodynamics of the child undergoing general anaesthesia.
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Ann Fr Anesth Reanim · Jan 2012
Review[Application of ultrasound in paediatric abdominal trunk blocks].
Although relatively few studies have compared US guidance with established "blind" techniques, the available evidence suggests that the use of US guidance is a safe and effective way to facilitate correct needle placement and adequate spread of LA for abdominal wall nerve blocks. It improves block effectiveness and safety by reducing LA doses and by detecting anatomic variants or unsuspected pathologies. ⋯ Matched with improving technology, the use of US has significant benefits over conventional techniques to perform classic and new abdominal wall nerve blocks in children. However, more studies are required to evaluate the potential of US to support this finding.
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Ann Fr Anesth Reanim · Jan 2012
Review[What should we do and what should we not do after an anaesthetic accident. The point of view of a medical expert].
Lawsuits following an anaesthetic accident are fortunately infrequent. Anaesthesiologists are mainly sued by parents when the accident led to death or permanent brain damage. The aims of this short review are to explain how the medical expert is chosen by the court, what are the goals of the mission given by the judge, and how to prepare the medical expertise.
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Ann Fr Anesth Reanim · Dec 2011
Review[Undesirable events during the perioperative period and communication deficiencies].
In recent decades, anaesthesia and surgery have undergone major scientific and technical developments. However, these improvements have not solved a recurring problem, communication deficiencies within teams in charge of surgical patients. Current figures show that 21% to 65% of accidents and errors in patient management during the perioperative period are related to communication problems. ⋯ To minimize the impact of these phenomena, it is important to improve standardization of information flow within operating theatres and to improve teamwork between anaesthetists and surgeons. This can be done through crew resource management training programs or simulation. This should ultimately contribute to minimise medical error and improve the overall quality of care provided to patients in operating theatres and during all the perioperative period.