Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Oct 2005
Review[Premixed 50% nitrous oxide and oxygen: theoretical recalls and practical modalities].
The concept of premixed 50% nitrous oxide and oxygen dated back to 1961 in England, where it is commercialised under the name Entonox. In France, after a so marginal use, premixed 50% nitrous oxide and oxygen now knows such a revival since we first consider the pain provoked by the cure. To use correctly premixed 50% nitrous oxide and oxygen, we need to know the main properties of the nitrous oxide. ⋯ In less than 10% of the cases, side effects are possible. Conditions of administration are given in details. The limits of the technic and the particular precautions of use are precised.
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Despite the availability of modern neuromuscular blocking agents with short or intermediate duration of action, incidence of residual neuromuscular blockade remains very high. Evidences have been recently provided that residual curarization must be defined as a train-of-four ratio below 0.9 at the thumb adductor during the recovery period after anaesthesia. Residual curarization may be associated with serious adverse events related to respiratory depression, pharyngeal dysfunction, hypoxemia and prolongation of the length of stay in the recovery room. Appropriate choice of drugs, perioperative monitoring of neuromuscular function and large indications of pharmacological reversal may reduce the incidence of residual curarization and improve the patient's safety in the postoperative setting.
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Ann Fr Anesth Reanim · Aug 2005
Review Guideline[Thromboprohylaxis in orthopedic surgery and traumatology].
Orthopaedic and trauma surgery are classified according 3 groups of venous thromboembolic risk. Elective total hip replacement (THR) or total knee replacement (TKR), hip fracture surgery or trauma patients are at high risk. Isolated lower extremity injury with fracture is at moderate risk whereas this risk is low without fracture as well as with knee arthroscopy. ⋯ In patients with isolated lower extremity injury or undergoing knee arthroscopy, LMWH should not be routinely used according to a low or a moderate risk and/or the duration of prophylaxis required. But LMWH has to be considered for patients with additional risk factors. Prophylaxis in other orthopedic procedures has not been assessed and will be extrapolated from the above recommendations.
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Peripheral nerve blockade is one of the therapeutic possibilities to treat spasticity of various muscles. Percutaneous nerve stimulation allows accurate location of nerves and neurolysis can be performed using intraneural injection of 65% ethanol or 5 to 12% phenol. Spastic contraction of various muscle groups is a common source of pain and disability which prevents from having efficient rehabilitation. ⋯ No complications occurred and minor side effects are transient painful phenomena during injection. These approaches proved to be accurate, fast, simple, highly successful and reproducible. Percutaneous neurolytic procedures should be done as early as possible, as soon as spasticity becomes painful and disabling in patients with neurological sequelae of stroke, head trauma or any lesion of the motor neuron.
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Ann Fr Anesth Reanim · May 2005
Review Case Reports[Value of skin tests for the choice of a neuromuscular blocking agent after an anaphylactic reaction].
We report a grade III allergic hypersensitivity reaction occurring in a 72-year-old patient immediately after anaesthesia induction. Anaphylaxis to cisatracurium was diagnosed on clinical symptoms, biological tests and positivity of the cutaneous tests to this neuromuscular blocking agent. Five days after this allergological assessment, rocuronium, a muscle relaxant for which skin tests appeared negative was used during surgery without adverse effects. The authors underline the value of a detailed allergological assessment to identify the pathophysiologic mechanism, the culprit drug and to propose a safer alternate drug that might be used.