Gastroen Clin Biol
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Achieving colonoscopy under general anaesthesia entails the problem of ambulatory-care anaesthesia, in particular because perception of patient's recovery determines to some extent the length of monitoring following colonoscopy. The aims of the study was to assess the quality of patient's recovery after a colonoscopy under general anaesthesia while using propofol, by means of psychomotor-tests. METHODS--Colonoscopy was performed in 40 patients according to the following anaesthetic protocol: induction: propofol 2 mg/kg, continuous support: propofol 10 mg/kg/h i.v. with a 50 mg bolus in case of insufficient sedation; series of 3 psychomotor-tests were performed the day before and 1 hour, 3 hours and 6 hours after colonoscopy. ⋯ CONCLUSION--Three hours after colonoscopy under general anaesthesia using propofol, 30 patients (75%) had recovered at least 90% to their initial performances. Newman test was the most disturbed but there was no predictive factor for the quality of recovery. Psychomotor-tests may be useful before authorizing early discharge after colonoscopy under general anaesthesia but other recommendations about conditions of discharge after sedation must be also implemented.
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Letter Case Reports
[Biliary pain after ingestion of paracetamol and codeine].
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Comparative Study
[Elective cholecystectomy by celioscopy versus subcostal approach cholecystectomy. Comparative study of postoperative pain and discomfort].
The aim of this prospective study was to evaluate postoperative pain and discomfort in 70 patients undergoing cholecystectomy. The choice of surgical approach was left to the surgeon. Accordingly, these patients were then divided in two groups: laparoscopic cholecystectomy (group I; n = 37); classic cholecystectomy (subcostal incision) (group II; n = 33). ⋯ The mean duration of surgery was shorter in group II (96 +/- 31 min) than in group I (119 +/- 49 min) (P < 0.01). Postoperative discomfort was evaluated by (group I versus group II respectively): a) the mean length of hospital stay after surgery (3.7 +/- 1.5 versus 6.7 +/- 1.1 days, P < 0.02); b) the mean delay to return of intestinal motility (1.5 +/- 0.6 versus 2.0 +/- 0.6 days, P < 0.001); c) the mean perfusion time (1.4 +/- 0.6 versus 2.6 +/- 0.8 days, P < 0.001); d) intensity of postoperative pain which was evaluated daily. There was no significant difference between these two groups concerning the use of analgesics; however, a statistically significant difference was found in the visual and verbal scales, starting on the second postoperative day and in autonomy as early as the first postoperative day.(ABSTRACT TRUNCATED AT 250 WORDS)
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Eighty-three consecutive patients (38 men, 45 women) underwent colectomy and ileorectal anastomosis (IRA) for Crohn's colitis between 1960 and 1988. The mean age at the time of IRA was 28.5 years after a mean interval of four years from diagnosis. At the time of IRA, 31 patients had proctitis, while 25 had perianal disease. ⋯ Patients under 30 years of age or patients suffering for more than 5 years had poorer functional results and more frequent reoperations at 5 years. Rectal preservation after IRA may be proposed with success to patients with a healthy rectum or with minimal or moderate proctitis, even if there is perianal disease that could be safely treated before IRA. In this last setting, the patient has to be informed of the risk of rectal preservation and the possible risk of requiring ulterior proctectomy.