Cahiers d'anesthésiologie
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The use of a pneumatic tourniquet to provide a bloodless field in orthopedic surgery is often complicated by tourniquet pain. The mechanism of this pain remains incompletely understood, but it is probably multifactorial. Nerve compression is a common etiologic feature. ⋯ Superficial (skin) compression and deep components compression like blood vessels and muscles can both induce tourniquet pain. Central nervous system can also interfere. Release of tourniquet can increase the pain by post-ischaemic oedema due to ischaemia and reperfusion injury.
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Airway control and maintenance of effective assisted ventilation are an absolute priority in emergency medicine. Developed by Brain in 1988, the laryngeal mask offers a new means of ventilation management and is a reliable compromise between the face mask and endotracheal tubing. The laryngeal mask ensures no protection against gastric contents inhalation and its use is limited in patients with decreased thoracopulmonary compliance. ⋯ The laryngeal mask cannot and does not replace endotracheal tubing which remains the only technique that guarantees upper airway patency and protection as well as efficient ventilation control. However, in some situations tubing may prove difficult and even, at times, impossible to perform. This is when the laryngeal mask will come in handy, either as a temporary solution or as an alternative to difficult or impossible tubing techniques.
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Cahiers d'anesthésiologie · Jan 1995
Biography Historical Article[Scientific anesthesiology of John Snow].
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The occurrence of bleeding in trauma patients is a life-threatening problem which can be explained by different mechanisms. The infusion of cristalloids, colloids, packed red blood cells, or even fresh frozen plasma is very rarely responsible for bleeding but it can contribute to dilute the patient's platelet pool, and especially dilutional thrombocytopenia is the first cause of bleeding after massive transfusion. Blood coagulation factor activity is decreased after a massive fluid infusion is performed but it has to reach a dramatically low plasma level in order to induce troubles. ⋯ Hypothermia can also impair platelet function and worsen the bleeding. A simplified monitoring of haemostasis can be proposed with platelet count, whole blood coagulation clotting time, immediately available activated partial thromboplastin time and prothrombin time with bedside portable monitors and thromboelastography. Haematocrit and body temperature have to be monitored as well.
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Cahiers d'anesthésiologie · Jan 1995
Review[Optimal use of the administration of morphine derivatives].
During the postoperative period, the efficacy of opioid treatment is different among patients. Indeed, an extreme variability exists between patients, concerning their analgesic requirement and their sensibility to opioids. ⋯ The combination of different analgesics must be prescribed systematically, if there is no contraindication. 3) Opoid side effects must be appropriately treated, in order to improve the quality of analgesia. These simple measures require regular evaluation of opioid analgesia, and treatment of the side effects.