Cahiers d'anesthésiologie
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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.
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General anaesthesia is often required for burns dressing. Ketamine was the most common agent for carrying out removal of adherent dressings. Disadvantages are delirium on emergence from anaesthesia and prolonged recovery. ⋯ Mean time of recovery was less than 15 min. Unpleasant dreaming occurred in 3 patients only, without agitation. The technique proved to be simple, effective and should revive interest for ketamine in the management of burned patients.
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Lumbar plexus block via the inguinal approach is indicated for analgesia following knee surgery. The technique consists in an injection of the anaesthetic solution through a catheter placed into the space limited by the fascia of the iliopsoas muscle. In this area are the different nervous roots which constitute the plexus. A good technique and a good knowledge of the anatomy of this region are necessary for a successful block and for the safety of the patient.
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Regional anaesthesia in the setting of pre-hospital trauma care implies adverse conditions. Therefore some practical advices may be useful; avoid spinal or epidural anaesthesia, prefer safer lidocaine. ⋯ Main usable blocks are: brachial plexus block (axillary or interscalenic approach), radial, medial and ulnar nerve blocks, intercostal and interpleural nerve blocks, sciatic and femoral nerve blocks, superior laryngeal nerve block. Using a nerve stimulator is strongly advised in most cases.
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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.