Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1994
[Unusual obstetrical situations: role of locoregional anesthesia].
Breech or twin delivery is a difficult obstetric situation in which both maternal and neonatal risks are increased and where the incidence of caesarean section and instrumental extraction is high. Epidural anaesthesia may worsen the obstetric situation especially if high doses of local anaesthetics are used resulting in a dense motor blockade. ⋯ Extension of the sensory block may be rapid, allowing obstetric intervention while maintaining maternal safety and comfort. For similar reasons and by using low dose techniques, epidural anaesthesia should not be anymore considered contra-indicated in the trial of labor after previous caesarean section.
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Cahiers d'anesthésiologie · Jan 1994
[Indications of blood components and outcome of transfusion practices in hemorrhage of multiple trauma].
Bleeding occurring in a patient with multiple trauma has an unpredictable evolution; blood losses are often very important and their origins mostly unclear. These problems should not prevent the use of a strategy for optimal use of blood components. Indications for packed red cells, fresh frozen plasma, platelets and coagulation factors are discussed. ⋯ Considering its cost, the use of albumin must and can be reduced when fluid replacement is realized with long lasting colloids, like starch. Warming of transfused blood is necessary, especially if acceleration disposals are used to prevent or minimize hypothermia. Use of portable monitors for haemoglobin and coagulation parameters is recommended.
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Headache and low back pain are common minor complications after epidural anaesthesia. Headache is due to cerebrospinal leakage through the site of accidental dural puncture. ⋯ Different mechanisms are suggested: needle trauma, myotoxicity of local anaesthetic and postural problem. Large prospective randomized studies are yet necessary to clarify the role of epidural anaesthesia, the duration of symptoms and the therapeutic.
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Cahiers d'anesthésiologie · Jan 1994
[Indications of the different components of blood and outcome of transfusion practices in postpartum hemorrhage].
Despite a high incidence of mortality associated with post-partum haemorrhage, indications for transfusion of blood and its components in obstetrics remain ill defined. Transfusion is often massive if needed. ⋯ Treatment of DIC calls for fresh frozen safely screened plasma, fibrinogen or platelets concentrates. Indications for autologous transfusion are very limited in these circumstances.
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Cahiers d'anesthésiologie · Jan 1994
Comparative Study[Peridural morphine or intravenous patient-controlled (PCA) morphine: which is the best choice?].
Postoperative analgesia must be adapted to each case. When postoperative course is moderately painful, as in day case surgery, non opioid analgesics are sufficient. ⋯ Morphine by intravenous PCA is the technique of choice for it provides an optimal comfort in most cases. Nevertheless, when an intensive analgesia is needed, as for active physiotherapy in a risk patient after an important surgery, an epidural combination of opioids and local anaesthetics is much more suitable.