Cahiers d'anesthésiologie
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Since the last decade, lumbar epidural analgesia has gained widespread use in obstetrics. Approximately 80% of parturients receive epidural analgesia for labour and vaginal delivery as well as caesarean section in most centres. There is little doubt that the most successful application of epidural analgesia during labour, considered by more than 75% of primiparas as extremely painful. ⋯ Thus, epidural analgesia usually can be extended to relieve both uterine pain and pain related to distension of the lower birth canal, as well as providing analgesia for forceps delivery or caesarean section. Epidural analgesia allows the mother to be awake, minimizes or completely avoids the problems of maternal aspiration and avoids neonatal drug depression from general anaesthetics. If the most popular indication for epidural analgesia is the provision of pain relief, there are certain complications of pregnancy in which epidural analgesia appears to be indicated on therapeutic grounds such as pregnancy-induced hypertension, breech delivery, multiple pregnancy, incoordinate uterine action and fetal and/or maternal medical complications.
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Hepatic injuries account for about 45% of all abdominal traumas and for 30 to 40% of penetrating abdominal injuries. In 60% of the cases, they are associated with other lesions, especially life-threatening head injuries. ⋯ Surgical care, relying mainly on perihepatic packing and vascular exclusion techniques must remain as conservative as possible. Once haemodynamics have been stabilized in patients who do not present any other abdominal lesion requiring laparotomy, the non-interventional attitude is often successful and bears lower morbidity.
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This review of postoperative analgesia after knee surgery provides a practical approach to the problem. The patient can be hospitalized or undergo day surgery, with different techniques being available for each situation. For day surgery, the intra-articular administration of local anaesthetic and/or opioids, the non-steroidal anti-inflammatory drugs can be used. ⋯ It must be emphasized that a combined approach using these different techniques may be useful in order to offer better analgesia and avoid some side effects. Each technique is described with advantages, side effects and practical usage its. The choice, in each professional environment, must be the best analgesic technique which can be performed safely.
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Epidural opioids for caesarean section are routinely used by many anaesthesists. Combined epidural injection of a local anaesthetic and an opioid provides a more rapid onset of profound analgesia. No side effects are observed in either the mother or the neonate with epidural "microdoses" of sufentanil or fentanyl, but the postoperative analgesia is of short duration. ⋯ Good postoperative analgesia can be obtained with intrathecal morphine or patient-controlled analgesia. Using other techniques depends on care and surveillance facilities. Opiates by spinal or intravenous route are not dangerous for breast-fed newborns.
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Cahiers d'anesthésiologie · Jan 1996
[Combination of propofol-ketamine-vecuronium for total intravenous anesthesia under hazardous conditions].
A total intravenous technique using propofol, ketamine and vecuronium was successfully used on 29 patients treated for elective surgery at the UNPROFOR French Medical Group (Sarajevo, Bosnia Herzegovina). Operative conditions were satisfactory for the surgeons. ⋯ No hypoxaemia was observed during the immediate postoperative period. The use of a propofol/ketamine/vecuronium combination is possible in field anaesthesia especially when opiates and inhalational agents are not available.