Cahiers d'anesthésiologie
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Anaesthesia for ambulatory surgery implies a strict selection of patients. Screening tests are non specific, compared to these ordered for in-patients. ⋯ The detection of an asymptomatic anomaly by routine testing is extremely infrequent and does not lead to changes in the operating schedule or in the outcome of anaesthesia. Clinical examination and patient history are the only predictive elements, so systematic complementary tests should be abandoned and replaced by judicious selective prescription.
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Cahiers d'anesthésiologie · Jan 1993
Review[The use of patient-controlled analgesia by the obstetrical patient].
Patient-controlled analgesia is a technique of analgesia recently developed for obstetrical pain. During labor, PCA using intravenous administration has already been used for more than a decade but meperidine may be conceivable replaced by fentanyl with which maternal and neonatal side-effect seem reduced. ⋯ After cesarean section, PCA using intravenous morphine has been shown to produce less pain relief than epidural morphine but is associated with a high degree of satisfaction. The wider use of PCA in obstetrics is however limited by its cost and will thus require evaluation of its cost/effectiveness ratio.
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Outpatient anaesthesia was investigated for a two-month period by means of a questionnaire filled from the preoperative anaesthesia consultation to the surgical procedure and the discharge of the patient. 868 consultations led to schedule 260 ambulatory procedures. ENT (88 patients), paediatric surgery (73 patients) and gynaecology (63 patients) were most frequently concerned. Indications of ambulatory practice could probably be enlarged provided that recovery rooms and surgical schedules were fully adapted.
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The use of regional anaesthesia in day care practice is discussed. Five criteria of discharge are described: the four "A"s: awake, ambulation, alimentation, analgesia plus micturition. Complementary sedation with the regional block, if needed, should be midazolam and fentanyl. ⋯ However, urinary retention and orthostatic hypotension can occur. Furthermore the risk of headache is not a contraindication to an ambulatory practice if some guidelines are observed. In addition, penile blocks and caudal blocks are widely used in pediatrics.
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Regional anesthesia represents a selective approach in shoulder surgery. The following technics can be used: brachial plexus block, cervical epidural and intra-articular anesthesia. The advantages of each technique are discussed.