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Dupont X.,Service dAnesthesie Reanimation Chirurgicale
Praticien en Anesthesie Reanimation | Year: 2011

Hallux valgus is a deformation of the first beam of the forefoot that can be surgically corrected. Postoperative pain is commonly severe. Peripheral nerve blocks provide effective analgesia with fewer side effects. Patients can be treated at home during several postoperative days. Popliteal sciatic nerve block is currently the gold standard, however less invasive surgical procedures may allow using distal blocks. © 2010 Elsevier Masson SAS. All rights reserved.

Journois D.,Service dAnesthesie Reanimation Chirurgicale | Journois D.,University of Paris Descartes
Praticien en Anesthesie Reanimation | Year: 2011

Continuous hemofiltration has gained from more than 20 years experience in intensive care unit and the use of sophisticated techniques. A series of pitfalls leads to frequently asked questions. A better understanding of filtration fraction, specific to hemofiltration technique, allows avoiding circuit obstruction, while patients are effectively anticoagulated. Restitution and maintenance of hydroelectrolytic equilibrium are critical. Clinical practice requires the definition of procedures and protocols concerning alarm settings, the use of catheters, pre- and post-dilution, and the choice of the most appropriate technique. © 2011 Elsevier Masson SAS. All rights reserved.

Aveline C.,Service dAnesthesie Reanimation Chirurgicale
Praticien en Anesthesie Reanimation | Year: 2015

Anticipating the treatment of pain is one of the keys to allow relief from prolonged pain. Analgesic protocol should be initiated preoperatively, favoring synergistic combinations. It is mandatory not to interrupt chronic analgesic treatments if any. A prescription must be issued before the procedure with clear and detailed explanations of the oral doses, time of administration, and rescue medication. Peripheral nerve blocks and/or infiltration with a long-acting local anaesthetic combined with multimodal analgesia prolong analgesia beyond the immediate perioperative period. Dexamethasone, whatever the route of administration, prolongs the duration of analgesia produced by local anaesthetics. Antihyperalgesics, such as gabapentinoids or ketamine, are useful, but associated with side effects. Intravenous lidocaine is effective but has been little evaluated during ambulatory surgery. The development of a monitoring system for ambulatory patients is one way to determine the effectiveness of outpatient process. These networks can also integrate the feedback provided from continuous perineural analgesia and help increase the number of surgical and ambulatory patients. © 2015 Elsevier Masson SAS.

Johansson S.G.O.,Karolinska University Hospital | Florvaag E.,University of Bergen | Oman H.,MIAB | Poulsen L.K.,Copenhagen University | And 10 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2010

Background: The aim of this study was to test, on a multinational level, the pholcodine (PHO) hypothesis, i.e. that the consumption of PHO-containing cough mixtures could cause higher prevalence of IgE antibodies to PHO, morphine (MOR) and suxamethonium (SUX). As a consequence the risk of anaphylaxis to neuromuscular blocking agents (NMBA) will be increased. Methods: National PHO consumptions were derived from the United Nations International Narcotics Control Board (INCB) database. IgE and IgE antibodies to PHO, MOR, SUX and P-aminophenyl-phosphoryl choline (PAPPC) were measured in sera from atopic individuals, defined by a positive Phadiatop® test (>0.35 kUA/l), collected in nine countries representing high and low PHO-consuming nations. Results: There was a significant positive association between PHO consumption and prevalences of IgE-sensitization to PHO and MOR, but not to SUX and PAPPC, as calculated both by exposure group comparisons and linear regression analysis. The Netherlands and the USA, did not have PHO-containing drugs on the markets, although the former had a considerable PHO consumption. Both countries had high figures of IgE-sensitization. Conclusion: This international prevalence study lends additional support to the PHO hypothesis and, consequently, that continued use of drugs containing this substance should be seriously questioned. The results also indicate that other, yet unknown, substances may lead to IgE-sensitization towards NMBAs. © 2009 John Wiley & Sons A/S.

Diemunsch P.,Service dAnesthesie Reanimation Chirurgicale | Pottecher J.,Service dAnesthesie Reanimation Chirurgicale | Chassard D.,Anesthesie reanimation Chirurgicale
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2012

An efficient communication between the obstetrics and anesthesiology teams is a prerequisite for an optimal management of a woman with a previous cesarean section (professional agreement). Epidural analgesia should be encouraged in this context due to a high risk of emergency obstetrical procedures, in order to avoid general anesthesia (professional agreement). When possible, spinal anesthesia is the technique of choice for elective repeat cesarean delivery even in case of morbidly adherent placenta (professional agreement). © 2012 Elsevier Masson SAS. All rights reserved.

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