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To determine neuraxial anesthesia practices in obstetric departments in Languedoc-Roussillon in parturient with large lumbar tattoo covering the puncture area. “A prospective anonymous survey was sent to anaesthesiologists” including a clinical case scenario with a tattooed woman. Questionnaire included items on neuraxial anaesthesia in various circumstances, reasons for the decision process, and “consensus management” or not “within the unit”. Fifty-four anaesthesiologists answered (response rate: 57%). Fifty-seven percent would perform an epidural anaesthesia (EA) through the tattoo. Thirty-nine percent would not; among which two third only would propose an alternative for EA. Elective or emergency caesarean section would prompt most of the anaesthesiologists to perform a spinal anaesthesia, especially in parturients with Mallampati Class III (93%) versus Class I (70%) airway. Seventy percent of responders reported no consensual management in their unit. Our study illustrates this lack of consensus in obstetrical units and among anaesthesiologists along with a variable attitude linked with the obstetrical and anaesthesiological situation. 相似文献
44.
V. Waisblat F.-J. Mercier B. Langholz A. Berthoz P. Cavagna D. Benhamou 《Annales fran?aises d'anesthèsie et de rèanimation》2010
Objectives
To assess the effects of rocking motion on labour pain and before epidural catheter insertion.Study design
Clinical prospective observational study.Patients and methods
Pain scores (numerical scale: 0–10) were recorded in 50 laboring women in three consecutive positions: lying down, sitting and then rocking back and forth while seated. The overall satisfaction (0–10) and any comment related to the rocking procedure were also recorded.Results
One woman refused to rock during the procedure and five alternated moving and still periods. Pain scores were similar in the lying (8.1 ± 1.8) and sitting position (8.0 ± 1.8), whereas they significantly decreased while rocking (6.6 ± 1.7; p < 0.001 versus both lying and sitting still positions). Satisfaction associated with rocking chair motion was high (8.9 ± 1.4).Discussion
Within the limits of an observational and preliminary study, we observed that rocking motion during the procedure was associated with a significant decrease in labour pain and that patient satisfaction was high. Several hypotheses are proposed to explain these effects, i.e. patient's involvement in an action that focuses attention, loss of parturient's landmarks and stimulation of the vestibular system which might lead to a change in the cognitive perception of the body. 相似文献45.
Objectives
The demographic decline in the Anaesthesia and Intensive Care practitioners predicted for 2020 may bring into question the speciality's vocation, and indeed peri-operative care as a whole in France. The objective of this study is to assess the French Anaesthetist and Intensive Care physicians’ demographics in 2010, and predicted numbers for 2020 taking into account recently initiated corrective measures.Methods
Data originating from the CFAR-SFAR-INED French medical demographics survey1, the French General Medical Council, and various studies and projections published by the INED and the DREES2 were collected and analysed. Factors were then identified that were likely to affect personnel numbers, speciality training requirements and the demand for patient care.Results
French General Medical Council data is the most reliable and reports 9692 Anaesthetists and Intensive Care physicians practising regularly in France on the 1st of January 2009. Of those, 9,391 (96.9 %) were practising on the mainland. Personnel growth reduced due to the effect of specialist training selection procedures: the percentage of doctors entering Anaesthesia and Intensive Care training dropped from 12.7 % per year in 1960 to 1.5 % in 1990. Since 2002, personnel in regular practice dropped by 1.1 % per year. Relatively few doctors were leaving the profession, the decrease was due to the reduction in the numbers entering practice: 222 per year on average from 1988 through 2004, compared to 355 per year for the two preceding decades (1971 to 1987). Anaesthetists and Intensive Care physicians are growing older; the average age increased from 42.8 years of age in 1989 to 51 on the 1st of January 2009. Further evidence of this trend is that the number of practitioners less than fifty years of age continues to decrease; just 47.5 % in 2005 compared with 80 % in 1989. 5,139 anaesthetists between 50 and 64 years of age will leave the profession before 2020, over half (52.3 %) of the total practising in 2005. Practitioner density increased from 13.1 Anaesthetists and Intensive Care physicians per 100,000 inhabitants in 1989 to 16.2 in January 2006. If only those in regular practice are considered, density is stable at 15.3 per 100,000 inhabitants as of 1st January 2009. The most recent 2009 projections predict a 13 % decrease in the number of practitioners between 2006 and 2015, and a 16 to 20 % decrease by 2020. Initial projections in 1991 and further projections in 1999 predicted 50 % and 35 to 50 % decreases by 2020. Numerous factors could amplify this reduction in the absence of increased training efforts. These factors include population growth (+6 to 7 % by 2020), the increasing health care demands of an ageing population (+15 %), medical progress, the increasing feminisation of the medical workforce, projected retirements and reductions in migratory flows.Conclusion
Despite increasing training throughput and increasing medical immigration, Anaesthetists and Intensive Care physicians in France are ageing noticeably and reducing in number. This foreshadows further personnel reductions in the future. A demographic catastrophe may well have been avoided; a more moderate reduction in personnel persists for 2020 with an ongoing risk of numerical inadequacy with respect to needs. This situation justifies a further increase in training throughput, along with adaptations in the provision of care, so as to ensure maintained care standards. 相似文献46.
47.
Shelly Choo Henry Perry Afua A. J. Hesse Francis Abantanga Elias Sory Hayley Osen Charles Fleischer‐Djoleto Rachel Moresky Colin W. McCord Meena Cherian Fizan Abdullah 《Tropical medicine & international health : TM & IH》2010,15(9):1109-1115
Objectives To survey infrastructure characteristics, personnel, equipment and procedures of surgical, obstetric and anaesthesia care in 17 hospitals in Ghana. Methods The assessment was completed by WHO country offices using the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, which surveyed infrastructure, human resources, types of surgical interventions and equipment in each facility. Results Overall, hospitals were well equipped with general patient care and surgical supplies. The majority of hospitals had a basic laboratory (100%), running water (94%) and electricity (82%). More than 75% had the basic supplies needed for general patient care and basic intra‐operative care, including sterilization. Almost all hospitals were able to perform major surgical procedures such as caesarean sections (88%), herniorrhaphy (100%) and appendectomy (94%), but formal training of providers was limited: a few hospitals had a fully qualified surgeon (29%) or obstetrician (36%) available. Conclusions The greatest barrier to improving surgical care at district hospitals in Ghana is the shortage of adequately trained medical personnel for emergency and essential surgical procedures. Important future steps include strengthening their number and qualifications. 相似文献
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49.
F. Pepino P. Granchamp I. Odin E. Decroisette N. Nathan 《Annales fran?aises d'anesthèsie et de rèanimation》2009
Inherited bleeding disorders contraindicate epidural analgesia because of the risk of epidural haematoma. However, there is no consensus about a minimal rate of factor XI required for its performance. We report here a case of epidural analgesia in a pregnant woman with a moderate and symptomatic factor XI deficiency, despite this theoretical contraindication. Indeed, the factor XI deficiency results in a haemorrhagic risk which is variable and not easily foreseeable. Nevertheless, no neurological after-effect or excessive bleeding occurred although no specific prophylaxis had been performed. 相似文献
50.
A. Gentile D. Tran-VanE. Dardare N. FritschA. Benois B. Fontaine 《Annales fran?aises d'anesthèsie et de rèanimation》2009