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561.
Although surgery of brain tumors and epilepsy are restricted to few specialized centers, anaesthesia for a patient with epilepsy is commonly encountered. Surgical treatments of epilepsy are currently soaring due to the lack of significant progress about effectiveness of antiepileptic drugs (AEDs). Theoretical principles for the anaesthesiologist are quite complex, involving interactions between physiological and pharmacological anaesthesia and AEDs, such as enzyme induction with the first generation molecules mainly (phenytoin, carbamazepin, phenobarbital). The latest generation AEDs (levetiracetam, lamotrigine, gabapentin, oxcarbazepin, vigabatrin, lacosamide...) are better tolerated and induce fewer drug interactions. Practically, the risk of severe perioperative complications is low, provided that the administration of AEDs is kept as close as possible to its usual dosage, and that metabolic disturbances are prevented. The main anaesthetic drugs to avoid are alfentanil, remifentanil and sevoflurane, although their contraindication are only relative, since the clinical benefit might be clear and the doses should remain moderate. 相似文献
562.
Lacrosse D Pirotte T Veyckemans F 《Annales fran?aises d'anesthèsie et de rèanimation》2012,31(1):29-33
Objective
In order to reduce the risk of postoperative apnoea, awake spinal anaesthesia or awake caudal anaesthesia are recommended for hernia surgery in newborn babies and former premature infants aged less than 60 weeks of amenorrhoea. However, additional sedation is sometimes necessary. Our working hypothesis was that a general anaesthesia with a face mask (sevoflurane) with no opiates nor neuromuscular blocking agents, maintaining the infant's spontaneous breathing and combined with a caudal anaesthesia, could provide a safe and effective alternative.Study design
The epidemiological and technical data about the patient and the anaesthesia, as well as any per- and postoperative complications, were collected prospectively and analysed retrospectively.Patients and methods
Ninety-eight infants undergoing hernia surgery were included during the period from 2003 to 2008.Results
Caudal anaesthesia proved successful at first attempt in 69% of the infants (term or premature). Three attempts were needed in 8% of the infants born at term and 2% of the infants born prematurely. One failure was recorded. Seven patients presented one episode of peroperative apnoea; they were easily taken care of by means of brief face mask ventilation. The follow-up of these seven infants did not reveal any reappearance of postoperative apnoea/bradypnoea.Conclusion
The technique proposed is an effective alternative to the awake locoregional anaesthesia techniques: it provides excellent conditions for surgery and presents similar perioperative morbidity and risk of postoperative apnoea. 相似文献563.
Objective
To detail specificity of regional anaesthesia techniques in the obese patient.Data sources
Articles were selected from Medline database using the combination of the following keywords: obesity, peripheral nerve block, spinal anaesthesia, epidural, morbidity, mortality.Study selection
Most recent original articles or review have mainly been selected. Some case reports that highlighted specific points were added.Data extraction
Articles were analyzed for advantages and drawbacks, and risks of different techniques in obese patient.Data synthesis
Techniques avoiding obese patient's mobilization are recommended. The use of skin landmarks may be challenging for both central and peripheral blocks. Ultrasound techniques should improve block performance, even though deep fat layers seem limit sound diffusion. Success rate and incidence of complications are usually increased after regional anaesthesia technique in obese patient. The reduction of intrathecal local anesthetic dose remains controversial in this population.Conclusion
Regional anaesthesia techniques could represent an alternative to general anaesthesia (less cardiorespiratory complications). However, many specific considerations have to be taken into account. 相似文献564.
Zetlaoui PJ 《Annales fran?aises d'anesthèsie et de rèanimation》2012,31(2):152-154
We report two cases of iliac bone surgery (repair of a symphysis disjunction and fixation of a fracture of the iliac ala) where TAP blocks were effective for postoperative analgesia. In the first case, we performed a bilateral block, and only a unilateral block in the second case. We discuss possible mechanisms to explain the efficacy of the TAP blocks in such surgeries. As for the femoral nerve block in major knee surgery, we think that blocking the parietal pain from skin and blocking parietal muscles contracture, can reduce postoperative pain in such surgeries. 相似文献
565.
566.
Prevalence and characterisation of Staphylococcus aureus causing community‐acquired skin and soft tissue infections on Java and Bali,Indonesia
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Dewi Santosaningsih Sanarto Santoso Nanik Setijowati Harun A. Rasyid Nyoman S. Budayanti Ketut Suata Dicky B. Widhyatmoko Priyo B. Purwono Kuntaman Kuntaman Damayanti Damayanti Cita R. S. Prakoeswa Mitchell Laurens Josephine W. I. van Nierop Geraldine L. Nanninga Neline Oudenes Michelle de Regt Susan V. Snijders Henri A. Verbrugh Juliëtte A. Severin 《Tropical medicine & international health : TM & IH》2018,23(1):34-44
567.
M. Pepin E. Rineau A. Caignard S. Leruez P. Gohier 《Journal fran?ais d'ophtalmologie》2018,41(5):441-446