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Aspects specifiques de l'anesthesie en chirurgie abdominale par laparotomie de l'adulte Export

EMC - Anesthesie-Reanimation, Vol. 2, No. 4. (October 2005), pp. 219-237.

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ResumeDe meilleures connaissances dans le domaine de la physiologie du peritoine et des differents organes intraperitoneaux ont permis une amelioration de la prise en charge des patients devant beneficier d'une chirurgie digestive majeure. L'abord de la cavite abdominale par laparotomie est responsable de la rupture de l'equilibre d'un milieu tres complexe, ce d'autant qu'un drainage est realise, et s'accompagne essentiellement de repercussions respiratoires, qui sont la cause la plus frequente des complications postoperatoires. De plus en plus de patients ages et en mauvais etat general beneficient d'interventions majeures. Leur prise en charge debute des la periode preoperatoire, ou une prise en charge nutritionnelle est parfois necessaire. La rehabilitation postoperatoire des patients revet egalement une importance primordiale, car elle facilite les suites operatoires : une meilleure gestion des nausees et vomissements postoperatoires, et le developpement des techniques d'analgesie locoregionale postoperatoire en sont les principales bases.AbstractImproved knowledge of the physiology of the peritoneum and various intra-abdominal organs has resulted in an improved management of patients undergoing major abdominal surgery. The access of the abdominal cavity by laparotomy induces maladjustment within a very complex environment. This is related to the fact that drainage of the abdomen is carried out, accompanied primarily by respiratory repercussions, the most frequent cause of postoperative complications. An increasing number of older patients with high surgical risk benefit from major abdominal surgery. Their anaesthetic management begins together with the preoperative period during which nutritional management is sometimes necessary. The postoperative rehabilitation of the patients is very important, because it facilitates recovery, reduces the hospital stay duration and improves the post-surgical health-related quality of life. Postoperative rehabilitation includes better management of nauseas and vomiting, and the use of regional anaesthesia for postoperative analgesia.


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