[Patient controlled epidural analgesia: interest in thoracic surgery]

To compare efficacy of pain control, the consumption of local anaesthetics and opioids as well as the side effects between continuous epidural analgesia, patient controlled analgesia and patient controlled epidural analgesia in thoracic surgery. Prospective randomised study included 66 patients who had thoracotomy. Patients were divided into 3 groups, to receive different pain control methods. Group 1 [n=22] received patient control analgesia Group 2 [n=22] received continuous epidural analgesia [Bupivacaine 0,125% + 5 micro g/ml of Fentanyl] between 6 and 10 ml/h in order to obtain a T2 level Group 3 [n=22] received patient controlled epidural analgesia [Bupivacaine 0,08% + 3 micro g/ml of Fentanyl] 6ml/h and bolus of 5ml. There was no difference between the three groups in age, delay of surgical operation and per operative morphine consumption. VAS was less at rest and after cough in patient group with patient controlled epidural analgesia. The difference was less significant in local anaesthetics and opioids consumption in patient with controlled epidural analgesia. The benefit of patient controlled epidural analgesia in thoracic surgery is proven by the following analgesic efficiency which allows good respiratory rehabilitation, decreasing the risk of drug toxicity by decreases consumption, weak hemodynamic effects and absence of motor block

insuffisance renale aigue isolee n'est pas associee a une surmortalite chez les malades de reanimation

This study assess the prognostic factors increasing mortality of patients with acute renal failure in intensive care units. The study included 923 patients admitted to the intensive care unite over a period of tow years. Acute renal failure was defined by the following criteria, a blood urea concentration of more than 30 mmol/l, a serum creatinine concentration of more than 180 micro mol/l or creatinine clearance less than 50 ml/min. patients were divided into two groups survivors [v] and dead patients [D]. 95 patients presented acute renal failure with a mortality rate of 57.9%. There was no difference between the two groups. There was no difference between the two groups. Patients in intensive care units with only acute renal failure doesn't have a worse prognosis, but the association to two or more other organ dysfunction's, mechanical ventilation of more that 12 days, sepsis or Glasgow coma scale less than 8 are predictive of mortality