[From medical complication to compensation for the prejudice]. / De la complication médicale à l'indemnisation du préjudice.

Claims in anesthesia and intensive care remains high, despite the reduction of morbidity and mortality associated with this activity. The absence of a national register makes it difficult to quantify. The Medical Committee of MACSF-Sou Medical Group, professional liability insurer of more than half of French physicians, provided us support. The amount of compensation paid is growing and the scope of compensated damage is expanded by the Dintilhac mission. The Act of March 4, 2002 has fully confirmed the principle of medical liability for misconduct. Generally, compensation for bodily injury is based on the demonstration of a causal link between a wrongful event and injury. The proof of fault lies with the applicant. Information accountable to patients and nosocomial infection are a particular setting. The Act of March 4, 2002 has also defined the concept of therapeutic risk. With the establishment of the Regional Commissions of Conciliation and Compensation (RCCI) and the National Office for Compensation of Medical Accident (Oniam), it is now possible for a patient to be compensated for an injury resulting from an accident Medical non-offending, while acknowledging the lack of accountability of the practitioner. The expertise conducted by an RCCI is adversarial. For the practitioner called to the cause, it is important to prepare for both substance and form, with the assistance of the medical board's insurance company.

[Patient-controlled epidural analgesia for labour: in practice]. / L'analgésie péridurale obstétricale contrôlée par la patiente: en pratique.

OBJECTIVES: Update on patient controlled epidural analgesia for labour. STUDY DESIGN: Literature review of the recent data on local anaesthetics, additional analgesics and of publications on the various protocols used. DATA COLLECTION: Pubmed database was checked with the following key words: PCEA, labour, opioids, clonidine. The abstracts of the ASA meetings from 2000 to 2005 were also examined. RESULTS: Patient controlled epidural analgesia (PCEA) is the method of choice for optimal labour pain management. The advantages of this technique are numerous. Some of them are established: consistent reduction in overall local anathetic requirement, less motor blockade, safety of the technique and team workload reduction. A better adequacy with the analgesic requirements and an increase in overall patient satisfaction are frequently retrieved, provided that the choice of the analgesics and the PCEA parameters are adequately chosen. CONCLUSION: The use of PCEA improves the quality of analgesic management offered to the parturients who are more and more willing to have a "more natural" childbirth. The PCEA gives them more autonomy and, in fine, enables them to better enjoy this unique event. The main barrier to a more widespread diffusion of PCEA in many institutions remains the financial issue, although a well-selected device and low cost disposables allow a reduction of indirect costs by decreasing care giver workload.

[Dissecting ascending aortic aneurysm in pregnancy: simultaneous cesarean section and surgical aortic repair]. / Dissection de l'aorte ascendante au cours de la grossesse: césarienne et réparation chirurgicale de l'aorte simultanées.

The authors report a case of an ascending aorta dissection, occurring at 35 weeks of pregnancy. Emergency Caesarean section, and surgical aortic dissection repair under cardiopulmonary bypass, were undertaken. The aetiology, diagnosis and anaesthetic management are discussed.