Annales françaises d'anesthèsie et de rèanimation
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Propofol ensures a calm and rapid induction of anaesthesia in case of planned cardioversion for supraventricular arrhythmia. An appropriate level of anaesthesia is obtained with a dose of 1.4 to 2 mg.kg-1. Propofol does not affect the success rate of cardioversion. ⋯ The frequent association with cardiac disease, in particular valvular disease or coronary insufficiency, should be taken into account and may represent a contra-indication for the administration of propofol. Furthermore, administration of this agent is not indicated if the arrhythmia is poorly tolerated, because of the risk of increasing hypotension. The known advantages of propofol on recovery have no significant role in this indication.
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Ann Fr Anesth Reanim · Jan 1994
[Proposal for a new multifactor screening score of difficult intubation in ORL and stomatognathic surgery: preliminary study].
This study assessed prospectively in 295 ENT adult patients the predictive value of clinical indicators for difficult intubation and of a new multifactorial score, established by the allocation of points (0, 3, 5 or 7) depending on the degree of presence of seven factors: pathology known to be associated with a difficult intubation, clinical signs of airways' pathology, inter-incisors gap and mandible's luxation, submental mandibular-thyroid distance, normal or short and broad neck, head and neck movements, and Mallampati's test. The incidence of difficult laryngoscopy was 14% and the use of particular techniques for tube insertion was required in 8% of patients. The presence of malformation or pathology often associated with a difficult intubation and the presence of functional signs of airways' pathology predict the difficulties of laryngoscopy and tracheal intubation with a good sensitivity and specificity. The analysis of the "Receiver Operating Characteristic curves" showed that a score higher or equal to 11 allows the prediction of difficult intubations with a sensitivity of 96% and a specificity of 90%.
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Ann Fr Anesth Reanim · Jan 1994
Case Reports[Difficult intubation: nasotracheal tube cuff inflation as an aid to difficult intubation].
A case is reported of an unexpected difficult nasotracheal intubation for respiratory distress syndrome in a 72-yr-old obese woman with chronic obstructive pulmonary disease. After positioning the tip of the tracheal tube in the oropharynx, direct laryngoscopy did not allow exposure neither of the glottis nor of the corniculate cartilages. Fibreoptic tracheal intubation was decided. ⋯ A recent prospective and randomized study has shown that tracheal tube cuff inflation in the oropharynx is effective in improving the success rate of blind nasotracheal intubation in paralysed patients with normal pharyngeal anatomy. Only case reports have shown the efficacy of tracheal tube cuff inflation in the pharynx as an aid to difficult blind nasotracheal intubation in emergency. Further controlled studies in this area would be valuable.
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Ann Fr Anesth Reanim · Jan 1994
Review[Antibiotic prophylaxis of penetrating injuries of the abdomen].
Antibiotic prophylaxis for a penetrating injury of the abdomen has a distinctive feature as contamination occurs before administration of antibiotics and because important blood loss can modify the pharmacokinetics of antibiotics. Due to the rate and severity of infectious complications, no controlled study has been undertaken. ⋯ Various antibiotic regimens have been administered, but it seems that those using an antibiotic active against anaerobes are more efficient to prevent postoperative infectious complications than without them. There is no benefit to administer antibiotics for more than 24 hours.
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Ann Fr Anesth Reanim · Jan 1994
Case Reports[Brown-Séquard syndrome after closed injury of the cervical spine].
The case of a Brown-Séquard syndrome at the C5 level, in a 21-year-old young man after a traffic accident is reported. Initially, the symptoms of spinal injury were concealed by those related to head and face trauma. The neurologic assessment showed a hemiplegia located in the same side as the medullar injury with a controlateral thermo-algesic anaesthesia. ⋯ Six weeks later, the patient was again able to walk. However the thermo-algesic anaesthesia remained unchanged. This case report underlines the necessity of a careful and complete neurologic assessment of trauma patients and reminds of the possibility of occurrence of a Brown-Séquard syndrome in them.