Annales françaises d'anesthèsie et de rèanimation
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Gas embolism is a severe complication of laparoscopic surgery. We report two cases: one with lethal peroperative cardiac arrest from massive coronary artery gas embolism recognized during open-chest cardiac massage; the second case, also associated with coronary artery gas embolism, resulted in severe but transient abnormal left ventricular anterior wall motion, subepicardial ischaemia and injury in ECG leads V1 to V5, but unremarkable coronary arteriography and full recovery. The pathophysiology of gas embolism occurring during a laparoscopic procedure, the mechanisms of gas entry into the systemic vascular bed, the clinical, ECG, pulse oximetry, end-tidal CO2 concentration changes and alarm signs are discussed. The diagnostic value of Doppler transoesophageal echocardiography when possible is underlined, and emergency management of gas embolism is considered.
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Ann Fr Anesth Reanim · Jan 1997
Case Reports[Peridural abscess complicating spinal anesthesia in a diabetic patient].
Infectious complications of spinal or epidural anaesthesia are rare, particularly after spinal anaesthesia. Most of them consist of a meningitis. We report a case of epidural abscess due to Staphylococcus aureus following spinal anaesthesia in a 62-year-old diabetic patient, diagnosed 45 days after the puncture with bacterial samples and magnetic resonance imaging. The pejorative neurological outcome required a laminectomy in spite of an efficient anti-staphylococcal treatment.
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Ann Fr Anesth Reanim · Jan 1997
[Interviews with families of organ donors: analysis of motivation for acceptance or refusal of donation].
The reasons for organ donation acceptance or refusal are still unclear. This study analysed the influence of the circumstances of the conversations with the relatives of brain dead patients on their consent for organ donation. ⋯ The circumstances of conversation with families play an essential role in their decision-making. A written guideline implementation for these conversations would probably be beneficial for the decisions of families in favour of organ donation.
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Ann Fr Anesth Reanim · Jan 1997
Case Reports[Anuric renal insufficiency caused by bilateral ureteral lithiasis].
A 73-year-old man was admitted to the ICU for anuria. He reported no history of urinary disease. ⋯ Bilateral retrograde ureteroscopy and drainage allowed a rapid recovery. When the abdominal roentgenography and echography cannot explain the occurrence of anuria, the computed tomography, or better the helical CT, can demonstrate the presence of otherwise unrecognized calculi.
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Ann Fr Anesth Reanim · Jan 1997
Case Reports[Acute Streptococcus salivarius meningitis after spinal anesthesia].
The case of a 50-year-old woman who experienced an acute Streptococcus salivarius meningitis after a spinal anaesthesia for hysteroscopy is reported. The contamination of the cerebrospinal fluid may occur from a puncture during a bacteriaemia. ⋯ Spinal anaesthesia is contra-indicated in the febrile patient. Asepsis is essential during spinal puncture, including wearing a surgical face mask.