Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1998
Case Reports-Cerebral air embolism after removal of an internal jugular vein catheter-.
Central venous catheters are usually inserted and manipulated by anaesthetists-intensivists and others familiar with their use under surgical conditions, yet they are often removed on the wards by junior doctors or nurses insufficiently trained in the removal procedure. In order to illustrate the risks presented by such a practice, we report a case of cerebral air embolism following the withdrawal of an internal jugular catheter in a sitting patient. The mechanisms of air entry into the venous and systemic circulation are considered, as well as the preventive and therapeutic measures.
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Ann Fr Anesth Reanim · Jan 1998
[Evaluation of training on intubation with a rigid fiber optic laryngoscope (UpsherScope)].
To evaluate the learning of tracheal intubation with a new rigid fibreoptic laryngoscope (UpsherScope). ⋯ The UpsherScope, a new rigid fibreoptic laryngoscope devised for routine and difficult intubation, is robust and allows the view of the tracheal tube passing between the vocal cords. However, in this study the intubation success rate remained low and was not improved by further experience. No benefit was found with the UpsherScope in patients with normal airways. Further studies are necessary to assess its efficiency in cases of difficult intubation.
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Ann Fr Anesth Reanim · Jan 1998
Case Reports[Total spinal anesthesia after posterior lumbar plexus block].
We report a case of total spinal anaesthesia which occurred after a lumbar plexus block using a posterior approach. After total hip arthroplasty under general anaesthesia, a lumbar plexus block was performed according to Winnie's landmarks at the L4 interspace using a nerve stimulator. ⋯ One minute after the injection of 27 mL of the same mixture, a complete anaesthetic block occurred with hypotension and loss of consciousness requiring intubation and controlled ventilation during 3h30, without sequelae. Lumbar plexus block using a posterior approach must be performed cautiously and a slow and fractionated injection of the full dose is recommended.
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Ann Fr Anesth Reanim · Jan 1998
Clinical Trial[Noninvasive postoperative ventilation using a buccal mask].
In this preliminary study we assessed the feasibility and efficiency of non-invasive ventilation (NIV) with a buccal mask (NIV-BM), not fitted with a mouthpiece, in surgical patients in acute respiratory failure whose lungs could not be ventilated with a face mask. In the eight patients enrolled in the study, NIV-BM increased tidal volume, decreased respiratory rate and improved PaO2. In two patients the trachea had to be intubated and one of them died of septic shock. NIV-BM can act as a valuable alternative in surgical patients in acute respiratory failure in whom a face mask cannot be used because of leaks or bad tolerance.
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Subcutaneous emphysema associated with impossible tracheobronchial aspiration occurred in a patient several hours after percutaneous tracheostomy. Misplacement of tracheal cannula was diagnosed and a tube exchanger was used to replace the cannula in a normal position. Twenty hours later a tracheal tear was recognized. This paper considers the pathophysiology and prevention of such a complication.