Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1998
Case Reports[Massive gas embolism following lung inflation for thoracic tomodensitometry in a multiple trauma patient with lung contusions].
We report a case of gas embolism into both right and left circulation in a polytrauma patient with lung contusions, revealed by thoracic CT scan showing the heart and aorta filled with gas. It followed a lung inflation with a O2/N2O mixture for about 30 seconds at a pressure of at least 40 cmH2O in order to obtain apnoea for CT scan and to recruit atelectatic territories. ⋯ The patient recovered fully. Lung inflation manoeuvre to obtain a prolonged apnoea during CT scan examinations of thorax is contraindicated in case of thorax trauma, as it carries a risk of gas embolism.
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Ann Fr Anesth Reanim · Jan 1998
Case Reports[Motor deficit of the lower limbs and urinary incontinence following peridural anesthesia].
Neurological complications of epidural anaesthesia are rare, but can be severe. We report the case of a 49-year-old man, with a history of non equilibrated diabetes, who experienced after an epidural anaesthesia for peripheral vascular surgery a polyneuropathy with muscle weakness of the lower extremities associated with a transient urinary incontinence. ⋯ An aggravation of a pre-existing diabetic and alcoholic polyneuropathy, associated with possible spinal ischaemia of multifactorial origin could be the cause of these complications. This case emphasizes the importance, during preanesthetic assessment of candidates for epidural or spinal anaesthesia, to search for a possible unrecognized neuropathy at risk of aggravation by regional anaesthesia.
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Ann Fr Anesth Reanim · Jan 1998
Case Reports[Sever acute pulmonary edema after peri-anesthetic laryngospasm in a newborn infant].
Severe acute pulmonary oedema following peranaesthetic laryngospasm in a newborn. The authors report a case of severe acute pulmonary oedema secondary to a laryngeal spasm in a 3-week-old neonate, immediately after induction of anaesthesia with halothane. ⋯ Such a secondary time course is unusual. Usually pulmonary oedema has a favourable outcome after oxygen administration and maintenance of positive expiration pressure, except in the neonate.
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Difficult intubation remains one of the major risks in anaesthetic practice. Recently, as other anaesthetic societies, the French Society for Anaesthesia and Intensive Care (SFAR) has produced algorithms for the management of a difficult intubation. New laryngoscopes and blades have been marketed in recent years, however their place in these algorithms remains unclear. ⋯ It is concluded that the McCoy blade is not convenient for its routine use in patients not to be at preoperatively known risk of difficult intubation. This blade significantly improves intubating conditions. Defining the exact place of this new blade in difficult intubation algorithms requires further studies.
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Ann Fr Anesth Reanim · Jan 1998
Case Reports[Effectiveness of valproic acid for postanoxic action myoclonus (Lance-Adams syndrome)].
We describe the case of a patient who experienced postanoxic action myoclonus after a transient cardiopulmonary arrest. Whereas benzodiazepines (clonazepam, midazolam, diazepam) were inefficient, valproic acid allowed a full control of the myoclonus. It is essential that the distinction between postanoxic action myoclonus and posthypoxic seizures is made early to avoid a delayed appropriate therapy and erroneous prognostic conclusions.