Annales françaises d'anesthèsie et de rèanimation
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Advanced prehospital emergency medical care of patients with a severe head injury must essentially focus on the impact of secondary cerebral insults of systemic origin on the outcome. The first objective of prehospital care is to prevent hypoxaemia and hypercapnia. Therefore, all patients with a Glasgow Coma Scale score equal to or lower than 8 must be treated with endotracheal intubation and controlled ventilation under continuous monitoring of SpO2 and PETCO2. ⋯ Sedation is maintained with an hypnoticopioid association (fentanyl). Simultaneously, the main goal is the maintenance of an optimal cerebral perfusion pressure, as arterial hypotension severely worsens cerebral ischaemia. Volume loading is accomplished with 0.9% saline and hydroxyethyl starch.
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Ann Fr Anesth Reanim · Apr 2000
Comparative Study[Evaluation of transfusion strategies during craniosynostosis repairs].
To evaluate the changes in transfusion practices during craniosynostosis surgery in children, with consideration of the transfusion-associated risks. ⋯ The risks of blood transfusion favoured the development of new of more restrictive transfusion practices, even in haemorrhagic surgery. To limit blood transfusion in craniosynostosis surgery, a harmonious cooperation between surgeons and anaesthetists is essential and blood replacement must be based on a definite determination of the acceptable blood losses.
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Ann Fr Anesth Reanim · Apr 2000
Case Reports[Severe pulmonary embolism with two indications for inferior vena cava filter placement].
A case of severe pulmonary embolism, treated with thrombolysis, and complicated by a haemorrhagic shock (peritoneal bleeding after a spleen trauma) is reported. A paradoxical renal artery embolism occurred, due to a patent foramen ovale. The benefit of a inferior vena cava filter insertion in case of paradoxical embolism is discussed.
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Ann Fr Anesth Reanim · Apr 2000
[Fiberoptic bronchoscopy during noninvasive positive-pressure ventilation in patients with chronic obstructive lung disease with hypoxemia and hypercapnia].
To assess the feasibility and safety of non invasive positive-pressure ventilation (NIPPV) via a face mask to performing fiberoptic bronchoscopy (FOB) in patients with COPD contraindicating FOB in spontaneous ventilation. ⋯ Application of NIPPV during FOB is a safe technic for maintaining adequate gas exchange in hypoxaemic and hypercapnic COPD patients not in acute respiratory failure. After the end of the procedure a close surveillance in the intensive care unit is essential.
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Ann Fr Anesth Reanim · Apr 2000
Case Reports[Cerebral arterial air embolism associated with pneumothorax in a patient with pressure support ventilation].
A 20-year-old woman was admitted to the ICU following a road traffic accident. She had a periorbital haematoma with a normal cerebral state on CT-scan, intrahepatic and intrasplenic haematomas and several fractures of the limb that were fixed on day 3. Twenty-four hours later, she developed a cough with symptoms of decerebration The head CT-scan showed diffuse pneumocephalus suitable with cerebral air embolism and the chest X ray a right tension pneumothorax. ⋯ Despite the lack of hyperbaric oxygen therapy the patient recovered fully. The pneumocephalus disappeared totally after 48 hours. Seven days later, CT-scan of the head with coronal slides showed an orbital floor fracture associated with an intra-orbital aerocele.