Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Mar 2003
Case Reports[Neuromuscular blockade monitoring at the corrugator supercilii and ocular myasthenia gravis].
A 67-year-old patient suffering from an ocular myasthenia gravis was scheduled for an elective ENT surgery. General anaesthesia was induced intravenously. Neuromuscular responses after train-of-four stimulation were normal at both the adductor pollicis (T(4)/T(1) = 1) and the corrugator supercilii (4 visual responses). ⋯ The second attempt was successful 4 min after cisatracurium injection (no response at the corrugator supercilii, T(1)/T(0) = 0.05 at the adductor pollicis). Residual neuromuscular blockade was antagonized at the end of surgery (1 h long) allowing an uneventful extubation. We concluded that monitoring neuromuscular blockade at the corrugator supercilii to assess the intubating conditions is not recommended in a case of ocular myasthenia gravis.
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Ann Fr Anesth Reanim · Mar 2003
[Survey of office space and computer availability offered to full time practitioners in departments of anaesthesia and intensive care of French university hospitals].
Office space and computer facilities offered to medical practitioners in departments of anaesthesia (DA) belonging to university hospitals in metropolitan France in 2002 were surveyed. ⋯ A high response rate was obtained. DA were found to be insufficiently provided with offices and computer facilities in french university hospitals. Such a situation, which is both surprising and questionable in an industrialised country, warrants a debate.
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Ann Fr Anesth Reanim · Mar 2003
Review[Brain oedema following blood-brain barrier disruption: mechanisms and diagnosis].
Brain oedema following blood-brain barrier (BBB) disruption, or vasogenic oedema, is present in most cases of brain oedema. According to the Starling's law, water, ions and plasma proteins cross the BBB toward the interstitium if the driving forces for transmural bulk flow are excessive (mechanical origin) and/or if the BBB permeability is enhanced (chemical origin). Both mechanisms coexist in most cases. ⋯ The BBB permeability can be enhanced by immediate (chemical mediators) or delayed (cellular infiltration) inflammatory response, or by alteration of the membrane integrity. This later can be transient (hyperosmolar BBB disruption), or permanent by activation of matrix metalloproteinase or by neovascularization with BBB breakdown. The reference method for the diagnosis of vasogenic oedema is the MRI diffusion-weighted imaging.
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Ann Fr Anesth Reanim · Mar 2003
Review[Osmotic cerebral oedema: the role of plasma osmolarity and blood brain barrier].
There are five types of oedema: vasogenic, cytotoxic, interstitial, hyperemic and osmotic. The differences lie on the type and localization of the oedema, the state of the blood-brain barrier (BBB) and the pathological context. Under physiological conditions, the osmolarity of extra cellular fluids (ECFs) is equal on both sides of the BBB. ⋯ The increase in plasma osmolarity as a treatment modality using mannitol or hypertonic saline is based on the same concepts. The most remote indication is the occurrence of a reactive mydriasis in the context of trauma for example. More recently, therapeutic hypernatremia has been proposed to control intracranial hypertension.