Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Mar 2003
Review[Anaesthesia for patients with intracranial hypertension due to cerebral oedema].
The main objective for anaesthesia in patients with intracranial hypertension (ICH) is to maintain the cerebral perfusion pressure (CPP). Before the operation, the assessment of the level of intracranial pressure relies on the Glasgow coma score and the signs of ICH on the CT-scan. In the perioperative period, repeated transcranial Doppler examinations may help in determining the adequate CPP. ⋯ Before intracranial surgery, large doses of mannitol have been demonstrated to improve neurological recovery in brain injured patients. The urinary losses due to the infusion of mannitol should be replaced with isotonic saline. Emergence and extubation are best performed in the intensive care unit under close systemic and cerebral haemodynamic control.
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The blood-brain barrier (BBB) is a complex biological system that consists of endothelial cells, pericytes and astrocytes, which are involved in the induction and maintenance of its physiological and ultrastructural characteristics. The BBB plays a primordial role in isolating the cerebral parenchyma as well as in controlling brain homeostasis by its selective permeability to nutriments and other molecules flowing through the cerebral microcapillaries. A better knowledge of this system is crucial in order to improve the efficiency of brain penetration by drugs, and in order to prevent BBB opening, leading to brain edema, in physiopathological situations such as brain ischemia, trauma or inflammatory processes.
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Ann Fr Anesth Reanim · Mar 2003
Clinical Trial[Which propofol target concentration for ASA III elderly patients for conscious sedation combined with regional anaesthesia?].
To determine the optimal propofol target concentration between 0.9-1.1 and 1.3 mg l(-1), for conscious sedation and amnesia using Diprifusor in ASA III patients over 60 years. ⋯ None of those three concentrations was satisfying in 100% of cases for the three criterias (sedation < S2, amnesia and none side effects). These results suggest that propofol target concentration 0.9 microg ml(-1) could be used safely for sedation in elderly ASA III patients. Moreover, we have shown that amnesia for events requires higher propofol concentrations than amnesia for pictures during conscious sedation.
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Ann Fr Anesth Reanim · Mar 2003
Case Reports[Automated external defibrillator use during cardiopulmonary resuscitation during flight].
Automated External Defibrillator (AED) during cardiopulmonary resuscitation should reduce mortality rate after out-of-hospital cardiac arrest. We report a case of defibrillation with AED during flight in a patient suffering cardiac arrest complicating an acute myocardial infarction. Two hours before landing, a 56-years-old man presented sudden cardiac arrest. ⋯ After landing, acute myocardial infarction was diagnosed and treated by prehospital thrombolysis and angioplasty with favorable outcome. AED is a crucial link of the chain of survival, especially where advance cardiac live support cannot be performed, like during flight. Despite an increasing AED availability, survival after cardiac arrest during flight remains exceptional.
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To evaluate prehospital management of elderly patients, agreement between prehospital and hospital diagnosis and to observe clinical course during hospitalization. ⋯ Analysis of elderly patient evolution after hospitalisation confirms the idea that the age should not influence the decision and the degree of prehospital medicalization.