Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · May 2003
Case Reports[Epidural analgesia in a pregnant woman with essential thrombocythaemia].
Epidural analgesia is often considered as risk of epidural haematoma in patient with essential thrombocythaemia because of the platelet disorder. In this observation, uncomplicated epidural analgesia was performed in a pregnant woman with asymptomatic essential thrombocythaemia, because the absence of bleeding symptoms was associated with normal thrombo-elastography and time of occlusion by PFA-100 suggesting normal platelet function. PFA-100 is a biological test evaluating platelet function in whole blood, which is easy and quick to perform. This case study suggests that this test might be useful in evaluating platelet function in obstetrics but must be validated before recommending its extensive use.
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Ann Fr Anesth Reanim · May 2003
Case Reports[Metformin-associated lactic acidosis remains a serious complication of metformin therapy].
We report 4 cases of lactic acidosis in diabetic patients usually treated with metformin. For the first 3 patients, the clinical history was similar because lactic acidosis was precipitated by gastro-intestinal disorders whereas all of them were simultaneously treated with several nephrotoxic drugs. These 3 patients presented with acute renal failure on arrival at hospital. ⋯ The fourth case, which was due to a voluntary intoxication, was the only one presenting with a favourable evolution. The metformin plasma and red blood cell levels were performed for 2 of 4 patients and confirmed the overdose. These observations remind that metformin-associated lactic acidosis remains a serious complication, and that medical doctors must respect strictly contra-indications and guidelines for withdrawing metformin.
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Ann Fr Anesth Reanim · May 2003
Clinical Trial[Spectral analysis of the ECG R-R interval permits early detection of vagal responses to neurosurgical stimuli].
To assess the efficacy of ECG spectral analysis, compared with heart rate (HR) monitoring in the detection of vagal response to surgical stimuli. ⋯ The ECG spectral analysis is a non-invasive technique, which permits the detection of intra-operative vagal reactions earlier than conventional monitoring of HR.
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Ann Fr Anesth Reanim · May 2003
Case Reports[Metformin-associated lactic acidosis precipitated by acute renal failure].
In type II diabetes treated with metformin, lactic acidosis is a rare but severe complication. Commonly patients with lactic acidosis show signs of shock, tissue hypoxia, acute hepatic or renal failure and the link between metformin therapy and lactic acidosis may be coincidental, associated or causal. Excessive plasma metformin concentrations show that lactic acidosis is due to a toxicological mechanism. ⋯ One month after this episode she has made a recovery of tubular necrosis, although no longer prescribed metformin. Metformin should be temporally stopped when acute renal failure occurs or is anticipated; patient with acute renal failure and high calculated anion gap should benefit from lactate measurements. Early bicarbonate haemodialysis is an adequate treatment of lactic acidosis caused by accumulation of metformin associated with acute renal failure
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Ann Fr Anesth Reanim · May 2003
[French national survey of the use of monitoring devices during cardiopulmonary bypass in 2001].
To study the different monitoring devices used during cardiopulmonary bypass (CPB) and to determine the factors, which may influence the choice of these equipments. ⋯ Equipments were not similar among the different French cardiac surgery centres. Furthermore, the French practice seems different from American, UK and Australian's one. These results highlight the need of establishing French guidelines, which are absent.