Annales françaises d'anesthèsie et de rèanimation
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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
[Lung contusion: relevance of initial injured pulmonary volume measurement by computed tomography].
To evaluate computed tomography quantification of injured pulmonary volume after thoracic trauma and its relevance for severity grade of patients with lung contusion. ⋯ Injured parenchymal pulmonary volume evaluation on initial tomodensitometry seems to be an important indicator of lung contusion severity. Thoracic computed tomography provides additional prognostic information in the initial evaluation of thoracic trauma with parenchymal injury.
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To review current data on the heart rate and blood pressure variability. ⋯ Various regulatory systems in the cardiovascular system play crucial roles in controlling and assuring adequate perfusion of the peripheral tissues. Among them the baroreceptor reflex is the most important regulatory mechanism in the short-term control of the heart rate and blood pressure, and operates through the autonomic nervous system. The gain of the cardiac baroreflex further referred to, as baroreflex sensitivity is an interesting way to study this system. Unfortunately, with our current knowledge, it is not possible to predict the instantaneous output of the baroreceptor in response to instantaneous changes in input within a frequency range of physiological importance. The fast Fourier transform can describe variables as the sum of elementary oscillatory components and it has been established as practical clinical methods for detecting abnormalities in cardiovascular control. A time-frequency distribution provides an indication of how the spectral energy distribution varies with time and it is an interesting tool in non-stationary data. One of the major motivations behind spectral analysis is the hope that the combination of time-domain and frequency-domain analyses will provide dynamical informations about the relation between blood pressure and heart rate.
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Ann Fr Anesth Reanim · May 2003
Case Reports[Candida albicans induced empyema: mode of revelation of a spontaneous oesophageal disrupture].
Oesophagus perforation, despite an often-loud symptomatology, is lately diagnosed. A similar course is illustrated by the observation of a patient who presented a Candida albicans-induced empyema. ⋯ A nosocomial pneumonia complicated the development but the patient could endly issue from ICU. This mode of revelation was unusual and the authors recommend thinking of the diagnosis of oesophagus rupture when a patient is admitted for a candidosis empyema.