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[Orbital haemorrhage after medial canthus episclera (sub-Tenon's) anaesthesia].
Medial canthus episclera (sub-Tenon's) anaesthesia is a technique proposed as a suitable alternative to the more classical peribulbar block because of the greater reliability and more constancy in effectiveness. We report two cases of retrobulbar haematoma after sub-Tenon's anaesthesia, one with central retina artery compression needed anterior room punction. Sub-Tenon's anaesthesia, like peribulbar anaesthesia, can give also retrobulbar haemorrhage if the insertion of the needle is not limited to the anterior orbit.
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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
Case Reports[Cardiac arrest and secondary pulmonary oedema following accidental intramucosal injection of naphazoline in an adult].
During neurosurgery for hypophysary adenoma under general anaesthesia in a prone position, a 34 year-old-women received accidental 6 ml intramucosal injection of lidocaine with naphazoline. The patient presented a severe bradycardia associated with a major increase in arterial blood pression followed by a brief cardiac arrest. She also presented a prolonged awakening and a pulmonary oedema, which lead to mechanical ventilation. The patient rapidly recovered a normal clinical state.
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Ann Fr Anesth Reanim · May 2003
Case Reports[Posterior reversible encephalopathy syndrome: about 2 cases related to the cyclosporine].
Following a pulmonary transplantation for cystic fibrosis, 2 patients exhibited a syndrome associating arterial hypertension, headache, visual trouble and generalized seizures. Cerebral magnetic resonance imaging revealed diffuse cortical and subcortical lesions predominantly in posterior regions. The exclusion of alternate diagnoses and the disappearance of the symptoms when the cyclosporine treatment was stopped confirmed the diagnosis of cyclosporine-related reversible posterior encephalopathy syndrome (PRES). Immediate appropriate management resulted in symptom disappearance and regression of radiological images.