Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jul 2003
Randomized Controlled Trial Comparative Study Clinical Trial[Topical methylprednisolone vs lidocaïne for the prevention of postoperative sore throat].
We assessed the efficacy of topical methylprednisolone or lidocaine for prevention of postoperative sore throat. ⋯ Topical methylprednisolone may therefore be a useful adjuvant in the prevention of sore throat after intubation.
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To review the perioperative anaesthetic management of ventricular assist devices. ⋯ Cardiac transplantation is an effective treatment for patients in end stage cardiac failure, but the average waiting time of 17 months, associated with the lack of organs (357 out of 832 candidates were transplanted in 1996) results in a high number of deaths in patients awaiting transplantation. The appearance in the 1980's, of the first ventricular assist device (VAD) provided a new possibility for the management of patients with end-stage cardiac failure awaiting transplantation ("bridge to transplant"). The perioperative anaesthetic management of these patients is complex. End stage cardiac failure, poorly responsive to pharmacological interventions, results rapidly in secondary organ dysfunctions. VADs produce a rapid improvement in haemodynamic, renal, hepatic and neuro-endocrine functions over a 2 months period, allowing transplantation to take place under optimal conditions. However VADs are not without complications (1 year mortality of 20%), of which the major are: infections (40%), perioperative haemorrhage (30%) and thrombo-embolic sequelae (30%). A best knowledge of pathophysiology of these complications is necessary to an optimal management of patients with ventricular assist devices.
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Ann Fr Anesth Reanim · Jul 2003
Review[Indications of vasopressin in the management of septic shock].
Vasopressin (antidiuretic hormone) is emerging as a potentially major advancement in the treatment of septic shock. Vasopressin is both a vasopressor and an antidiuretic hormone. It also has haemostatic, gastrointestinal, and thermoregulatory effects. This article reviews the physiology of vasopressin and all the relevant clinical literature on its use in the treatment of septic shock. ⋯ Vasopressin mediates vasoconstriction via V1-receptor activation on vascular smooth muscle. Septic shock causes first a transient early increase in blood vasopressin concentrations that decreases later to very low concentrations compared to other causes of hypotension. Vasopressin infusion of 0.01-0.04 U min(-1) in septic shock patients increases plasma vasopressin concentrations. This increase is associated with a lesser need for other vasopressors. Vasopressin has been shown to produce greater blood flow diversion from non-vital to vital organ beds than does adrenaline. A large randomized clinical trial should be performed to assess its place as a therapeutic agent of septic shock patient.
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Diagnosis of an acute obstructive dyspnea in children is very difficult, especially in the prehospital setting, because there are many possible causes. However, some of them may rapidly become life-threatening and therefore require a rapid prehospital management by a team staffed by a physician. The main causes of acute dyspnea in children usually include: obstructive dyspnea (acute laryngitis, foreign body aspiration, bronchiolotis, acute asthma), pulmonary infections and cardiac dyspnea, as well as dyspnea from other origins (cardiovascular collapse, hyperthermia, acidosis, intoxication, deshydratation). Following the assessment of the severity of the illness, the prehospital management should aimed at restoring an optimal oxygenation, before initiating a treatment adapted to the cause of the disease.
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Ann Fr Anesth Reanim · Jul 2003
Review[Children with bronchial hyperreactivity: is it a problem for the anaesthetist?].
Identification of the patients with hyperreactivity and understanding the underlying physiopathological mechanisms are crucial to prevent the occurrence of peri-operative respiratory adverse events in these patients. Preoperative assessment and preparation is based on the maintenance of any long-term anti-inflammatory treatment, especially the inhaled steroids. Furthermore, premedication is based on the administration of a beta2-agonist, antihistamine and anticholinergic drugs that are able to prevent against lung constriction induced by either vagal stimuli or endogenous mediators such as histamine. Anaesthesia management is primarily based on the use of inhalation agents and especially, isoflurane, which has both a protective and a potent bronchodilation effect.