Annales françaises d'anesthèsie et de rèanimation
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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.
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Ann Fr Anesth Reanim · Jul 2003
Review[Difficult tracheal intubation in paediatric: myth or reality?].
Difficult tracheal intubation is a rare event according to the airway feature in child. This situation is mostly predictable, occurring in identified malformations and in specific diseases. Pre-operative clinical evaluation must detect facial abnormalities (lip or palate cleft, microtia, facial asymmetry.), micro or retrognathia, limited mouth opening, reduced distance between thyroid cartilage and chin, macroglossia and external ear malformations. According to this clinical evaluation, a strategy for managing difficult tracheal intubation is planned.
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Ann Fr Anesth Reanim · Jul 2003
Comparative Study Clinical Trial[Comparison of a nurse-directed weight-based heparin nomogram with standard empirical doctor-based heparin dosage].
To assess efficiency of a nurse directed weight-based nomogram (NWN) for heparin dosage without training. ⋯ NWN protocol was easy to use without previous training. NWN was associated with the best anticoagulation state although its superiority was less evident than expected.
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Ann Fr Anesth Reanim · Jul 2003
Review[Outcomes of children after bronchial foreign body inhalation].
Bronchial foreign body inhalation is a frequent and potentially serious accident in children. It can provoke long-term complications such as bronchiectasis. ⋯ To decrease the risk of complications, one must emphasize the importance of early diagnosis and the potential role of fiberoptic bronchoscopy to help the diagnosis in case of suspected inhalation without clinical or radiological signs. Rigid bronchoscopy is the only procedure that allows diagnosis and removal of the foreign body.
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High frequency jet ventilation (HFJV) is an alternative ventilatory mode during anaesthesia for laryngeal microsurgery. This procedure ensures good visualization of the operating field but is not without risk. Thus, its use in paediatric patients requires sound knowledge of respiratory physiology of children and infants. ⋯ The air-oxygen mixture must be adjusted to provide the lowest FIO2 possible (< or = 30%) when using the CO2 laser. The main indications for the use of HFJV in paediatric laryngeal microsurgery are laryngomalcia, laryngeal papillomatosis and subglottic haemangioma. HFJV is a reliable and useful technique in airway paediatric surgery providing the operator has good knowledge of the physiological particularities in children.