Annales françaises d'anesthèsie et de rèanimation
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Recent surveys have reevaluated the risk of aspiration of gastric content during anesthesia in pediatric patients. Emergency, bowel obstruction and inadequate depth of anesthesia are the main high-risk situations. Airway protection requires the placement of cuffed tracheal tube. ⋯ Internal diameter of cuffed tubes should be reduced compared to uncuffed tubes. It is recommended to monitor cuff pressure if nitrous oxide is used during anesthesia. Crash induction is described with special reference to pediatric specificities.
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Since its introduction in 1981 by Brain, the laryngeal mask airway has achieved increased popularity in pediatrics. Despite widespread use, the definitive role of the laryngeal mask airway has yet to be established. ⋯ Finally, we review the techniques of insertion, details of misplacement, the removal and complication associated with the use of laryngeal mask airway. Cleaning, pre-use checking and maintenance were also discussed.
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Ann Fr Anesth Reanim · Jul 2003
Case Reports[Left ventricular thrombus and myocarditis induced by paraphenylenediamine poisoning].
We showed that the paraphenylenediamine (PPD) poisoning caused myocarditis but there is no data on the echocardiographic features. We report a case of myocarditis induced by PPD poisoning with echographic data. After ingestion of 5 g of PPD, a 18-year-old woman was admitted to the hospital with asphyxia and rhabdomyolysis. ⋯ A follow-up echocardiogram performed on the 15th day showed normalization of ventricular function and disappearance of the thrombus. No embolic event was noted. Echocardiography is indicated in the myocarditis induced by PPD poisoning to prove the ventricular function as well as the presence of a thrombus.
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Ann Fr Anesth Reanim · Jul 2003
Case Reports[Vasodilatory septic shock refractory to catecholamines: is there a role for terlipressin?].
We report two patients in vasodilatory septic shock refractory to catecholamines in which a continuous infusion of terlipressin was associated with a dramatic increase in systemic arterial blood pressure and short-term survival. Low doses of terlipressin were sufficient in both cases (0.01-0.0 mg h(-1)) to restore blood pressure by increase of systemic vascular resistances. The haemodynamic response was immediate, long-acting, dose-dependent and reversible in a few hours when the drug administration was stopped. ⋯ Terlipressin simultaneously induced vasoconstriction within the cutaneous vascular territory, leading to local skin necrosis. The splanchnic vascular territory seemed to be constricted in the same way. Further studies are needed to better understand and precise the role of terlipressin in the treatment of vasodilatory septic shock refractory to catecholamines.
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Ann Fr Anesth Reanim · Jul 2003
Case Reports[Lepirudin during cardiopulmonary bypass in a patient with heparin-induced thrombocytopenia].
Lepirudin is an alternative anticoagulant therapy in heparin-induced thrombocytopenia (HIT) during cardiopulmonary bypass (CPB). We report a case of a female patient with HIT referred for aortocoronary bypass graft despite persistence of antibodies to platelet factor 4-heparin complexes. Anticoagulation management is described. ⋯ Total lepirudin administration was 44 mg. No haemorrhagic or thrombotic events were observed during surgical procedure and postoperative course. Despite lepirudin administration is not yet clearly precise for CPB procedure, its use seems adapted and safe in subjects without renal insufficiency but requiring precise coordination for anaesthesiological, surgical and biological teams.