Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Feb 2004
Case Reports[Peri-operative anticoagulation with danaparoid for a patient with Budd-Chiari syndrome and heparin-induced thrombocytopenia].
We report a case of Budd-Chiari syndrome revealing a polycythemia vera and complicated by heparin-induced thrombocytopenia. A surgical porto-caval shunt was inserted with danaparoid as anticoagulant during the peri-operative period. The doses of danaparoid were as follows: a continuous intravenous infusion of 200 U/h with a target between 0.5 et 0.8 U/ml antifactor Xa activity during the preoperative period, followed by 100 U/h with a target of 0.3 U/ml during the peroperative period; an increase in doses of danaparoid to 150 and 200 U/h with a target above 0.5 U/ml was used during the postoperative period. This case report is a rare situation of hypercoagulable state, in a surgical context, treated with danaparoid.
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Ann Fr Anesth Reanim · Feb 2004
[Completeness of ICU activity reports sent to French healthcare authorities].
Hospital units report on their inpatient care activity by writing yearly activity reports, which are used by their Medical Information Department (MID) to develop standardized summaries for communication to healthcare authorities. The data are categorized by uniform patient groups and used to describe inpatient care activity and to guide resource allocation. The objective of this study was to evaluate the completeness of activity reports from intensive care units (ICUs) in France. ⋯ The analysis of this national database shows that data communicated to the MIDs and therefore to the healthcare authorities, are incomplete regarding SAPSII, ICU procedures, treatment intensity, and diagnoses. This may lead to the underestimation of ICU activity and resource needs, particularly if the SAPSII and selected procedures identified as markers for high-intensity critical care are used in the future.
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Ann Fr Anesth Reanim · Feb 2004
Review[Postoperative hyponatremia in children: pathophysiology, diagnosis and treatment].
To review the current data on pathophysiology, causes and management of postoperative hyponatremia in children. ⋯ The incidence of postoperative hyponatremia has been evaluated at 0.34% and its mortality significant. Postoperative hyponatremia is triggered by the diminished renal ability to excrete free water, due to antidiuretic hormone release. Inappropriate secretion of antidiuretic hormone is frequently seen after spine, cardiac and neurosurgery but can occur even after minor surgery. In this context, the infusion of hypotonic fluids represents a strong risk factor for developing hyponatremia. Other causes of hyponatremia are represented by extrarenal fluid losses, cerebral salt wasting syndrome, desalination phenomenon, adrenal insufficiency or some medications. Preventive treatment is essential and based on prohibition of hypotonic fluids infusion and the use of isotonic fluids infusions, maintenance of a normal total blood volume, the observance of the good practice recommendations for fluid infusion in children, and frequent blood and urine sodium concentration determinations in patients at risk for developing hyponatremia. Hyponatremic encephalopathy requires an emergent management, consisting in respiratory care and hypertonic sodium chloride infusion. Chronic hyponatremia is most often asymptomatic and the main neurological risk factor is represented by a too rapid correction of plasma sodium, which may lead to centropontine myelinolysis.
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Perthe's syndrome or traumatic asphyxia is a clinical syndrome associating cervicofacial cyanosis, petechia and subconjonctival hemorrhage to neurological symptoms. This syndrome appears after severe and transient compressive blunt chest injury. A Valsalva maneuver is necessary before thoracic compression for the development of this syndrome. ⋯ The prognosis is good but a prolonged thoracic compression could lead to cerebral anoxia and neurological sequelae. We report six cases of Perthe's syndrome most of them resulting from thoracic compression after road traffic accidents. All of them made a good prognosis.