Annales françaises d'anesthèsie et de rèanimation
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The reasons for sedation in neurointensive care can be divided into two main groups: (i) general indications, as for other intensive care patients, such as to allow the necessary treatments (therapeutic facilitation), controlling the states of agitations em leader; (ii) specific indications due to the neuro-physiologic effect of the sedatives: facilitation of the control of the intracranial pressure and lowering of the cortical excitability during the epileptic fits and thereby helping the recovery of the cerebral tissue and diminishing the secondary brain insults. It is important to remember that sedation is usually combined with the administration of opioids, which can potentiate the effect of the sedative drugs. ⋯ The amount of literature on sedation in intensive care is opposed to the few studies on neurointensive care: in January 2003, the American Society of Intensive Care has published recommendations for this topic without mentioning the interruption of sedation in neurointensive care patients. The aim of this article is to review the literature about the effects of the interruption of the sedation in neurointensive care patients.
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Ann Fr Anesth Reanim · May 2004
Review[Evaluation of the depth of sedation in neurocritical care: clinical scales, electrophysiological methods and BIS].
The primary goal of sedation is to achieve security and comfort of mechanically ventilated ICU patients. Delivery of pharmacologic agents must avoid over sedation, which increases morbidity by prolongation of the duration of mechanical ventilation. Similarly, under sedation may favour life-threatening events such as accidental extubation. ⋯ No electrophysiological monitor (BIS) has proved reliability for measuring the depth of sedation or analgesia yet. The presence of brain damage in ICU patients makes the level of sedation impossible to interpret. Glasgow coma scale, which is exclusively devoted to the consciousness domain, is the only recommendation that can be made in neurocritical care at the present time.
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Ann Fr Anesth Reanim · May 2004
Case Reports[Increase in bispectral index induced by antihyperalgesic dose of ketamine].
We report two cases of sudden increase in Bispectral Index (BIS) after the injection of low-dose ketamine for the prevention of postoperative hyperalgesia. The two patients were anaesthetised with a continuous infusion of remifentanil associated with propofol for one and isoflurane for the other. ⋯ The BIS value returned progressively to 40-50 despite no increase in target concentration. None of the patients complained of intra-operative recall.
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To study the reciprocal interferences between pregnancy and myasthenia gravis (MG) and to describe obstetric and anaesthetic management during labour and the post-partum period. ⋯ MG has no significant effect on the course of pregnancy and delivery, but MG exacerbation can occur, especially in the first trimester. Regional analgesia is medically indicated and must be performed early in labour, using low concentration of local anaesthetic to lessen the risk of motor block.