Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jun 2004
Review[Monitoring of heparin therapy during extracorporeal bypass: what are the remaining questions?].
Cardiac surgery with extracorporeal circulation induces major alterations of haemostasis and requires high level of anticoagulation, usually achieved by unfractionated heparin infusion. Optimization of anticoagulant regimen, through adapted biological monitoring, can probably improve postoperative course, at least for postoperative haemostatic status. Despite increasing knowledge on extracorporeal circulation-induced haemostatic abnormalities and the development of new biological devices for heparin monitoring, the optimal level of anticoagulation remains matter of debate, as well as the monitoring procedures. This critical review presents the current available data on heparin anticoagulation and monitoring in this specific context, and underlines the pending issues about anticoagulation management during extracorporeal bypass.
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Ann Fr Anesth Reanim · Jun 2004
Clinical Trial[Postoperative nausea and vomiting: cost and therapeutic algorithm. Part II: high-risk patients and late PONV].
To evaluate in high-risk patients and in usual clinical conditions, the efficiency of treatments based on an algorithm on late (24 h) postoperative nausea and vomiting (PONV). ⋯ The use of a PONV therapeutic algorithm based on a scored risk was associated to a lower reduction of late PONV than already published in the literature while the cost was increased as expected. This suggests the efficacy of antiemetic prophylactic treatment might have been overestimated by large multicenter trials and is less in usual clinical conditions. Thus local evaluation of practice is required by performing quality insurance programs.
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Ann Fr Anesth Reanim · Jun 2004
Clinical Trial[Short term effects of hypertonic saline during severe sepsis and septic shock].
Assessment of haemodynamic effects of 250 ml hypertonic saline 7.5% (HS) perfusion in critically ill patients with severe sepsis or septic shock. ⋯ In patients with severe sepsis or septic shock, 250 ml HS transiently (<120 min) increases CI and PCWP and induces an increase in sodium and chloride concentrations.
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Ann Fr Anesth Reanim · Jun 2004
Case Reports[A case of anaphylactic shock with tranexamique acid (Exacyl)].
A 72-year-old male patient was scheduled for coronary artery bypass graft surgery because of severe three-vessel disease. Induction of anaesthesia was uneventful. ⋯ Allergological investigations (cutaneous tests, serum IgE concentrations, in vitro histamine-release tests) suggest that this is the first reported case of anaphylactic shock to tranexamic acid. Several weeks later, the patient underwent surgery with a similar anaesthetic regimen and the clinical course was uneventful.