Annales françaises d'anesthèsie et de rèanimation
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Compartment syndromes are well recognized following major trauma. However, although uncommon, they may occur following athletic activity. We report a case of acute exertional peroneal compartmental syndrome in a 32-year-old that developed following horse riding. ⋯ At one-year follow-up visit following decompressive fasciotomy, muscular strength of the muscles of the anterior tibial compartment almost returned to normal. The presentation of this case of compartmental syndrome following horse riding allows to discuss the place of the regional anaesthesia. Because this anaesthesia technique can delay the diagnosis and the surgical treatment, it should not be used in first intention in the treatment of severe pain associated with compartmental syndrome.
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Ann Fr Anesth Reanim · Apr 2005
Review[Anaesthetic-induced myocardial preconditioning: fundamental basis and clinical implications].
Volatile halogenated anaesthetics offer a myocardial protection when they are administrated before a myocardial ischaemia. Cellular mechanisms involved in anaesthetic preconditioning are now better understood. The objectives of this review are to understand the anaesthetic-induced preconditioning underlying mechanisms and to know the clinical implications. ⋯ Ischaemic preconditioning (PC) is a myocardial endogenous protection against ischaemia. It has been described as one or several short ischaemia before a sustained ischemia. These short ischaemia trigger a protective signal against this longer ischaemia. An ischemic organ is able to precondition a remote organ. It is possible to replace the short ischaemia by a preadministration of halogenated volatile anaesthetic with the same protective effect, this is called anaesthetic PC (APC). APC and ischaemic PC share similar underlying biochemical mechanisms including protein kinase C, tyrosine kinase activation and mitochondrial and sarcolemnal K(ATP) channels opening. All halogenated anaesthetics can produce an anaesthetic PC effect. Myocardial protection during reperfusion, after the long ischaemia, has been shown by successive short ischaemia or volatile anaesthetic administration, this is called postconditioning. Ischaemic PC has been described in humans in 1993. Clinical studies in human cardiac surgery have shown the possibility of anaesthetic PC with volatile anaesthetics. These studies have shown a decrease of postoperative troponin in patient receiving halogenated anaesthetics.
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Ann Fr Anesth Reanim · Apr 2005
Case Reports[Intraspinal air, a rare complication of blunt chest trauma].
Pneumorachis, defined as the presence of air within the spinal canal, has rarely been described, and is exceptionally due to thoracic trauma. We report the case of a 37-year-old patient who sustained a motor vehicle accident. ⋯ The fracture of T4 associated with the pleural lesion is probably responsible for the pneumorachis. Possible pathogenic mechanisms of this rare blunt chest complication are discussed.
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Ann Fr Anesth Reanim · Apr 2005
[Selective digestive decontamination: the light as changed from red to green].
To study the efficacy of selective digestive decontamination (SDD) for the prevention of nosocomial infections, particularly pneumonia, as well as its impact on the emergence of multiresistant bacteria. ⋯ The data from the literature provide arguments to use SDD in targeted patient populations like multiple traumas in intensive care units, which have a low rate of multiresistant bacteria.
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Ann Fr Anesth Reanim · Apr 2005
[Activated protein C treatment: experience about 23 patients in the operative period].
To evaluate the use of activated C protein (ACP) in a Surgical Intensive Care Unit. ⋯ With global management of severe sepsis, including the use of activated C Protein, this prospective observational study showed a 30% reduction of the predicted mortality by SAPS II scoring without significant increase of bleeding episodes in a surgical context.