Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · May 2005
Review Case Reports[Value of skin tests for the choice of a neuromuscular blocking agent after an anaphylactic reaction].
We report a grade III allergic hypersensitivity reaction occurring in a 72-year-old patient immediately after anaesthesia induction. Anaphylaxis to cisatracurium was diagnosed on clinical symptoms, biological tests and positivity of the cutaneous tests to this neuromuscular blocking agent. Five days after this allergological assessment, rocuronium, a muscle relaxant for which skin tests appeared negative was used during surgery without adverse effects. The authors underline the value of a detailed allergological assessment to identify the pathophysiologic mechanism, the culprit drug and to propose a safer alternate drug that might be used.
-
Ann Fr Anesth Reanim · May 2005
Editorial Comment Comparative Study[Sedation in ICU: from clinical research to daily practice].
-
Ann Fr Anesth Reanim · May 2005
Randomized Controlled Trial Clinical Trial[Remifentanil-midazolam compared to sufentanil-midazolam for ICU long-term sedation].
Remifentanil has a unique metabolic pathway that holds potential benefits for long-term sedation. We compared remifentanil-midazolam to sufentanil-midazolam in 41 critically ill adults requiring mechanical ventilation. ⋯ Sufentanil infusion needed to be reduced over time and prolonged the weaning time when compared to remifentanil.
-
Ann Fr Anesth Reanim · May 2005
Review[Anaesthetic management of the patient with acute intracranial hypertension].
Transcranial Doppler and, if possible, measurement of intracranial pressure (ICP) allow preoperative diagnosis of acute intracranial hypertension (ICH) after brain trauma. The main goal of the anaesthesiologist is to prevent the occurrence of secondary brain injuries and to avoid cerebral ischaemia. Treatment of high ICP is mainly achieved with osmotherapy. ⋯ In case of ICH, halogenated and nitrous oxide should be avoided. Until the dura is open, mean arterial pressure should be maintained around 90 mmHg (or cerebral perfusion pressure around 70 mmHg). If a long-lasting (several hours) extracranial surgery is necessary, ICP should be monitored and treatment of ICH should have been instituted before.
-
Ann Fr Anesth Reanim · May 2005
Review[Pulmonary arterial hypertension in intensive care unit and operating room].
To review the perioperative anaesthetic management of pulmonary arterial hypertension. ⋯ Pulmonary arterial hypertension is classically divided in primary and secondary. Primary pulmonary hypertension (familial and sporadic) is relatively severe and rare. Muscularization of the terminal portion of the pulmonary vascular arterial tree, caused by smooth muscle cell hyperplasia is the first change. Pulmonary arterial hypertension linked with disorders of the respiratory system and hypoxemia or pulmonary venous hypertension including mitral valve disease and chronic left ventricular dysfunction are often associated with high morbidity and mortality. The main consequence of pulmonary hypertension development is the occurrence of right-sided circulatory failure. A better understanding of disease pathophysiology will contribute to the development of new therapies increasing then the prognosis of these patients. The management of primary pulmonary hypertension or secondary pulmonary arterial hypertension is a challenge for the anaesthesiologist because the risk of right ventricular failure is markedly increased.