Annales françaises d'anesthèsie et de rèanimation
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The ischemic threshold is reached when the availability of oxygen in the cerebral tissue does not cover oxygen requirement. For a patient sedated, with constant PaO(2) and haemoglobin, the cerebral blood flow (CBF) global and local is the essential factor to maintain such a balance. ⋯ A cerebral perfusion pressure (CPP) of 60 mmHg, recommended for a cerebral perfusion allowing a sufficient CBF for normal brain, does not prevent ischemia. Monitoring aimed to control parameters of the aerobic metabolism (PtiO(2), SjO(2) and microdialysis) and to detect the ischemic threshold allows to adapt the CPP to each patient and continuously.
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Ann Fr Anesth Reanim · Jul 2006
Review[Monitoring of cerebral oxygenation with SvjO(2) or PtiO(2)].
Jugular venous oxygen saturation (SvjO(2)) monitoring has been developed in order to detect cerebral ischaemia. The interpretation of SvjO(2) values remains nevertheless complex, and should be associated with cerebral haemodynamic multimonitoring with ICP and transcranial Doppler. With the hypothesis of a constant cerebral oxygen consummation, and also with a constant haematocrit, SvjO(2) variations correlates with cerebral blood flow variations. ⋯ A concomitant metabolic monitoring by cerebral microdialysis is of importance to fully address the real cerebral local ischaemic burden. Scientific studies are mainly focused on patients with a brain traumatism. Nor SvjO(2), nor PtiO(2) monitoring have at present been demonstrated to be associated with a clinical benefit, and their use should be restricted to scientific research.
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Ann Fr Anesth Reanim · Jul 2006
Multicenter Study[Assessment of patient satisfaction after regional anaesthesia in two institutions].
This study was designed to assess patient satisfaction after regional anaesthesia for limb surgery. ⋯ This study has emphasised some important factors of patient satisfaction which were not sufficiently taken into account in our daily practice.
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Traumatic brain injury leads to primary and secondary brain injuries. Primary brain injury results from mechanical forces applied to the head at the time of impact. Secondary brain injury occurs at some time after the primary impact. ⋯ The endogenous neuroinflammatory response after traumatic brain injury contributes to the development of blood-brain barrier breakdown, cerebral oedema and neuronal cell death and this has led to various pharmacological therapies to try to limit this type of damage. Studies employing glutamate receptor antagonist for cerebral protection have yielded promising results in laboratory animals but failed to produce clinically significant improvements. The present review will summarize the mechanisms of post traumatic cerebral inflammation with a special focus on the anti-inflammatory drug targets.
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Ann Fr Anesth Reanim · Jul 2006
[Validation of the french translated Richmond vigilance-agitation scale].
To test reliability of the Richmond Agitation Sedation Scale (RASS) after French translation. ⋯ The French translation of RASS was acceptable. The translated scale preserved substantial inter-rater reliability. Monitoring of vigilance status in intensive care settings can be performed with this reliable clinical tool.