Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jun 2008
Case Reports[Resuscitation after three hours of cardiac arrest with severe hypothermia following a toxic coma].
We report the case of a 37-year-old woman who survived from severe hypothermia (rectal temperature: 22 degrees C) and prolonged cardiac arrest with asystole after benzodiazepine and tricyclic antidepressant poisoning. Basic-cardiopulmonary resuscitation and mechanical ventilation was started by a French Mobile Intensive-Care unit. ⋯ The patient was discharged at day 13 without any neurological deficit. The discussion focuses on the benefit of extracorporeal-membrane oxygenation (ECMO) as extracorporeal circulation device through femoral access, the differential diagnosis between death and recoverable cardiac arrest and neuroprotection.
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Ann Fr Anesth Reanim · Jun 2008
Case ReportsPrevious safe administrations of neuromuscular blocking agents do not exonerate from the risk of anaphylactic shock.
We describe a grade IV anaphylactic shock to atracurium. A 34-year-old woman was scheduled for her ninth abdominal surgery. Within the last 10 months, for previous abdominal procedures she had received atracurium, cisatracurium or suxamethonium. ⋯ Anaphylaxis was immediately evoked and treatment started. The diagnosis of anaphylaxis to atracurium was confirmed by the allergological assessment. This case report highlights the fact that patients without any previous adverse events to neuromuscular blocking agents are never exempt from risk of anaphylactic shock, even with a designated low-risk agent of sensitization.
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Ann Fr Anesth Reanim · Jun 2008
Impact of the use of propofol remifentanil goal-directed sedation adapted by nurses on the time to extubation in mechanically ventilated ICU patients: the experience of a French ICU.
Inappropriate sedation could prolong the duration of mechanical ventilation. The present "before-after" study assessed the impact of a goal-directed sedation using an algorithm with a combination of propofol and remifentanil on the time to extubation. ⋯ Sedation with adapted infusions of propofol and remifentanil according to the Ramsay score and a pain scale decreases the time to extubation in ICU patients requiring sedation longer than 24h but increases the rate of self-extubations.
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Ann Fr Anesth Reanim · Jun 2008
Case Reports[Femoral-venous catheterization: a delayed perforation].
Later vascular injury after central venous catheterization is not common. In literature, there are only cases reporting jugular or subclavian vein catheterization territories with a higher significative risk if the catheter is larger and in left position. ⋯ This vascular perforation induced an infusion in the peritoneal and the retroperitoneal cavity with abdominal and pelvic pain. This case report may ask the question of recommendations about femoral catherization.
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Ann Fr Anesth Reanim · Jun 2008
[French survey of neuromuscular relaxant use in anaesthetic practice in adults].
Guidelines about the use of neuromuscular blocking agents based on a national consensus conference have been published in 2000. A survey was carried out to assess adherence to these guidelines. An online questionnaire was designed from the different guidelines concerning the use of muscle relaxant for tracheal intubation and surgery, monitoring and antagonism of neuromuscular blockade. ⋯ Antagonism of neuromuscular blockade was systematic, frequent, and episodic or excluded by 6, 26, 55 and 13% of responders, respectively. Monitoring and antagonism of neuromuscular blockade are underused despite the guidelines. Underestimation of the risk of postoperative residual curarization is linked to the underestimation of the duration of competitive neuromuscular blocking agents.