Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Apr 2009
[Impact of a quality assurance program on the use of neuromuscular monitoring and reversal of muscle relaxants].
As part of a quality assurance in the anaesthesia department, this study was designed to enhance the rate of neuromuscular blockade monitoring for patients receiving muscle relaxant during anaesthesia. ⋯ This study shows that as part of a quality assurance program systematic quantitative monitoring of neuromuscular blockade can be significantly increased.
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There is a large body of experimental evidence showing benefits of deliberate mild hypothermia (33-35 degrees C) on the injured brain as well as an improvement of neurological outcome after cardiac arrest in humans. However, the clinical evidence of any benefit of hypothermia following stroke, brain trauma and neonatal asphyxia is still lacking. Controversial results have been published in patients with brain trauma or neonatal asphyxia. ⋯ Hypothermia-induced hypocapnia should have a role on the reduction of intracranial pressure. The temperature target is unknown but no additional benefit was found below 34 degrees C. The duration of deliberate hypothermia for the treatment of elevated intracranial pressure might be at least 48 hours, and the subsequent rewarming period must be very slow to prevent adverse effects.
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Ann Fr Anesth Reanim · Apr 2009
Review[Management of transdermal therapeutics in perioperative care].
To provide guidance on perioperative management of most frequently encountered transdermal therapeutics in anaesthesiology: nicotine, fentanyl, nitroglycerin, scopolamine and estradiol. ⋯ The management of transdermal therapeutics in peri operative care can be adapted for each treatment and for each patient by knowing pharmacokinetics as well as anaesthetics and surgical interactions. In emergency situations, the actions to be taken do not generally differ, but one must be aware that the effects of trandermal treatments do not disappear immediately when removed, due to their pharmacokinetics properties.
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Ann Fr Anesth Reanim · Apr 2009
Review[Hypothermia and cerebral protection after head trauma. Influence of blood gases modifications].
The usefulness of therapeutic hypothermia is highly debated after traumatic brain injury. A neuroprotective effect has been demonstrated only in experimental studies: decrease in cerebral metabolism, restoration of ATP level, better control of cerebral edema and cellular effects. Despite negative multicenter clinical studies, therapeutic hypothermia is still used to a better control of intracranial pressure. ⋯ A clear understanding of blood gases variations induced by hypothermia is needed to understand the cerebral perfusion and oxygenation changes. It is essential to recognize and to use hypothermia-induced physiological hypocapnia and alkalosis under strict control of cerebral oxygen balance (jugular venous saturation or tissue PO(2)) and also to take into account the increased affinity of hemoglobin for oxygen. Management of post-traumatic intracranial hypertension using hypothermia, directed by intracranial pressure level, and consequently for long duration, is potentially beneficial but needs further clarification.
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Ann Fr Anesth Reanim · Apr 2009
[National survey on out-of-hospital difficult intubation management].
Difficult intubation rate is higher in the prehospital setting than in the operating room. Goal of this survey was to assess compliance of the French prehospital mobile emergency unit (Smur) to the recent French guidelines for the difficult airway management. ⋯ This survey shows that the French guidelines for the difficult airway management are only partially followed by the French Smur. An effort should be made for a larger diffusion of these guidelines towards the emergency physicians working in the Smur.