Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jul 2010
Case ReportsUnrecognized dural puncture during epidural analgesia in obstetrics later confirmed by brain imaging.
Accidental dural puncture is a well-recognized complication of obstetric epidurals that can potentially incapacitate the patient. Unrecognized dural puncture during epidural administration can lead to a delay in therapeutic intervention resulting in potentially serious complications. ⋯ Magnetic resonance neuroimaging was performed to confirm the diagnosis, and direct clinical management. We also discuss the role of neuroimaging in the investigation of postpartum headache.
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Ann Fr Anesth Reanim · Jul 2010
Case ReportsUltra-long duration of a peripheral nerve block: a possible consequence of intraneural (subepineural) local anaesthetic injection.
A 29-year-old patient was scheduled for bilateral halllux valgus surgery and a lateral sciatic popliteal nerve block was performed on each side using ropivacaine and lidocaine using nerve stimulation. Although the sensory and motor block had usual duration on the left side, the block lasted more than 48 hours on the right side with both sensory and motor impairment. ⋯ We postulate that this case of extremely long duration of a peripheral nerve block can be ascribed to subepineural trapping of the local anaesthetic. Part of the variability in the duration of the sensory and motor block after peripheral nerve blocks might be explained by the variable amount of drug injected intraneurally.
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Ann Fr Anesth Reanim · Jul 2010
[Activity and the available human resources working in 66 French Southern intensive care units].
The aim of the study was to determine the activity and the available human resources working in 66 intensive care unit (ICU). ⋯ In this study, more than 75% patients had at least two organ dysfunctions within their ICU stay and 88% required a billing procedure and had an admission SAPS II greater or equal to 15. Nevertheless, the staff resource remained below the 2002 decree in 27% ICUs.
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Ann Fr Anesth Reanim · Jul 2010
Case Reports[Bedside pretransfusion compatibility testing fiability with cold agglutinins during cardiopulmonary bypass associated hypothermia for cardiac surgery].
This case report is an example of a bedside pretransfusion compatibility testing issue. An 81-years-old woman was admitted in the operating room for aortic valve replacement under cardiopulmonary bypass. ⋯ Afterwards, the patient was diagnosed with cold agglutinins. It might have produced false positive results with the anti-A and anti-B reagents.
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Ann Fr Anesth Reanim · Jul 2010
[Impact of Express study on clinical practice in ARDS patients: a single French ICU experience].
The French Express study compared two alveolar recruitment managements (maximal versus standard) in Acute Respiratory Distress Syndrome (ARDS) patients ventilated with 6 ml/kg of ideal body weight (IBW). The objective of the present study was to assess in a single intensive care unit, the impact of Express study on the mechanical ventilation settings in non-included ARDS patients. ⋯ The participation in Express study led physicians to modify their mechanical ventilation settings. The maximal tidal volume decreased and the minimal respiratory rate increased in the ARDS eligible but non-included patients.