Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Oct 2011
Review[Strategy of postoperative rehabilitation after femoral neck fracture in elderly patients].
The femoral neck fracture in elderly patient is an entity that is within the scope of "disease causing a femoral neck fracture". The specific factors for successful management of these elderly patients are centered around patient's comorbidities, specific management in a clinical pathway, and more or less early rehabilitation after surgery. ⋯ The improvement of nutritional status, equilibrium for comorbidities and early rehabilitation with walking activities and physiotherapy significantly improve functional outcome at short and medium terms and postoperative mortality. The use of multimodal analgesia and regional analgesia primarily by perioperative continuous femoral nerve blocks also improve the medical prognosis and functional outcome of the patient.
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Ann Fr Anesth Reanim · Oct 2011
Case Reports[Pericardial puncture after central venous catheterism in infant. Systematic opacification and chest radiography to avoid serious complication].
Development of ultrasound in the operating room has improved the safety of patients requiring the placement of a central venous line in children. However, the risk of venous or myocardial perforation related to the use of guidewires or inappropriate dilators persists despite the use of ultrasound. ⋯ Immediate diagnosis and rapid treatment led to a favorable outcome. We believe chest radiography and systematic opacification are mandatory before fluid administration through the catheter, in order to reduce residual risk of serious complication.
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We report a case of delayed rocuronium-induced deep block antagonization with sugammadex, thus requiring a total of three injections and a cumulative dose of 12 mg/kg over a 30 min period. The patient was an emergency case with full stomach that had required a rapid sequence induction. Because of hyperkaliemia due to an acute renal failure, rocuronium was preferred to succinylcholine. Use of sugammadex in the acute renal failure context is discussed.
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Ann Fr Anesth Reanim · Oct 2011
Review[Post-surgery cognitive disorders: prevention, diagnosis and treatment strategies].
Hip fracture is an important step in the autonomy evolution in elderly. As gait is particularly jeopardised after such a traumatism, cognition may also be acutely impaired. Elderly post-surgery delirium is frequent, but chronic progression of cognitive impairment and dementia may occur. ⋯ A neurodegenerative disease such as Alzheimer's disease may be clinically silent prior the traumatic event, and may decompensate soon after as the cognitive reserve is not sufficient anymore. Dementia may then lead to progressive autonomy loss. A systematic interdisciplinary approach is needed to prevent frail patients from delirium, and to early cure it to decrease the risk of long-term autonomy loss.