Annales françaises d'anesthèsie et de rèanimation
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Pulse pressure variations are used to assess fluid responsiveness in mechanically ventilated patients. The accuracy of this index in open chest conditions remained unclear. The aim of the study was to evaluate the effect of open chest conditions on pulse pressure variations. ⋯ In these studied patients, preload dependancy indices were not modified by open chest conditions. Pulse pressure variations remained correlated to stroke volume even after thoracotomy.
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Ann Fr Anesth Reanim · Feb 2011
Case Reports[Splenic artery aneurysm rupture in late pregnancy: a case report and review of the literature].
Haemorrhages during pregnancy may have a non-obstetrical origin, the pregnancy itself favoring some specific aetiologies because of pregnancy-related physiological modifications. These non-obstetrical haemorrhages are rare but are associated with a high maternal and foetal mortality. ⋯ We report the case of a patient who had a caesarean section for suspicion of acute foetal distress during which was found a large intraperitoneal bleeding due to rupture of an unknown splenic artery aneurysm. We discuss the principal causes of non-obstetrical intra-abdominal bleeding, including subcapsular liver haematoma, rupture of uterine vessels and rupture of splenic artery aneurysm, with a specific focus on this last aetiology.
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We report a case of impossible injection into a thoracic epidural catheter associated with a difficult withdrawal of this catheter after its introduction on the T3-T4 level. Thanks to a gentle and continuous traction, the catheter was finally successfully removed without being broken, but presented a simple knot at 13mm from its end. ⋯ We have been probably confronted with a catheter taking an abnormal direction due to an anatomic structure. This case shows us that knots in an epidural catheter are also possible on the high thoracic level and that its ascent within the epidural space must happen without any resistance.
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Ann Fr Anesth Reanim · Feb 2011
[Cricothyrotomy in emergency context: assessment of a cannot intubate cannot ventilate scenario].
The aim of this study was to assess airway management by emergency physicians in case of a simulated situation where intubation and ventilation were both impossible. ⋯ Simulation with a manikin is useful to assess the adhesion rate to difficult intubation algorithms. Our study shows that the decision making process for cricothyrotomy is too often delayed as soon as ventilation became impossible and oxygenation compromized.