Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Sep 2011
Review[Surgery and invasive procedures in patients on long-term treatment with oral direct thrombin or factor Xa inhibitors].
Direct oral anticoagulants (DOAs), inhibitors of factor IIa or Xa, are expected to replace vitamin K antagonists in most of their indications. It is likely that patients on long-term treatment with DOAs will be exposed to elective or emergency surgery or invasive procedures. Due to the present lack of experience in such conditions, we cannot make recommendations, but only propose perioperative management for optimal safety as regards the risk of bleeding and thrombosis. ⋯ The treatment should be resumed only when the risk of bleeding has been controlled. In patients with a high risk of thrombosis (e.g. those in atrial fibrillation with an antecedent of stroke), bridging with heparin (low molecular weight, or unfractionated if the former is contraindicated) is proposed. In emergency, the procedure should be postponed for as long as possible (minimum 1-2 half-lives) and non-specific anti-haemorrhagic agents, such as recombinant human activated factor VIIa, or prothrombin concentrates, should not be given for prophylactic reversal, due to their uncertain benefit-risk.
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Ann Fr Anesth Reanim · Sep 2011
Clinical Trial[Ultrasound control of local anaesthetic location after TAP block performed using landmark-based technique: a cohort study].
TAP is a regional anaesthetic technique where local anaesthesic (LA) is injected between the internal oblique and the transversus abdominis muscles in order to block intercostal nerves. The technique originally described, is based on the identification of the lumbar triangle of Petit as the area where to insert the needle before the LA injection. We performed a study to determine, using ultrasonography, the actual location of the LA when TAP block was performed using landmark-based technique. ⋯ The localization of LA after the TAP block being performed by landmark-based techniques is highly variable. In the majority of patients, the LA was injected in adjacent anatomical structures with unpredictable block results. This may promote the use of ultrasound-guided technique to perform the TAP block.
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Ann Fr Anesth Reanim · Sep 2011
Case Reports[Anaesthesia for caesarean section in a pregnant woman with cor triatriatum].
A 41-year-old woman suffering from a left cor triatrium, pregnant for the first time, was hospitalized for a caesarean section in the context of a pulmonary arterial hypertension with severe anaemia. The anaesthetic strategy which was decided on involved setting up a haemodynamic monitoring prior to induction of a general anaesthetia with etomidate, remifentanil and succinylcholine and maintained with propofol, sufentanil and cisatracurium. ⋯ The improvement of the arterial pulmonary hypertension immediately after coming out of the operating theatre allowed the patient to be briefly monitored in the intensive care unit and to be allowed home on the 10th day following the operation. The patient's cardiopathy was corrected in the 5th month after the birth.
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Ann Fr Anesth Reanim · Sep 2011
[Assessment of withholding life support and withdrawing life support in a vital emergency department].
To evaluate the practices of withholding and withdrawing of life sustaining therapies in a vital emergencies department and to confront them with Leonetti law procedures. ⋯ The application of Leonetti law in vital emergencies department is flawed. It appears to be necessary to realize new studies and to release official guidelines or recommendations specifically made for emergencies department to improve the practices of withholding or withdrawing life sustaining treatments.
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Ann Fr Anesth Reanim · Sep 2011
[Management of hypotension during spinal anaesthesia for elective caesarean section: a survey of practice in Lorraine region].
The aim of the survey was to describe current practice in management of hypotension during spinal anaesthesia for elective caesarean section in Lorraine. ⋯ Management of hypotension during spinal anaesthesia for elective caesarean section was significantly influenced by the type of practice.