Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · May 2012
Guideline[Critical appraisal of organ procurement under Maastricht 3 condition].
The ethics committee of the French Society of Anesthesia and Intensive Care (Sfar) has been requested by the French Biomedical Agency to consider the issue of organ donation in patients after a decision of withdrawing life supporting therapies has been taken. This category of organ donation is performed in the USA, Canada, United Kingdom, the Netherlands and Belgium. The three former countries have published recommendations, which formalize procedures and operations. ⋯ It suggests that the nature of the confirmatory investigation required should be formalized by the French Biomedical Agency on behalf of the French parliamentarians. This should help preserving population trust regarding organ procurement and provide a framework to medical decision. This text has been endorsed by the Sfar.
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Accident of CPB is a reality. It is important to be prepared for discussion with the family, with the hospital administration, eventually with the justice. But we have also to support perfusionnist and anesthetic team in charge of the patient during accident.
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Ann Fr Anesth Reanim · May 2012
[Vasomotor tone and CBP : monitoring components, pratical and therapeutic approaches].
The vasomotor tone is an essential determinant of blood pressure. Vascular resistance is the result of a calculation including vasomotor tone, blood flow and blood viscosity. The vascular tone is modulated by the sympathetic system and the direct actions of drugs (patient's pathology, anaesthesia). ⋯ Monitoring parameters of extracorporeal circulation such as pressure, flow, arterial and venous oxygen saturation, blood level in the venous reservoir, and extensively blood gases, haemoglobin, CO(2) partial pressure level of the oxygenator vent, bispectral index, and oxygen saturation of cerebral tissue are reviewed. They will know the vasoplegia consequences and bear an indication of adequate tissue oxygenation. It may be obtained by using vasopressors (ephedrine, norepinephrine, terbutalin and vasopressin) methylene blue, increasing blood viscosity (erythrocytes) and blood flow, even by inducing hypothermia.
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New technologies have become available to minimize the adverse events of extracorporeal devices. Link to these technological improvements ECMO in lung transplantation is currently essential. ⋯ Its use as hemodynamic and respiratory support during the lung transplant surgery can replace conventional Cardiopulmonary bypass. And finally, ECMO is sometimes the only alternative in the most severe forms of primary graft failure.
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Ann Fr Anesth Reanim · May 2012
Letter Case Reports[Thigh haematoma after sciatic nerve block and fondaparinux].