Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · May 2012
[Neurological complications of the regional anesthesia: analysis of the expertises and conclusions of the Regional Commissions for Conciliation and Compensation].
All the files of complications of regional anaesthesias requiring an expertise for a Regional Commission for Conciliation and Compensation for medical accidents (CRCI) between 2003 and 2008 were analyzed. The objective was to estimate the homogeneity of the appointed experts, their opinions and the opinions of the CRCI. Querying the database, shared by the National Office for Compensation for Medical Accidents (ONIAM) and the CRCI, and identified 40 files corresponding to the selection criteria. ⋯ Damages assessed were highly variable, but the given evidence provided to understand why. The CRCI have generally followed the opinions of the experts, except in a few cases where the evidence allowed a different opinion without requiring a new expertise. In conclusion, the abnormalities in the appointment of experts do not seem to have had consequences in terms of damage assessment, but may alter the balance between causes faulty and not faulty, in favour of the latter.
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Ann Fr Anesth Reanim · May 2012
Case Reports[Extensive mesenteric ischemia related to naratriptan overuse associated with grapefruit juice absorption].
We reported the case of a 61-year-old woman, who has been hospitalized in ICU because of an extensive mesenteric ischaemia, involving the small bowel, secondary to a naratriptan overuse. This mesenteric ischaemia was complicated by multiple organ failure and was responsible for extensive small bowel resection and left colectomy. A concomitant abundant absorption of grapefruit juice, a well-known P450 inhibitor, may have enhanced this naratriptan toxicity. This case underscore that an abdominal pain occurring in the context of headache treatment may be related to a mesenteric ischaemia.
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Ann Fr Anesth Reanim · May 2012
[Announce a death rapes to the close relations in emergency situation and taken care].
The death is a part of the everyday life of the emergency medical teams, but to announce the death and to take care in immediate of the saddened close relations rest a testing experience for which the professionals of the emergency care are not still prepared. Our comment aims from the experience of care of families, saddened in immediate and also recorded within the framework of a specialized consultation, to pass on what the saddened persons can feel during the intervention of the help and the confrontation in the death of their close. Our objective being to bring to the professionals of the tracks of reflection to limit the risks of survictimisation.
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Ann Fr Anesth Reanim · May 2012
Case Reports[Refractory thrombotic thrombocytopenic purpura revealing an epiglotis neoplasia].
Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy with neurological disorder which incidence is relatively rare. Since the discovery of the ADAMTS 13 in 1996 and the changes in the treatment (plasma exchanges and rituximab), the prognosis of the TTP has considerably improved. We report the case of a 60-year-old man with a refractory TTP. The subsequent discovery of an epiglottis neoplasia and its treatment saved the patient.
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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.