Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Dec 2013
Case Reports[Massive rhabdomyolysis: An uncommon complication of cholesterol embolization syndrome.]
A 79-year-old man with atherosclerosis presented blue toes and livedo reticularis. The patient had eroded aortic atheromatous plaques, and cholesterol embolization syndrome was suspected. An endovascular technique to exclude sources of cholesterol emboli was however performed. ⋯ A massive rhabdomyolysis occurred associated with acute kidney injury and hyperkaliemia treated by continuous renal replacement therapy with regional citrate anticoagulation. Steroids have been introduced and renal function improved. Cholesterol crystals were also found on a skin biopsy, performed before endovascular procedure.
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Ann Fr Anesth Reanim · Dec 2013
Case Reports[Hypoxic accident during pediatric anesthesia due to an inappropriate setting of respirator.]
A 3-year-old child was anesthetized for ENT examination and surgery. After induction and tracheal intubation, the patient was ventilated (controlled mode). The respirator screen showed information compatible with a failure of intubation: no expired CO2, no expired flow, no alarm of high pressure limit, and no respiratory chest movement. ⋯ The expiratory CO2 was present when the patient was ventilated manually and disappeared under controlled ventilation. The increase in the value of the maximal insufflation pressure allowed efficient ventilation with an expiratory CO2 curve and showed high ventilation pressure compatible with a bronchospasm. This case report shows that in case of bronchospasm, if the value of the maximal insufflation pressure is low, this may lead to an erroneous diagnosis of failure of intubation.
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Different airway devices can be used by paediatrician anaesthesiologists for difficult airway management in infant younger than 2 years. The four devices analyzed (Airtraq® [Prodol Meditec]; Glidescope® Cobalt [Verathon]; Vidéolaryngoscope [Storz]; laryngoscope Truview® [Truphatek]) increase the Cormack and Lehane grade against direct laryngoscopy and optimized external larynx movements. They need training, on manikin then in vivo, for an optimal use. ⋯ The choice between these devices, in accordance with the published studies, which compared the devices, is difficult. The manikin studies allow to standardize airway, but the results are not transposable in vivo. Concerning the airway devices with disposable blade, the Glidescope®, for oral intubation, seems to be better than Airtraq® if we take into account the oropharyngeal volume needed.
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Ann Fr Anesth Reanim · Dec 2013
Randomized Controlled TrialEffect of patient-controlled sedation with propofol on patient satisfaction: A randomized study.
In this trial we sought to determine whether propofol-based patient-controlled sedation (PCS) during diagnostic cerebral angiography would result in improved patient satisfaction compared to placebo-based PCS. ⋯ This prospective, double-blind, randomized study showed that sedation using propofol PCS did not improve patients' satisfaction during diagnostic cerebral angiography. Therefore, an anesthetist should be rapidly available on request but not necessarily present during the whole procedure.