Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Mar 2014
Review[Nuclear magnetic resonance based metabolic phenotyping for patient evaluations in operating rooms and intensive care units.]
Metabolic phenotyping consists in the identification of subtle and coordinated metabolic variations associated with various pathophysiological stimuli. Different analytical methods, such as nuclear magnetic resonance, allow the simultaneous quantification of a large number of metabolites. Statistical analyses of these spectra thus lead to the discrimination between samples and the identification of a metabolic phenotype corresponding to the effect under study. ⋯ Metabolic phenotyping could be useful in anaesthesiology and intensive care medicine for the evaluation, monitoring or diagnosis of life-threatening situations, to optimise patient managements. This review introduces the physical and statistical fundamentals of NMR-based metabolic phenotyping, describes the work already achieved by this approach in anaesthesiology and intensive care medicine. Finally, potential areas of interest are discussed for the perioperative and intensive management of patients, from newborns to adults.
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Ann Fr Anesth Reanim · Mar 2014
Case ReportsFactor V and VIII combined deficiency: Clinical perioperative management for tonsillectomy in a child.
Combined factors V (FV) and VIII (FVIII) deficiency is a rarely seen hereditary coagulation disease. Experience of its management in surgery with a high-risk of bleeding is rare. The interest of this case report is to propose a strategy of perioperative management for such a deficit, but also to recall that a careful preoperative anesthetic evaluation with questioning and physical examination permits to detect unsuspected coagulation disorders and to schedule the preventive treatment. ⋯ Fresh frozen plasma and tranexamic acid were administered during the first 9 postoperative days. A local bleeding occurred at 8 days (scab coming off) and required systematically a surgical hemostasis and an intensification of the therapeutic protocol. Recombinant plasmatic factor VIII was administered for 7 days together with a daily perfusion of fresh frozen plasma for a total treatment period of 14 days.
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Ann Fr Anesth Reanim · Mar 2014
Case Reports[Interest of cervical epidural anesthesia in perioperative management of thyroidectomy with the high-risk anesthetic patient.]
Cervical epidural anesthesia is an anesthetic technique that can be useful in patients with high perioperative risk undergoing to cervical surgery. We report the case of a patient of 49 years old with hypertension, diabetes mellitus, epilepsy, left hemiparesis sequelae of stroke and congestive left ventricular failure. The patient underwent total thyroidectomy under cervical epidural anesthesia. No difficulty breathing or decompensation of chronic underlying diseases were noted in the postoperative.
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Ann Fr Anesth Reanim · Mar 2014
Availability and practice of bedside ultrasonography in emergency rooms and prehospital setting: A French survey.
The utility of bedside ultrasound (US) performed by emergency physicians has been proven for multiple purposes. There are no data about this technique in emergency departments (ED) in France. The primary objective is to determine the availability of ultrasound device (UD) in EDs and in prehospital settings in France. Minor objectives are to determine the number and type of UD, the most current applications of US and the factors correlated with availability of UDs in the setting of emergency medicine. ⋯ Availability of UDs in French public hospital EDs is 52% and 9% in prehospital units. Despite the progressive expansion of the technique over the last years, bedside ultrasonography is not yet completely integrated in the physical examination of the patient in an emergency situation in France. A reassessment will be required to confirm the current trend of expansion.