Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jun 2012
Case Reports[Major haemodynamic incident during continuous norepinephrine infusion: Beware of the infusion line. An avoidable postoperative hypertensive peak?].
The restoration of patients' mean arterial pressure after ineffective fluid resuscitation is obtained by vasopressive treatment such as norepinephrine. However, no guidelines exist concerning a norepinephrine infusion method: whether it be the norepinephrine concentration in the syringe, single or double pump administration via a carrier such as an isotonic saline solution, or use of minimized dead-volume extension sets. We present the case of a female patient requiring norepinephrine treatment, who quickly suffers a major haemodynamic incident (a sudden rise in systolic blood pressure above 220 mmHg associated with tachycardia up to 189 b/min). The main causes of this incident are discussed and infusion parameters considered with a view to developing an optimal infusion method for a drug with a specific therapeutic index.
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Ann Fr Anesth Reanim · Jun 2012
[Evaluation of the concordance between guidelines and transfusion practices in neonatal intensive care units].
To assess the concordance rate between the prescriptions of blood products and Afssaps guidelines for transfusion practices in neonatology. ⋯ Global concordance's rate between the guidelines and the prescriptions is fairly well. PRBC are the most blood product transfused. Excessive transfusions related to this concordance rate are leading to important theoretical costs. New informations to the guidelines are warranted to improve transfusional practices in this institution.
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Ann Fr Anesth Reanim · Jun 2012
[Massive transfusion: analysis of practices according to available medical devices].
An assessment of practices and available medical devices during the treatment of a massive haemorrhage has been realised in the shock unit of our hospital. ⋯ Maximum flow rates noted by manufacturers are not the real values because some parameters such as venous catheter diameter (limitative factor) and the red blood cell viscosity (diluted or not) are not considered. The choice of an infusion system is mainly based on the technical capacities (flow rate fluctuations, pressure gradient on blood bags, warming, air purging), practical modalities of use (medical devices and assembly) and cost. The pressure cuff with transfusion gravity set should be limited to non-critical situations or during the assembly of the fast flow fluid warmers (but no warming fluids, no air embolism prevention). The accelerated transfusion set is not the best option for a shock unit because it needs an operator permanently. The fast-flow fluid warmers are recommended for all types of massive haemorrhages, they are more secure but they require a long time to be assembled.
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It could append that patient pain relief in palliative care is not achieved despite the use of opioids and the multimodal approach. Therefore, regional techniques are used in the palliative care unit of the Limoges University Hospital since four years. ⋯ Despite this underperformance in terms of pain control, a multicenter study is ongoing to evaluate the improvement of quality of life induced by the regional techniques.