Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · May 2012
Brachial cuff measurements of blood pressure during passive leg raising for fluid responsiveness prediction.
The passive leg raising maneuver (PLR) for fluid responsiveness testing relies on cardiac output (CO) measurements or invasive measurements of arterial pressure (AP) whereas the initial hemodynamic management during shock is often based solely on brachial cuff measurements. We assessed PLR-induced changes in noninvasive oscillometric readings to predict fluid responsiveness. ⋯ Regardless of CVP (i.e., during "blind PLR"), noninvasiveΔ(PLR)SAP more than 17% reliably identified fluid responders. During "CVP-guided PLR", in case of sufficient change in CVP, noninvasiveΔ(PLR)SAP performed better (cutoff of 9%). These findings, in sedated patients who had already undergone volume expansion and/or catecholamines, have to be verified during the early phase of circulatory failure (before an arterial line and/or a CO measuring device is placed).
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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
[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[Acute negative pressure pulmonary edema: illustration from a unusual clinical case following a postoperative recurrent laryngeal nerve palsy].
Acute postoperative negative pressure pulmonary edema (NPPE) is a respiratory complication due to upper airway obstruction occurring most commonly in the postoperative period. Pathophysiologically, NPPE is explained by the abrupt generation of highly negative intrathoracic pressure that lead to fluid transudation from the pulmonary capillaries. This observation reports an unusual case of a young patient who has undergone total thyroidectomy for multinodular goiter. ⋯ This article stresses the importance of prevention of recurrent nerve palsy during thyroid surgery. It also highlights a little known respiratory complication: the NPPE. Understanding the pathophysiology of NPPE, rapid diagnosis and appropriate therapeutic measures could prevent its potential lethal consequences.