Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Feb 2012
[A protocol for the cessation of sedation in brain-injured patients].
The cessation of sedation in brain-injured patients may result in severe agitation and/or acute withdrawal syndrome related to the prolonged administration of large doses of benzodiazepines and/or opioids. The aim of the present study was to assess the clinical efficacy of a written protocol to withdraw sedation for these patients. ⋯ The cessation of sedation in severely brain-injured patients can be successfully managed with the use of clorazepate, associated with buprenorphine in the presence of agitation.
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Ann Fr Anesth Reanim · Feb 2012
Case Reports[Anaesthetic management for caesarean delivery and acute myocardial infarction by spontaneous coronary dissection].
Myocardial infarction is rare during pregnancy and is associated with a high maternal and foetal mortality rate. We report the case of a 32-year-old woman at 38 weeks gestation who developed a myocardial infarction with spontaneous coronary dissection treated with coronary angioplasty and who needed an emergency caesarean section. We discuss the anaesthetic management of urgent caesarean section in this context.
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Ann Fr Anesth Reanim · Feb 2012
Case Reports[Incidental finding of phaeochromocytoma during surgery: the anaesthesiologist's nightmare].
We report the case of a patient who presented hypertension paroxysmal with acute pulmonary oedema followed by cardiocirculatory arrest during gynaecological surgery for resection of latero-aortic lymph nodes suspected to be cervical cancer metastases. This intervention, originally oncologic, has discovered ectopic phaeochromocytoma a posteriori. The management of perioperative serious adverse events revealing the undiagnosed phaeochromocytoma is discussed.
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During pregnancy, the plasma concentration of factor VII increases to reach values during the third trimester that can be twice the normal values (N: 70% to 140%). Congenital factor VII deficiency is a rare condition which may lead to haemorrhage. We report the case of a patient with a congenital factor VII deficiency who presented with severe postpartum haemorrhage requiring resuscitation with blood transfusion and surgical haemostasis. We discuss the treatment of congenital factor VII deficiency and its anaesthetic management, as well as the hemorrhagic risk during pregnancy.
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We report two cases of iliac bone surgery (repair of a symphysis disjunction and fixation of a fracture of the iliac ala) where TAP blocks were effective for postoperative analgesia. In the first case, we performed a bilateral block, and only a unilateral block in the second case. We discuss possible mechanisms to explain the efficacy of the TAP blocks in such surgeries. As for the femoral nerve block in major knee surgery, we think that blocking the parietal pain from skin and blocking parietal muscles contracture, can reduce postoperative pain in such surgeries.