Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Oct 2011
Review[Post-surgery cognitive disorders: prevention, diagnosis and treatment strategies].
Hip fracture is an important step in the autonomy evolution in elderly. As gait is particularly jeopardised after such a traumatism, cognition may also be acutely impaired. Elderly post-surgery delirium is frequent, but chronic progression of cognitive impairment and dementia may occur. ⋯ A neurodegenerative disease such as Alzheimer's disease may be clinically silent prior the traumatic event, and may decompensate soon after as the cognitive reserve is not sufficient anymore. Dementia may then lead to progressive autonomy loss. A systematic interdisciplinary approach is needed to prevent frail patients from delirium, and to early cure it to decrease the risk of long-term autonomy loss.
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Ann Fr Anesth Reanim · Oct 2011
Review[Transcutaneous aortic valve implantation: Anesthetic and perioperative management].
To describe the perioperative management, from the point of view of the anesthesia-intensive care unit specialist, of patients with aortic stenosis who undergo transcatheter aortic valve implantation (femoral or apical TAVI). ⋯ TAVI expands treatment options for patients with aortic valve stenosis. The anaesthesia team must be involved in the care of these patients with the same level of expertise and care as in heart surgery on critical patients.
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Ann Fr Anesth Reanim · Oct 2011
Review[Hip fracture in elderly patients: emergency management and indicators].
Hip fracture is a common condition associated with a poor outcome with 20-30% one-year mortality in the elderly. Autonomy and quality of life remains key considerations in this population. ⋯ In this way, a new approach must be evaluated and requires an optimal cooperation between emergency physician, orthopaedic surgeon, anaesthetists and geriatrician. Place and interest of new models of care such as orthogeriatrics unit have to be determined.
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Ann Fr Anesth Reanim · Oct 2011
Review[Preoperative management to reduce morbidity and mortality of hip fracture].
Hip femur is extremely common in the elderly and is one of the most common reasons for admission in trauma care. The main reported causes of death after hip fracture were cardiovascular (29%), neurological (20%) and pulmonary. Large epidemiological studies have shown a relatively small decrease in mortality for 20 years despite an active approach to medical and surgical management. ⋯ This period should not be prolonged by unnecessary investigations that will not change the perioperative management. The preoperative period is a key moment because it allows to choose the anesthetic technique. Even if this choice is controversial, continuous spinal anesthesia (titrated) do not modify the cardiovascular and neurological physiological balance of these precarious patients.
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Ann Fr Anesth Reanim · Oct 2011
Review[Hip fracture surgery in the elderly patient: epidemiological data and risk factors].
Health care administration is concerned about the escalating cost of geriatric trauma care and more specifically hip fracture (HF). By 2050, the wordwide annual incidence of HF among elderly people will be 4.5 million (predictible incidence in France: 150,000) and prevention will be more important than ever. The risk of hip fracture in older people increases exponentially with age. ⋯ The most important cause of osteoporosis is the gradual bone loss that occurs after the menopause. Similarly, there is a strong association with gender: the female-to-male ratio of HF is greater than 2/1 in people over 50 years of age (mean age: 83.2 yrs in female and 79.6 yrs in male in France). One year mortality after hip fracture is remarkably high, around 20 to 30%.