Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Nov 2010
Review[Obstructive sleep-apnoea syndrome in adult and its perioperative management].
Obstructive sleep apnoea (OSA) syndrome in adult is defined as an Apnoea-Hypopnoea Index (AHI) of 5 or more per hour of sleep in a context of excessive daytime sleepiness and snoring. OSA is considered as mild with an AHI of 5-15, moderate with an AHI of 15-30, and severe with an AHI greater than 30. OSA is a highly prevalent disease since it should affect 7-15% of the middle-aged population, but most patients are not yet diagnosed for OSA. ⋯ In the postoperative period, early resuming continuous positive airway pressure and installing the OSA patient in a nonsupine position could be effective in preventing pharyngeal obstruction. Considering the timing of postoperative complications, a careful monitoring in the post-anesthesia care unit for three hours is an appropriate strategy for a majority of OSA patients. Alternatives to opioids should be promoted for postoperative pain control.
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Ann Fr Anesth Reanim · Nov 2010
Case Reports[Obstetrical epidural analgesia during labour: one dural puncture, repeated postural headaches, three blood patches…].
We report the case of a patient in whom three blood patches had to be performed to treat a post-dural puncture headache following the insertion of an epidural catheter for labour analgesia. There are few data about repeated blood patches used to treat recurring symptoms after failure of a previous blood patch. The technical guidelines used to perform a first blood patch should be followed for the next procedure as well. The role of the cerebrospinal fluid leaking in the symptoms has to be verified, to avoid performing a useless blood patch and to miss another cause, which needs an urgent treatment.
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Lemierre's syndrome is a rare disease, mostly affecting young adults in good health, which can lead to significant morbidity and mortality. We report one case with favourable outcome and clinical features stereotypics: angina, septic thrombosis of the internal jugular vein, pulmonary septic metastasis, Fusobacterium necrophorum on blood cultures. Antibiotic therapy targeting anaerobes has been rapidly initiated and maintained 4-6 weeks. The anticoagulation has been maintained 4 weeks.
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To test a high-frequency jet ventilator, the Monsoon™ (Acutronic laboratory) on a lung model with regard to delivered tidal volume and tracheal pressure measured through the injector. ⋯ Use of a dedicated injector line and a range of settings (RR and I/T rapport) are required to measure an actual EPP through the injector.
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Ann Fr Anesth Reanim · Nov 2010
[Ultrasound-guided regional anaesthesia and the common classification of medical acts by the social security].
Ultrasound imaging is a major technological advance in the practice of regional anesthesia. For the social security, their rationale relies on the concept of a global medical act i.e., each medical act is worked out, in order to describe the realized medical act totally. At present the social security uses this concept to prevent the anesthetists from quoting a supplementary ultrasound act. In this article we discuss the legitimacy of quoting ultrasound-guided regional anaesthesia.