Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Sep 2010
Review[Coagulation disorders after traumatic brain injury: pathophysiology and therapeutic implications].
Early activation of coagulation is common after traumatic brain injury. Its origin is probably mainly intracerebral, due to tissue factor release from the injured brain. ⋯ Disseminated intravascular coagulation is linked to brain ischemia caused by intravascular microthrombosis. This review will focus on pathophysiology of coagulation disorders after traumatic brain injury, and on their implications for therapeutic approaches.
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Human serum albumin is a small (66kD) globular protein representing over 60 % of the total plasma protein content. It is made up of 585 amino 6 acids and contains 35 cysteine residues forming disulfide bridges that contribute to its overall tertiary structure. It has a free cysteine-derived thiol group at Cys-34, which accounts for 80 % of its redox activity. ⋯ However, human serum albumin is an important circulating antioxidant and it may be beneficial in critically ill patients to limit oxidative damage. A number of studies suggest that in specific groups of hypoalbuminemic critically ill patients, albumin administration may have beneficial effects on organ function, although the exact mechanisms remain undefined. Further trials are needed to confirm theses observations and to clearly demonstrate whether albumin should be administered in critically ill patients with hypoalbuminemia.
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Ann Fr Anesth Reanim · Sep 2010
[Management of newborns with meconium-stained amniotic fluid: prospective evaluation of practice].
Regional guideline for immediate tracheal suctioning (ITS) in vigorous and non-vigorous infants born through meconium-stained amniotic fluid (MSAF) has been established in 2003. The objective of this study was to evaluate guideline application. ⋯ Recommendations for ITS were implemented in 70% of cases but only in 42% of cases in non-vigorous babies. We have to improve formation and circulation of new recommendations.
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Ann Fr Anesth Reanim · Sep 2010
Case ReportsAnaesthetic management for caesarean section in a parturient with uncorrected coarctation of the aorta.
We present the case of a woman who refused RMI examination to diagnose a coarctation of her aorta before her third pregnancy. At term of 34 weeks of gestation the caesarean delivery was scheduled under spinal-epidural anaesthesia. Despite the use of a titrated regional anaesthesia, an important arterial hypotension occurred, restored with low doses of vasopressive agents.
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Ann Fr Anesth Reanim · Sep 2010
Case Reports[Respiratory support using veno-venous ECMO during lung resection for aspergilloma].
Respiratory support using extra corporeal membrane oxygenation (ECMO) is rarely used in the setting of adult lung surgery, with the exception of lung transplantation. We report the case of a patient with pulmonary aspergilloma, for whom selective bronchial intubation was required to facilitate surgery. ⋯ Intra-operatively, an attempt to lung exclusion was responsible for severe hypoxemia. The use of veno-venous ECMO allowed to improve oxygenation and lung resection was carried out successfully at the expense of major intra-operative bleeding.