Annales françaises d'anesthèsie et de rèanimation
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The purpose of this review is to draw up a statement on current knowledge available on the more recent hydroxyethyl starch (HES). ⋯ The first HES was made available in the United States in 1970. The development of a new generation of HES restarted the discussion on clinical interest and the limits in the use of these macromolecules. This interest is also strengthened today by the recent data attached to plasma substitution in intensive care or perioperative resuscitation. The interest for crystalloids and colloids is still widely debated, and among the latter, the relative interest of the HES last generation compared to older ones. Recent HES development is in line with a decrease molecular weight, change rate molar substitution and to amend the glucose to hydroxyethyl report. The ultimate goal is to reduce the side effects of these molecules preventing their use. Side effects are dominated by haemostasis and renal dysfunction. The latest developments are the so-called HES "balanced" solutions.
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Ann Fr Anesth Reanim · Jul 2010
Continuous non-invasive arterial pressure measurement: evaluation of CNAP device during vascular surgery.
Standard non-invasive blood pressure (BP) monitoring is an intermittent, discontinuous procedure. Beat-to-beat BP monitoring requires invasive measurement via an arterial catheter and may be associated with serious complications. The Infinity CNAP SmartPod (Dräger Medical AG & Co. KG, Lübeck, Germany) has recently been proposed for non-invasive continuous beat-to-beat BP measurements. The present study was designed to compare BP obtained with the CNAP and with an invasive method in the operating room. ⋯ Despite low accuracy for SAP and DAP measurements, CNAP system seems more accurate for MAP measurement in patients undergoing vascular surgery.
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Ann Fr Anesth Reanim · Jul 2010
Case ReportsUnrecognized dural puncture during epidural analgesia in obstetrics later confirmed by brain imaging.
Accidental dural puncture is a well-recognized complication of obstetric epidurals that can potentially incapacitate the patient. Unrecognized dural puncture during epidural administration can lead to a delay in therapeutic intervention resulting in potentially serious complications. ⋯ Magnetic resonance neuroimaging was performed to confirm the diagnosis, and direct clinical management. We also discuss the role of neuroimaging in the investigation of postpartum headache.
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Ann Fr Anesth Reanim · Jul 2010
Case ReportsUltra-long duration of a peripheral nerve block: a possible consequence of intraneural (subepineural) local anaesthetic injection.
A 29-year-old patient was scheduled for bilateral halllux valgus surgery and a lateral sciatic popliteal nerve block was performed on each side using ropivacaine and lidocaine using nerve stimulation. Although the sensory and motor block had usual duration on the left side, the block lasted more than 48 hours on the right side with both sensory and motor impairment. ⋯ We postulate that this case of extremely long duration of a peripheral nerve block can be ascribed to subepineural trapping of the local anaesthetic. Part of the variability in the duration of the sensory and motor block after peripheral nerve blocks might be explained by the variable amount of drug injected intraneurally.
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Ann Fr Anesth Reanim · Jul 2010
[Activity and the available human resources working in 66 French Southern intensive care units].
The aim of the study was to determine the activity and the available human resources working in 66 intensive care unit (ICU). ⋯ In this study, more than 75% patients had at least two organ dysfunctions within their ICU stay and 88% required a billing procedure and had an admission SAPS II greater or equal to 15. Nevertheless, the staff resource remained below the 2002 decree in 27% ICUs.