Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · Nov 2009
[Pupillary dilatation monitoring to evaluate acute remifentanil tolerance in cardiac surgery].
Remifentanil is a powerful morphinic agonist often ordered for anaesthesia. The use of peroperative large doses of this opioid increases the risk to develop postoperative hyperalgesia and acute tolerance. But how early these effects can occur? Despite the fact that these effects could be masked during the preoperative time because of general anaesthesia, it seems they could occur precociously. In order to try to describe this time, this study evaluated the acute tolerance under general anaesthesia requiring large doses of remifentanil by using an effective peroperative monitoring of nociception: the continuous pupillary diameter monitoring. ⋯ The development of acute remifentanil tolerance could possibly explain these results. If evaluations with continuous pupillary diameter monitoring are still limited, these results suggest that the use of powerful opioids such as remifentanil should be associated with a N-methyl-D-aspartate (NMDA) receptor antagonist agent, including short time administrations.
-
Ann Fr Anesth Reanim · Nov 2009
Case Reports[A case of malignant hyperthermia arising five hours after the beginning of anaesthesia with sevoflurane and after five uneventful surgical procedures].
We report a case of per anaesthesia malignant hyperthermia (MH) arisen in a 16-year-old young man presenting antecedents of five anaesthesia with use of halogenated agents without complication and having started a typical crisis of MH after five hours of anaesthesia with sevoflurane and with recurrence of the crisis after 14 hours in ICU. The association in the same clinical case of these three peculiarities of the crisis of MH already described separately in the international literature allows us to insist on their importance, with the French-speaking anaesthesiologists community.
-
Ann Fr Anesth Reanim · Nov 2009
[National evaluation of knowledge and practice of cardiopulmonary resuscitation of children and infants in the field].
After the publication of new recommendations for cardiopulmonary resuscitation (2005 guidelines and 2006 French recommendations), we conducted a study amongst EMS teams concerning their approach with children and infants, nationwide. The objective was to measure the level of knowledge of guidelines and practice. ⋯ This study emphasizes the lack of knowledge, especially with regard to first aid. Formations will be developed.
-
Ann Fr Anesth Reanim · Oct 2009
Review[Interest of ultrasonographic guidance in paediatric regional anaesthesia].
The use of ultrasonographic guidance for regional anaesthesia has known recently a big interest in children in recent years. The linear ultrasound probes with a 25 mm active surface area (or probes with 38 mm active surface area in older children), with high sound frequencies in the range 8-14 MHz, allow a good compromise between excellent resolution for superficial structure and good penetration depths. In children, the easiest ultrasound guided blocks are axillar blocks, femoral blocks, fascia iliaca compartment blocks, ilio-inguinal blocks and para-umbilical blocks, caudal blocks. ⋯ Spinous process, ligament flavum, dura mater, conus medullaris and cerebrospinal fluid are identifiable, and give some information on spine, epidural space and the depth between epidural space and skin. At last, in caudal block, ultrasounds permit to evaluate the anatomy of caudal epidural space, especially the relation of the sacral hiatus to the dural sac and the search of occult spinal dysraphism. Benefit of this technique is the visualization of targeted nerves or spaces and the spread of injected local anaesthetic.
-
Ann Fr Anesth Reanim · Oct 2009
Review[Residual curarization and pharyngeal muscles: remain vigilant!].
The different concepts treating of "residual curarization" were presented according to two directions: the analysis of their contents--epidemiologic, clinical, instrumental--and the description of the pharyngeal striated muscles functions in these contexts. It appears that certain, too marked, "residual curarization" levels remain a well-evidenced factor increasing some morbidities in numerous clinical situations. All the methods of instrumental monitoring of the level of curarization--mecanography, electromyography, accelerometry--appeared useful to document the levels of "residual curarization" before patient's extubation or awakening. ⋯ Faced to such evidences, our medical speciality will, undoubtedly, have to acquire new knowledge to develop muscle relaxant management control processes eliminating the surmorbidities related to "residual curarization". These tests must be validated also to exclude morbidity-prone dysfunctions of the pharyngeal striated muscles. Considering this new paradigm would be a major safety evolution for our speciality.