Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Oct 2009
Case Reports[Barotrauma by Venturi effect during apnea testing for the determination of brain death. Should it change the terms of application of this test?].
The clinical diagnosis of brain death is based on three clinical criteria, one of them being the abolition of the spontaneous breathing shown by an apnoea testing [1,2]. During this manoeuvre, oxygen is administered by intratracheal way through oxygen supply tubing inserted into the endotracheal tube. ⋯ The authors report a new case of tension pneumothorax occurred during an apnoea testing despite the precautionary measures necessary to prevent such a catastrophic complication. In addition to the possible pathophysiologic explanation of the event advanced by the authors, it seems lawful to redefine the practical modalities of implementation of this test to avoid the loss of potential grafts.
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Ann Fr Anesth Reanim · Oct 2009
Case Reports[Prehospital cricothyrotomy for neoplasic upper airway obstruction: report of two cases].
We report two cases of emergency cricothyrotomies performed in patients with severe neoplasic upper airway obstruction. Airway control was rapidly performed using a wire guided technique of cricothyrotomy and allow adequate ventilation in the two cases. The indications and the realization conditions of this procedure in the emergency context are discussed.
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Ann Fr Anesth Reanim · Oct 2009
[Audit on preoperative cardiac evaluation before non-cardiac surgery: the importance of a pocket guide to improve the anaesthesist's adhesion to ACC/AHA guidelines].
The American College of Cardiology/American Heart Association (ACC/AHA) guidelines stratify perioperative cardiac risk according to clinical markers, functional capacity, and type of surgery. They help determining which patients are candidates for preoperative cardiac testing and optimizing the cost-effectiveness of the evaluation strategy. Auditing our preoperative anaesthetic screening practice revealed an exceedingly high rate of referrals to the cardiologists. A small pocket-size reminder was created in order to improve the adhesion of the anaesthesiologists to the recommendations of the ACC/AHA, and confirm or obviate the need for a formal preoperative specialized cardiology consultation. Another audit was conducted 1 year later in order to evaluate the effectiveness of this reminder. ⋯ The use of the pocket reminder concerning the ACC/AHA recommendations significantly reduced both the total number of cardiology referrals, and the number of unjustified referrals. The use of a pocket guide may help in reducing both the cost and the postponement of scheduled surgery.
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Ann Fr Anesth Reanim · Sep 2009
Review[Incidence and complications of post operative residual paralysis].
A 0.9 train-of-four ratio, measured at the thumb, is currently considered to reflect adequate recovery of neuromuscular block. Recent studies have documented that a train-of-four ratio <0.9 is associated with a decrease in chemoreceptor sensitivity to hypoxia and with a functional impairment of the pharyngeal muscles. These residual effects of neuromuscular blocking agents promote insufficient ventilatory response to hypoxia and regurgitation/aspiration. ⋯ Clinical tests such as the head lift test and visual or tactile evaluation of the response to peripheral nerve stimulation are no longer sufficient to exclude postoperative residual curarisation. Residual curarisation is still present at the time of extubation despite the use of subject if monitoring of neuromuscular function, clinical tests and/or reversal of neuromuscular blocking agents. In contrast, acceleromyographic monitoring provides a valuable tool to avoid residual curarisation and to reduce the related-side effects.