Annales françaises d'anesthèsie et de rèanimation
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Sugammadex, a cyclodextrin, is a novel agent designed to encapsulate selectively steroidal neuromuscular blocking agents such as rocuronium and vecuronium as well. One molecule of sugammadex is able to encapsulate only one molecule of muscle relaxant. ⋯ However, in order to preserve this efficacy, the dose of sugammadex needs to be adjusted to the degree of muscle paralysis at the time of reversal : 2 mg/kg after obtaining 2 responses at the adductor pollicis muscle after a train of four stimulation, 4 mg/kg with a post-tetanic count between 1 and 3 responses, and 12 to 16 mg/kg in case of rescue reversal (3 to 15 minutes after 0.6 to 1.2 mg/kg rocuronium). Even if the original property of sugammadex lets us think that per-operative neuromuscular transmission monitoring would not be furthermore useful, the assessment of the exact degree of muscle paralysis before reversal is mandatory for choosing the right dose of sugammadex.
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Ann Fr Anesth Reanim · Sep 2009
Review[In and out-of-hospital cardiac arrest and echography: a review].
Cardiac arrest is a frequent emergency for doctors and resuscitation teams. Patients displaying asystole or pulseless electrical activity are non-shockable. They have extremely poor outcomes. ⋯ A synthesis algorithm dedicated to care of CA, including transthoracic echocardiography for search of curable causes, is proposed. This algorithm fulfills the ILCOR, ERC and AHA recommendations. The echocardiography should be part of ACLS, nevertheless clinical studies are needed to assess its impact on morbimortality.
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Ann Fr Anesth Reanim · Sep 2009
Review Case Reports[Anaphylaxis in terminal pregnancy: two case studies and review of the literature].
Anaphylaxis is a relative uncommon event in pregnancy that can have serious implications for both mother and foetus. Two cases of grade 3 anaphylactic shock occurring at the end of the third trimester of pregnancy are reported; the causal agents were respectively amoxicillin and suxamethonium. ⋯ A review of the literature confirms the good maternal outcome; neurologic damage in the newborn is frequent. On the basis of physiologic findings degranulation of placental mast cell is evoked in the genesis of birth asphyxia.
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Plastic surgery is more and more developing. Facial blocks are adapted to surgical procedures performed in this setting. ⋯ After a reminding of facial nerve anatomy, facial and cervical blocks are described with their indications. Guidelines for performance and monitoring are also indicated.