Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · Apr 2009
[National survey on out-of-hospital difficult intubation management].
Difficult intubation rate is higher in the prehospital setting than in the operating room. Goal of this survey was to assess compliance of the French prehospital mobile emergency unit (Smur) to the recent French guidelines for the difficult airway management. ⋯ This survey shows that the French guidelines for the difficult airway management are only partially followed by the French Smur. An effort should be made for a larger diffusion of these guidelines towards the emergency physicians working in the Smur.
-
Ann Fr Anesth Reanim · Apr 2009
[Results of a national survey about the use of sedation scales in emergency prehospital medicine].
The primary goal of sedation in emergency prehospital care is to guarantee the security of the mechanically ventilated patients by optimising their adaptation to the respirator. If the French prehospital guidelines are well codified, their applicability in routine clinical practice seem to be rather empirical. The aim of this national survey was to evaluate the use of the clinical sedation scales by the prehospital physicians. ⋯ The principal reasons given by the physicians for not using the sedation scales were their ignorance in 57% of the cases (n=200) and the systematic choice of a deep sedation in 42% of the cases (n=147). For 18% of them (n=62), the use of sedation scores was considered too complicated. The final results show that the utilisation ratio of the sedation scores is very low in emergency prehospital medicine and suggest that an effort toward improving the use of sedation in prehospital emergency medicine is necessary.
-
Ann Fr Anesth Reanim · Apr 2009
[Acute respiratory distress subordinate to a morphine overdose during a frail elderly patient controlled analgesia].
We describe a case-report of an 85-year-male patient with a patient-controlled analgesia (PCA) after a total hip arthroplasty. Four hours after surgery, acute respiratory distress secondary to a morphine overdose occurred, requiring an antagonisation with naloxone. ⋯ Too important morphine's doses managed in comparison with the patient's age and his renal failure could explain this morphine's accumulation and the respiratory distress. This observation reminds us the obligation to determine the optimal posology in accordance with the rate of glomerular filtration estimated by Cockcroft and Gault formula for patients using a PCA.
-
Ann Fr Anesth Reanim · Apr 2009
[Incidence and evolution of thrombotic images within the internal jugular vein following Swan-Ganz catheter insertion in cardiac surgery].
Insertion of Swan-Ganz catheter for a few days may be necessary in cardiac surgery. This study was aimed at determining the incidence and the evolution of thrombotic images within the internal jugular vein as well as assessing their association with the presence of a prolonged fever at postoperative day 7 in the lack of any documented infection. ⋯ Thrombotic images in the internal jugular vein after catheterization are frequent and disappear at day 90. The limited sample size of this study does not provide strong evidence of the role of jugular thrombi in the prolongation of fever after cardiac surgery.
-
Ann Fr Anesth Reanim · Apr 2009
[Impact of a quality assurance program on the use of neuromuscular monitoring and reversal of muscle relaxants].
As part of a quality assurance in the anaesthesia department, this study was designed to enhance the rate of neuromuscular blockade monitoring for patients receiving muscle relaxant during anaesthesia. ⋯ This study shows that as part of a quality assurance program systematic quantitative monitoring of neuromuscular blockade can be significantly increased.