Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Apr 2014
Review[Blood transfusion via the cardiopulmonary bypass circuit: The anesthesiologist point of view.]
Cardiac surgery frequently requires blood transfusion. The use of transfusion should be restricted due to side effects. Blood transfusion via the cardiopulmonary bypass (CPB) circuit is easy and allows a fast transfusion. ⋯ Platelet transfusion during bypass is illogical because of the destruction of platelets during CPB and must be avoided. Fresh frozen plasma transfusion during CPB is seldom indicated but is possible. It could reverse heparin resistance.
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Ann Fr Anesth Reanim · Apr 2014
Review[Interaction between hypnotic agents and the hypothalamic-pituitary-adrenocorticotropic axis during surgery.]
During stress, the relationship between the central nervous system and the immune system is essential to maintain homeostasis. The main neuroendocrine system involved in this interaction is the hypothalamic-pituitary-adrenal axis (HPA), which via the synthesis of glucocorticoids will modulate the intensity of the inflammatory response. ⋯ Nevertheless, with the large literature on this subject, etomidate seems to be the most deleterious hypnotic agent on the HPA axis function. Its use should be limited when HPA axis is already altered.
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Ann Fr Anesth Reanim · Apr 2014
Review[Contribution of ultrasonography for the preoperative assessment of the gastric contents.]
The assessment of the risk of pulmonary aspiration of gastric contents may be difficult in the preoperative period, apart from typical circumstances. The development of ultrasonography in anesthesia and critical care has led to consider ultrasonic imaging of gastric contents for preoperative risk assessment of "full" stomach in clinical practice. Ultrasonography of the body of the stomach allows direct visualization of the gastric contents. ⋯ Qualitative assessment of the gastric antrum allows easily diagnosis of a "full" stomach. The measurement of antral area may allow a more accurate estimate of the presence or absence of gastric contents at risk of lung injury in the event of regurgitation and aspiration (gastric volume >0.8 ml/kg and/or with solid particles), defining the "risk" stomach. The use of antral ultrasonography may help the anesthesiologist to assess the risk of pulmonary aspiration according to clinical history of the patient, in order to choose an appropriate strategy minimizing the occurrence of this complication.
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Extracorporeal circulation (ECC) has to ensure homeostasis of the patient and to minimize pathophysiological disorders inherent in the technique. However, we cannot dissociate it from the surgery and anesthesia knowing that the discipline involves a close partnership with these stakeholders. The purpose of this publication is to review the essential elements that at present can contribute to the quality of the CEC and suggest improvements and developments to be implemented in this area.
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Ann Fr Anesth Reanim · Apr 2014
Case Reports[Catheter for continuous interpectoral block and postoperative pain relief in breast surgery.]
We describe the case of four patients who had undergone breast surgery. The post-operative analgesia consisted in levobupivacaine administered through a catheter placed between the pectoralis minor and the pectoralis major using ultrasound guided technique. The quality of the analgesia was excellent quality. No side-effects were encountered.