Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · May 2005
Randomized Controlled Trial Clinical Trial[Remifentanil-midazolam compared to sufentanil-midazolam for ICU long-term sedation].
Remifentanil has a unique metabolic pathway that holds potential benefits for long-term sedation. We compared remifentanil-midazolam to sufentanil-midazolam in 41 critically ill adults requiring mechanical ventilation. ⋯ Sufentanil infusion needed to be reduced over time and prolonged the weaning time when compared to remifentanil.
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Ann Fr Anesth Reanim · May 2005
Review[Anaesthetic management of the patient with acute intracranial hypertension].
Transcranial Doppler and, if possible, measurement of intracranial pressure (ICP) allow preoperative diagnosis of acute intracranial hypertension (ICH) after brain trauma. The main goal of the anaesthesiologist is to prevent the occurrence of secondary brain injuries and to avoid cerebral ischaemia. Treatment of high ICP is mainly achieved with osmotherapy. ⋯ In case of ICH, halogenated and nitrous oxide should be avoided. Until the dura is open, mean arterial pressure should be maintained around 90 mmHg (or cerebral perfusion pressure around 70 mmHg). If a long-lasting (several hours) extracranial surgery is necessary, ICP should be monitored and treatment of ICH should have been instituted before.
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Ann Fr Anesth Reanim · May 2005
Review[Pulmonary arterial hypertension in intensive care unit and operating room].
To review the perioperative anaesthetic management of pulmonary arterial hypertension. ⋯ Pulmonary arterial hypertension is classically divided in primary and secondary. Primary pulmonary hypertension (familial and sporadic) is relatively severe and rare. Muscularization of the terminal portion of the pulmonary vascular arterial tree, caused by smooth muscle cell hyperplasia is the first change. Pulmonary arterial hypertension linked with disorders of the respiratory system and hypoxemia or pulmonary venous hypertension including mitral valve disease and chronic left ventricular dysfunction are often associated with high morbidity and mortality. The main consequence of pulmonary hypertension development is the occurrence of right-sided circulatory failure. A better understanding of disease pathophysiology will contribute to the development of new therapies increasing then the prognosis of these patients. The management of primary pulmonary hypertension or secondary pulmonary arterial hypertension is a challenge for the anaesthesiologist because the risk of right ventricular failure is markedly increased.
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Ann Fr Anesth Reanim · May 2005
Case Reports[Successful extracorporeal resuscitation of a probable perioperative anaphylactic shock due to atracurium].
We report the case of a 55-year-old woman ASA 2 scheduled for a cholecystectomy, who presented 25 minutes after the induction, a circulatory arrest probably due to a cardiac anaphylaxis attributed to atracurium. After 60 minutes of futile resuscitation without any spontaneous cardiac rhythm a percutaneous cardiopulmonary bypass (CPB) was initiated. Twenty minutes later and after three external electric shocks electric cardiac activity returned normal. ⋯ She was discharged home without any neurologic or cardiac sequellae. Biological assessment done during the circulatory arrest and cutaneous tests performed ten weeks later confirmed an isolated allergy to atracurium. CPB is the most efficient support in case of reversible cardiac arrest but unfortunately the less accessible outside from cardiac surgery unit.
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Ann Fr Anesth Reanim · May 2005
Case Reports[Allergic reaction to patent blue dye for sentinel lymph node detection during uterus oncological surgery].
Patent blue V dye is used to localize the sentinel lymph node during breast and uterine oncological surgery. The case of a grade III anaphylactic reaction related to patent blue dye paracervical injection is described in a 34-year-old woman scheduled for hysterectomy. This complication needs to be rapidly diagnosed to apply adapted supportive treatment.