Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jul 2004
Review[Indications and limits of recombinant human erythropoietin in intensive care unit].
To analyze the data from the literature on erythropoietin and the future indications of recombinant human erythropoietin in intensive care unit (ICU) patients. ⋯ An anemia is often observed in patients hospitalized in ICU. This anemia may be due to many reasons. The management of anemia consists on the treatment of the underlying disease associated with the transfusion of red blood cells. Recent studies provided evidence of an association between transfusions and mortality in ICU patients. The anemia of ICU patients is compared to the anemia of chronic diseases, which is characterized by a blunted erythropoietin. A treatment with rHuEPO may be a future therapeutic of the anemia in such patients. A multicentric study shows the efficacy of recombinant erythropoietin therapy on a decrease in the use of red blood cell, and another clinical trial highlights a decrease of the proportion of ICU patients receiving red blood cell. Recombinant erythropoietin could be an alternative to transfusion in certain conditions and certain ICU patients. Further studies are needed to determine the consequences on mortality rate and to clarify the place of this therapy in ICU patients.
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Ann Fr Anesth Reanim · Jul 2004
[Target-controlled infusion of propofol for intraoperative sedation: determination of effect-site concentration and assessment of bispectral index].
To determine the effect-site concentration (Ce) of propofol, required to achieving adequate sedation. To assess the efficacy and safety of a target-controlled infusion system during monitored anaesthesia care and to evaluate the ability of bispectral index (BIS) to predict sedation level. Study design. - Prospective clinical study. ⋯ Target-controlled infusion of propofol provides easy and safe management of intraoperative sedation, allowing a fast and precise adjustment of the propofol concentration to the clinical response of the patient.
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To estimate qualitatively and quantitatively analgesic methods used after thoracotomy. ⋯ Intravenous patient-controlled analgesia and thoracic epidural analgesia are the most commonly analgesic techniques used after thoracotomy for pulmonary surgery. In the latter case, most centres choose to maintain these patients in high dependency units.
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Thyrotoxic hypokaliaemic paralysis is a rare cause of severe hypokalaemia. We report the case of a 34-year-old Asiatic man who presented in our emergency department an episode of quadriplegia due to low plasma potassium levels. ⋯ Intravenously potassium treatment allowed complete recovery from paralysis. Also, the patient received specific medical treatment with antithyroid drugs and propranolol.
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Ann Fr Anesth Reanim · Jul 2004
Case Reports[Prolonged motor blockade after combined epidural and general anaesthesia for oncologic gynaecological surgery].
The case described is a patient submitted to an oncologic gynaecological surgery under combined epidural and general anaesthesia. The anaesthesia involved complications, a prolonged motor blockade for up to 9 h whereas recommended doses had been respected. ⋯ The combined epidural and general anaesthesia was approved as an interesting technique for both per and postoperative analgesia, but also for postoperative rehabilitation. Nevertheless, for older patients, inhalational anaesthetics and opioids have to be decreased during the intervention, moreover local anaesthetics doses for epidural anaesthesia have to be reduced too, in order to control motor blockade duration.