Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Nov 2003
[Factors associated with laparoscopic approach for cholecystectomy, appendicectomy and inguinal herniorraphy in France].
To determine on a national level the factors associated with the use of laparoscopy for digestive surgery. ⋯ These data obtained from a large national survey confirmed the higher frequency of laparoscopy in middle aged patients, female (except for inguinal herniorraphy), without important comorbidity, in private hospitals. Laparoscopy was associated with prolonged procedures and with a change in the anaesthetic technique for appendicectomy and inguinal herniorraphy: tracheal intubation was almost constantly used. Whatever the procedure, closed circuit anaesthesia was more frequently used when surgery was performed under laparoscopy, reflecting newer equipment of the hospital, private or public.
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Ann Fr Anesth Reanim · Nov 2003
Case Reports[Fat embolism after total hip prosthesis replacement preserving the femoral stem].
Fat embolism is a known complication of traumatology, especially in long bone fractures. It may also occur in liposuction and articular surgery (0.1%). Fat embolic events are most often clinically insignificant and difficult to recognize since clinical manifestations are varied and there is no routine laboratory or radiographic diagnosis. ⋯ We report the case of a 33-year-old woman who developed acute respiratory distress 10 days after hip arthroplasty. Several aetiologies such as fibrinocruoric pulmonary embolism, pulmonary aspiration and bacterial pneumonia were discussed. Fat embolism was diagnosed, based on suggestive clinical manifestations, radiographic and laboratory findings, although fat embolism after hip arthroplasty without intramedullary pressurization is infrequent.
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Ann Fr Anesth Reanim · Nov 2003
Case Reports[Glanzmann's thrombasthenia and pregnancy: a case and review of the literature].
Glanzmann's thrombasthenia is a thrombopathy due to a qualitative or quantitative abnormality of glycoproteins GP IIb-IIIa. Pregnancy is uncommon and dangerous. Delivery often results in important haemorrhage, which is treated with HLA compatible platelet and packed red blood cells transfusions. ⋯ Caesarean section has no proven advantage. We report a case with caesarean, which was successfully managed by platelet transfusion over seven peripartum days, with no adverse event. Literature is discussed.
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Ann Fr Anesth Reanim · Nov 2003
Case Reports[Value of a long duration temporary caval filter in critical thrombo-embolic situations].
In the event of proximal venous thrombosis with a risk of pulmonary embolism, contraindications to or complications of anticoagulant treatment are not uncommon in surgical or intensive care units. These are worrying but temporary situations and represent a classic indication for partial interruption of the inferior vena cava, for which permanent caval filters are not usually suitable. Temporary filters are an attractive option in this context, as long as they are safe and stable, can be left in place long enough to permit normalization of the thrombosis and anticoagulation problems and can then be removed in all circumstances, whether or not they have trapped a thrombus while in place. ⋯ The filters were removed without any difficulty after 4 and 6 weeks. We did not observe any complications related to infection or migration. Monitoring is recommended throughout the implantation period, in order to identify any clots trapped in the filter and to monitor their lysis or non-emboligenic fibrous structure, authorising removal of the filter.
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Ann Fr Anesth Reanim · Nov 2003
Case Reports[A puzzling circulatory failure after total hip replacement].
The diagnosis of acute circulatory failure in the postoperative course of hip replacement must concentrate on frequent complications, but rare complications requiring specific treatment must also be diagnosed. We report on the occurrence of a case of acute adrenal insufficiency subsequent to enoxaparin-induced type II thrombocytopenia. A delay was necessary to establish a correct diagnosis for two reasons: (1) an unusual clinical presentation and (2) an underevaluation of the medical risk during the preoperative visit. The evolution was nevertheless favorable after prescription of steroids that had to be prescribed chronically.