Annales françaises d'anesthèsie et de rèanimation
-
Diagnosis of an acute obstructive dyspnea in children is very difficult, especially in the prehospital setting, because there are many possible causes. However, some of them may rapidly become life-threatening and therefore require a rapid prehospital management by a team staffed by a physician. The main causes of acute dyspnea in children usually include: obstructive dyspnea (acute laryngitis, foreign body aspiration, bronchiolotis, acute asthma), pulmonary infections and cardiac dyspnea, as well as dyspnea from other origins (cardiovascular collapse, hyperthermia, acidosis, intoxication, deshydratation). Following the assessment of the severity of the illness, the prehospital management should aimed at restoring an optimal oxygenation, before initiating a treatment adapted to the cause of the disease.
-
Ann Fr Anesth Reanim · Jul 2003
Review[Indications of vasopressin in the management of septic shock].
Vasopressin (antidiuretic hormone) is emerging as a potentially major advancement in the treatment of septic shock. Vasopressin is both a vasopressor and an antidiuretic hormone. It also has haemostatic, gastrointestinal, and thermoregulatory effects. This article reviews the physiology of vasopressin and all the relevant clinical literature on its use in the treatment of septic shock. ⋯ Vasopressin mediates vasoconstriction via V1-receptor activation on vascular smooth muscle. Septic shock causes first a transient early increase in blood vasopressin concentrations that decreases later to very low concentrations compared to other causes of hypotension. Vasopressin infusion of 0.01-0.04 U min(-1) in septic shock patients increases plasma vasopressin concentrations. This increase is associated with a lesser need for other vasopressors. Vasopressin has been shown to produce greater blood flow diversion from non-vital to vital organ beds than does adrenaline. A large randomized clinical trial should be performed to assess its place as a therapeutic agent of septic shock patient.
-
Ann Fr Anesth Reanim · Jul 2003
Review[Children with bronchial hyperreactivity: is it a problem for the anaesthetist?].
Identification of the patients with hyperreactivity and understanding the underlying physiopathological mechanisms are crucial to prevent the occurrence of peri-operative respiratory adverse events in these patients. Preoperative assessment and preparation is based on the maintenance of any long-term anti-inflammatory treatment, especially the inhaled steroids. Furthermore, premedication is based on the administration of a beta2-agonist, antihistamine and anticholinergic drugs that are able to prevent against lung constriction induced by either vagal stimuli or endogenous mediators such as histamine. Anaesthesia management is primarily based on the use of inhalation agents and especially, isoflurane, which has both a protective and a potent bronchodilation effect.
-
Ann Fr Anesth Reanim · Jul 2003
Review[Difficult tracheal intubation in paediatric: myth or reality?].
Difficult tracheal intubation is a rare event according to the airway feature in child. This situation is mostly predictable, occurring in identified malformations and in specific diseases. Pre-operative clinical evaluation must detect facial abnormalities (lip or palate cleft, microtia, facial asymmetry.), micro or retrognathia, limited mouth opening, reduced distance between thyroid cartilage and chin, macroglossia and external ear malformations. According to this clinical evaluation, a strategy for managing difficult tracheal intubation is planned.
-
Ann Fr Anesth Reanim · Jul 2003
Comparative Study Clinical Trial[Comparison of a nurse-directed weight-based heparin nomogram with standard empirical doctor-based heparin dosage].
To assess efficiency of a nurse directed weight-based nomogram (NWN) for heparin dosage without training. ⋯ NWN protocol was easy to use without previous training. NWN was associated with the best anticoagulation state although its superiority was less evident than expected.