Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Feb 2001
Review[Diagnosis of status epilepticus by continuous EEG monitoring in a neurointensive care unit].
Continuous EEG monitoring use has documented a surprisingly high incidence of convulsive and non-convulsive status epilepticus in patients with acute brain injuries. Seizures are the cause of secondary insult. ⋯ To minimise these problems, we suggest the following: train the bedside nurse, make a library of the artefacts, have the EEG technologist check electrodes and establish low impedance, have the electroencephalographer examine the EEG, correlate the activity and movements of the patient. In the diagnosis and the management of convulsive and non-convulsive status epilepticus, the value of continuous EEG monitoring appears to be established.
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Most anaesthetics and analgesics have both pro- and anticonvulsant activity. The data in the literature should be analysed with respect to the patient population, the recording of epileptic activity and the method of EEG analysis. Among inhaled anaesthetics, isoflurane has strong anticonvulsant properties. ⋯ Among narcotics, fentanyl and alfentanil may induce clinical or electroencephalographic seizures. Considering the large number of patients treated with these agents without any neurological adverse effect, the clinical relevance of these data is unclear. Neuromuscular blocking agents do not possess pro- or anticonvulsant properties.
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We describe a case of a parturient scheduled for Caesarean section in whom diplopia from abducens (sixth cranial) nerve palsy followed spinal anaesthesia performed with a 25 gauge Whitacre needle. After delivery, the patient experienced neckache, diplopia and postural headache successively. ⋯ Despite two consecutive epidural blood patches, no improvement of diplopia was observed. In 8 months, the nerve palsy had completely resolved.
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Ann Fr Anesth Reanim · Jan 2001
Case Reports[Acute hemolysis following perioperative blood salvage in chldren operated for the surgical correction of craniosynostosis].
We report the case of a 6-month-old child, who suffered from acute haemolysis following transfusion of salvaged blood. This complication, of favourable outcome, was related to the accidental aspiration of benzalkonium chloride into the cell saver. This case emphasizes that any adjunction of antiseptic solution is contraindicated during blood saving. The use of a cell saver must be associated with written protocols, describing clearly the contraindications, precautions of use, and the different steps of use of this method of autologous blood transfusion.
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Ann Fr Anesth Reanim · Jan 2001
[Measurement of carbon monoxide in expired breath in prehospital management of carbon monoxide intoxication].
Carbon monoxide detectors are currently used by the French prehospital medical teams. These detectors can also be used to measure expired breath carbon monoxide concentration. The interest of this measurement has never been studied. ⋯ Measurement of expired carbon monoxide concentration, easy and quick to perform is correlated with clinical severity in carbon monoxide poisoning.