Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1994
[Prehospital air ambulance and systemic secondary cerebral damage in severe craniocerebral injuries].
Advanced supportive therapy at the site of the accident, associated with direct transfer to a trauma centre increases survival and reduces morbidity rates. Patients with severe head injury, especially those with multiple injuries, often arrive in the emergency department with potentially causes of serious secondary systemic insults to the already injured brain, such as acute anemia (Hematocrit < or = 30%), hypotension (systolic arterial pressure (Pasys) < or = 95 mmHg, 12.7 kPa), hypercapnia (Paco2 > or = 45 mmHg, 6 kPa) and/or hypoxemia (Pao2 < or = 65 mmHg, 8.7 kPa). The incidence of such insults and their impact on mortality were studied in a group of 51 consecutive adults suffering from non penetrating severe head injury (Glasgow score < or = 8, mean age 31 +/- 17 yrs) rescued by a medicalized helicopter. ⋯ Nineteen patients (Group I) were admitted without secondary systemic insults to the brain, 13 with isolated head injury, and 6 with multiple injuries, with a low Glasgow Outcome Score (GOS 1-3) of 42% at 3 months. In 32 patients (Group II), despite advanced supportive measures at the scene of the accident and during transportation, one or more secondary systemic insults to the brain were detected upon arrival at the emergency room, one with isolated head injury, 31 with multiple injuries, with a bad GOS of 72% at 3 months. We conclude that: 1) advanced trauma life support prevents from secondary systemic insults in the great majority of isolated severe head injured patients. 2) secondary systemic insults to the already injured brain are frequent in patients with multiple injuries and are difficult to avoid despite rapid aeromedical trauma care, 3) secondary systemic insults to the brain have a catastrophic impact on the outcome of severely head injured patients.
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Ann Fr Anesth Reanim · Jan 1994
[Proposal for a new multifactor screening score of difficult intubation in ORL and stomatognathic surgery: preliminary study].
This study assessed prospectively in 295 ENT adult patients the predictive value of clinical indicators for difficult intubation and of a new multifactorial score, established by the allocation of points (0, 3, 5 or 7) depending on the degree of presence of seven factors: pathology known to be associated with a difficult intubation, clinical signs of airways' pathology, inter-incisors gap and mandible's luxation, submental mandibular-thyroid distance, normal or short and broad neck, head and neck movements, and Mallampati's test. The incidence of difficult laryngoscopy was 14% and the use of particular techniques for tube insertion was required in 8% of patients. The presence of malformation or pathology often associated with a difficult intubation and the presence of functional signs of airways' pathology predict the difficulties of laryngoscopy and tracheal intubation with a good sensitivity and specificity. The analysis of the "Receiver Operating Characteristic curves" showed that a score higher or equal to 11 allows the prediction of difficult intubations with a sensitivity of 96% and a specificity of 90%.
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An unknown myopathy can be revealed by the administration of an anaesthetic agent. The symptoms are those of malignant hyperpyrexia (MH). The MH phenotype can be detected by means of contracture tests in vitro. ⋯ Myopathy is difficult to diagnose, either because the patient undergoes surgery before being symptomatic or because he is only a carrier of MH. In case of an abnormal reaction following the administration of recognized triggering agents or the occurrence of MH, the procedure should be discontinued. In case of absolute necessity, the procedure may be continued but with non-triggering agents only.
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1. Propofol as an induction agent At a dose of 2 to 2.5 mg.kg-1, as a bolus injection over 30 to 60 seconds, for gynaecological procedures of short duration (abortion, D and C), propofol can be characterized as follows when compared with other induction agents: ADVANTAGES OVER METHOHEXITONE AND ETOMIDATE: decreased incidence of hiccups and abnormal movements, increased quality of induction, similar to that obtained with thiopentone, decreased postoperative nausea and vomiting. ADVANTAGES OVER THIOPENTONE: shorter recovery period, more rapid recovery of consciousness and orientation. ⋯ COMPARED WITH DESFLURANE: shorter induction time than desflurane, less respiratory problems at induction, similar recovery period, same incidence of nausea and vomiting. The administration of propofol for maintenance of anaesthesia has the main advantage of reducing the incidence of postoperative nausea and vomiting when compared to conventional halogenated anaesthetics. Respective costs of the various techniques, using propofol or the new halogenated anaesthetics, may be a criterion for choice in the future.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1994
[Value of transcranial Doppler ultrasonography in the management of severe head injuries].
Transcranial doppler ultrasonography (TCD) is a non invasive technique for the assessment of cerebral blood flow (CBF). The aim of this prospective study was to evaluate the benefit of TCD for the monitoring of major head trauma patients. Therefore 10 of such patients, aged 17 to 37 years, had a TCD at admission and subsequently at least twice a day. ⋯ In the opposite there was no statistically significant relation between ICP and MV (r = 0.18) nor between CPP and MV (r = 0.23). However, a MV over 100 cm.s-1 was regularly associated with a ICP over 60 mmHg. The close correlation between RI, PI and ICP allows to use RI or PI to estimate ICP.(ABSTRACT TRUNCATED AT 250 WORDS)