Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1994
[Subarachnoid hemorrhage: cerebral damage, fluid balance, intracranial pressure and pressure-volume relation].
Changes in osmolality and electrolyte concentrations are observed frequently in patients with subarachnoid haemorrhage (SAH). Intracranial pressure (ICP) plays a determinant role in the development of secondary brain damage following SAH and may be caused by haemorrhage itself, oedema formation and disturbance of cerebrospinal fluid (CSF) dynamics. The relationships among these factors are the aim of this investigation. ⋯ Mannitol (1 g.kg-1.d-1 in four doses) was infused if the sodium plasma concentration was not corrected by the former treatment or if ICP exceeded 20 mmHg. Treatment was aimed at preserving cerebral perfusion by providing adequate pre-load, low viscosity (Ht 30%) and sustained arterial pressure. Correction of hyponatraemia was therefore achieved more through hypertonic fluids infusion than by using diuretics.
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Ann Fr Anesth Reanim · Jan 1994
[The injured brain. Basis for hydroelectrolytic and hemodynamic resuscitation].
Brain insult in neurosurgical patients is highly dependent on hydroelectrolytic and haemodynamic disturbances. The magnitude of their effect is related to blood-brain barrier integrity and characteristics of cerebral perfusion pressure. Moderate disturbances in ionic balance or CPP may lead to interstitial oedema or worsening of cerebral ischaemia. ⋯ Normovolaemia and the choice of an appropriate agent for plasma volume expansion are essential. Correction of hypovolaemia is best obtained with (except for packed red cells when necessary) normal saline, 4% human albumin or hydroxyethylstarch. The benefit of utilizing hypertonic electolytic or HES solutions in neurosurgical patients has still to be assessed.
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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)
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Ann Fr Anesth Reanim · Jan 1994
[Pollution and retro-pollution by the distribution system of medical gases].
The anaesthetic machine, the recovery room or the ICU ventilator as well as any other simple oxygenation device can be accidentally supplied with a "wrong" gas, or a mixture of "wrong" and "true" gases, or a gas containing chemical impurities, as a result of one of the following causes: a) the source of the medical gas pipeline supply contains a "wrong" gas or impurities; b) the gas pipeline is polluted by a "wrong" gas or solvents, introduced during the installation or maintenance of the pipeline; c) the pipeline is polluted by a wrong gas at a point of inter-connection or cross-connection of two pipelines; d) supply of a "wrong" gas through wrong quick couplers connected to the pipeline; e) back flow of a gas in another pipeline supply through a defective gas mixer, which is today the most common cause of pipeline contamination or retropollution. It occurs with some types of mixers in case of absence or malfunction of non-return valves, associated with a pressure difference between the two gas lines. The means of prevention, recognition and emergency treatment of these events include: a) systematic removal of mixers and flowmeter-mixers from supplies when not in use; b) periodical checking of these devices for an accidental communication between the gases to be mixed; c) systematic use of an oxygen analyser for a continuous measurement of FIO2, especially when the machine is connected to the N2O pipeline supply; d) the presence of a reserve cylinder of oxygen connected to every anaesthetic machine.
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Ann Fr Anesth Reanim · Jan 1994
[Physiopathological consequences of blood-brain barrier involvement].
Most of the adverse effects of cerebral injury derive result from the formation of cerebral oedema, which causes brain swelling, brain shift and intracranial hypertension. The mechanisms of cerebral oedema are specific of the type of cerebral injury and the effectiveness of treatments such as corticosteroids depend on the type of cerebral oedema. ⋯ Signs of upward transtentorial herniation are less specific. Early detection of these syndromes is essential if therapeutic measures to reduce intracranial pressure are to be taken before secondary neurological injury occurs.