Annales françaises d'anesthèsie et de rèanimation
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Single lung transplantation was performed in several steps: laparotomy to prepare an omentopexy, followed by pneumonectomy and implantation of a pulmonary graft, both by postero-lateral thoracotomy. The patients suffered from lymphangiomyomatosis (1), panacinar emphysema (2) and idiopathic pulmonary fibrosis (1). Immunosuppressive treatment was started before surgery. ⋯ Except in one patient with preoperative pulmonary hypertension, the increase in pulmonary vascular resistances remained moderate after clamping of the pulmonary artery. Sufficient oxygen delivery, with more than 50% venous oxygen saturation, was maintained at this time by the infusion of dopamine and dobutamine. Two other specific problems were encountered in the emphysematous patients: severe hypotension following the start of artificial ventilation and after placing the patient in lateral position; thoracic asymetry with overdistension of the emphysematous lung, and mediastinal shift.(ABSTRACT TRUNCATED AT 250 WORDS)
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A 37-year-old chronic alcoholic female was admitted with epigastric pain, complete anorexia, vomiting and diarrhoea. She was dehydrated, and had polypnoea. Laboratory investigations revealed severe metabolic acidosis (pH 7.14) with a major anion gap (37.4 mmol.l-1), and ketone bodies in blood and urine. ⋯ The ketone bodies disappeared on the following day. During the acute illness, were found high blood levels of glucagon and low levels of insulin. The diagnosis of alcoholic ketoacidosis, the pathogenesis of which remains unknown, is discussed.
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Ann Fr Anesth Reanim · Jan 1991
Review Case Reports[Paraplegia after epidural anesthesia for vascular surgery].
A case is reported of a 67-year-old man who underwent major vascular surgery (iliobifemoral bypass with unilateral sympathectomy) under epidural anaesthesia and resulting in permanent neurological damage. Lumbar epidural anaesthesia was carried out using a mixture of bupivacaine, lidocaine with adrenaline, and alfentanil. The surgical course was uneventful, except for a 30 minute period of relative hypotension (90 vs. 110 mmHg preoperatively). ⋯ Unfortunately, the patient died on the 16th day after an episode of severe chest pain. The probable cause of the neurological damage was an anterior spinal infarct. It was not possible to determine the degree of responsibility of the peripheral vascular disease, the anaesthetic or the surgery.
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Ann Fr Anesth Reanim · Jan 1991
Review Case Reports[Iterative epidural anesthesia after accidental dural puncture. Analysis with epidurography].
The case is reported of a 63-year-old man who was to undergo a gastrectomy for stomach carcinoma. An epidural catheter for postoperative analgesia (epidural morphine) was inserted into the T10-11 space prior to induction of general anaesthesia. Unfortunately, cerebrospinal fluid (CSF) surged back through the Tuohy needle, which was immediately withdrawn. ⋯ Another epidurography, 24 hours later, showed the same picture. The analgesic technique was therefore altered to subcutaneous buprenorphine. Careful management of this situation, in order to prevent total spinal anaesthesia, is discussed in the light of the literature.
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Ann Fr Anesth Reanim · Jan 1991
Review[Incidence and etiology of cardiac arrest occurring during the peroperative period and in the recovery room. Apropos of 102,468 anesthesia cases].
This study reviewed retrospectively 186 cardiac arrests (CA) observed in a series of 102,468 anaesthetics, carried out in a University Hospital between 1983 and 1987. Among them 29 were partly or totally related to anaesthesia and 11 had a fatal outcome. On the other hand, 157 CA (144 deaths) were not related to anaesthesia. ⋯ Outcome was independent of ASA class, but was related to aetiology: hypoxaemia (5 out of 6 recovered) and overdose with or without hypovolaemia (7 out of 8 recovered) had favourable outcomes. Furthermore, outcome of CA due to regional anaesthesia was satisfactory (7/8 recovered) (p = 0.08, NS). Such an analysis of the causes of anaesthetic disasters and their rate of occurrence can lead to more effective prevention.