Annales françaises d'anesthèsie et de rèanimation
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A seventeen year old boy sustained pelvic, femoral shaft and malleolar fractures in a road traffic accident. Six hours after admission, the patient became comatose (Glasgow coma score = 7); the coma worsened such that, 24 h later, the coma score was 4. Petechiae were present on the conjunctiva and anterior chest wall. ⋯ Ten months after the accident, magnetic resonance imaging showed a small ventricular dilatation due to subcortical atrophy. Residual ischaemic lesions and demyelination could be seen in the right centrum ovale and temporal lobe. The cerebral lesions contrast with the reversibility of the clinical state.
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Ann Fr Anesth Reanim · Jan 1988
Case Reports[Oral dantrolene in a parturient with myotonic dystrophy and susceptibility to malignant hyperthermia].
A 33 year old woman, with myotonia atrophica and a known susceptibility to malignant hyperthermia, presented during her second pregnancy with multiple episodes of hyperthermia. They were associated with a rapid rise in the serum creatine phosphokinase (CPK) level, and not with infection or a myotonic crisis. Because of the obstetric conditions, caesarean section was planned. ⋯ The occurrence of episodes of high fever during pregnancy linked to MHS and myotonia atrophica is discussed, as well as the anaesthetic management of such a patient. Side-effects of dantrolene for the mother or the foetus are also considered, especially as foetal levels of this drug would seem not to reach therapeutic levels. It would appear interesting to measure maternal dantrolene blood levels, especially if high doses are administered, to avoid reaching therapeutic levels in the foetus.
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Ann Fr Anesth Reanim · Jan 1988
[Registration of peranesthetic cases of malignant hyperthermia in France. An update].
Sixty-two suspected crises of anaesthetic malignant hyperthermia (MH) were collected between 1969 and 1988 by a retrospective inquiry which lasted four years. 33 patients (53%) died whilst 29 survived. 20 cases were confirmed to be MH, either directly or indirectly by way of muscle biopsy and halothane and caffeine contracture tests carried out according to the European MH group protocol by two laboratories. This group included 11 of the deaths, one family member of whom, at least, is sensitive (MHS), 7 MHS survivors and 2 survivors too young to undergo muscle biopsy but belonging to MHS families. 21 cases were highly suspect of MH: 15 of the deaths which occurred in a typical way, and 6 patients of three different families who have suffered from anaesthetic deaths which, clinically, suggested MH. Another 15 were possible MH cases, all survivors, including one case of Steinert's disease and a brother of a case of central core disease. 2 cases were still being debated, because they had equivocal results for the caffeine test (MHEc); the last 4 had negative muscle biopsies and were excluded. 33 close relatives of the MH patients were diagnosed as MHS. 44 others were found to be free from the genetic predisposition. ⋯ Dantrolene was only used in 32% of cases, and then at inadequate doses and very often too late; this probably explains the large number of treatment failures. The number of severe forms of MH was also very high in this series (70%). The need to increase the means of prevention and screening for MH in France is stressed.
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Ann Fr Anesth Reanim · Jan 1988
Case Reports Comparative Study[Changes in intracranial pressure in severe head injured patients in hemodialysis].
Two cases of acute post-traumatic renal failure in severely head injured patients are reported. An increase in intracranial pressure (ICP) was shown up by continuous monitoring during haemodialysis: it was more important during conventional haemodialysis than during continuous arteriovenous haemofiltration. ⋯ The increase in ICP is explained in the dog as a result of blood-brain differences in urea concentration and osmolality leading to an increase in cerebral spinal fluid volume and cerebral tissue swelling. If dialysis is necessary in these patients, it should be carried out early and progressively, the patient's ICP being monitored continuously.
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Ann Fr Anesth Reanim · Jan 1988
[Relation of the fall in PO2 in ventilation of the lower lung in pulmonary surgery and the preoperative distribution of respiratory function].
Hypoxaemia during one-lung ventilation is influenced by the anatomic distribution of lung perfusion and hypoxic vasoconstriction. This study aimed to assess whether preoperative selective bronchospirometry could predict the degree of peroperative hypoxaemia. Twelve patients scheduled for pneumonectomy, lobectomy, wedge resection or decortication were included in the study. ⋯ When both lungs were ventilated, mean PaO2 was 390.5 +/- 92.4 mmHg; during one-lung ventilation, it fell to 210.8 +/- 109.2 mmHg. Routine spirometry could not predict the magnitude of fall in PaO2; however, it was correlated with the bronchospirometric oxygen consumption of each lung (r = 0.83; p less than 0.01). The anatomical distribution of lung perfusion seemed to be the predominant factor influencing the decrease in PaO2 during one-lung ventilation.