Presse Med
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Recent hemodynamic studies performed in large cohorts of adult patients with sickle cell disease have established the prevalence of pulmonary hypertension in this disease about 6 to 10%. Over half of these correspond to postcapillary pulmonary hypertension. Precapilliary arterial pulmonary hypertension seems to be a relatively infrequent complication of the disease. ⋯ However, pulmonary vascular disease appears to have a significant impact on the functional status and vital prognosis of patients with sickle cell disease. The predictive value of echocardiography to detect pulmonary hypertension in this population is low (25-32%) when the threshold of tricuspid regurgitation velocity of 2.5m/s is used. At present, no specific treatments for pulmonary arterial hypertension is currently approved for the treatment of PAH associated with sickle cell disease due to lack of data in this specific population.
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The stay in intensive care unit can be potentially traumatic at the origin of post-traumatic stress symptoms. The severity of post-traumatic stress symptoms is linked to the intensity and the type of traumatic memories of the intensive care stay. Sedatives and analgesics given to ventilated patients in intensive care influence the traumatic memory. ⋯ Links between sedation, dissociative symptoms, delirium and post-traumatic stress symptoms are documented. Environmental and pharmacological measures are to be considered to reduce the traumatic potential risk of the intensive care. Intensive care caregivers, liaison-psychiatrist and general practitioner have each a specific role to play in the screening of the post-traumatic stress symptoms.
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Local anaesthetics may induce cardiac arrest, usually because of rapid absorption from the site of injection or because of an intended intravascular injection. Early central nervous system symptoms usually precede seizures. Cardiac arrhythmias follow the CNS signs. ⋯ They need to be performed immediately and the efficacy of the lipid rescue requires a correct coronary flow to be efficacious. Finally, prevention is the key of a safe injection. It is important to control the dose, to inject slowly, without any excessive pressure and to verify that no blood reflux occurs.
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Anaphylactic reactions may be either of immune(allergy, usually IgE-mediated, sometimes IgG-mediated) or non-immune origin. The incidence of anaphylactic reactions during anaesthesia varies between countries ranging from 1/1250 to 1/13,000 per procedure. In France, the estimated incidence of allergic reactions is 100.6 [76.2-125.3]/million procedures with a high female predominance (male: 55.4 [42.0-69.0], female: 154.9 [117.2-193.1]). ⋯ Premedication cannot prevent the onset of an allergic reaction. Providing a latex-free environment can be used for primary or secondary prevention. Treatment is based on allergen administration interruption, epinephrine administration in a titrated manner based on symptoms severity, and on volume expansion.