Presse Med
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Several experimental studies have demonstrated the adverse effects of anesthetic agents on the developing brain. Most of these agents appear to induce apoptosis of immature neurons and could interfere with the development of dendritic arborization. Extrapolation of experimental data to clinical settings is uncertain because of the pharmacokinetic and pharmacodynamic differences between the diverse species. ⋯ Several recent epidemiologic studies nonetheless suggest a potential association between anesthesia and long-term damage to cognitive functions. In studying the potential effect of general anesthetics on the immature human brain, it is difficult to separate the effects of anesthesia from the effects of the surgery. Several prospective studies are currently underway to elucidate this important question.
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Case Reports
[Accidental cannabis poisoning in children: experience of the Marseille poison center].
To assess the frequency and severity of accidental cannabis poisoning in children. ⋯ Considering the observed increase in cases each year, mostly benign but potentially serious, prevention and information efforts have to be improved for drug users with young children and for healthcare professionals led to manage this kind of accident.
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Impaired microcirculation and tubule injuries explain the changes in kidney function during and after surgery. Surgery is a risk factor for acute renal failure, the incidence of which ranges from 0.8% to 40%, depending on the kind of surgery. Mortality due to perioperative acute renal failure ranges from 17% to 60%, depending on the kind of surgery. ⋯ The most promising of these isneutrophil gelatinase-associated lipocalin(NGAL). Renal protection consists in maintaining an optimal blood volume and cardiac output. Nephrotoxic agents always must be removed.
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Postoperative cognitive dysfunction is not a problem specific to cardiac surgery. It nonetheless occurs most frequently after heart surgery, performed with or without extracorporeal circulation. The perioperative inflammatory process appears to be the predominant pathophysiologic mechanism. ⋯ Age is the risk factor most often found in the literature. Preventive measures, based on knowledge of risk factors, might reduce the risk of cognitive dysfunctions modulated by a genetic predisposition. No curative treatment has thus far been shown to be efficacious.
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The cognitive dysfunctions observed in patients after anesthesia are due not only to the effects of but also to the surgery, the disease requiring surgery, and post-operative treatment. Initial cognitive recovery from anesthetic agents is usually fast, from several hours to several days, but can be delayed by postoperative treatment (analgesia, for example) that have deleterious cognitive effects. During the initial period after surgery, acute impairment of cognitive functions is seen in some patients at risk (major surgery, aged patients, brain sensitivity, or sepsis), specifically transitory (1-3 days in most cases) postoperative delirium. ⋯ Cognitive dysfunction is still observed at 3 months after surgery in about 10-15% of patients older than 60 years and in about 6% of younger patients. In patients with a pre-existing cerebral disease with cognitive symptoms, the incidence of long-lasting additional cognitive impairment remains unknown. The mechanisms of this long-term cognitive dysfunction remain to be elucidated.