Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1994
Comparative Study[Comparison of cardiac output measured continuously by thermodilution and calculated according to Fick's principle].
Recently, a thermodilution technique for continuous measurement of cardiac output was introduced. The aim of this study was to evaluate the accuracy of continuous cardiac output measurement using the thermodilution technique (CCO) and to assess the correspondence between CCO and cardiac output obtained with the Fick's principle (Fick-CO). Nine patients were studied in the postoperative period after cardiac surgery. ⋯ However, the accuracy of CCO is acceptable. The technique does not require any user calibration and eliminates the need of bolus injections. Further studies are necessary to determine the benefits of this new technique in the various clinical situations.
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Ann Fr Anesth Reanim · Jan 1994
Case Reports[Accidental subdural extra-arachnoid catheterization during epidural analgesia in obstetrics].
The authors describe a case of accidental catheterization of the subdural extra-arachnoid space during epidural analgesia for labour. The epidural catheter had been inserted at the L3-L4 interspace without any problem. A severe hypotension occurred 90 min after the onset of analgesia. ⋯ After delivery, a water-soluble contrast medium (10 mL of Omnipaque 180) was injected through the catheter and subsequent radiograph of spine showed subdural spread of the contrast medium. This complication might occur more frequently than usually thought and may be life-threatening. Anaesthetic management is discussed in the case of Caesarean section during labour.
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Ann Fr Anesth Reanim · Jan 1994
[Proposal for a new multifactor screening score of difficult intubation in ORL and stomatognathic surgery: preliminary study].
This study assessed prospectively in 295 ENT adult patients the predictive value of clinical indicators for difficult intubation and of a new multifactorial score, established by the allocation of points (0, 3, 5 or 7) depending on the degree of presence of seven factors: pathology known to be associated with a difficult intubation, clinical signs of airways' pathology, inter-incisors gap and mandible's luxation, submental mandibular-thyroid distance, normal or short and broad neck, head and neck movements, and Mallampati's test. The incidence of difficult laryngoscopy was 14% and the use of particular techniques for tube insertion was required in 8% of patients. The presence of malformation or pathology often associated with a difficult intubation and the presence of functional signs of airways' pathology predict the difficulties of laryngoscopy and tracheal intubation with a good sensitivity and specificity. The analysis of the "Receiver Operating Characteristic curves" showed that a score higher or equal to 11 allows the prediction of difficult intubations with a sensitivity of 96% and a specificity of 90%.
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An unknown myopathy can be revealed by the administration of an anaesthetic agent. The symptoms are those of malignant hyperpyrexia (MH). The MH phenotype can be detected by means of contracture tests in vitro. ⋯ Myopathy is difficult to diagnose, either because the patient undergoes surgery before being symptomatic or because he is only a carrier of MH. In case of an abnormal reaction following the administration of recognized triggering agents or the occurrence of MH, the procedure should be discontinued. In case of absolute necessity, the procedure may be continued but with non-triggering agents only.
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Ann Fr Anesth Reanim · Jan 1994
[Lack of sensitivity to per-anesthetic malignant hyperthermia in 32 patients who developed neuroleptic malignant syndrome].
The aim of this study was to verify whether a relationship exists between neuroleptic malignant syndrome (NMS) and anaesthetic-induced malignant hyperthermia (MH) or not. The in vitro halothane-caffeine tests were performed on muscle tissue obtained from 32 patients with documented NMS episodes. The diagnosis of NMS relied on Levenson's criteria. ⋯ Three patients were classified as MH equivocal. These findings demonstrate the lack of any link between NMS and MH. Therefore, patients with a history of NMS are not likely to be at risk of developing MH and special measures against MH are not required for anaesthesia in these patients.