Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · Jan 1996
[Claims related to anesthesia at the University Hospitals of Paris].
To evaluate the number and the reason of anaesthesia-related malpractice claims in university hospitals of Paris. ⋯ There are few anaesthesia-related claims in the Paris university hospitals. Only few claims result in a compensation. By contrast, when a indemnification is alloted, its amount is very high. Locoregional anaesthesia seems to be at a higher risk for malpractice claims.
-
Ann Fr Anesth Reanim · Jan 1996
[Resistance to vecuronium in burnt patients. Influence of the burnt surface on the effectiveness of the dose 95].
To assess the neuromuscular blocking effect of vecuronium in adult burn patients, to draw dose-response curves, to determine the ED 95 according to burn surface area, to analyze the time course of this pattern in order to recognize the development of a resistance according to the length of postinjury period. ⋯ Acutely burn patients become resistant to the neuromuscular blocking effect of vecuronium. This resistance is related to the magnitude of burn injury. The mechanism of resistance is related to an increase in nicotonic acetylcholine receptors. In these patients, the dose of vecuronium must be titrated to achieve effective muscular paralysis: the correcting factor is 1.3 for a BSA under 20%, 1.9 for a BSA between 20 and 40%, 2.5 for a BSA between 40 and 60%, and 2.9 for a BSA above 60%.
-
Ann Fr Anesth Reanim · Jan 1996
[Substances responsible for peranesthetic anaphylactic shock. A third French multicenter study (1992-94)].
Since 1989, the epidemiological survey of anaphylactoid reactions occurring during anaesthesia is obtained in France with repeated inquiries by the Perioperative Anaphylactic Reactions Study Group. The members of this group collect during the study period the cases of patients having suffered from an anaphylactoid reaction and tested in their allergo-anaesthetic outpatient clinic, their characteristics (age, gender), the results of the allergological tests (mechanism, agents responsible for the reactions). The two previous surveys published in the Annales françaises d'anesthesie et de réanimation in 1990 and 1993 included 1,240 and 1,585 patients respectively. ⋯ It is therefore essential to systematically carry out an allergologic assessment several weeks after the reaction, in order to discard for the subsequent anaesthetics the agent(s) responsible for anaphylaxis. If the muscle relaxants remain the first drugs involved in shock occurring at induction, there is a significant increase in latex shock, as demonstrated by the three epidemiological surveys (0.5%, 12.5% and now 19%). The incidence of other anaesthetic agents, antibiotics and plasma substitutes remains unchanged.
-
Ann Fr Anesth Reanim · Jan 1996
Case Reports[Cancer pain: beneficial effect of ketamine addition to spinal administration of morphine-clonidine-lidocaine mixture].
To assess the benefit of ketamine addition to a morphine-clonidine-lidocaine mixture administered continuously by the intrathecal route for the treatment of cancer pain. ⋯ Ketamine by intrathecal route potentiates analgesia obtained with morphine-clonidine and lidocaine, while impeding the development of a tolerance vis-à-vis the former.
-
Ann Fr Anesth Reanim · Jan 1996
Case Reports[Problems posed by spinal anesthesia in a patient with Gélineau disease].
A 44-year-old patient, with narcolepsy-cataplexy, underwent surgery for lumbar disk hernia under spinal anaesthesia. Our purpose was to prevent an interaction between the patient's disease and general anaesthetic agents with the risk of postoperative hypersomnia. During surgical procedure, two narcolepsy fits occurred, without clinical consequences. ⋯ General anaesthesia seems to be the best choice for these patients cholinergic agents and mainly the alpha1 adrenergic blocking drugs are contra-indicated as they increase the risk of narcolepsy-cataplexy fits. Anaesthetic sleep, narcolepsy, cataplexy and epilepsy are clinically rather similar. The EEG does not allow to differentiate between narcolepsy and anaesthetic-sleep, whereas cataplexy and epilepsy result in specific EEG patterns.