Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1996
Case Reports[Severe hyperthermia caused by sudden withdrawal of continuous intrathecal administration of baclofen].
Baclofen is used for the treatment of post-traumatic spasticity. It carries a risk of overdose as well as of an acute withdrawal syndrome. We report two cases of severe hypertonia and hyperthermia (> 42 degrees C), occurring after accidental discontinuation of intrathecal infusion of baclofen. ⋯ In parallel, the patients developed transient life-threatening alterations of hepatic (cytolysis), haematologic (coagulopathy) and cardiorespiratory functions for some days. It is concluded that the occurrence of such a withdrawal syndrome should be prevented, especially in patients with chronic intrathecal administration and first symptoms should be recognized without delay. Relationships with other malignant hyperthermias are discussed.
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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.
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Ann Fr Anesth Reanim · Jan 1996
Clinical Trial[A study of pneumatic performances of 2 new anesthesia ventilators: a trial].
To assess the pneumatic performance of two new anaesthesia ventilators. ⋯ These two new machines with pneumatic compensation overcome the main drawback seen with conventional "bellows-in-box" ventilators.
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Ann Fr Anesth Reanim · Jan 1996
[Role of albumin in pulmonary edema and septic shock, plasma volume expansion excluded].
Patients with septic shock deserve a global approach. Intravascular volume loading is part of the treatment. ⋯ Moreover, hydroxyethylstarch could have promising properties in case of increased capillary permeability. In summary and in agreement with the North American consensus conference, albumin should not be recommended for the treatment of septic shock, whether associated with non cardiogenic pulmonary oedema or not.
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Quality assessment (assurance/improvement) is the set of methods used to measure and improve the delivered care and the department's performance against pre-established criteria or standards. The four stages of the self-maintained quality assessment cycle are: problem identification, problem analysis, problem correction and evaluation of corrective actions. Quality assessment is a measurable entity for which it is necessary to define and calibrate measurement parameters (indicators) from available data gathered from the hospital anaesthesia environment. ⋯ Definition and implementation of corrective measures, based on the findings of the two previous stages, are the third step of the evaluation cycle. The Hawthorne effect is an outcome improvement, before the implementation of any corrective actions. Verification of the implemented actions is the final and mandatory step closing the evaluation cycle.