Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1997
Case Reports[Digestive hemorrhage disclosing an angiodysplasia and von Willebrand disease type 2].
The authors report a case of a 76-year-old man, with not past history of abnormal bleeding, who suffered an acute, recurrent, intestinal haemorrhage from extensive angiodysplasia of the colon. Intestinal bleeding and angiodysplasia were associated with a von Willebrand's disease. Genetic analysis showed a point mutation in arginine 611 of the mature von Willebrand's factor subunit (A1 loop) confirming a von Willebrand's disease type 2.
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Ann Fr Anesth Reanim · Jan 1997
Case Reports[A low dose of nalbuphine reverses respiratory depression but not analgesia induced by intraspinal morphine].
Postoperative pain management after scoliosis surgery is based in our institution on intrathecal morphine administration. This case report describes an immediate and major postoperative respiratory depression that occurred in the recovery room, requiring the maintenance of the endotracheal tube. This respiratory depression was reversed by i.v. administration of a low dose of nalbuphine, which allowed tracheal extubation without suppression of morphine-induced analgesia.
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With monochromatic infrared gas spectrometers (MIS), the displayed concentration is computed from measured IR absorption and a gain factor specific for the selected volatile agent (VA). As MIS cannot detect which VA is actually present, the displayed concentration can be very different from the actual one. As bottles and vaporizers are very specific for desflurane, it is impossible to misfill a vaporizer; however an erroneous selection of VA on MIS remains possible. ⋯ When either desflurane, or isoflurane or enflurane were delivered at constant concentrations, all VA measured by the MIS, namely desflurane, sevoflurane, isoflurane, enflurane and halothane were successively selected and the displayed concentrations compared with the actual vapour concentration using a Capnomac Ultima (Datex) monitor. Consequences of erroneous selection can be included in three categories: 1) dangerous error, when a displayed concentration is much lower than the actual one, e.g. desflurane or sevoflurane erroneously selected; 2) evident error, when displayed concentration is much higher than 10 vol%; 3) uncomfortable situation, when displayed and actual concentrations are similar, e.g. isoflurane erroneously selected instead of desflurane. This error can only be detected by a careful checking of the device.
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Ann Fr Anesth Reanim · Jan 1997
[Dental accidents in relation to general anesthesia. Experience of mutual medical insurance group].
This article reviewed retrospectively 511 cases of dental damage reported to the French group for medical insurances from 1990 to 1995, and representing 40% of all accidents related to anaesthesia. The mean incidence rate was 9.5 accidents/100 anaesthetists/year and tended to decrease over time. The part of cases qualified as being linked to a fault was high and mainly due to the lack of dental examination and of informed consent during the preanaesthetic assessment. Although the mean cost of a dental accident is low compared with other anaesthetic accidents, the global cost is substantial considering their high incidence.
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Ann Fr Anesth Reanim · Jan 1997
[PhysioFlex: a target-controlled self-regulating closed-circuit inhalation anesthesia regulator].
Physi Flex is the first commercially available apparatus capable for quantitative, or self-regulating target controlled inhalational anaesthesia, with a totally closed circuit, in adults and children. The fresh gas supply to the circuit is intermittent, automatically regulated by continuous monitoring of the volume and composition of the gas mixture in the breathing circuit. The circle system includes, instead of the two conventional one way valves, a blower creating a continuous unidirectional flow at 70 L.min-1. ⋯ The O2-flow and consumption, the N2O flow and uptake, FICO2 and FETCO2, FI and FET of the volatile anaesthetic, all other important data are displayed in a numerical and graphical form on a color screen and registered for a delayed analysis. The end tidal concentration of the volatile anaesthetic drives a stepmotor with a syringe containing the selected volatile anaesthetic agent with is directly injected into the breathing circuit where it is vaporized. Therefore the concentration of the anaesthetic vapour can be instantaneously increased with this injector at induction and lowered at end of anaesthesia with the carbon absorber, and the fresh gas consumption is significantly decreased.