Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1997
Review Comparative Study[Techniques for measuring intracranial hypertension].
A wide variety of monitoring devices have been used for intracranial pressure measurement. The aim of this article is to present the most common devices and to assess their accuracy, stability and complications, with reference to current literature. ⋯ However new techniques with distal measurement (fiberoptic or strain gauge) seem to be accurate, but have a higher cost. Some practical problems, such as the zero pressure reference level and the side of measurement, are also discussed.
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Ann Fr Anesth Reanim · Jan 1997
Review[Evaluation of ischemic repercussions of intracranial hypertension].
The main risk involved in severe intracranial hypertension is, the occurrence of cerebral ischaemia, either locally during herniation or globally as a consequence of reduced cerebral perfusion pressure (CPP). Neurological features of ischaemia occur at a late stage. A continuous monitoring of brain function with EEG or evoked potential techniques, while largely used in the operating room have not been so far fully evaluated in the intensive care setting. ⋯ ICP and CPP monitoring remains the basis for intensive care surveillance during the phase of intracranial hypertension, with alarming settled at admitted critical values (ICP = 30 mmHg; CPP = 70 mmHg). As ischaemic threshold for cerebral blood flow may be different in patients and in normal experimental animals, the reliability of these critical values of ICP and CPP is uncertain. Therefore, transcranial Doppler, jugular metabolic monitoring and, as recently available, cortical tissue PO2 monitoring are mandatory for early detection and assessment of ischaemia.
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A main indication for intracranial pressure monitoring is severe head trauma, where it acts as a diagnostic, prognostic and therapeutic guide. Others indications for intracranial pressure monitoring are patients with CSF circulation disturbances, whatever the cause, and various pathologies inducing intracranial hypertension, such as encephalopathies. Intracranial pressure monitoring must be associated with the measurement of mean arterial pressure, arterial and jugular venous oxygen saturation and blood flow velocity in major intracranial arteries with transcranial Doppler sonography.
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Ann Fr Anesth Reanim · Jan 1997
Comparative Study[Evaluation of acute pain in prehospital medicine].
To evaluate acute pain in prehospital setting. ⋯ Acute pain is frequently observed in prehospital emergency medicine. Pain scales such as VRS and VAS are used easily and convenient for the assessment of pain intensity in this context. However, even if pain is correctly evaluated, it is still inadequately treated. The reasons of these inadequacies must be assessed and corrected with pain treatment protocols including opioids.
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Ann Fr Anesth Reanim · Jan 1997
Clinical Trial Controlled Clinical Trial[Interscalenic block and surgery of the shoulder. A prospective study of a continuous series of 167 patients].
To determine the relationship between minimal stimulating current and success rate of interscalene brachial plexus block (IBPB), to assess the quality of anaesthesia and postoperative analgesia, and to evaluate the benefits and drawbacks of this technique in shoulder surgery. ⋯ The correlation between minimal stimulating current and success rate has clearly shown the benefit of the nerve stimulation. IBPB, which provides a successful and efficient anaesthesia with minimal risk and satisfactory postoperative analgesia, has become the standard technique for shoulder surgery.