Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Feb 2001
Review[Hyponatremia in neurologic intensive care: cerebral salt wasting syndrome and inappropriate antidiuretic hormone secretion].
Hyponatraemia is a frequent complication in neurologically injured patients; it is a secondary cerebral injury. Hyponatraemia leads to consciousness problems, convulsions, worsening of the neurological status and thus the neurological evaluation. Hyponatraemia is secondary to free water retention (inappropriate ADH secretion) or to renal salt loss. ⋯ The diagnostic approach and monitoring are based on the assessment of sodium and water losses. Therapy is based on correction of the circulating volume and natraemia. Speed of correction is a matter of debate: slow correction presents the risk of further neurological injury whereas rapid correction presents the risk of central pontine myelinosis.
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Ann Fr Anesth Reanim · Feb 2001
Review[Diagnosis of status epilepticus by continuous EEG monitoring in a neurointensive care unit].
Continuous EEG monitoring use has documented a surprisingly high incidence of convulsive and non-convulsive status epilepticus in patients with acute brain injuries. Seizures are the cause of secondary insult. ⋯ To minimise these problems, we suggest the following: train the bedside nurse, make a library of the artefacts, have the EEG technologist check electrodes and establish low impedance, have the electroencephalographer examine the EEG, correlate the activity and movements of the patient. In the diagnosis and the management of convulsive and non-convulsive status epilepticus, the value of continuous EEG monitoring appears to be established.
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Most anaesthetics and analgesics have both pro- and anticonvulsant activity. The data in the literature should be analysed with respect to the patient population, the recording of epileptic activity and the method of EEG analysis. Among inhaled anaesthetics, isoflurane has strong anticonvulsant properties. ⋯ Among narcotics, fentanyl and alfentanil may induce clinical or electroencephalographic seizures. Considering the large number of patients treated with these agents without any neurological adverse effect, the clinical relevance of these data is unclear. Neuromuscular blocking agents do not possess pro- or anticonvulsant properties.