Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jul 2006
Case Reports[Gastric foreign body. Rare complication of nasogastric tube placing].
The use of an uncuffed endotracheal tube for the placement of nasogastric tubes during surgery is not a procedure free of any risk. We report a rare case of gastric foreign body secondary to this procedure. ⋯ The endoscopic extraction found an endotracheal tube. It is a common habit in our institution to use this method when placing this tube through a nostril in order to ease the nasogastric tube insertion when it is difficult.
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Ann Fr Anesth Reanim · Jul 2006
Review[Monitoring of cerebral oxygenation with SvjO(2) or PtiO(2)].
Jugular venous oxygen saturation (SvjO(2)) monitoring has been developed in order to detect cerebral ischaemia. The interpretation of SvjO(2) values remains nevertheless complex, and should be associated with cerebral haemodynamic multimonitoring with ICP and transcranial Doppler. With the hypothesis of a constant cerebral oxygen consummation, and also with a constant haematocrit, SvjO(2) variations correlates with cerebral blood flow variations. ⋯ A concomitant metabolic monitoring by cerebral microdialysis is of importance to fully address the real cerebral local ischaemic burden. Scientific studies are mainly focused on patients with a brain traumatism. Nor SvjO(2), nor PtiO(2) monitoring have at present been demonstrated to be associated with a clinical benefit, and their use should be restricted to scientific research.
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Traumatic brain injury leads to primary and secondary brain injuries. Primary brain injury results from mechanical forces applied to the head at the time of impact. Secondary brain injury occurs at some time after the primary impact. ⋯ The endogenous neuroinflammatory response after traumatic brain injury contributes to the development of blood-brain barrier breakdown, cerebral oedema and neuronal cell death and this has led to various pharmacological therapies to try to limit this type of damage. Studies employing glutamate receptor antagonist for cerebral protection have yielded promising results in laboratory animals but failed to produce clinically significant improvements. The present review will summarize the mechanisms of post traumatic cerebral inflammation with a special focus on the anti-inflammatory drug targets.
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Ann Fr Anesth Reanim · Jul 2006
[Is training on basic skills and management of critical events responsible of ethical considerations in anaesthesia and intensive care?].
To provide information on morbidity and ethical questions associated with learning of invasive techniques (tracheal intubation, positioning of central venous or epidural catheters) and management of anaphylactic shock. ⋯ Despite an apparent morbidity with a loss of benefit, informed consent of the patients were rarely obtained.