Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · May 2007
Review[Hierarchical strategy for treating elevated intracranial pressure in severe traumatic brain injury].
The objective of the treatment of intracranial hypertension is to decrease intracranial pressure (ICP) while maintaining cerebral blood flow (CBF). Despite numerous treatments, none of them associates total efficiency and security. Systemic secondary cerebral injuries, which are responsible for cerebral ischemia, lead us to administer non specific treatments in order to optimize CBF and cerebral oxygenation. ⋯ In case of refractory intracranial hypertension, it may be useful to deepen neurosedation. Controlled hypocapnia and barbiturates remain a third line therapy providing to monitor and maintain an appropriate CBF and cerebral oxygenation. Controlled hypothermia and decompressive craniectomy must be individually discussed.
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Ann Fr Anesth Reanim · May 2007
Review[What is the contribution of Stewart's concept in acid-base disorders analysis?].
To explain the different approaches for interpreting acid-base disorders; to develop the Stewart model which offers some advantages for the pathophysiological understanding and the clinical interpretation of acid-base imbalances. ⋯ Due to its simplicity, the traditional Henderson-Hasselbalch approach of acid-base disorders, remains commonly used. However, it gives an inadequate pathophysiological analysis which may conduct to a false diagnosis, especially with complex acid-base imbalances. Despite its apparent complexity, the Stewart concept permits to understand precisely the mechanisms of acid-base disorders. It has to become the most appropriate approach to analyse complex acid-base abnormalities.
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Ann Fr Anesth Reanim · May 2007
Comparative Study Clinical Trial[Influence of the analgesic strategy on the respiratory function after thoracic surgery for lobectomy].
To compare the influence of thoracic epidural analgesia (TEA) with intravenous patient-controlled analgesia with morphine (PCA) on the early postoperative respiratory function after lobectomy. ⋯ The results of this study suggest that the use of TEA is associated with a better preservation of respiratory function assessed by spirometric data and noctural arterial desaturation recording after thoracic surgery for lobectomy.
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Ann Fr Anesth Reanim · May 2007
Clinical Trial[Psoas compartment block with general anaesthesia: descriptive study of 93 cases].
During many years the approach to the lumbar plexus has been the anterior paravascular technique described as a "3-1" block by Winnie. The posterior approach results in a complete block of the principal nerves of the lumbar plexus. The goal of the study was to evaluate the performance of the psoas compartment block with general anaesthesia. ⋯ The psoas compartment block with general anaesthesia have shown it feasibility and efficiency on intra- and postoperative analgesia during hip surgery.
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Ann Fr Anesth Reanim · May 2007
Case Reports[Is it necessary to revalue the risk of a gas embolism complicating an intervention with carbon dioxide insufflation?].
Due to the characteristics of the carbon dioxide, gas embolism occurring during coelioscopy using this gas is usually considered as non critical. We report three observations of gas embolism which have occurred during laparoscopic surgery, one mild and two having led to death in spite of hyperbaric oxygen therapy. These observations prompted us to reevaluate the role of carbon dioxide in the severity of gas embolism.