Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Nov 2008
Review[Open chest cardiopulmonary resuscitation: is there an interest in France?].
To expose and clarify indications, techniques, results, complications and cost for open chest cardiopulmonary resuscitation manoeuvres (OCCRM) in traumatic or nontraumatic cardiac arrest. ⋯ According to the French "physician in ambulance" prehospital system, OCCRM might be promising in France, because this system favours the fastness of care and therefore would minimize the time factor.
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Ann Fr Anesth Reanim · Nov 2008
Case Reports[Fulminant myocarditis: clinical value of extracorporeal life support].
Fulminant myocarditis is a rare cause of cardiogenic shock which usually occurs in young adults without known cardiac disease. Initial course may be complicated by a cardiogenic shock refractory to optimal medical treatment. Temporary circulatory assistance using an extracorporeal life support is of great clinical value in this setting, since myocardial systolic function usually fully recovers after a short time delay.
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Ann Fr Anesth Reanim · Nov 2008
Case Reports[The law number 2005-370 of April 22, 2005 concerning the patients' rights at the end of life: a case of prehospital medicine].
The law number 2005-370 of April 22, 2005 concerning the patients' rights at the end of life imposes from now the refusal of futility of care, a shared decision-making in unconscious patients and the duty of a palliative strategy. Our observation underlines the feasibility to withhold or withdraw life-sustaining treatments in prehospital area, in following the different steps of the legal decision-making process. However, this case also shows the major difficulty to decide, because of a lack of traceability. Finally, this case illustrates the current difficulty to identify or to join the consultant, provided by the law.
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We report a case of a falsely elevated-bispectral index (BIS) during a general anaesthesia combining remifentanil TCI, desflurane and nitrous oxide for an isolated-limb chemotherapy. During surgery, BIS increased and stabilized around 70, with neither residual neuromuscular blockade nor clinical sign of awareness. These high BIS values were attributed to high-electromyographic activity and electric artefacts, such as extracorporeal-circulation machine and tourniquet. ⋯ The patient did not complain of intraoperative recall. This case reminds us that the BIS has some limits as being sensitive to EMG or environment artefacts that should be eliminated before deepening anesthesia. To do so, a decision algorithm is proposed that may be used for all situations of surprising high BIS, taking into account the level of neuromuscular blockade, clinical response to orders and the presence of devices likely to induce electrical or mechanical artefacts.