Annales françaises d'anesthèsie et de rèanimation
-
Etomidate blocks the cortisol synthesis by specifically inhibiting the activity of 11 beta-hydroxylase, resulting in a primary adrenal insufficiency. Therefore, a serum accumulation of 11 beta-deoxycortisol and a low secretion of serum cortisol must be required as diagnostic criteria to assign that adrenal impairment to the drug. These requirements have been rarely fulfilled in studies exploring the contribution of etomidate to the adrenal insufficiency despite numerous causes of adrenal derangement. ⋯ Although there are still uncertainties as to whether etomidate directly affects mortality and morbidity, it seems preferable to avoid the use of etomidate in patients with severe sepsis and septic shock. In patients with severe traumatic brain injury, arterial hypotension is one of major factors of poor outcome and can be prevented with the use of etomidate for facilitating tracheal intubation. Substitutive opotherapy with low doses of hydrocortisone should be assessed after a single dose of etomidate for critically ill patients.
-
Ann Fr Anesth Reanim · Nov 2008
[Which settings to optimize anaesthetics delivery: fresh gas flow or delivered fraction?].
During volatile closed-circuit anaesthesia, a chosen end-tidal fraction (Fet) could be achieved by setting either delivered fraction (Fd) or fresh gas flow (FGF). This study compared the efficacy of both strategies and the resulting drug consumption. ⋯ Massive overdosage of Fd is the fastest, reproducible and cheapest strategy to achieve (or to increase) a chosen Fet. High FGF is the fastest to decrease Fet during or at the end of anaesthesia. Combining Fd and FGF adjustments in order to maximize Fd/Fet gradients overwrites pharmacokinetic differences between desflurane and sevoflurane and reduces differences with isoflurane. Automatic adjustments based on volatile pharmacockinetics would be helpful to achieve a target Fet without overdosage.
-
Ann Fr Anesth Reanim · Nov 2008
[A survey of neuromuscular relaxant use from anaesthesiology residents in training].
There is need to assess our practice of neuromuscular monitoring according to national consensus guidelines. The aim of this study was to evaluate practice adherence to guidelines in teaching hospitals. ⋯ This questionnaire addressed to anaesthesiology residents in training was a practical and objective mean to obtain relevant information concerning our practices. It revealed an inadequate availability of quantitative neuromuscular monitors in the operating room. As a result, neuromuscular monitoring and reversal of neuromuscular blockade were underused. Teaching hospitals should improve their implication in residents' education and adherence to practice guidelines.