Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 2012
An information campaign on aminoglycosides use during septic shock failed to improve the quality of care.
Septic shock remains a major cause of death in intensive care units (ICU) and an inappropriate antibiotic regimen worsens the prognosis. The aim of the study was to assess the impact of an information campaign on modalities of prescription of aminoglycosides in septic shock. ⋯ An information campaign describing the modalities of prescription of aminoglycosides in septic shock failed to improve medical practices and patient outcomes. A mobile team of antibiotics could be useful in daily practice.
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Ann Fr Anesth Reanim · Jan 2012
Case Reports[Intracerebral haemorrhage and postpartum cerebral angiopathy associated with the administration of sulprostone and norepinephrine].
We report the case of a 29-year-old female who had developed a postpartum cerebral angiopathy (PCA) complicated by an intracerebral haematoma and convulsions, after a postpartum haemorrhage with sulprostone and norepinephrine infusion. PCA is an under diagnosed neurovascular pathology, responsible of reversible and non-specific symptoms. However, it can be complicated by haemorrhagic or ischemic stroke with vital or functional risks. As PCA is favored by vasoactive treatments, their administration in peripartum period, when it is imperative, should be strictly controlled.
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Ann Fr Anesth Reanim · Jan 2012
[Reliability of pulsatile saturometry in patients with shock. Digital standard sensors are not reliable for facial measurement!].
Non-invasive monitoring of oxygen saturation by pulse oxymetry (SpO(2)) is sometimes perturbed on fingers during shock states. Other sites are possible (toes, forehead, nose, ear). Self-adhesive standard digital sensors are commonly used off-label in these sites. We have assessed their reliability for all of these sites. ⋯ In patients with a shock receiving vasoconstrictive catecholamines, the reliability of SpO(2) measurements with standard sensors appears better for fingers than for toes and face locations. These standard sensors should be discouraged for facial measurement because of their low reliability, even when the plethysmographic curve seems correct. Sensors specifically designed for each facial site exist, and their reliability should be estimated in patients receiving vasoconstrictive catecholamines.
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Ann Fr Anesth Reanim · Jan 2012
[Epidural analgesia for surgical treatment of peritoneal carcinomatosis: a risky technique?].
To study the risks of haemodynamic instability, and the possible occurrence of spinal haematoma, meningitis and epidural abscess when epidural analgesia is performed for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). ⋯ In this series of 35 patients, the use of epidural analgesia for HIPEC does not seem to be associated with a worse risk of haemodynamic instability, spinal haematoma, meningitis or epidural abscess. HIPEC with platinum salt is not incompatible with the safety of epidural analgesia, with an optimized fluid management peroperatively and the following of perimedullary anesthesia practice guidelines.
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Ann Fr Anesth Reanim · Jan 2012
Case Reports[Dissection of the descending aorta complicated by preeclampsia at 30 weeks of gestation: medical treatment and caesarean delivery].
The authors report the case of a dissection of the descending thoracic aorta in a woman in the third trimester of the pregnancy. After an initial medical therapy by a combination of three intravenous anti-hypertensive medications, a caesarean section was decided under general anaesthesia at 30 weeks of gestation as the result of the occurrence of a severe preeclampsia. The aetiology, diagnosis, and anaesthetic management are discussed.