Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jul 2012
Case Reports[Nemaline rod myopathy revealed by acute respiratory failure after an outpatient cataract surgery].
We report the case of a 63-year-old patient admitted to the ICU for an acute respiratory failure one week after an outpatient cataract surgery that revealed a nemaline rod myopathy. We present this rare myopathy whose particularities are its aetiology, which can be inherited, mostly with a congenital onset, or sporadic, and the variability of the age at presentation. We discuss the exceptional onset of severe unknown underlying diseases in the context of outpatient surgery.
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Few randomized controlled studies, the only trial design where causality can be established between an intervention and the benefits or harms thereof, have been published on the benefits and risks of a restrictive vs a liberal transfusion strategy. We review the 19 controlled studies on erythrocyte transfusion thresholds published since the eighties. These studies suggest that, overall, morbidity (including cardiac morbidity) and mortality, along with hemodynamic, respiratory and oxygen transport variables, are similar when a restrictive transfusion strategy (transfusion threshold between 7 and 8 g/dL) or a liberal strategy (transfusion threshold of 10 g/dL) are used. ⋯ In conclusion, most recommendations on transfusion practice are limited by the lack of evidence-based data and reveal our ignorance on the topic. High quality clinical trials in different patient populations must become available in order to determine optimal transfusion practices. Since then, a restrictive strategy aiming for a moderately anaemic threshold (7-8 g/dL) is appropriate under most circumstances.
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Ann Fr Anesth Reanim · Jul 2012
Review[From medical complication to compensation for the prejudice].
Claims in anesthesia and intensive care remains high, despite the reduction of morbidity and mortality associated with this activity. The absence of a national register makes it difficult to quantify. The Medical Committee of MACSF-Sou Medical Group, professional liability insurer of more than half of French physicians, provided us support. ⋯ With the establishment of the Regional Commissions of Conciliation and Compensation (RCCI) and the National Office for Compensation of Medical Accident (Oniam), it is now possible for a patient to be compensated for an injury resulting from an accident Medical non-offending, while acknowledging the lack of accountability of the practitioner. The expertise conducted by an RCCI is adversarial. For the practitioner called to the cause, it is important to prepare for both substance and form, with the assistance of the medical board's insurance company.