Annales françaises d'anesthèsie et de rèanimation
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Perioperative management of a child with sickle-cell disease requires close collaboration between hematologist, surgeon and anesthetist. The level of preoperative preparation must consider both the surgical risk and the impact of the disease. Preoperative hydration and blood transfusion are the most important part of preoperative management. ⋯ Preoperative assessment of a child with thalassemia must include evaluation of the impact of chronic hemolytic anemia and iron overload induced by repeated transfusions. The most important factor in the management of a child with glucose-6-phosphate dehydrogenase deficiency is to avoid exposure to oxidative stressors. Outpatients should be informed of the risk of hemolytic crisis, and free hemoglobin in the urine should lead to discontinuation of drugs associated with hemolysis and to maintenance of urine output to prevent acute renal failure.
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Ann Fr Anesth Reanim · Dec 2013
Multicenter Study[Multicenter survey on ventilator-associated pneumonia prevention in intensive care.]
Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in intensive care unit (ICU). The aim of the study was to evaluate the follow-up of the guidelines for VAP prevention. ⋯ The compliance to prevention of VAP was poor. Proposals for improving practice are discussed.
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Ann Fr Anesth Reanim · Dec 2013
Review[Hyperbaric oxygen therapy and inert gases in cerebral ischemia and traumatic brain injury.]
Cerebral ischemia is a common thread of acute cerebral lesions, whether vascular or traumatic origin. Hyperbaric oxygen (HBO) improves tissue oxygenation and may prevent impairment of reversible lesions. ⋯ The addition of inert gases to HBO sessions, especially argon or xenon which show neuroprotective experimental effects, may provide an additional improvement of cerebral lesions. Further multicentric studies with a strict methodology and a better targeted definition are required before drawing definitive conclusions about the efficiency of combined therapy with HBO and inert gases in acute cerebral lesions.
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The technology of anesthesia ventilators has substantially progressed during last years. The choice of a pediatric anesthesia ventilator needs to be led by multiple parameters: requirement, technical (pneumatic performance, velocity of halogenated or oxygen delivery), cost (purchase, in operation, preventive and curative maintenance), reliability, ergonomy, upgradability, and compatibility. ⋯ Paradoxically, complex and various available technologies had not been much prospectively studied. Anesthesia ventilators performances in pediatrics need to be clarified in further clinical and bench test studies.
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Ann Fr Anesth Reanim · Dec 2013
Review[How can we determine the best cerebral perfusion pressure in pediatric traumatic brain injury?]
The management of cerebral perfusion pressure (CPP) is the one of the main preoccupation for the care of paediatric traumatic brain injury (TBI). The physiology of cerebral autoregulation, CO2 vasoreactivity, cerebral metabolism changes with age as well as the brain compliance. Low CPP leads to high morbidity and mortality in pediatric TBI. ⋯ Transcranial Doppler can be used to determine the best level of CPP. Other indicators can predict the impairment of autoregulation like pressure reactivity index (PRx) taking into consideration the respective changes in ICP and CPP. Measurement of brain tissue oxygen partial pressure is an other tool that can be used to determine the optimal CPP.