Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · Dec 2013
Review[Anesthesia in spontaneous ventilation for difficult intubation.]
Difficult intubation in children is rare and often predictable during anesthesia consultation. This allows to establish a strategy to provide fiberoptic guided tracheal intubation with spontaneous ventilation in function of age and children pathology. A good knowledge of physiologic and anatomic children particularities, of fiberoptic technique and the respect for some principles lead to ensure the security of this procedure. ⋯ Finally, third principle is to ensure patient oxygenation with several techniques like use of endoscopic facial mask or nasopharyngeal tube. The use of laryngeal mask is a rescue technique in case of spontaneous ventilation lost. In conclusion, each institution has to establish an algorithm with his own knowledge, constantly feasible and regularly taught.
-
An increasingly amount of evidence suggests that lung ultrasonography constitutes a relevant complementary diagnostic tool for adults patient in acute respiratory failure. A comprehensive and standardized ultrasonographic semiology has been described, relying on accurate and reproducible data directly obtained at patient's bedside. ⋯ Pioneers works in this field have suggested an attractive similarity between the ultrasonographic patterns described in adults and children. Nevertheless, the clinical usefulness of lung ultrasonographic approach in the pediatric critical care medicine still needs to be confirmed by specifically designed studies.
-
Ann Fr Anesth Reanim · Dec 2013
Observational Study[Impact of a trauma network on mortality in patients with severe pelvic trauma.]
To evaluate the impact of a regional trauma network on intra-hospital mortality rates of patients admitted with severe pelvic trauma. ⋯ The regional trauma network could screen the most severely injured patients with pelvic trauma to admit them at a level I trauma centre. The observed mortality of these patients was lower than the predicted mortality despite increased time from trauma to admission.
-
Ann Fr Anesth Reanim · Dec 2013
Case Reports[Hypoxic accident during pediatric anesthesia due to an inappropriate setting of respirator.]
A 3-year-old child was anesthetized for ENT examination and surgery. After induction and tracheal intubation, the patient was ventilated (controlled mode). The respirator screen showed information compatible with a failure of intubation: no expired CO2, no expired flow, no alarm of high pressure limit, and no respiratory chest movement. ⋯ The expiratory CO2 was present when the patient was ventilated manually and disappeared under controlled ventilation. The increase in the value of the maximal insufflation pressure allowed efficient ventilation with an expiratory CO2 curve and showed high ventilation pressure compatible with a bronchospasm. This case report shows that in case of bronchospasm, if the value of the maximal insufflation pressure is low, this may lead to an erroneous diagnosis of failure of intubation.
-
Regarding immediate post-anaesthesia problems, one must distinguish slow awakening and the apparition of neurologic or behavioural problems. Post-anaesthesia delirium, an usual cause of transient agitation in the recovery room following halogenated-based anaesthetic, is not included in this discussion. ⋯ Slow awakening is usually caused by overdose, either absolute or relative. Regarding the occurrence of neurologic or behavioural problems, one must consider situations at risk, patients at risk, the consequences of iatrogenicity but also the unknown cerebral tumour or metabolic disorder.