Annales françaises d'anesthèsie et de rèanimation
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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.
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Ann Fr Anesth Reanim · Dec 2013
Review[Ambulatory surgery in France: Practical and medicolegal considerations.]
In France, ambulatory anaesthesia and surgery seem to be well codified. Many recommendations have been published by the Health Authority and the professional associations: they are summarized in this review. However, numerous practical problems persist: for example, two situations specific to paediatric practice are problematic parental comprehension and application of the information provided and poor access to strong analgesics outside the hospital. Despite this, the paediatric population is an ideal target for ambulatory care because of its usual good health and quicker recovery after minor injury as proven by the small percentage of failure and readmission.
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Ann Fr Anesth Reanim · Dec 2013
Review[Interest of the cholinesterase assay during organophosphate poisonings.]
Cholinesterases are the main targets of organophosphorus compounds. The two enzymes present in the blood (butyrylcholinesterase, BChE; acetylcholinesterase, AChE) are biomarkers of their systemic toxicity. ⋯ Better biomarker of the exposure, it allows a diagnosis of the severity of the poisoning and helps to assess the efficacy of oxime therapy. Besides the practical aspects of blood collection and sample processing, and the interpretation of the assays, this review stresses the complementarity of both enzyme assays and recalls their crucial interest for the confirmation of poisoning with an organophosphorus in a situation of war or terrorist attack and for the monitoring of occupational exposures.
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Ann Fr Anesth Reanim · Dec 2013
Observational Study[Postoperative intravenous morphine titration in PACU after bariatric laparoscopic surgery.]
There is limited information available regarding intravenous (IV) morphine administration in obese patients in PACU. The aim of this study was to compare two IV morphine titration (IMT) regimen in two surgical centers. ⋯ Implementation of a IMT regimen in PACU was not associated with effective pain relief after laparoscopic surgery in obese patients.
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Ann Fr Anesth Reanim · Dec 2013
Comparative Study[Endotracheal intubation with the GlideScope(®), the Airtraq(®), the McGrath(®) videolaryngoscope and direct laryngoscopy: A comparative study on an infant manikin.]
The primary purpose of this experimental study was to compare intubation times for direct laryngoscopy with a Miller blade and for 3 VL: GlideScope® videolaryngoscope, Airtraq®, and McGrath®. ⋯ In this infant manikin model, the learning curve of the different VL was 3 attempts and the Airtraq® VL appears the airway device enabling the quickest orotracheal intubation. These experimental results need to be confirmed by clinical studies in infants and children.