Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Dec 2013
Case ReportsMaintenance of unconsciousness with low plasma propofol concentrations in the neohepatic phase of liver transplantation using bispectral index-guided propofol anesthesia: A case report.
The authors present a case where a drug-effect parameter, the bispectral index, was used to guide propofol infusion when propofol-remifentanil anesthesia was used for liver transplantation. The target concentration of remifentanil was kept constant throughout the operation, and the bispectral index indicated that propofol infusion was not required during the anhepatic and neohepatic phases of the operation. The measured plasma propofol concentrations during the neohepatic phase were far below the usual values that are used to maintain anesthesia. ⋯ The patient regained consciousness rapidly several minutes after administration of neostigmine and cessation of remifentanil infusion. The measured plasma propofol concentrations were similar before and after recovery of consciousness. The possible mechanisms for the maintenance of anesthesia at reduced propofol concentrations are multifactorial and may be related to reduced liver function as well as an interaction between propofol and remifentanil or the use of a neuromuscular relaxant to suppress somatic afferent activity.
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Ann Fr Anesth Reanim · Dec 2013
Case Reports[Massive rhabdomyolysis: An uncommon complication of cholesterol embolization syndrome.]
A 79-year-old man with atherosclerosis presented blue toes and livedo reticularis. The patient had eroded aortic atheromatous plaques, and cholesterol embolization syndrome was suspected. An endovascular technique to exclude sources of cholesterol emboli was however performed. ⋯ A massive rhabdomyolysis occurred associated with acute kidney injury and hyperkaliemia treated by continuous renal replacement therapy with regional citrate anticoagulation. Steroids have been introduced and renal function improved. Cholesterol crystals were also found on a skin biopsy, performed before endovascular procedure.
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Ann Fr Anesth Reanim · Dec 2013
Case Reports[Severe shock after protamine infusion in a neonate undergoing cardio pulmonary bypass.]
Shock after protamine infusion are rare. We report here the case of a 6-day-old boy having presented severe and recurring hypotensions after protamine infusions during cardiac surgery under cardio pulmonary bypass. The physiopathology of these reactions is complex and, in the presented case, involved mechanism may not be anaphylactic.
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Ann Fr Anesth Reanim · Dec 2013
[Paediatric anaesthesia outside the operating theatre suite: The situation in Germany and Quebec.]
The authors describe the way pediatric anesthesia is organized outside the operating theatre in their country. In Germany, children can be anesthetized outside the operating theater in the hospital but also outside the hospital according to the concept of office-based anesthesia. National recommendations have been published and their revision is currently underway. In Quebec, pediatric anesthesia outside the operating theatre is well organized in order to ensure quality of care, patient's safety and efficiency of the system.