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
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[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.
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Different airway devices can be used by paediatrician anaesthesiologists for difficult airway management in infant younger than 2 years. The four devices analyzed (Airtraq® [Prodol Meditec]; Glidescope® Cobalt [Verathon]; Vidéolaryngoscope [Storz]; laryngoscope Truview® [Truphatek]) increase the Cormack and Lehane grade against direct laryngoscopy and optimized external larynx movements. They need training, on manikin then in vivo, for an optimal use. ⋯ The choice between these devices, in accordance with the published studies, which compared the devices, is difficult. The manikin studies allow to standardize airway, but the results are not transposable in vivo. Concerning the airway devices with disposable blade, the Glidescope®, for oral intubation, seems to be better than Airtraq® if we take into account the oropharyngeal volume needed.