Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Apr 2014
Review[Blood transfusion via the cardiopulmonary bypass circuit: The anesthesiologist point of view.]
Cardiac surgery frequently requires blood transfusion. The use of transfusion should be restricted due to side effects. Blood transfusion via the cardiopulmonary bypass (CPB) circuit is easy and allows a fast transfusion. ⋯ Platelet transfusion during bypass is illogical because of the destruction of platelets during CPB and must be avoided. Fresh frozen plasma transfusion during CPB is seldom indicated but is possible. It could reverse heparin resistance.
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Ann Fr Anesth Reanim · Apr 2014
Review[Interaction between hypnotic agents and the hypothalamic-pituitary-adrenocorticotropic axis during surgery.]
During stress, the relationship between the central nervous system and the immune system is essential to maintain homeostasis. The main neuroendocrine system involved in this interaction is the hypothalamic-pituitary-adrenal axis (HPA), which via the synthesis of glucocorticoids will modulate the intensity of the inflammatory response. ⋯ Nevertheless, with the large literature on this subject, etomidate seems to be the most deleterious hypnotic agent on the HPA axis function. Its use should be limited when HPA axis is already altered.
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Ann Fr Anesth Reanim · Apr 2014
A survey of percutaneous chest drainage practice in French university surgical ICU's.
Percutaneous chest drainage guidelines were published in 2010 by the British Thoracic Society. On several points (insertion technique, drain size), they seem to differ from French practices. Our objectives were to evaluate practice of pleural drainage in French University surgical intensive care units (ICU's), and to compare it with the British guidelines. ⋯ The frequent use of trocar (and therefore of large drains) for pleural drainage in French ICU's differs significantly from the British guidelines.
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Ann Fr Anesth Reanim · Apr 2014
In vitro evaluation of diffusion of lidocaine and alkalinized lidocaine through the polyurethane membrane of the endotracheal tube.
Endotracheal tube (ETT) and its inflated cuff are likely to induce specific reactivity at the emergence time. In ICU, the tolerance of the ETT cuff could be a part of patient agitation and increased of sedation. ⋯ The safety, controlled release, and lack of deleterious effects on cuff membrane were confirmed. In case of unexpected cuff rupture, an adequate determination of the mixture allows to obtain a safe solution with the achievement of a physiological pH (7.4) and the small dose of lidocaine (40 mg).
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Ann Fr Anesth Reanim · Apr 2014
Case Reports[Spontaneous pneumomediastinum secondary to inhalation of crack.]
The use of cocaine causes numerous cardiovascular and pulmonary side effects. In this context, the occurrence of a pneumomediastinum represents a specific complication, often misunderstood by primary care physicians. ⋯ A short observation period with outpatient follow-up is appropriate in the majority of patients. Invasive procedures have a low yield and should be based on a high degree of clinical suspicion for esophageal rupture or bronchial tree laceration.