Annales françaises d'anesthèsie et de rèanimation
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Cardiac surgery and cardiopulmonary bypass (CPB) have made significant progress in recent years. Despite these efforts, adverse events continue to occur during surgery. From recent studies of incidents and accidents during CPB, this article focuses on critical recommendations to respect when in charge of a CPB. ⋯ Others have not proven their benefit in terms of postoperative morbidity or mortality. The management of anticoagulation, hematocrit, pump flow, and the temperature is discussed. Finally, the importance of teamwork especially in terms of cohesion and communication is highlighted.
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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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Extracorporeal circulation (ECC) has to ensure homeostasis of the patient and to minimize pathophysiological disorders inherent in the technique. However, we cannot dissociate it from the surgery and anesthesia knowing that the discipline involves a close partnership with these stakeholders. The purpose of this publication is to review the essential elements that at present can contribute to the quality of the CEC and suggest improvements and developments to be implemented in this area.
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Ann Fr Anesth Reanim · Apr 2014
Case Reports[Two cases of pneumocephalus following noninvasive continuous positive airway ventilation after transsphenoidal neurosurgery.]
The early use of continuous positive airway pressure ventilation has been shown to be effective and is recommended for patients with obstructive sleep apnea. The complications of continuous positive airway pressure ventilation are not well described. ⋯ In both cases, pneumocephalus caused major morbidity and required specific treatment and prolonged considerably hospital stay. Based on these observations we believe new precautions in the use of noninvasive continuous positive airway pressure ventilation should be recommended.
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Ann Fr Anesth Reanim · Apr 2014
Observational Study[Tracheostomy in French ICUs and patient outcome: National opinion survey.]
Tracheostomy is a frequent procedure in ICU but patient follow-up and management after ICU has been poorly documented. We conducted a practice survey in French general ICUs and in neurointensive care units concerning tracheostomized ICU patients and their management after ICU. ⋯ Tracheostomy is a frequent procedure, mostly percutaneous. Indications and timing for tracheostomy correspond to the recommendations. Reported difficulties in post-ICU management are important and present nationwide.