Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1996
Review[Indications and role of albumin for vascular loading in trauma patients and during preoperative period].
The use of albumin solutions for volume replacement remains controversial. The last American guidelines recommend the use of albumin for resuscitation in case of a contra-indication of artificial colloids or the requirement of sodium restriction. Recent trials did not show any beneficial effect of albumin on the mortality and morbidity rates. ⋯ For resuscitation, albumin could be used when the recommended upper limit of hydroxyethyl starch vol-ume has been reached and fresh frozen plasma not yet required. During preoperative haemodilution, low molecular weight hydroxyethyl starch has at least the same efficacy as albumin. When a rheological effect is required, albumin could be used.
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Ann Fr Anesth Reanim · Jan 1996
Review[Indications and role of albumin for vascular loading during postoperative intensive care].
Prospective clinical trials comparing human albumin to other plasma volume expanders during the three first postoperative days in adult patients were analysed. Fifteen studies were selected. Nine of them concerned the evaluation during the immediate postoperative period, after cardiac surgery with cardiopulmonary bypass (CPB). ⋯ After cardiac surgery, mainly uncomplicated coronary artery bypass graft or valve replacement, albumin can be substituted by HES. These conclusions are only valid for blood losses below 50% of blood volume. The place of isooncotic albumin for fluid resuscitation in case of blood loss exceeding 50% of blood volume cannot be specified.
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Ann Fr Anesth Reanim · Jan 1996
Review[Three-in-one block or femoral nerve block. What should be done and how?].
The "3 in 1" block and the femoral nerve block are widely used for lower limb surgery and postoperative analgesia. Whether these blocks are in fact a same regional block with two different names or represent definitively two different blocks remains controversial. A large number of anatomical as well as functional variations of the lumbar plexus have been described and complicate a rational analysis of the spread of local anaesthetics following these blocks. ⋯ However, once the "3 in 1" block is well performed, a complete anaesthesia covering the territories of the femoral nerve, the lateral femoral cutaneous nerve, and the obturator nerve occurs. Specific indications of each technique are different: major knee surgery and postoperative analgesia for the "3-in-1" block and leg surgery for femoral nerve block. The best approach for knee arthroscopy remains open for discussion.
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Ann Fr Anesth Reanim · Jan 1995
Review Practice Guideline Guideline[French Society of Anesthesia and Intensive Care. Arterial catheterization and invasive measurement of blood pressure in anesthesia and intensive care in adults].
A group of 13 experts appointed by the French Society of Anaesthesia and Intensive Care has produced the following guidelines for arterial catheterisation and invasive measurement of systemic arterial blood pressure in adults. Teflon or polyurethane catheters are recommended with a maximal size of 18 gauge for femoral and axillary arteries and 20 gauge for the others. For small arteries (radial and pedious arteries) a maximal length of 3-5 cm should be preferred. ⋯ The catheter removal should be considered as an aseptic surgical procedure. The catheter completeness has to be checked. A systematic culture of the catheter is not required.
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Ann Fr Anesth Reanim · Jan 1995
Review[Indications for the use of magnesium in anesthesia and intensive care].
Magnesium (Mg), a cofactor in numerous enzymatic reactions, is often ignored by clinicians, as the symptomatology of Mg depletion is not specific and usually associated with that of the cause of the depletion. Furthermore, the plasma Mg concentration (0.8 to 1.1 mmol. L-1) is only equivalent to one percent of the total body content. ⋯ Mg, because of its calcium channel blocking properties and as it lowers the release of epinephrine, is indicated for surgery of pheochromocytoma. In eclamptic and pre-eclamptic patients, the use of Mg is valuable, but not as an anti-epileptic agent. Other clinical uses of Mg have been proposed, but they are either anecdotal or of uncertain efficiency.