Annales françaises d'anesthèsie et de rèanimation
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Few randomized controlled studies, the only trial design where causality can be established between an intervention and the benefits or harms thereof, have been published on the benefits and risks of a restrictive vs a liberal transfusion strategy. We review the 19 controlled studies on erythrocyte transfusion thresholds published since the eighties. These studies suggest that, overall, morbidity (including cardiac morbidity) and mortality, along with hemodynamic, respiratory and oxygen transport variables, are similar when a restrictive transfusion strategy (transfusion threshold between 7 and 8 g/dL) or a liberal strategy (transfusion threshold of 10 g/dL) are used. ⋯ In conclusion, most recommendations on transfusion practice are limited by the lack of evidence-based data and reveal our ignorance on the topic. High quality clinical trials in different patient populations must become available in order to determine optimal transfusion practices. Since then, a restrictive strategy aiming for a moderately anaemic threshold (7-8 g/dL) is appropriate under most circumstances.
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Ann Fr Anesth Reanim · Jul 2012
Review[How to assess the impact of morbimortality conferences on healthcare quality and safety in ICU ?].
To estimate the morbidity and mortality conferences (MMC) impact in intensive care unit (ICU) setting on quality of care and patients' safety. ⋯ Further studies are required to assess the impact of MMC in the ICU. Based on this literature review, a 4-level evaluation scheme can be suggested: 1) evaluation of MMC implementation in care units and facilities; 2) evaluation of MMC organization; 3) evaluation of MMC on quality of care; 4) evaluation of MMC impact on patients' mortality and morbidity.
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Ann Fr Anesth Reanim · Jul 2012
Review[Catheter-related bladder discomfort in post-anaesthesia care unit].
Catheter-related bladder discomfort (CRBD) is an unrecognized clinical event. Symptoms of CRBD secondary to an indwelling urinary catheter mimic those of an overactive bladder, i.e. urinary frequency and urgency with or without urge incontinence. ⋯ Antimuscarinic drugs, as oxybutynin, are today the main treatment. Further studies are warranted to confirm efficacy of ketamine, tramadol and gabapentin in this situation.
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Ann Fr Anesth Reanim · Jul 2012
Case Reports[Prolonged residual paralysis after a single intubating dose of rocuronium: an unexpected cause].
Postoperative curarization following a single dose of rocuronium is a known risk quickly diagnosed through the monitoring of neuromuscular blockade. Different etiologies can cause a prolonged block. We report the case of a misdiagnosis of prolonged neuromuscular blockade by a failure in the monitoring system of curarization.
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Ann Fr Anesth Reanim · Jul 2012
[Drug's administration via feeding tubes: evaluation of practices in an intensive care unit of a Tunisian hospital].
Drugs' administration via feeding tubes is a potential source of iatrogenic events for the intensive care patients because of the problem of not adapted galenic forms. ⋯ This study shows that it is possible to reduce risk of administration errors in the intensive care unit and to facilitate the administration of drug via feeding tube by prescribing liquid oral form or soluble solid oral form. It also shows the need for cooperation with the pharmacist in order to adapt the galenic forms and to redact protocol of administration.