Annales françaises d'anesthèsie et de rèanimation
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Accident of CPB is a reality. It is important to be prepared for discussion with the family, with the hospital administration, eventually with the justice. But we have also to support perfusionnist and anesthetic team in charge of the patient during accident.
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Ann Fr Anesth Reanim · May 2012
Review[Circumcision in children: an organizational or an ethical challenge?].
To review society, ethical and anaesthesiological issues related to circumcision in children. ⋯ The ethical point associated with circumcision is to allow best analgesia, in a way matching child's age. Analgesia, is achievable by both the surgeon and the anesthesiologist.
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Ann Fr Anesth Reanim · May 2012
Review[Intraoperative ventilatory strategy in cardiac surgery: towards a multimodal approach].
Cardiac surgery with or without cardiopulmonary bypass (CPB) remains associated to respiratory morbidity. The underlying mechanisms are multiple. ⋯ The limitation of the inspired fraction, assisted ventilation controlled with low tidal volume, maintenance of ventilation during CPB and finally, a maneuver of vital capacity are the main components of respiratory management. Thus, to be fully effective, these strategies should be integrated into a multimodal approach starting from the induction and followed until ICU.
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Ann Fr Anesth Reanim · May 2012
[Neurological complications of the regional anesthesia: analysis of the expertises and conclusions of the Regional Commissions for Conciliation and Compensation].
All the files of complications of regional anaesthesias requiring an expertise for a Regional Commission for Conciliation and Compensation for medical accidents (CRCI) between 2003 and 2008 were analyzed. The objective was to estimate the homogeneity of the appointed experts, their opinions and the opinions of the CRCI. Querying the database, shared by the National Office for Compensation for Medical Accidents (ONIAM) and the CRCI, and identified 40 files corresponding to the selection criteria. ⋯ Damages assessed were highly variable, but the given evidence provided to understand why. The CRCI have generally followed the opinions of the experts, except in a few cases where the evidence allowed a different opinion without requiring a new expertise. In conclusion, the abnormalities in the appointment of experts do not seem to have had consequences in terms of damage assessment, but may alter the balance between causes faulty and not faulty, in favour of the latter.
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A 4 year old girl is referred to our institution for resection of a nephroblastoma with an extension of the tumor into the lumen of the inferior vena cava. To perform a correct resection of the tumor, the operation was conducted under cardiopulmonary bypass. ⋯ As the procedure was unventful, and no other cause of air emboli was found, the etiology of this emboli is problably retrograde because of the large opening of the inferior vena cava that was required to remove the tumor. To avoid similar case the use of transcranial doppler monitoring may be of interest.