Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 2013
Review[Anesthesia for non-cardiac surgery in children with congenital and acquired heart diseases].
The goals of this review are to recall some pathophysiological principles at work in most of congenital heart diseases; to specify factors to be considered when defining perioperative risk for a child with an acquired or congenital heart disease; to describe an anaesthetic management strategy in the context of some specific heart diseases.
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Hyperglycemia is significantly associated with increased mortality in critically ill patients and then, strict control of blood glucose (BG) concentration is important. Lowering of BG levels with intensive insulin therapy (IIT) was recommended in order to improve patient outcomes. But recently, some recent prospective trials failed to confirm the initial data, showing conflicting results (significantly increased mortality with IIT, more hypoglycemic episodes). ⋯ A difference in variability of BG control could explain why the effect of IIT varied from beneficial to harmful. Managing and decreasing this BG variability could be an important goal of BG control in critically ill patients. Clinicians have to consider definitions, physiopathology and impacts of glucose variability, in order to improve patient outcomes.
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Ann Fr Anesth Reanim · Nov 2012
Review Case Reports[Impaired consciousness associated with a hysterical conversion after obstetrical epidural analgesia: a case report with literature review].
The occurrence of impaired consciousness after epidural analgesia is an alarming situation that requires urgent diagnostic and therapeutic approach. Various causes may be responsible for such a state. Hysterical conversion remains an outstanding issue. Through a clinical case of a hysterical conversion and a literature review the authors draw attention to the difficulty of diagnosing this entity after epidural analgesia.
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Ann Fr Anesth Reanim · Nov 2012
Review[Atrial fibrillation: from cardiology to perioperative management].
Atrial fibrillation (AF) is the most frequent arythmia. During the perioperative period and in intensive care units, management of patients with AF is frequent and difficult. As in cardiology, two main issues are present: the risk of acute hemodynamically instability and the risk of thromboembolic complication. ⋯ Two main factors must be kept in mind: acute AF in these situations are often of short duration; the risk of anticoagulation can be superior to the risk of thrombotic complication in this situation. An individualized benefit-risk analysis must be done in each patient. New treatments, antiarrhythmic or mainly antithrombotic drugs, are under evaluation and will be soon available.
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Ann Fr Anesth Reanim · Nov 2012
Review[Dexmedetomidine and clonidine: a review of their pharmacodynamy to define their role for sedation in intensive care patients].
Alpha-2 adrenergic agonists ("alpha-2 agonists") present multiple pharmacodynamic effects: rousable sedation, decreased incidence of delirium in the setting of critical care, preservation of respiratory drive, decreased whole body oxygen consumption, decreased systemic and pulmonary arterial impedance, improved left ventricular systolic and diastolic function, preserved vascular reactivity to exogenous catecholamines, preserved vasomotor baroreflex with lowered set point, preserved kidney function, decreased protein catabolism. These pharmacodynamic effects explain the interest for these drugs in the critical care setting. ⋯ Given the few double-blind randomized multicentric trials available, the present non exhaustive analysis of the literature aims at presenting the utilization of alpha-2 agonists as potential first-line sedative agents, in the critical care setting. Suggestions regarding the use of alpha-2 agonists as sedatives are detailed.