Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · Oct 2012
Review[Inhaled agents in neuroanaesthesia for intracranial surgery: pro or con].
Isoflurane, desflurane and sevoflurane all preserve cerebrovascular carbone dioxide (CO(2)) reactivity. They are all concentration-dependant cerebral vasodilatators and decrease cerebral metabolism. Sevoflurane induces the smallest cerebral vasodilatation and preserve cerebral autoregulation up to 1.5CAM, compared to isoflurane and desflurane which impair it upon 1CAM. ⋯ Finally, neuroprotective properties have been described in experimental model for all the inhaled agents but clinical proofs are still lacking. In conclusion, for intracranial surgery without any ICHT inhaled agents can be used as a maintenance anesthetic with a preference for sevoflurane. In case of ICHT or a risk of ICHT during the surgery, propofol is preferred for it slightest effect on ICP and cerebral hemodynamic.
-
In tumoral surgery, the risk factors for perioperative epilepsy can be roughly grouped into two categories: those related to the preoperative patient's conditions (type and location of the tumors, their impact on the surrounding brain…) and those specifically related to surgery (cerebral edema, parenchymal hematoma, surgical approach, complete or incomplete resection...). The first category is supposed to be responsible for preoperative and late postoperative epilepsy, while the second would be more related to the risk of epilepsy in the first postoperative week (or may be even in the first 48hours). It is well accepted (but not always respected) by the neuro-oncologists that there is no indication for preventive antiepileptic drugs (AED) in a patient with a brain tumor that has never presented seizure. ⋯ In practice, a modern attitude would restrict prophylactic AED use to the higher risk patients (preoperative epilepsy, temporal astrocytoma, the extent of edema and mass effect...). A drug of last generation should be used, starting one week before surgery. The duration of the treatment should be limited to one week postoperatively in the absence of seizure.
-
Ann Fr Anesth Reanim · Oct 2012
Review Meta Analysis[Early rehabilitation for neurologic patients].
Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. ⋯ Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.
-
Ann Fr Anesth Reanim · Oct 2012
Review[Controversies in neuroanaesthesia: positioning in neurosurgery].
Positioning of the neurosurgical patient has several features such as the existence of specific positions (i.e: sitting, prone hyperlordotic, crouching ou kneeling positions) or the range of facilities for the same surgical indications. The last point, a source of controversy, is the subject of this review. Current indications for the sitting position, positioning for lumbar spine surgery and prevention of eye injuries are successively addressed.
-
Ann Fr Anesth Reanim · Oct 2012
Review[Lung ultrasound: clinical applications and perspectives in intensive care unit].
To describe the use of lung ultrasound in clinical practice and the new opportunities offered by this technology in intensive care unit (ICU) patients. ⋯ Lung ultrasound is an easy, non-invasive, and non-irradiant technology. It brings lot of useful information at the patient's bedside.