Annales françaises d'anesthèsie et de rèanimation
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Adequate instruments for measuring patient outcome after subarachnoid aneurysmal haemorrhage (SAH) are required to interpret results of clinical trials before making clinical recommendations. Graded measures are generally used, e.g. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS). ⋯ The questionnaire assessed their motor activity, vitality and psychological troubles and handicap. Over 84 patients with GOS-5, 55 (65%) had persistent cognitive and psychological troubles including memory deficit, vitality and depressive troubles. Providing the use of combined scales to assess handicap and quality of life, these results suggest that SAH can result in a persistent alteration of cognitive function in patients, even in those classified as having a good outcome using the routine graded scales.
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Delayed neurological deficit occurs among 30% of patients after aneurysmal subarachnoid haemorrhage, mainly related to cerebral vasospasm. The early detection of cerebral ischemia remains problematic. Conventional cerebral monitoring (as intracranial pressure and cerebral perfusion pressure) appears to be insufficient, because cerebral ischemia may occur without elevated intracranial pressure. ⋯ Local monitoring as oxygen tissue partial pressure (PtiO2) and microdialysis are sensible for brain ischemia detection, but may also ignore episodes occurring in non-monitored brain area. For the detection of most episodes of brain ischemia, several monitoring system should be use performing a multimodal intracerebral monitoring. Brain microdialysis and oxygen tissue partial pressure are promising monitoring system.
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Cerebral vasospasm, a recognized complication of aneurysmal subarachnoid haemorrhage, can lead to delayed ischaemic neurological deficit, and death. The systematic administration of nimodipine confers a modest but real benefit against delayed ischaemic damage. When vasospasm occurs, triple-H therapy (hypervolaemia, hypertension, and haemodilution) has long been advocated in order to increase flow, but its usefulness remains unclear. ⋯ In addition, according to phase II randomized trials, promising new treatments for vasospasm or its ischaemic complications include magnesium sulfate, the selective endothelin A-receptor antagonist clazosentan, and statins. The simple and safe profile of prophylactic use of statins appears particularly attractive. However, all these potential candidates need further validation through (on-going) clinical phase III trials.
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Ann Fr Anesth Reanim · Oct 2007
Case Reports[Hyperbaric oxygen therapy as an adjunctive treatment for acute mediastinitis due to oesophageal perforation: a case report].
In spite of antibiotic treatment, of progress of resuscitation and surgery, acute posterior mediastinitis remains associated to a high mortality. We report a case of man with posterior mediastinitis by performing of the cervical oesophagus. While his state remained still with the classic treatment, the contribution of the hyperbaric oxygen therapy quickly improved his state. This therapeutics in addition in the usual treatment could improve the survival in this affection.