Annales françaises d'anesthèsie et de rèanimation
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In 2003 were promulgated the texts regulating rest and safety, in the USA (approved by the ACGME) and in France (January 9th, 2001 and September 14th, 2001). The institution of the "rest for safety", an eleven hours duration interruption of activity, immediately after a night-call, can be viewed as a progress in the search for safety. Several studies showed a link between excessive work hours and occurrence of medical incidents related to tiredness. ⋯ The idea that taking the necessary rest would be synonymous with a decrease of efficiency in patient care is not demonstrated, but the danger of a poorer information transmission should be handed with an optimization of our manpower and organization. Aging is accompanied by a progressive disorganization of sleep. The foreseeable shortage of manpower, synonymous with aging of the medical actors and increased vulnerability to tiredness, is a posteriori the justification of the institution of the rest for safety.
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Ann Fr Anesth Reanim · Jul 2007
["Difficult intubation" workshops : impact on knowledge and practices].
To evaluate the impact of difficult intubation workshops on airway management knowledge and daily medical practice in anaesthesiology. ⋯ These results showed that difficult intubation remains a real problem for anaesthesiologists. They also revealed differences between subjective and objective knowledge and pointed out defects in terms of organization and management which should be improved.
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Ann Fr Anesth Reanim · Jul 2007
Case Reports[Refractory hypoxemia treated early by HFO in a severe traumatic brain injury patient].
A 23-year-old man without previous medical history, was transferred to our surgical intensive care unit for management of a traumatic brain injury (Glasgow Coma Score of 3 on admission). He rapidly presented a refractory hypoxaemia essentially due to posterior alveolar collapse. Severe hypoxaemia and hypercarboxaemia didn't respond to conventional ventilation and complicated the management of the brain injury and the control of intracranial pressure. The introduction of high-frequency oscillatory ventilation permitted a respiratory improvement in 48 hours and a good neurological outcome.
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Ann Fr Anesth Reanim · Jul 2007
Case Reports[Hypertriglyceridemia-induced pancreatitis in pregnancy. A case report].
We report the case of a 31-year-old pregnant patient in the 33rd week of gestation, with no history of dyslipidaemia, admitted for sub-acute epigastric pain. The milky aspect of blood samples was remarkable. Blood analysis showed a moderate increase in pancreatic enzymes but a major hyperlipaemia: triglyceridaemia 113 g/l and total cholesterolaemia 25 g/l. ⋯ Rapid clinical improvement allowed discharge from intensive care at day 3. This case report illustrates lipid decrease with undertaken treatments. We discuss the management of hypertriglyceridemia-induced pancreatitis in pregnancy.
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Ann Fr Anesth Reanim · Jul 2007
Case Reports[Isolated severe neurologic disorders in post-partum: posterior reversible encephalopathy syndrome].
Just after Caesarean section for twin pregnancy and feto-pelvic dysproportion, a woman presented severe headaches and arterial hypertension, then blurred vision, then generalised seizures. There were no oedematous syndrome, proteinuria was negative, ASAT were 1.5 N and platelet count was 120,000/mm(3). Cerebral CT-scan was normal. ⋯ PRES has to be evoked in post-partum central neurological symptoms, even in absence of classical sign of pre-eclampsia, like proteinuria. PRES and eclampsia share probably common physiopathological pathways. There management and prognosis seems identical.