Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Nov 2003
Review[Critical review of the literature concerning the comparative use of two antiseptic solutions before intravascular or epidural catheterization].
To analyze the most pertinent data from the literature concerning the use of an antiseptic solution before the elaboration of invasive procedures such as blood cultures, insertion of peripheral or central intravenous catheters, and arterial or epidural catheters, and to identify, if any, the "ideal" antiseptic or, at least, the most efficient. ⋯ Even if the in vitro studies favor iodine products, chlorhexidine in alcoholic solution seems more efficient than povidone iodine in aqueous solution in the clinical setting. Several explanations are suggested to understand the in vitro/in vivo discordances. The place of povidone iodine in alcoholic solution, whose performances on the healthy skin are similar to those of alcoholic chlorhexidine, is being in evaluation.
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To evaluate recent data provided on new treatments of patients with septic shock. ⋯ The improvement of survival in septic syndrome patients is a difficult challenge. The uses of different new therapeutic options like protein C reactive, steroids, or early goal therapy in association should make it possible to reduce the mortality in septic patients.
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Ann Fr Anesth Reanim · Nov 2003
[Factors associated with laparoscopic approach for cholecystectomy, appendicectomy and inguinal herniorraphy in France].
To determine on a national level the factors associated with the use of laparoscopy for digestive surgery. ⋯ These data obtained from a large national survey confirmed the higher frequency of laparoscopy in middle aged patients, female (except for inguinal herniorraphy), without important comorbidity, in private hospitals. Laparoscopy was associated with prolonged procedures and with a change in the anaesthetic technique for appendicectomy and inguinal herniorraphy: tracheal intubation was almost constantly used. Whatever the procedure, closed circuit anaesthesia was more frequently used when surgery was performed under laparoscopy, reflecting newer equipment of the hospital, private or public.
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Ann Fr Anesth Reanim · Nov 2003
Case Reports[Value of a long duration temporary caval filter in critical thrombo-embolic situations].
In the event of proximal venous thrombosis with a risk of pulmonary embolism, contraindications to or complications of anticoagulant treatment are not uncommon in surgical or intensive care units. These are worrying but temporary situations and represent a classic indication for partial interruption of the inferior vena cava, for which permanent caval filters are not usually suitable. Temporary filters are an attractive option in this context, as long as they are safe and stable, can be left in place long enough to permit normalization of the thrombosis and anticoagulation problems and can then be removed in all circumstances, whether or not they have trapped a thrombus while in place. ⋯ The filters were removed without any difficulty after 4 and 6 weeks. We did not observe any complications related to infection or migration. Monitoring is recommended throughout the implantation period, in order to identify any clots trapped in the filter and to monitor their lysis or non-emboligenic fibrous structure, authorising removal of the filter.