Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Dec 2011
Review[From iatrogenesis to medical errors: review of the literature and analytical approach].
Iatrogenesis and medical errors have been increasingly studied over the past years. Because of the lack of consensus concerning the definitions, it remains difficult to draw general conclusions from the published. Moreover, it is still likely to be underestimated because of underreporting. This review aims at evaluating the overall incidence of iatrogenesis and medical errors in anaesthesia and intensive care and at discussing the strategies to prevent these incidents, at the individual or systemic level.
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Ann Fr Anesth Reanim · Nov 2011
Review Meta Analysis[Perioperative adverse events related to antidepressive agents use].
Depression is the most common psychiatric disease, which is treated by the use of antidepressive agents possessing various mechanisms of action. Thus, the use in preoperative period of antidepressive agents is frequent (7% of patients scheduled for surgery). The objective of this review was to update the knowledge on the drug interactions between antidepressive agents and drugs used in perioperative period. ⋯ The clinical practice showed a limited risk of adverse event related to antidepressant agents interaction with perioperative used drugs. In the two past decades, few relevant observations of adverse event related with imipramine and monoamine oxidase inhibitors use was reported. The most recent antidepressive agents had no serious adverse interaction. Nevertheless, the serotonin syndrome has to be known as far as it is more and more reported. In case of hypotension, the use of vasopressive agent has to be careful because of excessive response.
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Ann Fr Anesth Reanim · Nov 2011
Review[Epidemiology of war injuries, about two conflicts: Iraq and Afghanistan].
Since March 2003, military operations in Iraq "Operation Iraqi Freedom" (OIF) and in Afghanistan "Operation Enduring Freedom" (OEF), have made many wounded and killed in action (KIA). This article proposes to highlight the specific epidemiology of combat casualties, met in these both non-conventional and asymmetric conflicts. Personal protective equipments, Kevlar helmet and body armor, proved their efficiency in changing features of war injuries. ⋯ This analysis concluded that during modern conflicts, most injuries are caused by explosive devices; injuries are more severe and interestingly more specifically the head region and extremities than the trunk. Hemorrhage is the first cause of death, leading to the concept of avoidable death. Specific databases focused on mechanisms and severity of injuries, diagnostic and treatment difficulties, outcomes can guide research programs to improve war injuries prevention and treatment.
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Ann Fr Anesth Reanim · Oct 2011
Review[Post-surgery cognitive disorders: prevention, diagnosis and treatment strategies].
Hip fracture is an important step in the autonomy evolution in elderly. As gait is particularly jeopardised after such a traumatism, cognition may also be acutely impaired. Elderly post-surgery delirium is frequent, but chronic progression of cognitive impairment and dementia may occur. ⋯ A neurodegenerative disease such as Alzheimer's disease may be clinically silent prior the traumatic event, and may decompensate soon after as the cognitive reserve is not sufficient anymore. Dementia may then lead to progressive autonomy loss. A systematic interdisciplinary approach is needed to prevent frail patients from delirium, and to early cure it to decrease the risk of long-term autonomy loss.
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Hip fracture is a major health burden due to both its frequency and its deep impact on patient's outcome. The key issue of this poor outcome seems to be cardiac complications. The onset of these cardiac complications seems to appear early in the clinical course in the form of perioperative myocardial ischemia that are both preventable and treatable. Their clinical and electrocardiographic pattern is very poor and they can be thoroughly detected by only either a systematic electrocardiographic 12 lead monitoring or troponin dosage.