Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · May 2011
Review[The basis of ischemia-reperfusion and myocardial protection].
The myocardial infarction represents a major cause of mortality. The deleterious phenomena arising during the ischaemia and the reperfusion of the myocardium are studied for more than 40 years. ⋯ We know now that the reperfusion itself is also a source of noxious effects (calcium overload, free radicals production, mitochondrion alteration). To combat these deleterious processes, two maneuvers demonstrated their efficiency by protecting the ischemic myocardium : it is the preconditioning and the postconditionning.
-
Blood cardioplegia is worldwilde used during cardiac surgery. It provides a safe myocardial protection during this surgery. All along the year blood cardioplegia has been improved but it's of importance to apply it correctly. This can be a disadvantage during some cardiac surgery technics.
-
The prevalence of significant splanchnic arterial stenoses is increasing, but remains mostly asymptomatic due to abundant collateral circulation. Acute insufficiency of mesenteric arterial blood flow accounts for 60 to 70% of cases of mesenteric ischemia and results mostly from a superior mesenteric embolus. Despite major advances have been achieved in understanding the pathogenic mechanisms of bowel ischemia, its prognosis remains dismal with mortality rates about 60%. ⋯ CT and MR-based angiographic techniques have emerged as alternatives less invasive and more accurate to analyse splanchnic vessels and evaluate bowel infarction. The goal of treatment of patients with acute mesenteric ischemia is to restore intestinal oxygenation as quickly as possible after initial management that includes rapid hemodynamic monitoring and support. Surgery should not be delayed in patients suspected of having intestinal necrosis.
-
Ann Fr Anesth Reanim · May 2011
Review Historical Article[MCAU/MRAU session: point of view of the pre-hospital Emergency Medical Services, costs assessment].
Since the 1970s, it has become possible to handle patients with serious pulmonary and cardiac failure with extracorporeal membrane oxygenation (ECMO) when conventional treatment fails, but only in specialized centers. When the latter were too far away, the risks of such transport were considered too high until the Mobile Cardiac Assistance Unit (MCAU) and Mobile Respiratory Assistance Unit (MRAU) were created. We are first going to expose the point of view of the pre-hospital Emergency Medical Services (EMS). ⋯ D. in need of such assistance should call the cardiac surgeon of the reference center : if the indication is confirmed, they will call the EMS (Service d'Aide Médicale Urgente, SAMU), and decide together which means is the most appropriate for a quick transportation of the team and the ECMO to the patient's bedside, and then back to the ECMO center, depending on the problems raised by ground vehicles on the one hand and aircrafts or helicopters on the other. Then, we are going to evaluate the cost of such transportation, which is quite considerable. As a conclusion, because of its high cost, the mobile inter-hospital ECMO. service should only be used when the patient is considered too ill to be transported on conventional therapy : in that case, this procedure represents huge progress.
-
The ovarian hyperstimulation syndrome (OHSS) is a complication of controlled ovarian hyperstimulation (COH) protocols performed in women undergoing assisted reproductive technologies. This syndrome is characterized by multiple intra-ovarian corpus luteum and constitution of a third space that can lead to a life-threatening situation. Although the pathophysiology remains unclear, vascular endothelial growth factor (VEGF) and other cytokines, secreted under the influence of exogenous gonadotrophins administered for COH, are involved in increasing capillary permeability. ⋯ Mortality rate, though not accurately quantified, is significant (1/45 000 to 1/500 000) and mostly due to thromboembolic complications. The only effective treatment is prevention, by adapting ovarian stimulation protocols to OHSS risk factors. There are no specific treatments and therapy is mainly symptomatic until the condition resolves spontaneously.