Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · May 2014
Review[Simulation in healthcare in North America: Update and evolution after two decades.]
Update on simulation-based education and its evolution in North America. ⋯ Simulation is fully integrated in healthcare in North America and represents one of the main elements for healthcare professional education. Simulation is also a symbol of excellence for health and teaching institutions. The evolution of simulation in North America is likely to inform the future of simulation in France.
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Ann Fr Anesth Reanim · May 2014
Review[Perioperative conflicts between anaesthesiologists and surgeons: Ethics and professionalism.]
In the perioperative period, several potential conflicts between anaesthetists/intensive care specialists and surgeons may exist. They are detrimental to the quality of patient care and to the well-being of the teams. They are a source of medical errors and contribute to burn-out. ⋯ The teaching of communication techniques that begins with the initial training, the evaluation of team behaviours (through simulation training for example), the respect of others' constraints, particularly when it comes to learning, as well as transparency regarding conflicts of interests, are all additional elements of conflict prevention. Lastly, conflicts may at times be caused by deviant behaviours, which must be met with a clear and uncompromising collective and institutional approach. This article concludes by offering a standardised approach for conflict resolution.
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Ann Fr Anesth Reanim · May 2014
Review[The initial management in intensive care of pelvic ring injury patients.]
Pelvic trauma care is complex since it is frequently associated with multiple injuries and may lead to dramatic and uncontrollable haemorrhage. After pelvic trauma, the mortality, around 8 to 10%, is mainly related to severe pelvic hemorrhage but also to extrapelvic injuries (thoracic, abdominal or brain injuries). ⋯ This review was performed with a systematic review of the literature; it describes the pelvic fracture pathophysiology, and the efficacy and safety of haemostatic procedures and with their respective indications. A decision making algorithm is proposed for the treatment of trauma patients with pelvic fracture.
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Ann Fr Anesth Reanim · Apr 2014
Review[Veno-venous extracorporeal oxygenation and veno-arterial extracorporeal oxygenation. Questions, answers.]
A round table, organized by the French Society of Perfusion (Sofraperf) at the French national congress on extracorporeal circulations (Perfusion 2013), was attended by perfusionists, anaesthesiologists, intensivists and surgeons around the theme of respiratory veno-venous support and veno-arterial circulatory support with extracorporeal oxygenation in intensive care units. The debate was conducted in a participatory manner by bi-directional questions-answers session between moderators and assistance. The authors report management of this type of therapy that is not perfectly homogeneous, supported on literature data. Cannulae, cannulation, circuit, oxygenator, anticoagulation, control, surveillance, weaning are subject to paragraphs with defined entry whose contents are mutually enriching.
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Ann Fr Anesth Reanim · Apr 2014
Review[Interaction between hypnotic agents and the hypothalamic-pituitary-adrenocorticotropic axis during surgery.]
During stress, the relationship between the central nervous system and the immune system is essential to maintain homeostasis. The main neuroendocrine system involved in this interaction is the hypothalamic-pituitary-adrenal axis (HPA), which via the synthesis of glucocorticoids will modulate the intensity of the inflammatory response. ⋯ Nevertheless, with the large literature on this subject, etomidate seems to be the most deleterious hypnotic agent on the HPA axis function. Its use should be limited when HPA axis is already altered.