Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1994
Case Reports[Arterial embolism caused by an intra-aortic thrombus or a patent foramen ovale? Diagnosis by transesophageal echocardiography].
This case report demonstrates the value of transoesophageal echocardiography (TOE) in comparison with transthoracic echocardiography as it allows a better view of the thoracic aorta, the auricles, the interauricular septum and the cardiac valves, especially in the intubated and ventilated patients. A 84-year-old woman was admitted to the ICU for hypoxia after carotid-subclavian bypass surgery for acute ischaemia of the left upper limb. ⋯ The patient died on the 8th postoperative day from refractory hypoxia. the autopsy confirmed the pulmonary embolism and the intraaortic thrombi. It is concluded that TOE, readily feasible is indicated in case of hypoxia, shock and systemic embolism without cause immediately recognizable, especially in ventilated patients.
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Ann Fr Anesth Reanim · Jan 1994
Case Reports[Value of fiberoptic bronchoscope in children with epiglottitis].
Acute epiglottitis is an infectious disease causing a severe respiratory distress. Any attempt to move the child in the horizontal position or to examine his throat can result in cardiac arrest. Diagnosis, endotracheal intubation as well as decision making of the optimal time for extubation are greatly facilitated by the use of a fiberoptic bronchoscope. ⋯ The expiratory flow blows bubbles of saliva, which guide the bronchoscope to the glottis. When the internal diameter of the endotracheal tube is larger than 4 mm, the bronchoscope is used as a guide. When it is less than 4 mm. the bronchoscope is inserted in the trachea with a guide wire slipped in the operating channel; the bronchoscope, but not the wire is withdrawn and the endotracheal tube is inserted over the guide wire.(ABSTRACT TRUNCATED AT 250 WORDS)
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Two cases of severe accidental hypothermia (core temperature below 25 degrees C) are reported. Both occurred in an urban area during the same winter period. Both patients had the same age and similar clinical symptoms. ⋯ Therefore a rapid rewarming via a cardiopulmonary bypass was preferred. The patient died from a prolonged shock with disseminated intravascular coagulation. The use of cardiopulmonary bypass which is essential in case of cardiac arrest rhythm, is controversial in case of severe hypothermia with a still beating heart.
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Ann Fr Anesth Reanim · Jan 1994
Comparative Study[Comparison of cardiac output measured continuously by thermodilution and calculated according to Fick's principle].
Recently, a thermodilution technique for continuous measurement of cardiac output was introduced. The aim of this study was to evaluate the accuracy of continuous cardiac output measurement using the thermodilution technique (CCO) and to assess the correspondence between CCO and cardiac output obtained with the Fick's principle (Fick-CO). Nine patients were studied in the postoperative period after cardiac surgery. ⋯ However, the accuracy of CCO is acceptable. The technique does not require any user calibration and eliminates the need of bolus injections. Further studies are necessary to determine the benefits of this new technique in the various clinical situations.
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An unknown myopathy can be revealed by the administration of an anaesthetic agent. The symptoms are those of malignant hyperpyrexia (MH). The MH phenotype can be detected by means of contracture tests in vitro. ⋯ Myopathy is difficult to diagnose, either because the patient undergoes surgery before being symptomatic or because he is only a carrier of MH. In case of an abnormal reaction following the administration of recognized triggering agents or the occurrence of MH, the procedure should be discontinued. In case of absolute necessity, the procedure may be continued but with non-triggering agents only.