Annales françaises d'anesthèsie et de rèanimation
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The femoral vein is a convenient venous access site which has remained relatively neglected since earlier reports of major complications. However, over the last 10 years, its beneficial use for various purposes (mainly haemodialysis) justifies a reexamination of the value of femoral venous catheterization. The ease of femoral catheterization and its complications were prospectively studied in 92 intensive care patients. ⋯ Percutaneous catheterization of the femoral vein might therefore be considered as a good venous access route. It can be successfully used by inexperienced physicians. There is no serious risk of injury to surrounding structures and the risks of thrombosis and infection are acceptable in comparison with other routes.
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Ann Fr Anesth Reanim · Jan 1989
Case Reports[A mistake in the filling of a vaporizer detected by an infrared analyser of halogenated anesthetic agents].
An anaesthetic pitfall related to an incorrectly filled vaporizer, without harmful effects on the patient, is reported. A halothane specific vaporizer has been accidentally partially filled with enflurane. The incident was suspected when the Datex Normac infrared analyser, calibrated for halothane, displayed an inspired concentration of 0.83% v/v, whereas the Dräger Vapor 19 vaporizer dial was set to deliver 0.4% v/v with a fresh gas flow of 2.7 l.min-1 to a circle system. ⋯ It may therefore be possible to detect a vaporizer filling error when the values "measured" by the analyser are not in concordance with those set on the vaporizer. Filling an enflurane vaporizer with halothane is more dangerous, as it results in a high halothane output with a Normac "enflurane" inspired concentration remaining very low. The indexed pin safety system remains the best means of avoiding wrong vaporizer filling.
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A rare case of post-traumatic pleural effusion is reported. A 19 year old male patient was admitted after a road traffic accident with a scalp wound, femoral shaft fracture and haematuria related to a ruptured bladder. Shortly after extubation following bladder surgical repair, the patient had to be reintubated because of acute respiratory failure. ⋯ The liquid was sero-haematic and contained a high concentration of creatinine (839 mumol.l-1). Thoracic CT scan and intravenous urography displayed a left epirenal collection and a dilatation of the upper urinary tract with rupture of the renal pelvis. The surgical treatment of this urinothorax consisted of the rupture repair of the posterior diaphragm and of the urinary tract.
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Four different techniques of retrograde tracheal intubation were studied in 77 cadavers (patients who had died less than 4 h before). None had any laryngeal disease or a previous intubation. Following techniques were evaluated: cricothyroid membrane puncture; infracricoid puncture; catheter guide inserted through the endotracheal tube; catheter guide only inserted through the distal lateral eye (Murphy eye) of the endotracheal tube. ⋯ All 20 attempts were successful when infracricoid puncture was used and the guide passed through the distal lateral eye of the endotracheal tube. The different techniques and equipment needed are discussed in the light of the available literature. Retrograde tracheal intubation seems to be an easy and useful technique, which all anaesthetists should know, in case of difficult intubation.
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Ann Fr Anesth Reanim · Jan 1989
Case Reports[Practical approaches for surgical procedures in congenital factor VII deficiency].
A 33 year old female with a congenital deficit in factor VII underwent four operations, all without any haemorrhage. One of then was carried out using substitutive therapy. She had a non-A non-B hepatitis one month after this treatment. ⋯ Such a dose should be administered in either one or several injections, according to whether the risk of haemorrhage is important or not. Substitutive therapy should be continued as long as the risk persists. Using a test dose of factor VII and, afterwards, measuring its biological activity can help to determine the best time for starting the treatment in order to obtain a level of factor VII greater than the minimum required for surgical haemostasis (10%).