共查询到20条相似文献,搜索用时 46 毫秒
1.
2.
3.
O. Desebbe J. NeideckerO. Bastien J.-J. Lehot 《Annales fran?aises d'anesthèsie et de rèanimation》2013
Paediatric pulmonary arterial hypertension (PAH) is a challenge for the paediatric anaesthetist. Due to its high morbidity and mortality, support should be provided by a dedicated team. Understanding the pathophysiology of PAH allows performing an appropriate therapeutic approach. In case of high vascular pulmonary resistance, the main objectives of anaesthetic management are to maintain an optimal pulmonary flow and to avoid the decrease in systemic arterial pressure. Haemodynamic monitoring is essential to detect the onset of an acute PAH crisis but also to give direct information on the efficacy of treatment. 相似文献
4.
J. Turc A. LamblinF. Klack P.-F. WeyJ.-Y. Martinez 《Annales fran?aises d'anesthèsie et de rèanimation》2012
Anaesthetic management of patients with pulmonary hypertension is challenging and alternatives to general anaesthesia are encouraged. We report anaesthetic management of two patients with pulmonary hypertension admitted for femoral neck fracture. In order to reduce the risk of right-sided heart failure and systemic hypotension, it was decided to operate the patients under continuous spinal anaesthesia. Anaesthesia was induced with excellent hemodynamic tolerance. Quality and extension of the block was correct and allowed surgery. No postoperative complication was observed. These cases suggest that continuous spinal anaesthesia may be considered for the management of patients with pulmonary hypertension undergoing femoral neck fracture surgery. 相似文献
5.
E. Couchot O. PautO. Ghez A. CharpentierF. Ughetto 《Annales fran?aises d'anesthèsie et de rèanimation》2009
Pertussis is a leading cause of death from community infections in infant. Life-threatening clinical presentations of pertussis can associate multiple organ system failure with respiratory distress. The question of the optimal management of these severe forms of pertussis, in order to reduce the high mortality rate, is raised by the clinicians caring for such patients. We report the case of a 1 month infant who was admitted to the pediatric intensive care unit (PICU) for a severe pertussis. He presented with an acute respiratory distress syndrome, a severe pulmonary hypertension was treated initially with mechanical ventilation and nitric oxide. At day 4 (D4), a cardiogenic shock occurred and, despite epinephrine and norepinephrine infusion, fluid expansion, the hemodynamic condition worsened with two episodes of cardiac arrest. The child was then successfully resuscitated, and, facing the extreme hemodynamic instability, extracorporeal membrane oxygenation (ECMO) was considered. ECMO allowed epinephrine and norepinephrine to be progressively discontinued, and protective mechanical ventilation. ECMO withdrawal was possible at D9, with milrinone as the sole inotropic agent. Weaning from mechanical ventilation was possible on D15 and the total length of stay in PICU was 20 days. While the analysis of the literature, through limited experiences on the use of ECMO in children with severe pertussis does not allow concluding definitively on the utility of ECMO in this situation, the contribution of ECMO in the favourable outcome for our patient was considerable. This is an argument, to our opinion, for considering ECMO in the management of those very instable patients. 相似文献
6.
F. Julien A. Mosolo J.P. Hubsch R. Souilhamas D. Safran B. Cholley 《Annales fran?aises d'anesthèsie et de rèanimation》2010
Respiratory support using extra corporeal membrane oxygenation (ECMO) is rarely used in the setting of adult lung surgery, with the exception of lung transplantation. We report the case of a patient with pulmonary aspergilloma, for whom selective bronchial intubation was required to facilitate surgery. Intolerance to unilateral ventilation was anticipated due to poor underlying lung function. Intra-operatively, an attempt to lung exclusion was responsible for severe hypoxemia. The use of veno-venous ECMO allowed to improve oxygenation and lung resection was carried out successfully at the expense of major intra-operative bleeding. 相似文献
7.
W. Naija E. Gayat B. Lortat-Jacob A. Mebazaa 《Annales fran?aises d'anesthèsie et de rèanimation》2009
Objective
The purpose of this review was to present an update of the anaesthesic management in patients with right ventricular failure (RVF).Data sources
All references obtained from the medical database Medline® related to the area and more specifically during the last five years were reviewed.Data synthesis
The preanaesthesic visit leads to identify the etiology of RVF, to evaluate the functional reserve of the patient, to plan complementary exams and to inform the patients about the risks associated with the perioperative period. During the peroperative period, the monitoring depends of the severity of the illness; however the invasive monitoring of the systemic blood pressure seems always necessary. Any hemodynamic instability should be avoided during the peri-operative period. Since the risk of death is maximal in the first days after the anaesthesia, the patient is ideally managed in intensive care during this period.Conclusion
Right ventricular failure is often misestimates. However, the perioperative morbidity and mortality of patients with RVF are important. In the perioperative period, the anaesthesiologist should identify patients at risk of right ventricular failure in order to adapt their management. 相似文献8.
L. Lonjaret O. Lairez V. Minville F. Bayoumeu O. Fourcade F.J. Mercier 《Annales fran?aises d'anesthèsie et de rèanimation》2013
Objective
Pulmonary embolism remains a leading cause of maternal death in France and in other developed countries. Prevention is well codified, but management remains complex both for diagnosis and therapeutics. The objective of this review was to update the knowledge on diagnosis and treatment of pulmonary embolism during pregnancy.Article type
Review.Data source
Medline® database looking for articles published in English or French between 1965 and 2012, using pulmonary embolism, pregnancy, heparin, thrombolysis and vena cava filter as keywords. Editorials, original articles, reviews and cases reports were selected.Data synthesis
Pulmonary embolism is one of the leading causes of maternal death in France. Clinical signs and biologic tests are not specific during pregnancy. Doppler ultrasound is helpful for diagnosis and avoids maternal and fetal radiation. Treatment is based on full anticoagulation. Low molecular weight heparin is the treatment of choice. A temporary vena cava filter may be proposed, especially at the end of pregnancy, or when heparin is contraindicated. In case of pulmonary embolism with cardiogenic shock, thrombolysis is an alternative treatment.Conclusion
Diagnostic approach is first based on the use of ultrasound- Doppler, and frequently on-to computed tomographic pulmonary angiography or ventilation–perfusion lung scanning. The treatment is based on low molecular weight heparin. Others therapeutics, such as thrombolysis or temporary vena cava filter, may be useful in certain circumstances. 相似文献9.
A. Renard A. Valla J. Sedat C. Ichai H. Quintard 《Annales fran?aises d'anesthèsie et de rèanimation》2010
Pulmonary embolism is a common disease with a mortality rate of approximately 3%. Polytraumatised patients are particularly susceptible to thromboembolism because of prolonged immobilisation and inflammatory syndrome, thrombembolic risk also increases significantly during the peripartum period. Rapid diagnosis and intervention are essential for survival. Conventional treatment consists of systemic intravascular thrombolysis, but this procedure is often contraindicated in intensive care patients because of the high risk of haemorrhage. We report two cases of successful treatment using radiological endovascular thrombectomy. 相似文献
10.
S. Aknin M. Frappart R. Berguiga J.-M. Malinovsky 《Annales fran?aises d'anesthèsie et de rèanimation》2014
Acute postoperative negative pressure pulmonary edema with hemoptysia as a complication of general anesthesia is seldom. Its is related to an obstacle on airway, with important negative intrathoracic depression during inspiration leading to pulmonary edema and hemoptysia. Physiopathology and treatment of such complication have been discussed. 相似文献
11.
We report a case of partial thyroidectomy under ultrasound-guided regional anesthesia, according a new anterior approach, in a patient with a severe primitive pulmonary hypertension. 相似文献
12.
L. Lonjaret O. Lairez O. Fourcade V. Minville 《Annales fran?aises d'anesthèsie et de rèanimation》2012
We report the use of continuous spinal anesthesia for hip fracture surgery in a patient with pulmonary arterial hypertension. Preoperative evaluation, anesthetic technique and preoperative monitoring are discussed. 相似文献
13.
Q. Reynaud J. Catella E. Diconne P. Lafond B. Tardy 《Annales fran?aises d'anesthèsie et de rèanimation》2014
Lower limbs superficial venous thrombosis (LLSVT) is usually considered as common and of a benign prognosis. LLSVT can, however, be responsible for major thromboembolic complications: lower limbs deep vein thrombosis (LLDVT) and pulmonary embolism (PE). We report a case of a LLSVT complicated with a massive bilateral PE and an ischemic cerebral stroke, occurring immediately after a varicose vein surgery. Venous ultrasonography of the lower limbs must be systematically performed in case of LLSVT, in order to evaluate the presence of an associated LLDVT. A rigorous diagnostic and therapeutic approach is the only way to optimize the treatment of this disorder, and to avoid the occurrence of dramatic venous thromboembolic complications. 相似文献
14.
V. Royon P.-G. Guitard C. Abriou N. Frebourg J.-F. Menard T. Clavier B. Dureuil B. Veber 《Annales fran?aises d'anesthèsie et de rèanimation》2012
Objectives
Pulmonary contusion (PC) is common in cases of polytrauma. The aim of this study was to perform a multivariate analysis of risk factors associated with the occurrence of infection in PC and analyze the microbiological epidemiology.Patients and methods
All patients with PC admitted to the intensive care unit (ICU) between January 2002 and December 2006 were included in this retrospective observational study. Patients with penetrating thoracic trauma or those who died in the 48 hours following admission to hospital were excluded. Diagnosis of bacterial infection in PC was performed if hyperthermia was associated with a positive quantitative culture (103 colony forming units/mL) on the bronchial sample. Univariate analysis provided statistical difference between variables that were integrated in the multivariate analysis model. Multivariate analysis was then performed to determine the risk factors of bacterial infection in PC.Results
One hundred and seventeen patients were included. The incidence of bacterial infection in PC was 33.3% (39 patients). The most frequently encountered bacteria were Haemophilus sp., Staphylococcus aureus, Enterobacteriaceae, Pseudomonas sp. and Streptococcus sp. According to multivariate analysis, the existence of hypothermia at hospital admission increased the risk of PC infection (OR = 2.61; IC 95% [4.2–13.3]).Conclusion
In conclusion, PC was infected in 33.3% of cases. The existence of hypothermia was identified as a risk factor. A prospective study is warranted to confirm these results. 相似文献15.
An increasingly amount of evidence suggests that lung ultrasonography constitutes a relevant complementary diagnostic tool for adults patient in acute respiratory failure. A comprehensive and standardized ultrasonographic semiology has been described, relying on accurate and reproducible data directly obtained at patient's bedside. Therefore, pleural effusion, pneumothorax, pulmonary consolidation and interstitial lung disease can be diagnosed in a critical care environment with a similar level of performance than when reference diagnosis methods such as thoracic CT-scan are employed. Furthermore, lung ultrasonography seems to be able to contribute to an early therapeutic decision based on such online physiopathological data. Pioneers works in this field have suggested an attractive similarity between the ultrasonographic patterns described in adults and children. Nevertheless, the clinical usefulness of lung ultrasonographic approach in the pediatric critical care medicine still needs to be confirmed by specifically designed studies. 相似文献
16.
L. Pellegrini P.-Y. CordierG. Lerussi L. VellyN. Bruder 《Annales fran?aises d'anesthèsie et de rèanimation》2012
The treatment of pulmonary embolism is mainly based on anticoagulants and intravenous thrombolysis in case of collapse. The cerebral hemorrhage is the main complication of thrombolysis and contraindicates anticoagulation. We report the case of a patient with a subdural and intraparenchymal hematoma complicating intravenous thrombolysis. The patient had persistent respiratory and hemodynamic instability related to the pursuit of embolic phenomena. The implementation of a cava filter was performed and the patient had a favorable outcome. 相似文献
17.
Gavand Y Krausz-Grignard M Barrucand B Courtois L Samain E 《Annales fran?aises d'anesthèsie et de rèanimation》2011,30(9):688-691
A 41-year-old woman suffering from a left cor triatrium, pregnant for the first time, was hospitalized for a caesarean section in the context of a pulmonary arterial hypertension with severe anaemia. The anaesthetic strategy which was decided on involved setting up a haemodynamic monitoring prior to induction of a general anaesthetia with etomidate, remifentanil and succinylcholine and maintained with propofol, sufentanil and cisatracurium. This strategy allowed the hemodynamic to be stabilized during the operation. The improvement of the arterial pulmonary hypertension immediately after coming out of the operating theatre allowed the patient to be briefly monitored in the intensive care unit and to be allowed home on the 10th day following the operation. The patient's cardiopathy was corrected in the 5th month after the birth. 相似文献
18.
19.
A. Lafrikh A. DidierM. Bordes F. SemjenK. Nouette-Gaulain 《Annales fran?aises d'anesthèsie et de rèanimation》2010
We used successfully Airtraq-combined to a gum-elastic boogie to intubate twice a dysmorphic infant with mucolipidosis, in whom direct laryngoscopy failed. If this result is confirmed by prospective studies, Airtraq could be a first-line device to intubate infants with difficult intubation. 相似文献
20.
Giquello JA Humbert S Duc F Monrigal JP Granry JC 《Annales fran?aises d'anesthèsie et de rèanimation》2011,30(11):804-808