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51.
Objective
To determine the epidemiology and risk factors for gastric aspiration in a French university hospital.Methods
Files were prospectively selected from a computer database of rare and severe complications between January 2002 et April 2007. Medical files were then analyzed according to a predetermined list of specific items.Results
Forty patients suffered from gastric aspiration among 117 033 anaesthesias (4 medical files lost) (31/100,000 global incidence). All occurred during general anaesthesia, 83% at induction, 8% in the recovery room, half of the cases for emergent cases (15% of emergency). In emergency, the incidence of gastric aspiration increased by 4.5. Only 14 patients (39%) had a “full stomach”, 17 (47%) other risk factors and five (14%) none. A rapid induction–intubation sequence with a Sellick manoeuvre was performed in only 50% of patients with a full stomach and in 23.6% of those with other risk factors. Gastric aspiration occurred in three patients with a laryngeal mask. Aspiration was associated with clinical symptoms in 21 patients. Eleven patients developed an ARDS (5 deaths).Discussion
The incidence of gastric aspiration was slightly higher in this series than in other published series. Rapid induction–intubation sequence with Sellick manoeuvre is not always used in patients with a full stomach. Restraining this technique only to these latter patients does not guarantee practionners to avoid the risk of gastric aspiration. There is a large need to define which patients are at higher risk of gastric aspiration by national recommendations of clinical practice. 相似文献52.
Objective
This review discusses variability among patients in anesthesia, due to genetic polymorphisms.Data sources
Articles in French and English languages were retrieved from PubMed database. The initial request was “anesth* and (genotyp* or polymorphism* or genetic*)”.Study selection
Original articles, general reviews and one case report. Letters were excluded.Data extraction
Rare genetic diseases were excluded from the scope of this review. We stressed on frequent genetic polymorphisms that may have a daily impact in anesthesiology.Data synthesis
Most results were related to pain studies. We selected various examples to describe how genetic polymorphisms impacts the pharmacology of a given drug, and what are the clinical consequences.Conclusion
There is a growing field of pharmacogenetic related evidences in anesthesiology. The results from various animal and human studies underline the genetic origin of variability among individuals. How anaesthesists have to integrate these parameters for their daily practice is still unclear, but pharmacogenetic will obviously be a leading field of anesthesia research in the future. 相似文献53.
S. Adamczyk E. RobinO. Barreau M. FleyfelB. Tavernier G. LebuffeB. Vallet 《Annales fran?aises d'anesthèsie et de rèanimation》2009
Objective
The aim of this study was to assess the value of central venous oxygen saturation (ScvO2) for the decision of blood transfusion in comparison with the criteria of the French guidelines for blood transfusion (2003).Study design
Prospective, observational.Patients and methods
Sixty patients, haemodynamically stable, for whom a blood transfusion (BT) was discussed in the postoperative course of general surgery, were included. ScvO2 (%) and haemoglobin (g/dl) were measured before and after BT. Patients were retrospectively divided into two groups according to ScvO2 measured before BT (< or ≥ 70%). Results are expressed as median.Results
The ScvO2 before transfusion was greater or equal to 70% in 25 (47.2%) patients. Following BT, the ScvO2 increased significantly (from 57.8 to 68.5%) in the group with initial ScvO2 less than 70% whereas it was unchanged in patients with initial ScvO2 greater or equal 70% (from 76.8 to 76.5%). Twenty patients (37.7%) did not meet the French guidelines for BT criteria. Eighteen patients out of 33 that met the criteria had ScvO2 greater or equal 70% before BT while 13 patients with ScvO2 less than 70% were not detected by these same criteria.Conclusion
ScvO2 could be a relevant biological parameter to complete the current guidelines for BT in stable patient with a central venous catheter during the postoperative period. 相似文献54.
N. Libert S. SchérierC. Dubost L. FranckI. Rouquette J.-C. TortosaJ.-M. Rousseau 《Annales fran?aises d'anesthèsie et de rèanimation》2009
Hereditary and acquired angioedema (HAE/AAE) are the clinical translation of a qualitative or a quantitative deficit of C1 esterase inhibitor (C1 INH). The frequency and severity of clinical manifestations vary greatly, ranging from a moderate swelling of the extremities to obstruction of upper airway. Anaesthesiologists and intensivists must be prepared to manage acute manifestations of this disease in case of life-threatening laryngeal edema. Surgery, physical trauma and labour are classical triggers of the disease. The anaesthesiologists should be aware of the drugs used as prophylaxis and treatment of acute attacks when considering labour and caesarean section. Androgens are contraindicated during pregnancy. If prophylaxis is required, tranexamic acid may be used with caution. The safest obstetric approach appears to be to administer a predelivery infusion of C1 INH concentrate. It is important to avoid manipulation of the airway as much as possible by relying on regional techniques. We report the case of a patient suffering from an HAE discovered during pregnancy. The management included administration of C1 INH during labor and early epidural analgesia for pain relief. A short review of the pathophysiology and therapeutic options follows. 相似文献
55.
Status epilepticus (SE) refractory to benzodiazepines and other antiepileptic agents is managed with intravenous anesthetic compounds, such as thiopental, propofol or midazolam. These drugs display quite different pharmacodynamic and pharmacokinetic properties, but have not been prospectively compared to date. Their use is clearly advocated for the treatment of generalized convulsive SE, whereas partial-complex, or absence SE are generally managed less aggressively, in consideration of their better prognosis. The most important aspect seems to be related to the correct use of these anesthetics in the right context, rather than the choice of one specific compound. An electroencephalographic burst-suppression should be targeted for about 24 hour, before progressive weaning of the dosage under EEG monitoring. If this approach proves unsuccessful, the use of other drugs, including inhalational anesthetics, has been described. 相似文献
56.
O. Felician E. Tramoni F. Bartolomei M. Guye M. Poncet M. Ceccaldi 《Revue neurologique》2009,165(5):449-459
Introduction
The term “autobiographical memory” (AuM) refers to contextually bound experiences that occurred in a specific time, place, and affective setting. AuM is a component of memory commonly impaired in amnestic disorders. Alteration occurs rarely in isolation but rather in the setting of a larger memory impairment. Isolated AuM deficit is a controversial clinical entity, however, recently reported in the context of temporal lobe epilepsy. This study aims at characterizing this poorly documented clinical syndrome and at discussing its potential pathophysiological basis.Patients and methods
We studied a group of three subjects with a history of pharmacosensitive epilepsy and severe AuM complaints. They all were submitted to a neuropsychological evaluation that included an extensive episodic memory assessment, along with wake/sleep electroencephalogram (EEG) and brain magnetic resonance imaging (MRI).Results
We observed the following findings: preserved autonomy and intact global cognitive functioning; normal performance to standardized episodic memory assessment, contrasting with decreased performance to specific AuM evaluation; frontal and/or temporal epileptic activity on EEG; and normal structural brain MRI.Conclusion
We reported on a group of patients exhibiting selective impairment of some components of personal memory, associated with interictal frontal and/or temporal abnormalities on EEG. To account for these findings, we hypothesise that interictal epileptic-related activity is impeding long-term consolidation or storage of autobiographical material. 相似文献57.
Introduction
Parry-Romberg syndrome is a rare entity of unknown etiology, characterized by hemifacial or hemibody atrophy affecting subcutaneous tissues. Its main clinical manifestations are neurological, ocular and dermatological. Paroxysmal kinesigenic dyskinesia (PKD) is characterized by brief episodes of choreic/dystonic movements triggered by sudden movements and improved by antiepileptic drugs particularly carbamazepine. It can be sporadic or familial with an autosomal dominant inheritance. Little is known about the pathophysiology of PKD, although a channelopathy is thought likely. The association of these two diseases is rare.Case report
Over three years, a 42-year-old patient progressively developed left hemiatrophy. Since age 14, he presented paroxysmal dystonic disorders of the limbs triggered by sudden movements and controlled by carbamazepine. The diagnosis of PKD associated with Parry-Romberg syndrome was established. Investigations revealed immunologic and diffuse electrophysiological abnormalities (EEG and EMG).Conclusion
PKD associated with Parry-Romberg syndrome is very rare but does not appear to be fortuitous. It suggests a common mechanism via an underlying channelopathy or dysimmune disorder. 相似文献58.
Febvre M Trosini-Desert V Atassi K Hermant C Colchen A Raspaud C Vergnon JM;Endoscopy Working Group of the French Society of Pulmonary Medicine 《Revue des maladies respiratoires》2007,24(10):1363-1392
These guidelines on flexible bronchoscopy depict important clues to be known and taken into account while practicing flexible bronchoscopy, in adult, except in emergency situations. This is a practical clarification. Safety conditions, complications, anesthesia, infectious risks, cleaning and disinfection are detailed from a review of the literature. Intensive care practice of bronchoscopy requires more attention due to higher risks patients and is discussed extensively. Standards and performances of the various sampling techniques complete this work. Indications for bronchoscopy, therapeutic and paediatric bronchoscopy are not covered in these guidelines. 相似文献
59.
60.
D. Petot 《Annales médico-psychologiques》2008,166(5):350-355