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Ract C, Le Moigno S, Bruder N, Vigué B. Transcranial Doppler ultrasound goal-directed therapy for the early management of severe traumatic brain injury. Intensive Care Med 2007; 33:645-51. [PMID: 17325830 DOI: 10.1007/s00134-007-0558-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Accepted: 01/25/2007] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the usefulness of early transcranial Doppler ultrasound (TCD) goal-directed therapy after severe traumatic brain injury initiated before invasive cerebral monitoring is available. DESIGN Prospective, observational clinical study. SETTING Surgical intensive care unit, university hospital. PATIENTS AND PARTICIPANTS Twenty-four severely brain-injured patients. INTERVENTIONS All patients had TCD measurements immediately on admission (T0) and when invasive cerebral monitoring was available (T1). TCD was considered abnormal when two out of three measured values were outside the following limits: Vm<30 cm/s, Vd<20 cm/s, PI > 1.4. When admission TCD was abnormal, attending physicians modified treatment to increase cerebral perfusion pressure. MEASUREMENTS AND RESULTS Admission TCD was performed 18+/-11 min (T0) after admission, whereas cerebral invasive monitoring was available 242+/-116 min (T1) after admission. At T0, 11 (46%) patients had abnormal TCD values (group 1) and 13 had normal TCD values (group 2); mean arterial pressure was comparable between groups. All group 1 patients received mannitol and/or norepinephrine. At T1, mean arterial pressure was increased compared to admission in group 1 (105+/-17 mmHg vs. 89+/-15 mmHg, p<0.05) and only two patients had still an abnormal TCD. Although group 1 patients had higher intracranial pressure than those of group 2 (32+/-13 mmHg vs. 22+/-10 mmHg, p<0.01), both cerebral perfusion pressure and jugular venous oxygen saturation were comparable between the groups. CONCLUSIONS The use of TCD at hospital admission allows identification of severely brain-injured patients with brain hypoperfusion. In such high-risk patients, early TCD goal-directed therapy can restore normal cerebral perfusion and might then potentially help in reducing the extent of secondary brain injury.
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Grillo P, Velly L, Bruder N. Accident vasculaire cérébral hémorragique : nouveautés sur la prise en charge. ACTA ACUST UNITED AC 2006; 25:868-73. [PMID: 16698232 DOI: 10.1016/j.annfar.2006.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Haemorrhagic stroke is frequent and associated with a high mortality and morbidity. Less than 30% of patients are still alive five years after onset and few patients regain functional independence. The worsening effect of anticoagulation has been demonstrated and the failure to rapidly normalize coagulation further increases haematoma expansion. In a recent phase II trial, recombinant activated factor VII given within 4 hours of stroke onset, reduced haematoma growth, mortality and disability. An aggressive blood pressure and intracranial pressure control early after the haemorrhage seems beneficial. A large prospective randomized study (the STICH trial) did not demonstrate any beneficial effect of surgery.
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78
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Samama CM, Albaladejo P, Benhamou D, Bertin-Maghit M, Bruder N, Doublet JD, Laversin S, Leclerc S, Marret E, Mismetti P, Samain E, Steib A. Venous thromboembolism prevention in surgery and obstetrics. Eur J Anaesthesiol 2006; 23:95-116. [PMID: 16438749 DOI: 10.1017/s0265021505002164] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2005] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE To produce up-to-date clinical practice guidelines on the prevention of venous thromboembolism in surgery and obstetrics. METHODS A Steering Committee defined the scope of the topic, the questions to be answered, and the assessment criteria. Eight multidisciplinary working groups (total of 70 experts) performed a critical appraisal of the literature in the following disciplines: pharmacology of antithrombotic agents, orthopaedics; general surgery (gastrointestinal (GI) and varicose vein surgery); urology; gynaecology and obstetrics; thoracic, cardiac and vascular surgery; surgery of the head, neck and spine; and surgery of burns patients. The resultant reports and guidelines were submitted for comment and completion of the Appraisal of Guidelines Research & Evaluation questionnaire to a total of 150 peer reviewers, before producing definite guidelines. RESULTS The report answers the following questions for each type of surgery: (i) What is the venous thromboembolism incidence according to clinical and/or paraclinical criteria in the absence of prophylaxis? (with stratification of venous thromboembolism risk into low, moderate and high categories); (ii) What is the efficacy and safety of the prophylactic measures used? (iii) When should prophylaxis be introduced and how long should it last? (iv) Does ambulatory surgery affect efficacy and safety of prophylaxis? CONCLUSIONS Apart from answering the above questions, the guidelines provide a summary table for each discipline. This table stratifies types of surgery into the three risk categories, specifies the recommended prophylaxis for venous thromboembolism (pharmacological and/or mechanical) and grades each recommendation. In addition, whenever appropriate, the recommended prophylaxis is adjusted to low- and high-risk patients.
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79
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Lestienne B, Vergnes MC, Audibert G, Faillot T, Bosson JL, Payen JF, Bruder N. [Prevention of venous perioperative thromboembolism in ENT and maxillofacial surgery]. ACTA ACUST UNITED AC 2005; 24:935-7. [PMID: 16006088 DOI: 10.1016/j.annfar.2005.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There are few studies of poor methodological quality on the risk of thromboembolism in head and neck surgery. The incidence of symptomatic deep vein thrombosis is estimated between, 0.1% and 0.6%. The patient's risk factors (cancer, alcoholism, smoking, malnutrition) determine for the assessment of the potential benefit of thromboembolism prophylaxis. No method can be recommended based on the literature. In patients receiving anticoagulant therapy undergoing superficial head and neck surgery or dental extraction, the literature suggest to continue anticoagulation throughout the perioperative period.
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80
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Beydon L, Audibert G, Berré J, Boulard G, Gabrillargues J, Bruder N, Hans P, Puybasset L, Ravussin P, de Kersaint-Gilly A, Ter Minassian A, Dufour H, Lejeune JP, Proust F, Bonafé A. [Pain management in severe subarachnoid haemorrhage]. ACTA ACUST UNITED AC 2005; 24:782-6. [PMID: 15922538 DOI: 10.1016/j.annfar.2005.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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81
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Berré J, Hans P, Puybasset L, Beydon L, Audibert G, Bruder N, Ravussin P, Boulard G, Ter Minassian A, Dufour H, de Kersaint-Gilly A, Gabrillargues J, Lejeune JP, Proust F, Bonafé A. [Epilepsy in patients suffering from severe subarachnoid haemorrhage]. ACTA ACUST UNITED AC 2005; 24:739-41. [PMID: 15885965 DOI: 10.1016/j.annfar.2005.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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82
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Audibert G, Faillot T, Vergnes MC, Bosson JL, Bernard C, Payen JF, Lestienne B, Bruder N. Thromboprophylaxie en chirurgie rachidienne traumatologique et non traumatologique. ACTA ACUST UNITED AC 2005; 24:928-34. [PMID: 16006087 DOI: 10.1016/j.annfar.2005.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The risk of deep vein thrombosis (DVT) after spinal cord injury is very high. Without prophylaxis the incidence of DVT using venography is 81% and the risk of symptomatic DVT is between 12 and 23%. The risk is much lower in elective spine surgery. After discectomy or laminectomy on less than two spine levels, the risk of DVT is less than 1%. After spinal fusion or extended laminectomy, the risk can be estimated between 0.3 and 2.2%. A prophylaxis is recommended for all patients after spinal cord injury (grade A). The association of a mechanical method and heparin is recommended (grade B). The duration of prophylaxis is 3 months in patients with a motor deficit (grade C). No prophylaxis is recommended after discectomy or limited laminectomy in patients without additional risk factors. Mechanical methods are recommended after spinal fusion or extended laminectomy. For patients with additional risk factors a low molecular weight heparin is recommended.
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83
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Payen JF, Faillot T, Audibert G, Vergnes MC, Bosson JL, Lestienne B, Bernard C, Bruder N. Thromboprophylaxie en neurochirurgie et en neurotraumatologie intracrânienne. ACTA ACUST UNITED AC 2005; 24:921-7. [PMID: 16006086 DOI: 10.1016/j.annfar.2005.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The incidence of deep vein thrombosis (DVT) is between 20 and 35% using contrast venography, with a rate of symptomatic DVT between 2.3 and 6% in neurosurgery without any prophylaxis. The risk of DVT is poorly evaluated in head injured patients but is around 5%. Specific risk factors in neurosurgery are: a motor deficit, a meningioma or malignant tumour, a large tumour, age over 60 years, surgery lasting more than 4 hours, a chemotherapy. The benefit of mechanical methods or low molecular weight heparin (LMWH) for the prevention of DVP in neurosurgery is demonstrated (grade A). Each method decreases the risk by about 50%. A postoperative prophylaxis with a LMWH does not seem to increase the risk of intracranial bleeding (grade C). There is no demonstrated benefit to begin a prophylaxis with LMWH before the intervention. The duration of the prophylaxis is 7 to 10 days but this has not been scientifically determined.
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84
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Hans P, Audibert G, Berré J, Bruder N, Ravussin P, Ter Minassian A, Puybasset L, Beydon L, Boulard G, Bonafé A, de Kersaint-Gilly A, Gabrillargues J, Lejeune JP, Proust F, Dufour H. [Cardiovascular and pulmonary consequences of severe subarachnoid haemorrhage]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:734-8. [PMID: 15885973 DOI: 10.1016/j.annfar.2005.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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85
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Dufour H, Bonafé A, Bruder N, Boulard G, Ravussin P, Lejeune JP, Gabrillargues J, Beydon L, Audibert G, Berré J, Hans P, Puybasset L, Ter Minassian A, Proust F, de Kersaint-Gilly A. Diagnostic en hôpital général et prise en charge immédiate des hémorragies méningées graves. ACTA ACUST UNITED AC 2005; 24:715-20. [PMID: 15967627 DOI: 10.1016/j.annfar.2005.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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86
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Proust F, Dufour H, Lejeune JP, Bonafé A, de Kersaint-Gilly A, Puybasset L, Berré J, Bruder N, Ravussin P, Hans P, Audibert G, Boulard G, Ter Minassian A, Beydon L, Gabrillargues J. [Severe subarachnoid haemorrhage: treatment of rebleeding and of an intracerebral haematoma]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:756-60. [PMID: 15885969 DOI: 10.1016/j.annfar.2005.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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87
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Bruder N, Ravussin P, Hans P, Berré J, Puybasset L, Audibert G, Boulard G, Beydon L, Ter Minassian A, Dufour H, Bonafé A, Gabrillargues J, Lejeune JP, Proust F, de Kersaint-Gilly A. Anesthésie pour le traitement des hémorragies méningées graves par rupture d'anévrisme. ACTA ACUST UNITED AC 2005; 24:775-81. [PMID: 15922545 DOI: 10.1016/j.annfar.2005.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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88
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Puybasset L, Beydon L, Dufour H, Proust F, Audibert G, Bonafé A, Berré J, Boulard G, Gabrillargues J, Bruder N, de Kersaint-Gilly A, Hans P, Ravussin P, Lejeune JP, Ter Minassian A. [Severe subarachnoid haemorrhage: patient follow-up (biology, local metabolic measurements)]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:787-90. [PMID: 15925477 DOI: 10.1016/j.annfar.2005.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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89
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Boulard G, Ravussin P, Proust F, Bonafé A, Audibert G, De Kersaint-Gilly A, Hans P, Berré J, Bruder N, Puybasset L, Ter Minassian A, Dufour H, Lejeune JP, Gabrillargues J, Beydon L. [Organisation of care for patients suffering from subarachnoid haemorrhage]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:721-2. [PMID: 15876514 DOI: 10.1016/j.annfar.2005.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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90
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Ter Minassian A, Proust F, Berré J, Hans P, Bonafé A, Puybasset L, Audibert G, de Kersaint-Gilly A, Beydon L, Bruder N, Boulard G, Ravussin P, Dufour H, Lejeune JP, Gabrillargues J. [Severity criteria for subarachnoid haemorrhage: intracranial hypertension, hydrocephalus]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:723-8. [PMID: 15922542 DOI: 10.1016/j.annfar.2005.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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91
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Audibert G, Puybasset L, Bruder N, Hans P, Berré J, Beydon L, Ravussin P, Boulard G, Ter Minassian A, de Kersaint-Gilly A, Dufour H, Gabrillargues J, Bonafé A, Proust F, Lejeune JP. Hémorragie sous-arachnoïdienne grave : natrémie et rein. ACTA ACUST UNITED AC 2005; 24:742-5. [PMID: 15885975 DOI: 10.1016/j.annfar.2005.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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92
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Proust F, Ter Minassian A, Hans P, Puybasset L, Berré J, Bonafé A, Dufour H, Audibert G, De Kersaint-Gilly A, Boulard G, Beydon L, Ravussin P, Lejeune JP, Gabrillargues J, Bruder N. [Treatment of intracranial hypertension in patients suffering from severe subarachnoid haemorrhage]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:729-33. [PMID: 15967626 DOI: 10.1016/j.annfar.2005.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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93
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Proust F, Bonafé A, Lejeune JP, de Kersaint-Gilly A, Gabrillargues J, Dufour H, Puybasset L, Bruder N, Hans P, Beydon L, Audibert G, Boulard G, Ter Minassian A, Berré J, Ravussin P. L'anévrisme : occlure le sac pour prévenir le resaignement. ACTA ACUST UNITED AC 2005; 24:746-55. [PMID: 15922551 DOI: 10.1016/j.annfar.2005.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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94
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Berré J, Gabrillargues J, Audibert G, Hans P, Bonafé A, Boulard G, Lejeune JP, Bruder N, De Kersaint-Gilly A, Ravussin P, Ter Minassian A, Dufour H, Beydon L, Proust F, Puybasset L. Hémorragies méningées graves : prévention, diagnostic et traitement du vasospasme. ACTA ACUST UNITED AC 2005; 24:761-74. [PMID: 15885968 DOI: 10.1016/j.annfar.2005.03.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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95
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Auquier P, Pernoud N, Bruder N, Simeoni MC, Auffray JP, Colavolpe C, François G, Gouin F, Manelli JC, Martin C, Sapin C, Blache JL. Development and Validation of a Perioperative Satisfaction Questionnaire. Anesthesiology 2005; 102:1116-23. [PMID: 15915023 DOI: 10.1097/00000542-200506000-00010] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background
Satisfaction is considered a valuable measure of outcome of healthcare processes. Only a few anesthesia-related validated questionnaires are reported. Because their scope is restricted to specific clinical contexts, their use remains limited. The objective of the current study was to develop and validate a self-reported questionnaire, Evaluation du Vecu de l'Anesthesie Generale (EVAN-G), assessing the satisfaction of the perioperative period surrounding general anesthesia.
Methods
Development of the EVAN-G questionnaire comprised a phase of item generation and a phase of psychometric validation. The patient sample was generated to be proportionally matched to the population of patients undergoing general anesthesia in France. The structure of the questionnaire was identified studying interitem, item-dimension, and interdimension correlations and factor analyses. Data were concurrently gathered to assess external validity. The discriminant validity was determined by comparison of scores across well known patient groups. Reliability was assessed by computation of Cronbach alpha coefficients and by test-retest.
Results
Eight hundred seventy-four patients were recruited in eight anesthesia departments. The EVAN-G includes 26 items; six specific scores and one global index score are available. Correlations between EVAN-G scores and other concurrent measures supported convergent validity. The EVAN-G correlated poorly with age, American Society of Anesthesiologists physical status, total anesthesia time, and number of previous anesthesias. Significantly higher satisfaction was reported by patients older than 65 yr, belonging to the laryngeal mask group. Reliability and reproducibility were shown.
Conclusion
The EVAN-G adds important information oriented toward patients' perceptions. The authors' approach provides a novel, valid, and reliable tool that may be used in anesthesia practice.
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96
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Blanloeil Y, Bruder N. [After the passage to the year 2000, the passage of Afar at the year 2005]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:337-8. [PMID: 15826780 DOI: 10.1016/j.annfar.2005.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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97
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Charvet A, Metellus P, Bruder N, Pellissier D, Grisoli F, Gouin F. [Pulmonary embolism of cement during vertebroplasty]. ACTA ACUST UNITED AC 2004; 23:827-30. [PMID: 15345256 DOI: 10.1016/j.annfar.2004.06.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2003] [Accepted: 06/01/2004] [Indexed: 11/18/2022]
Abstract
A 62-year-old woman with severe osteoporosis experienced pulmonary embolism by polymethylmethacrylate after percutaneous vertebroplasty. The patient immediately developed respiratory and cardiac distress, and a computed tomographic scan revealed the presence of cement in the pulmonary circulation. Proper techniques can minimize the risk of pulmonary embolism during percutaneous vertebroplasty: adequate preparation of cement and fluoroscopy during the procedure are recommended.
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98
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Meaudre E, Polycarpe A, Pernod G, Salinier L, Cantais E, Bruder N. Œdème pulmonaire neurogénique au cours des hémorragies sous-arachnoïdiennes et brain natriuretic peptide. ACTA ACUST UNITED AC 2004; 23:1076-9. [PMID: 15581723 DOI: 10.1016/j.annfar.2004.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Accepted: 09/07/2004] [Indexed: 10/26/2022]
Abstract
We report two cases of neurogenic pulmonary oedema following subarachnoid haemorrhage. A 58-year-old woman became increasingly dyspneic and needed oxygen support during a few days. A 53-year-old woman rapidly developed clinical and laboratory signs of respiratory failure, recovering in 48 hours. In both cases, chest radiography showed bilateral diffuse infiltrates, electrocardiogram revealed ST abnormalities, and cardiac troponin I level was elevated. In both patients, pro brain natriuretic peptide level was increased whereas global cardiac function was normal. The factors initiating its secretion are discussed.
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99
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Baldesi O, Bruder N, Velly L, Gouin F. Spurious bispectral index values due to electromyographic activity. Eur J Anaesthesiol 2004; 21:324-5. [PMID: 15109199 DOI: 10.1017/s0265021504254126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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100
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Bruder N, Ravussin P. Modifications hémodynamiques cérébrales et systémiques au moment du réveil en neurochirurgie. ACTA ACUST UNITED AC 2004; 23:410-6. [PMID: 15120789 DOI: 10.1016/j.annfar.2004.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Major complications after intracranial surgery occur in 13-27% of patients. Among multiple causes, haemodynamic and metabolic changes of anaesthesia recovery may be responsible for intracranial complications. Recovery from neurosurgical anaesthesia is followed by an increase in body oxygen consumption and catecholamines concentrations. However, in normothermic patients, theses changes are usually mild and not prevented by a 2-h recovery delay. Systemic hypertension is common after neurosurgery and a link between perioperative hypertension and intracranial haemorrhage has been established. The cerebral consequences of recovery associate cerebral hyperaemia and increased ICP in patients with a tight brain at the end of surgery. Cerebral hyperaemia may promote or exacerbate cerebral haemorrhage or oedema. This has been demonstrated in patients operated for subdural haematoma removal or undergoing carotid surgery. Prevention of hypothermia and pain are key factors to prevent metabolic changes. Beta-blockers seem to be suitable agents to obtain haemodynamic control in neurosurgical patients.
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