Les nouveaux agents volatils halogénés en neuro-anesthésie : quelle place pour le sévoflurane ou le desflurane ?

[Intracranial hypertension related to sedation with sevoflurane using the AnaConDa(®) device in a patient with severe traumatic brain injury]

Sedation in neurocritical patients remains a challenge as there is no drug that meets all the requirements. Since the appearance of the AnaConDa(®) device, and according to the latest recommendations, sevoflurane has become an alternative for patients with brain injury. The use of AnaConDa(®) produces an increase in the anatomical dead space that leads to a decrease in alveolar ventilation. If the decrease in the alveolar ventilation is not offset by an increase in minute volume, there will be an increase in PaCO2. We report the case of a patient with severe traumatic brain injury who suffered an increase in intracranial pressure as a result of increased PaCO2 after starting sedation with the AnaConDa(®) device.

Recent advance and possible future in TREK-2: a two-pore potassium channel may involved in the process of NPP, brain ischemia and memory impairment

TREK-2, a new member of the mechanosensitive tandem-pore K+ channel family, share 65% amino acid sequence identity and some similar basic electrophysiological and pharmacological properties with TREK-1. It also has some specific regulatory pathway and tissue distribution contrasted with TREK-1 and TRAAK. TREK-2 distributes extensively in CNS and periphery tissue. It can be regulated by G-protein-coupled receptor (GPCR) and may involve in several of physiological and pathophysiological conditions. The long-chain unsaturated free fatty acids such as arachidonic acid (AA), PHi, pressure and temperature can increase the activity of TREK-2. The purpose of this review is to present the recent study and possible importance of TREK-2 in neuropathic pain, thereby emphasizing TREK-2 as one of the important mechanisms underlying. This information should be very useful and prospective for effective chronic pain therapy and future analgesic drug development. This review also further predicts the role of TREK-2 in brain ischemia, memory and other tissue. The specific location and function of TREK-2 in these tissues need further study.

Conduite à tenir concernant le traitement médicamenteux des patients adressés pour chirurgie programmée

This review focuses on potential drug interactions between anaesthetic drugs or techniques and chronic medications in patients scheduled for surgery. The vast majority of therapeutics can be continued until the morning of surgery. However, for some drugs such as ACE inhibitors, there is strong evidence to recommend their discontinuation prior to surgery. When juged necessary, interruption of chronic therapeutic needs to be anticipated and planned. In the other hand, for other drugs such as beta-blockers or L-Dopa, acute withdrawal is associated with documented adverse outcome. As a result, such drugs have to be continuing throughout the operative period. Although a general consensus exists for many medications, there are still controverses as to the management of antithrombotic drugs and some central nervous system agents. Advances in anaesthesia include knowledge on the mechanisms involved in drug interactions, which allows us to improve the preoperative management of chronic therapeutics.