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Recommandations de pratiques professionnelles : Intérêts de l’apprentissage par simulation en soins critiques. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury. Anaesth Crit Care Pain Med 2020; 39:279-289. [PMID: 32229270 DOI: 10.1016/j.accpm.2020.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To update the French guidelines on the management of trauma patients with spinal cord injury or suspected spinal cord injury. DESIGN A consensus committee of 27 experts was formed. A formal conflict-of-interest (COI) policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. METHODS The committee studied twelve questions: (1) What are the indications and arrangements for spinal immobilisation? (2) What are the arrangements for pre-hospital orotracheal intubation? (3) What are the objectives of haemodynamic resuscitation during the lesion assessment, and during the first few days in hospital? (4) What is the best way to manage these patients to improve their long-term prognosis? (5) What is the place of corticosteroid therapy in the initial phase? (6) What are the indications for magnetic resonance imaging in the lesion assessment phase? (7) What is the optimal time for surgical management? (8) What are the best arrangements for orotracheal intubation in the hospital environment? (9) What are the specific conditions for weaning these patients from mechanical ventilation for? (10) What are the procedures for analgesic treatment of these patients? (11) What are the specific arrangements for installing and mobilising these patients? (12) What is the place of early intermittent bladder sampling in these patients? Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® Methodology. RESULTS The experts' work synthesis and the application of the GRADE method resulted in 19 recommendations. Among the recommendations formalised, 2 have a high level of evidence (GRADE 1+/-) and 12 have a low level of evidence (GRADE 2+/-). For 5 recommendations, the GRADE method could not be applied, resulting in expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. CONCLUSIONS There was significant agreement among experts on strong recommendations to improve practices for the management of patients with spinal cord injury.
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Brain ischemia with normal cerebral perfusion pressure after TBI: when to increase arterial carbon dioxide pressure? Minerva Anestesiol 2014; 80:970-971. [PMID: 24492664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Cerebrospinal fluid pressure after epidural blood patching. Int J Obstet Anesth 2014; 23:286. [PMID: 24934310 DOI: 10.1016/j.ijoa.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/05/2014] [Indexed: 11/28/2022]
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Post-mortem cranioplasty: medical, ethical and religious considerations. ACTA ACUST UNITED AC 2014; 33:e99-e100. [PMID: 24836117 DOI: 10.1016/j.annfar.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
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[The initial management in intensive care of pelvic ring injury patients]. ACTA ACUST UNITED AC 2014; 33:344-52. [PMID: 24833399 DOI: 10.1016/j.annfar.2014.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
Abstract
Pelvic trauma care is complex since it is frequently associated with multiple injuries and may lead to dramatic and uncontrollable haemorrhage. After pelvic trauma, the mortality, around 8 to 10%, is mainly related to severe pelvic hemorrhage but also to extrapelvic injuries (thoracic, abdominal or brain injuries). It is therefore crucial to manage pelvic trauma in specialized trauma center. The initial trauma assessment aims to determine the role of the pelvic injury in hemorrhage to define the therapeutic strategy of pelvic trauma care (arterial embolisation/pelvic ring stabilisation). This review was performed with a systematic review of the literature; it describes the pelvic fracture pathophysiology, and the efficacy and safety of haemostatic procedures and with their respective indications. A decision making algorithm is proposed for the treatment of trauma patients with pelvic fracture.
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Brain empyema due to Ochrobactrum anthropi. Med Mal Infect 2014; 44:128-9. [PMID: 24534092 DOI: 10.1016/j.medmal.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 01/03/2014] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
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[How can we determine the best cerebral perfusion pressure in pediatric traumatic brain injury?]. ACTA ACUST UNITED AC 2013; 32:e225-9. [PMID: 24199905 DOI: 10.1016/j.annfar.2013.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The management of cerebral perfusion pressure (CPP) is the one of the main preoccupation for the care of paediatric traumatic brain injury (TBI). The physiology of cerebral autoregulation, CO2 vasoreactivity, cerebral metabolism changes with age as well as the brain compliance. Low CPP leads to high morbidity and mortality in pediatric TBI. The recent guidelines for the management of CPP for the paediatric TBI indicate a CPP threshold 40-50 mmHg (infants for the lower and adolescent for the upper). But we must consider the importance of age-related differences in the arterial pressure and CPP. The best CPP is the one that allows to avoid cerebral ischaemia and oedema. In this way, the adaptation of optimal CPP must be individual. To assess this objective, interesting tools are available. Transcranial Doppler can be used to determine the best level of CPP. Other indicators can predict the impairment of autoregulation like pressure reactivity index (PRx) taking into consideration the respective changes in ICP and CPP. Measurement of brain tissue oxygen partial pressure is an other tool that can be used to determine the optimal CPP.
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L’aspirine et ses dangers : syndrome de Reye chez un adulte jeune. ACTA ACUST UNITED AC 2013; 32:814-6. [DOI: 10.1016/j.annfar.2013.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 08/20/2013] [Indexed: 11/26/2022]
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Utilisation d’un ECMO (extracorporeal membrane oxygenation) dans un cas d’hypoxémie réfractaire associée à un traumatisme crânien grave. ACTA ACUST UNITED AC 2013; 32:701-3. [DOI: 10.1016/j.annfar.2013.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 04/25/2013] [Indexed: 11/24/2022]
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A prospective video-based observational and analytical approach to evaluate management during brain tumour surgery at a university hospital. Neurochirurgie 2013; 59:142-8. [PMID: 23953035 DOI: 10.1016/j.neuchi.2013.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 04/24/2013] [Accepted: 05/24/2013] [Indexed: 11/18/2022]
Abstract
The operating room (OR) is a high-risk complex setting, where patient safety relies on the coordinated efforts of multiple team members. However, little attention has been paid to evaluating the strategies employed by OR practitioners to prevent and correct incidents that inevitably occur during surgery. Therefore, we were prompted to investigate human factor (HF) engineering methods that have been used in an innovative way in order to systematically observe and analyze the management of incidents in the neurosurgical OR of a French university hospital. A technical case report illustrates our approach that associates the following procedures: the recording of OR team member activities and behaviour by video cameras and direct observation of a HF researcher, with the description and the explicit demonstration of safety related procedures in self- and cross-confrontation interviews of OR team members. This technical report emphasizes complementary aspects of clinical performance related to safety skills. Moreover, individual and team performances rely on complementary abilities that associate practical knowledge, skills, and attitudes, which are engaged at various degrees to prevent and manage incidents. This report also enlightens new quality-improvement opportunities as well as further objectives for future studies.
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The management of femur shaft fracture associated with severe traumatic brain injury. ACTA ACUST UNITED AC 2013; 32:510-5. [DOI: 10.1016/j.annfar.2013.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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[Immediate hypersensitivity to cisatracurium. Value of skin tests]. ACTA ACUST UNITED AC 2012; 31:824-5. [PMID: 22902006 DOI: 10.1016/j.annfar.2012.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/31/2012] [Indexed: 11/28/2022]
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Abstract
The invasive monitoring of intracranial pressure is useful in circumstances associated with high-risk of raised intracranial pressure. However the placement of intracranial probe is not always possible and non-invasive assessment of intracranial pressure may be useful, particularly in case of emergencies. Transcranial Doppler measurements allow the estimation of perfusion pressure with the pulsatility index. Recently, new ultrasonographic methods of cerebral monitoring have been developed: the diameter of the optic nerve sheath diameter, a surrogate marker of raised intracranial pressure and the estimation of median shift line deviation.
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Relative accuracy of arterial and capillary glucose meter measurements in critically ill patients. DIABETES & METABOLISM 2012; 38:230-5. [DOI: 10.1016/j.diabet.2011.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 12/13/2011] [Accepted: 12/19/2011] [Indexed: 01/08/2023]
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[Experts' recommendations for stroke management in intensive care: intracranial hypertension]. Rev Neurol (Paris) 2012; 168:501-11. [PMID: 22571966 DOI: 10.1016/j.neurol.2011.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 04/29/2011] [Accepted: 07/19/2011] [Indexed: 11/20/2022]
Abstract
This article aims to describe the arguments underlying the experts' recommendations for management of stroke patients in the intensive unit, focusing on intracranial hypertension. This article describes the pathophysiology, diagnostic methods and therapeutic options for intracranial hypertension after stroke, including medical and surgical management.
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Early encephalic toxicity after inadvertent intrathecal injection of low osmolar contrast medium. Neuroradiol J 2012; 25:222-4. [PMID: 24028919 DOI: 10.1177/197140091202500212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 02/08/2012] [Indexed: 11/17/2022] Open
Abstract
Only nonionic contrast media are allowed for intrathecal use because of their lower neurotoxicity. In case of inadvertent intrathecal administration of an ionic contrast medium, the typical following syndrome is called ascending tonic clonic seizure syndrome. We describe the case of a 61-year-old woman with low back pain who underwent myelography. Ioxaglate, a water-soluble ionic low osmolar contrast medium was accidentally injected intrathecally. She first presented encephalic signs of neurotoxicity, followed by opisthotonic spasms and respiratory distress. In our case, ioxaglate is a low osmolar agent, leading to early encephalic toxicity (preceding medullary signs), because of its cephalic migration. The patient was successfully treated by sedation, anticonvulsant therapy and fluid hydration. Intrathecal administration of an ionic contrast medium is clearly contraindicated. In case of inadvertent injection of a low osmolar product, encephalic signs are seen first.
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[Gum elastic bougie to facilitate gastric tube insertion]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2012; 31:268-269. [PMID: 22326942 DOI: 10.1016/j.annfar.2011.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 12/16/2011] [Indexed: 05/31/2023]
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[Medical handovers in ICU: a snapshot of practice in the South West of France]. ACTA ACUST UNITED AC 2012; 31:208-12. [PMID: 22309619 DOI: 10.1016/j.annfar.2011.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 12/08/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Medical handover is critical for quality of care in ICU. Time assigned to medical handovers can vary across different units, with significant impact on the organization of medical work. We aimed to study the time spent for medical handover in ICU and its variation across academic, general and private hospitals in the area of the South West of France, the Midi-Pyrénées region. METHODS Between August and October 2010, we questioned by phone, 86 physicians issued from 19 different ICUs. This prospective observational study mainly focused on four items: unit's characteristics, health diaries organization, medical handovers procedures, and self-assessment of satisfaction for medical handover (numeric scale from 0 to 10). RESULTS Eleven general hospital centers, three private hospitals, five university hospitals were concerned by the survey. The mean time spent for medical handover was 59±35 min on monday morning, significantly longer than other days, evening, and to weekend handovers (P<0.001 for all comparisons). When reporting it to the number of ICU bed, the time spent for handover per patient was significantly shorter in private hospital compared to general and academic hospital (P<0.05 for all comparison). CONCLUSION Time spent for medical handover is important, with an approximate total time of 1h 30 min on monday, and 1h the other days. Physician in private hospitals spend less time for medical handovers. This fact should be considered for medical timework organization, especially in academic hospital and in hospital with large ICU.
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Pourquoi et comment contrôler les agressions cérébrales secondaires en urgence lors d’une d’une agression cérébrale. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-011-0326-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Diagnostic accuracy of ultrasonography of optic nerve sheath diameter for detecting raised intracranial pressure. Acta Anaesthesiol Scand 2011; 55:899; author reply 899-900. [PMID: 21658015 DOI: 10.1111/j.1399-6576.2011.02468.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Increase in optic nerve sheath diameter induced by epidural blood patch: a preliminary report. Br J Anaesth 2011; 107:627-30. [PMID: 21693468 DOI: 10.1093/bja/aer186] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Post-dural puncture headache (PDPH) might be related to cerebrospinal fluid hypotension. Studies in brain-injured patients have shown a good relationship between optic nerve sheath diameter (ONSD) measured by ocular sonography and invasively measured intracranial pressure (ICP). The aim of this study was to evaluate changes in ONSD after lumbar epidural blood patch (EBP). METHODS Consecutive subjects receiving an EBP for PDPH were included. ONSD and pain measurements were performed before (T(0)), 10 min (M(10)), 2 h (H(2)), and 20 h (H(20)) after the EBP. RESULTS Ten subjects were included. ONSD [median (inter-quartile range)] increased with time after EBP, from 4.8 mm (4.5-5.1) at T(0) to 5.2 mm (4.9-5.7) at M(10) (P=0.005 vs T(0)), 5.5 mm (5.1-6.0) at H(2) (P=0.007 vs T(0)), and 5.8 mm (5.2-6.3) at H(20) (P=0.02 vs T(0)). EBP was clinically successful in nine of 10 subjects. In subjects in whom EBP was successful, ONSD significantly increased at M(10) and T(2) compared with T(0) (P=0.004 and 0.008, respectively) but did not reach statistical significance at H(20) (P=0.06). In the subject in whom EBP failed, a small increase in ONSD was observed over time. CONCLUSIONS In this preliminary report, EBP was followed by ONSD enlargement in subjects with successful EBP, but not in the subject with EBP failure. Since ONSD is a surrogate marker of ICP, this suggests that a sustained increase in ICP is associated with successful EBP.
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Trauma-related death in the elderly: a new challenge for trauma system? Minerva Anestesiol 2011; 77:567. [PMID: 21617617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Accuracy of glucose measurements in critically ill patients. Crit Care 2011. [PMCID: PMC3068335 DOI: 10.1186/cc9826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Brain midline shift assessment using sonography in neurocritical care patients. Crit Care 2011. [PMCID: PMC3067017 DOI: 10.1186/cc9763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Le monitorage de la pression intracrânienne améliore-t-il le devenir des traumatisés crâniens graves ? ACTA ACUST UNITED AC 2010; 29:e171-5. [DOI: 10.1016/j.annfar.2010.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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[Coagulation disorders after traumatic brain injury: pathophysiology and therapeutic implications]. ACTA ACUST UNITED AC 2010; 29:e177-81. [PMID: 20655167 DOI: 10.1016/j.annfar.2010.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Early activation of coagulation is common after traumatic brain injury. Its origin is probably mainly intracerebral, due to tissue factor release from the injured brain. Abnormalities in blood coagulation tests are associated with poor neurological prognosis. Coagulation activation may induce disseminated intravascular coagulation and fibrinolysis. Disseminated intravascular coagulation is linked to brain ischemia caused by intravascular microthrombosis. This review will focus on pathophysiology of coagulation disorders after traumatic brain injury, and on their implications for therapeutic approaches.
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Stress induced by simulation-based training in anesthesiologist residents. Crit Care 2010. [PMCID: PMC2934288 DOI: 10.1186/cc8687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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[How to succeed at funding a research year in anaesthesiology and critical care in France?]. ACTA ACUST UNITED AC 2009; 28:579-83. [PMID: 19467823 DOI: 10.1016/j.annfar.2009.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 04/02/2009] [Indexed: 11/24/2022]
Abstract
Good research needs good financial support. The research fellowship is a full-time job that leaves no time for another job to pay the rent. Funding the daily-life part of the fellowship is therefore a sine qua none condition for serenity and good research. Preparing grants applications for research is a crucial step towards success. There is however a lack of easily available information for personal funding application in Anesthesiology and Critical Care research. In this review, we aimed to present the different stages of this long process, from grant application to taxes payment.
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Hypothermie et protection cérébrale après traumatisme crânien. Influence des gaz du sang. ACTA ACUST UNITED AC 2009; 28:352-7. [DOI: 10.1016/j.annfar.2009.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Comments about article: induced hypothermia and fever control for prevention and treatment of neurological injuries. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2009; 28:100-102. [PMID: 19108980 DOI: 10.1016/j.annfar.2008.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Noninvasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Crit Care 2008. [PMCID: PMC4088488 DOI: 10.1186/cc6338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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[Intracerebral monitoring of a patient with vasopasm]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2007; 26:973-979. [PMID: 17936565 DOI: 10.1016/j.annfar.2007.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Delayed neurological deficit occurs among 30% of patients after aneurysmal subarachnoid haemorrhage, mainly related to cerebral vasospasm. The early detection of cerebral ischemia remains problematic. Conventional cerebral monitoring (as intracranial pressure and cerebral perfusion pressure) appears to be insufficient, because cerebral ischemia may occur without elevated intracranial pressure. Global cerebral monitoring as venous jugular oxygen saturation are useful for regional monitoring. Local monitoring as oxygen tissue partial pressure (PtiO2) and microdialysis are sensible for brain ischemia detection, but may also ignore episodes occurring in non-monitored brain area. For the detection of most episodes of brain ischemia, several monitoring system should be use performing a multimodal intracerebral monitoring. Brain microdialysis and oxygen tissue partial pressure are promising monitoring system.
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[Coma with bilateral mydriasis after use of transdermal scopolamine in ICU]. ACTA ACUST UNITED AC 2007; 26:1070-2. [PMID: 17961969 DOI: 10.1016/j.annfar.2007.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Accepted: 09/24/2007] [Indexed: 11/30/2022]
Abstract
We report the case of an ICU patient with previous medical history of head trauma with hydrocephalus requiring ventricular derivation, presenting a coma (Glasgow Coma Score=8) with bilateral mydriasis after the use of transdermal scopolamine (1 mg) for profuse bronchial secretions. Neurological explorations (CT-scan and electroencephalogram) confirmed the absence of organic cause to the neurological deterioration. Neurological status rapidly and completely improved after removal of transdermal scopolamine suggesting a central anticholinergic syndrome.
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[Microdialysis and brain injury: importance of animal study]. ACTA ACUST UNITED AC 2006; 25:735-40. [PMID: 16698229 DOI: 10.1016/j.annfar.2006.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Brain microdialysis allows the exploration of brain extracellular medium. This review discusses the main contribution of brain microdialysis for the knowledge of the pathophysiology of brain ischemia and trauma. We describe fundamental principle of microdialysis, limits, and validated metabolic parameters as the lactate/pyruvate ratio or glycerol. The interest to use microdialysis for testing metabolic hypothesis and potential scientific research ways will also be discussed.
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Abstract
The benefit of therapeutic hypothermia after severe head injury is highly controversial. However, hypothermia is still used and studied in this context for multiple reasons. Efficacy of hypothermia is demonstrated after cerebral ischemia in numerous animal studies and after cardiac arrest in human studies. Hyperthermia is a major independent factor of outcome after cerebral ischemic or traumatic brain injury. Moreover, ICP is related to core temperature, and hypothermia may be used to decrease intracranial hypertension. However, many questions are still unresolved and can explain discrepancies between clinical studies: direct measurement of cerebral temperature, relationship between ICP, temperature and PaCO(2), level and duration of hypothermia and precise methods for cooling and particularly for rewarming.
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Abstract
BACKGROUND Measure of blood flow velocity in retrobulbar vessels is performed to determine the severity of ophthalmic pathologies as glaucoma. In children, this measure is usually performed under general anaesthesia. Sevoflurane is known to not modify cerebral blow flow velocities. However, its effect on retrobulbar circulation is not known. This study was designed to evaluate the effect of sevoflurane on retrobulbar circulation flow velocity in children undergoing examination for ocular disorders under general anaesthesia. METHODS Thirteen mechanically ventilated children (Fi(O2))=1) were included. Blood flow velocities of central retinal artery, ophthalmic artery, and middle cerebral artery were measured by Doppler ultrasound during 1 and 2 age-adjusted minimal alveolar concentration (MAC) sevoflurane anaesthesia. Intra-ocular pressure and non-invasive haemodynamic parameters were also measured. End-tidal carbon dioxide tension was controlled during all the study period. RESULTS Mean arterial pressure decreased from 1 to 2 age-adjusted MAC sevoflurane (58 [12] vs 54 [12] mm Hg, P=0.01). In the ophthalmic artery, end diastolic velocity (EDV) decreased significantly at 2 MAC (1 MAC: 4.4 [4] cm s(-1) vs 2 MAC: 1.4 [2.4] cm s(-1); P=0.04) and resistivity index (RI) increased significantly (1 MAC: 0.83 [0.11] vs 2 MAC: 0.93 [0.09]; P=0.007). Systolic velocity, EDV, and RI remained constant in the central retinal artery and in the middle cerebral artery. CONCLUSION High alveolar concentration of sevoflurane decreased blood flow velocity in the ophthalmic artery, but not in the central retinal and the middle cerebral arteries in children ventilated in hyperoxic condition. This effect was related to a decrease in mean arterial pressure. This vessel-dependent effect may be explained by the different autoregulatory mechanisms of these arteries. In the present hyperoxic conditions, the vascular effect of sevoflurane may have been limited in the central retinal artery and not in the ophthalmic artery.
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[Preoperative betablockers use in vascular and thoracic surgery]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2004; 23:804-10. [PMID: 15345252 DOI: 10.1016/j.annfar.2004.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Revised: 06/03/2004] [Accepted: 06/03/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate betablockers use and effect in the preoperative period in vascular and thoracic surgery. PATIENTS AND METHODS Retrospective study concerning patients scheduled for high or intermediate surgical risk procedure (n = 321) in a French vascular and thoracic surgery department during 2002. Eligibility for betablocker therapy was defined as previously described for inclusion criteria in Mangano's Study (N Engl J Med 1996;335:1713-20). Therapy effect was evaluated with heart rate in the operating room. RESULTS Forty-six percent (99/213) of eligible patients for betablockers were really treated in the preoperative period. In patients treated with betablockers, 40% appeared in the operating room with the most favorable heart rate (55-65 b/min). During surgical procedure, heart rate over 80 b/min was observed in more than 30% of patients with betablocker therapy. In patients eligible for betablocker therapy but untreated with these drugs, only 12% have received betablockers in the preoperative period. CONCLUSION Betablockers underuse is important in the preoperative period, and effect on heart rate is rarely optimal. This fact should encourage physicians to apply protocols for perioperative betablockers administration.
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Acute thrombosis of the external iliac artery after a short procedure in the high lithotomy position. Anesthesiology 2000; 93:1353-4. [PMID: 11046227 DOI: 10.1097/00000542-200011000-00032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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