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Critical Care 04/2012; 4:1-2. · 4.93 Impact Factor
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Annales francaises d'anesthesie et de reanimation 11/2011; 30(11):852-4. · 0.77 Impact Factor
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ABSTRACT: Sepsis-associated encephalopathy is a global cerebral dysfunction induced by the systemic response to inflammation and infection, without a liver or renal injury. Alteration of consciousness, from confusion to coma, is the main clinical symptom. This encephalopathy is associated with an increase in mortality due to sepsis. Its physiopathology is unknown. There is frequently an increased permeability of the blood-brain barrier, which might explain a role of endotoxins on cerebral metabolism. Changes in neurotransmitter release or concentrations (norepinephrine, serotonin, dopamine, GABA) have been reported. There is not any specific treatment of septic encephalopathy. In most cases, this syndrome is rapidly reversible after the treatment of sepsis.
Annales Françaises d Anesthésie et de Réanimation 09/2006; 25(8):863-7. · 0.84 Impact Factor
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ABSTRACT: Emergence delirium in the post-anaesthesia care unit (PACU) is poorly understood. The goal of this prospective study was to determine frequency and risk factors of emergence delirium in adults after general anaesthesia.
In this prospective study, 1,359 consecutive patients were included. Contextual risk factors and occurrence of delirium according to the Riker sedation scale were documented. Groups were defined for the analysis according to the occurrence or not of agitation, then after exclusion of patients with preoperative anxiety and neuroleptics, or both, and antidepressants or benzodiazepines treatments.
Sixty-four (4.7%) patients developed delirium in the PACU, which can go from thrashing to violent behaviour and removal of tubes and catheters. Preoperative anxiety was not found to be a risk factor. Preoperative medication by benzodiazepines (OR=1.910, 95% CI=1.101-3.315, P=0.021), breast surgery (OR=5.190, 95% CI=1.422-18.947, P=0.013), abdominal surgery (OR=3.206, 95% CI=1.262-8.143, P=0.014), and long duration of surgery increased the risk of delirium (OR=1.005, 95% CI=1.002-1.008, P=0.001), while a previous history of illness and long-term treatment by antidepressants decreased the risk (respectively, OR=0.544, 95% CI=0.315-0.939, P=0.029 and OR=0.245, 95% CI=0.084-0.710, P=0.010).
Preoperative benzodiazepines, breast and abdominal surgery and surgery of long duration are risk factors for emergence delirium.
BJA British Journal of Anaesthesia 07/2006; 96(6):747-53. · 4.24 Impact Factor
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ABSTRACT: We report a case of accidental puncture of the small bowel during an ilioinguinal/iliohypogastric nerve block procedure for hernia repair. The diagnosis was made a few days later during a laparoscopic exploration owing to the progressive onset of clinical and radiological intestinal obstruction. A large, obstructing subserosal haematoma was found without any apparent perforation of the mucosa, and the damaged loop was resected. Such a complication has already been reported once in the literature after use of a long bevel needle for the puncture. This case is the first reported using an atraumatic short bevel needle. We discuss the technical aspects of the procedure and underline the fact that regional anaesthesia in children is never totally risk free.
Pediatric Anesthesia 03/2003; 13(2):164-6. · 2.10 Impact Factor
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ABSTRACT: Anesthetized patients for lumbar disk surgery can be placed in prone or knee chest position which may adversely affect circulation. Augmentation of the delta-down component of the systolic blood pressure variation in ventilated patient is a sensitive indicator of intra operative hypovolemia. According to results, cardiac filling pressure is more affected in the knee chest position than in prone position. Preload state variation between the two positions, evaluated with albumin fluid challenge, seems to be more important than 500 ml.
Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression 02/1994; 34 Spec No 1:53-4.
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ABSTRACT: The aim of the study was to assess the effects of the sitting prone position on right ventricular function in a group of patients requiring low back surgery with using of right heart catheterization with a low fast response thermodilution technique. This posture involves moderated hemodynamic effects. A discrete right ventricle impairment characterised by a decreased compliance was observed and may be due to a moderate compression by the sternum and was improved by fluid challenge. Thus, the sitting prone position appears a safe position.
Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression 02/1994; 34 Spec No 1:51-2.
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Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression 02/1994; 34 Spec No 1:45-6.
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ABSTRACT: The most satisfactory method of prone positioning for the posterior approach to the spine and posterior fossa has been influenced by the necessity of providing good operating condition: prone position without abdominal and thoracic compression with a patient's head in the neutral position. Communication between the cava veins and the vertebral venous plexus explain that induce positioning can produce an excessive venous intraoperative bleeding with decreased surgical visibility. Furthermore venous return to the heart decreased resulting in some degree of impaired cardiac output. Hemodynamic disturbances of cerebral or spinal cord bloods flows can occurred.
Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression 02/1994; 34 Spec No 1:38-42.
