Annales Francaises D Anesthesie Et De Reanimation最新文献

Panton-Valentine leukocidin-producing Staphylococcus aureus necrotizing pneumonia is an unusual cause of community-acquired pneumonia associated with a high fatality rate. The specificities of its presentation must be known by the critical care doctor, in order to quickly make the diagnosis and start the right antibiotics and discuss adjunctive therapy with intravenous immunoglobin. Moreover, the management of close contacts (household and healthcare workers) of patient with such a pneumonia is not well-known. The present case report underlines the clinical presentation of this pneumonia, the specificities of its treatment, and specifies the management of close contacts.

Objectives

Evaluation of the acceptability of complications related to obstetrical epidural analgesia in two populations, parturients and anesthesiologists.

Study design

Prospective, transversal, single center study.

Materials and methods

Evaluation of the acceptability of complications associated with obstetric epidural analgesia performed using a questionnaire of six clinical scenarii in two populations: parturients cared at the University maternity of Nancy and anesthesiologists of Lorraine. Patients were interviewed by an anesthesiologist, physicians via Internet. Acceptability was assessed using two tools, the absolute acceptability with a visual analog scale and the relative acceptability obtained by classifying clinical scenario against each other, in ascending order of acceptability.

Results

One hundred and forty-six parturients and 87 anesthetists assessed the acceptability of the different scenarios. The three less serious scenarios (hypotension, failure, dural tap) were acceptable for both populations. One case (spinal hematoma) was unacceptable for parturients. Three cases of varying severity (failure, dural tap, plexus injury with sequelae) were judged significantly less acceptable by patients than physicians (5.9 vs. 7.9 [P < 0.001], 5.75 vs. 8.1 [P < 0.01], 4.1 vs. 5.1 [P = 0.035]). Multivariate analysis did not show any predictive factor of acceptability in both populations.

Conclusion

In this study, the overall acceptability of the inherent complications of epidural analgesia was good in the two populations. It was essentially based on the notion of severity and preventability. A large interindividual variability was observed and a better acceptance by the anesthesiologists.

Objective(s)

Assess the efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of postpartum haemorrhage.

Study design

Systematic review with meta-analysis.

Material and methods

Systematic review of the literature with the aim of identifying prospective, randomised, controlled trials that assessed the effect of tranexamic acid on peripartum blood loss and transfusion requirement in three clinical contexts: (i) prevention of post-partum haemorrhage in case of elective caesarean section, (ii) prevention of post-partum haemorrhage in case of vaginal delivery, (iii) treatment of post-partum haemorrhage.

Results

Prophylactic administration of tranexamic acid reduced blood loss (mean difference for intraoperative blood loss: −177.9 mL, IC 95%: −189.51 to −166.35, total blood loss: −183.94, IC 95%: −198.29 to −169.60), and the incidence of severe post-partum haemorrhage (OR: 0.49, IC 95%: 0.33 to 0.74). None of the published trials assessed the effect of tranexamic acid on blood products administration or transfusion requirement. Only one study assessed and reported the efficacy of tranexamic acid when administered as a treatment for postpartum haemorrhage. A significant reduction in blood loss was reported within 30 minutes after randomisation (P = 0.03) and confirmed after 6 hours (median: 170 mL (58–323) vs 221 mL (110–543), P = 0.04). None of the included studies adequately studied the incidence of side effects after tranexamic acid administration.

Conclusion

Although tranexamic acid administration seemed to significantly reduce blood loss and the incidence of severe post-partum haemorrhage, further prospective trials are needed to confirm the efficacy and safety of tranexamic administration in the treatment of postpartum haemorrhage. Those studies should assess the pharmacokinetic profile and the safety of this drug in pregnant women.

Introduction

Tracheal rupture is one of the most serious post-intubation complication. However, it is widely underestimated.

Clinical case

An 86-year-old patient with a history of pancreas adenocarcinoma treated with gemcitabin was admitted in intensive care unit for an acute respiratory failure with no identified etiology. The worsening of her respiratory status required invasive mechanical ventilation. One laryngoscopy, performed by a trained operator, found a Cormack 1. Intubation was realized without stylet and the cuff inflated with a syringe. Hemodynamic instability, impaired gas exchange and an extensive subcutaneous emphysema occurred immediately. A CT-scan showed a supracarinal tracheal rupture.

Comment

The etiological analysis of this case identifies several causes of pars membranosa fragility, such as female sex, age greater than 50 years and the short stature. The emergency intubation and the cuff inflated by a syringe were the risk factors of tracheal rupture in this patient.

Conclusion

Special care should be paid to this complication, early diagnosis has probably a prognostic value. Training operators in the use of stylets and monitoring cuff pressure are required.

Objective

To study the preoperative psychological experience and beliefs in adult patients scheduled for surgery at the University Hospital of Parakou.

Patients and methods

A descriptive and analytical study with prospective data collection conducted over three months (June 1st to August 30, 2012) and involved 75 patients.

Results

Of the 108 patients scheduled for surgery, 75 patients (69.44%) had been chosen. The average age was 44.11 ± 16.24 years with a male predominance (56%). Fifty-five patients (73.3%) were anxious and 32 patients (46.7%) were afraid of dying. Forty-five patients (60%) had not received any information about the procedure they should undergo and 60 patients (80%) were not informed of the possible complications of surgery. Fifty-eight patients (77.3%) were aware of the anesthetic technique and 5.2% of patients were aware of the possible complications of anesthesia. In 56 patients (74.7%), the disease was of natural origin, in 18.6% of cases there was an enchantment and 5 patients (6.7%) the disease is due to a deity. In the context of spiritual care, 15 patients (20%) had consulted a marabout, 11 patients (14.7%) a healer and 10 patients (13.3) a fetish.

Conclusion

The preoperative period induces a significant burden of anxiety among patients and their families. In Benin, the announcement of surgery is an opportunity for confrontation of the patient to an obsession with death which he manages to escape despite the countless sacrifices of traditional conjuring.

Objective

The flow rate of intravenous administration of vasoactive agents should be steady in order to prevent changes in hemodynamics. In the newborns, because the flow rate is often lower than 1 mL/h, it is difficult to switch of the syringe. The aim of our study was to compare the variations of concentration of active substance delivered after a manual or an automatic switch off the syringe with three different volumes (10 mL, 20 mL and 50 mL).

Materials and methods

Glucose solution (10 g/L) was used to simulate the administered substance. Saline was administered in “Y” simultaneously with the glucose solution through a catheter. The infused substance was collected at the tip of the catheter. The glucose concentration was measured at 15min-interval for 3 hours.

Results

The manual switch of the syringe was associated with a significant alteration of the flow rate, lasting more than 15 min. In contrast, the automatic switch of syringes was associated with no change of the flow rate, especially with small-volume syringes (10 mL).

Conclusion

In newborns, in order to prevent the change in flow rate of drugs after a switch of syringes, our results suggest the use of syringe-pump with built-in automatic switch and small-volume syringes.

Maxillo-facial traumas are frequent and most often occur in young patients. Naso-tracheal or orotracheal intubation may be contraindicated in case of combined occlusal fracture and nasal or ethmoido-nasal fracture. This study was carried out a clinical case of a patient treated at the Lille University Hospital for a maxillofacial trauma associating fracture of nose and maxilla. The purpose was to assess the reliability of submental intubation as an alternative to tracheotomy. Submental intubation is a reliable single and safe technique allowing an one-stage surgical treatment in case of complex association of fractures without using tracheotomy. Its use should be implemented on a larger scale.