ANESTHESIOLOGIE REANIMATION HAITI (HUEH)

SOURCE Les complications péri-opératoires liées à l’anesthésie, la chirurgie qui la motive ou l’état clinique du patient, peuvent entraîner de la part de celui qui en est victime le souhait d’intenter une  action en justice , qui n’est pas facile à supporter pour le praticien mis en cause. La SFAR vise à appréhender le risque péri-anesthésique et surtout à en prévenir la réalisation, notamment au moyen de ses " Recommandations " techniques. La SFAR considère également qu’elle se doit de donner des conseils à ses membres sur les attitudes généralement recommandables en cas d’accident et sur les moyens permettant d’aborder les éventuels procès dans les meilleures conditions possibles. Des dispositions de  la loi n° 2002-303 du 4 mars 2002 , relative aux droits des malades et à la qualité du système de santé, sont susceptibles de modifier certains éléments d’appréciation. Le premier point important à prendre en considération est que, en cas de procès porté devant ...

Non-invasive Detection of Hypovolemia or Fluid Responsiveness in Spontaneously Breathing Subjects Background  In the assessment of hypovolemia the value of functional hemodynamic monitoring during spontaneous breathing is debated. The aim of our study was to investigate in spontaneously breathing subjects the changes in hemodynamic parameters during graded central hypovolemia and to test whether slow patterned breathing improved the discriminative value of stroke volume (SV), pulse pressure (PP), and their variations (SVV, PPV). In addition, we tested the alterations in labial microcirculation. Methods  20 healthy volunteers participated in our study. Central hypovolemia was induced by lower body negative pressure (LBNP). Continuous signals of ECG, non-invasive blood pressure and central venous pressure were recorded. During baseline and each stage of LBNP the labial microcirculation was investigated by orthogonal polarization spectral imaging, 3 minute periods of pattern...

Prophylactic phenylephrine for caesarean section under  spinal anaesthesia: systematic review and meta-analysis We conducted a systematic review to determine the harm and benefit associated with prophylactic phenylephrine for caesarean section under spinal anaesthesia. We included 21 randomised controlled trials with 1504 women. The relative risk (95% CI) of hypotension with phenylephrine infusion – as defined by authors – before delivery was 0.36 (0.18–0.73) vs placebo, p = 0.004; 0.58 (0.39–0.88) vs an ephedrine infusion, p = 0.009; and 0.73 (0.55–0.96) when added to an ephedrine infusion, p = 0.02. After delivery, the relative risks of hypotension and nausea and vomiting with phenylephrine compared with placebo were 0.37 (0.19–0.71), p = 0.003, and 0.39 (0.17–0.91), p = 0.03, respectively. There was no evidence that hypertension, bradycardia or neonatal endpoints were affected. Phenylephrine reduced the risk for hypotensio...

More than a decade ago, a 43-year-old woman went to a surgeon for a hysterectomy. She was put under, and everything seemed to be going according to plan, until, for a horrible interval, her anesthesia stopped working. She couldn’t open her eyes or move her fingers. She tried to breathe, but even that most basic reflex didn’t seem to work; a tube was lodged in her throat. She was awake and aware on the operating table, but frozen and unable to tell anyone what was happening. SOURCE

Abstract BACKGROUND: Postoperative pain remains a significant problem following paediatric surgery. Premedication with a suitable agent may improve its management. Clonidine is an alpha-2 adrenergic agonist which has sedative, anxiolytic and analgesic properties. It may therefore be a useful premedication for reducing postoperative pain in children. OBJECTIVES: To evaluate the evidence for the effectiveness of clonidine, when given as a premedication, in reducing postoperative pain in children less than 18 years of age. We also sought evidence of any clinically significant side effects. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 12, 2012), Ovid MEDLINE (1966 to 21 December 2012) and Ovid EMBASE (1982 to 21 December 2012), as well as reference lists of other relevant articles and online trial registers. SELECTION CRITERIA: We included all randomized (or quasi-randomized), controlled t...

Management of pulmonary embolism

Management of difficult airway patients and the use of a difficult airway registry at a tertiary care pediatric hospital. Sheeran PW ,  Walsh BK ,  Finley AM ,  Martin AK ,  Brenski AC . Author information Abstract BACKGROUND: Appropriate recognition and management of the pediatric difficult airway is essential. Two patient deaths in a 2-year period involving children with a known difficult airway led to the formation of the institution's multidisciplinary Difficult Airway Committee. METHODS: Patients with a suspected difficult airway or a known difficult airway are entered into a registry of difficult airway patients. A note describing the airway and any experiences at airway manipulation is entered as part of a difficult airway note in the patient's electronic medical record as soon as the patient is recognized as having a difficult airway. A call system has been developed to mobilize expert emergency airway assistance for these patients. Multi...

BONNE FETE  FEVRIER 2014 DR. YOLAINE EDOUARD JEAN-PIERRE (CHEF DE SERVICE): 5 FEVRIER DR. JOHANNE DOMMERCANT (MDS) : 6 FEVRIER DR. DENISE FABIEN (MDS) : 14 FEVRIER DR. BENOUCHECA PIERRE : 10 FEVRIER