Praticien en Anesthesie Reanimation最新文献

{"title":"","authors":"","doi":"10.1016/j.pratan.2024.08.001","DOIUrl":"10.1016/j.pratan.2024.08.001","url":null,"abstract":"","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 5","pages":"Pages 306-308"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Évaluation de la profondeur d’anesthésie en pédiatrie","authors":"Nada Sabourdin","doi":"10.1016/j.pratan.2024.09.001","DOIUrl":"10.1016/j.pratan.2024.09.001","url":null,"abstract":"<div><div>Le monitorage de la composante hypnotique de l’anesthésie est basé sur l’analyse spectrale de l’activité électroencéphalographique, qui varie sous l’effet des agents anesthésiques. Chez l’enfant, le spectre de l’EEG est différent de l’adulte. L’analyse est basée sur les données brutes du signal ou sur leur transformation algorithmique. Les agents anesthésiques réduisent globalement l’amplitude du signal EEG et homogénéisent le spectre. Les paramètres mesurant la profondeur d’anesthésie doivent être sélectionnés spécifiquement avant l’âge de 1 an. Chez les enfants, le monitorage de la profondeur d’anesthésie est donc possible et important.</div></div><div><div>The hypnotic component of anaesthesia is the only one usually monitored. Monitoring of the depth of anaesthesia is based on spectral analysis of the EEG signal related to the administration of the anaesthetic drugs. In the youngest paediatric patients, the EEG spectrum is different from the one of adult patients. The analysis is based on the raw data of the EEG signal and their algorithmic transformation. Taken as a whole, the effect of anaesthetic agent is to reduce the amplitude and the spectrum of the EEG. Before one year of age, the parameters used to monitor anaesthesia need to be adapted. Monitoring of the depth of anaesthesia is not only possible but also important in paediatric patients.</div></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 5","pages":"Pages 263-266"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Échocardiographie pour le remplissage vasculaire","authors":"Laurent Muller,&nbsp;Claire Roger","doi":"10.1016/j.pratan.2024.07.003","DOIUrl":"10.1016/j.pratan.2024.07.003","url":null,"abstract":"<div><p>L’échocardiographie permet avec une bonne précision de détecter une hypovolémie critique et d’évaluer la réponse à l’expansion volémique. Elle constitue le monitorage en première intention lors des états de choc notamment hypovolémique. Le diagnostic de l’hypovolémie repose sur l’appréciation du collapsus systolique du ventricule gauche et sur la mesure des variations de diamètre des veines caves. L’intégrale temps vitesse (ITV) mesurée dans la chambre de chasse sous aortique permet également d’évaluer le volume d’éjection systolique et son évolution après remplissage vasculaire. Chez les patients dont l’hypovolémie n’est pas critique on peut sensibiliser le diagnostic en utilisant l’ITV au cours d’épreuves dynamiques comme l’élévation passive des membres inférieurs ou le remplissage rapide de volumes restreints. L’échocardiographie permet aussi de préciser les situations où le remplissage vasculaire est contre-indiqué.</p></div><div><p>Cardiac echography is an useful to detect hypovolemia and to predict the effect of vascular filling. It can be considered as a first line monitoring in patients with critical hypovolemia. The diagnosis of hypovolemia is supported by the measurement of two parameters: the systolic collapse of the left ventricle and the changes in the diameters of the two vena cava, along with respiratory cycle. The time-speed integral of the sub aortic systolic outflow provides an evaluation of the left ventricle ejection output and its changes according to fluid challenges. In patients with less critical hypovolemia, the diagnosis can be sensitised by the lower limbs passive elevation or by rapid infusion of restricted volume of fluids. Cardiac echography also allows detecting contra-indications to vascular filling.</p></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 4","pages":"Pages 214-221"},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lu pour vous","authors":"","doi":"10.1016/j.pratan.2024.06.001","DOIUrl":"10.1016/j.pratan.2024.06.001","url":null,"abstract":"","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 4","pages":"Pages 250-253"},"PeriodicalIF":0.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"L’hyperthermie maligne comme on ne l’attend pas","authors":"Perrine Deschamps ,&nbsp;Gaspar Gomes Martins ,&nbsp;Florian Beck ,&nbsp;Gabriel Thierry","doi":"10.1016/j.pratan.2024.07.005","DOIUrl":"10.1016/j.pratan.2024.07.005","url":null,"abstract":"<div><p>L’hyperthermie maligne (HM) est une maladie rare touchant des patients génétiquement prédisposés et qui s’exprime dramatiquement sous la forme d’une crise lors de l’exposition à des agents pharmacologiques utilisés en anesthésie-réanimation (A-R) (agents halogénés et/ou curare dépolarisant). La symptomatologie est explosive, mais tend à être retardée avec l’utilisation plus fréquente du sévoflurane et plus rare du suxaméthonium. Cet aspect est illustré par le cas d’un patient ayant une œsophagectomie qui a développé une crise d’hyperthermie maligne en fin d’intervention, 8<!--> <!-->heures après le début de l’exposition au sévoflurane. L’administration du dantrolène a permis une stabilisation hémodynamique et une correction rapide des troubles métaboliques. Un bilan génétique a permis la mise en évidence d’une mutation hétérozygote du gène <em>RYR1</em>. La rareté de la pathologie, l’utilisation d’agents halogénés comme le sévoflurane et le desflurane et le nombre important de mutations potentiellement responsables d’hyperthermie maligne rendent parfois le diagnostic difficile.</p></div><div><p>Malignant hyperthermia (MH) is a rare disease diagnosed in genetically predisposed patients, that expresses as a crisis when patients are exposed to pharmacological agents used in anesthesia and intensive care (halogenated agents and/or depolarizing curare). The symptomatology is explosive but tends to be delayed with the more frequent use of sevoflurane and the rarer use of suxamethonium. A patient undergoing esophagectomy who developed a malignant hyperthermia crisis illustrates this point. This crisis began at the end of the surgical procedure, eight hours after the start of exposure to sevoflurane. Dantrolene administration was life-saving, enabling hemodynamic stabilization and rapid correction of metabolic disorders. A genetic work-up was performed and revealed a heterozygous mutation in the <em>RYR1</em> gene. The rarity of this pathology, the use of halogenated agents such as sevoflurane and desflurane, and the large number of mutations potentially responsible for malignant hyperthermia, sometimes make diagnosis difficult.</p></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 4","pages":"Pages 236-242"},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment construire sa carrière en anesthésie–réanimation","authors":"Francis Bonnet","doi":"10.1016/j.pratan.2024.07.007","DOIUrl":"10.1016/j.pratan.2024.07.007","url":null,"abstract":"","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 4","pages":"Pages 203-204"},"PeriodicalIF":0.0,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toxicité digestive des antibiotiques phénicolés","authors":"Julie Dupont ,&nbsp;Benjamin Corsia ,&nbsp;Elena Le Cam ,&nbsp;Lamine Abdennour ,&nbsp;Alexandre Bleibtreu ,&nbsp;Nicolas Weiss ,&nbsp;Vincent Degos ,&nbsp;Alice Jacquens","doi":"10.1016/j.pratan.2024.07.006","DOIUrl":"10.1016/j.pratan.2024.07.006","url":null,"abstract":"<div><p>La toxicité des phénicolés a conduit à une réduction drastique de leur utilisation depuis les années 1960. Cependant, leur large spectre et leur diffusion dans le système nerveux central font des phénicolés un traitement des abcès cérébraux de choix. Nous rapportons ici quatre cas d’abcès cérébraux traités par thiamphénicol ou chloramphénicol compliqués d’acidose lactique et d’anoxie digestive. La gravité de ces complications et leur potentielle létalité invitent à effectuer le suivi quotidien de la lactatémie et du pH sanguin pendant l’administration des antibiotiques phénicolés.</p></div><div><p>Phenicol antibiotics toxicity has led to drastically reduce their use since the 60's. However, their large spectrum and diffusion into the central nervous system make phenicols an appropriate treatment in bacterial brain abscess. We report four cases of brain abscess treated with thiophenicol or chloramphenicol and complicated with lactic acidosis and anoxic colitis. We therefore recommend daily monitoring of lactatemia and blood pH during phenicols administration.</p></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 4","pages":"Pages 243-249"},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1279796024000901/pdfft?md5=8fa04befa51ba7fee5579a2bfc3dd223&pid=1-s2.0-S1279796024000901-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lombalgies et analgésie péridurale pour travail obstétrical","authors":"Francis Bonnet,&nbsp;Nathalie Durieux","doi":"10.1016/j.pratan.2024.07.001","DOIUrl":"10.1016/j.pratan.2024.07.001","url":null,"abstract":"<div><p>À la suite d’une péridurale pour césarienne, une parturiente développe des lombalgies persistantes qui entravent la prise en charge de son nouveau-né. La mise en cause judiciaire du médecin-anesthésiste amène à questionner la relation entre péridurale, grossesse et lombalgies.</p></div><div><p>Further to an epidural analgesia for C-section, a parturient developed a persistent backache that prevented her for taking care of the newborn. After judiciary complaint, the relationship between epidural analgesia, backache and pregnancy was questioned.</p></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 4","pages":"Pages 222-224"},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"L’échographie neuraxiale : pour ou contre ?","authors":"Christophe Aveline","doi":"10.1016/j.pratan.2024.07.002","DOIUrl":"10.1016/j.pratan.2024.07.002","url":null,"abstract":"<div><p>L’echographie neuroaxiale, bien que peu pratiquée, a de nombreux avantages en termes de fiabilité et de sécurité des anesthésies rachidiennes. L’échorepérage permet de préciser le niveau de ponction par rapport à la position du cône médullaire et de réduire le nombre de tentatives de ponction. La pratique d’un échorepérage est devenue une recommandation des sociétés d’anesthésie locorégionales américaines et européennes.</p></div><div><p>Neuroaxial ultrasonography, although not commonly used, conveys a series of advantages concerning the reliability and the safety of neuroaxial regional anesthesia. It determines precisely the level of needle insertion compared to the position of the spinal cord and reduces the number of attempts. It is nowadays a recommendation of the American and the European Societies of Regional Anaesthesia.</p></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 4","pages":"Pages 232-235"},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La NIVATS : « Non-Intubated Video-Assisted Thoracic Surgery » ou chirurgie thoracique vidéo-assistée en ventilation spontanée. De la physiologie à la mise en application pratique","authors":"Nabil Zanoun,&nbsp;Yoann Elmaleh,&nbsp;Fehmi Kattou,&nbsp;Franck Ehooman,&nbsp;Karim Guessous","doi":"10.1016/j.pratan.2024.06.003","DOIUrl":"10.1016/j.pratan.2024.06.003","url":null,"abstract":"<div><p>La chirurgie thoracique est grevée d’une morbi-mortalité élevée. Le développement récent des techniques chirurgicales mini-invasives a permis l’émergence de la NIVATS (<em>Non-Intubated Video-Assisted Thoracic Surgery</em>) comme une alternative à l’anesthésie générale avec curarisation et intubation sélective en chirurgie thoracique. Cette méthode repose sur le maintien de la ventilation spontanée. Une anesthésie locorégionale est le plus souvent réalisée, permettant ainsi de limiter le niveau de sédation. La réussite de la NIVATS nécessite, avant tout, une sélection minutieuse des patients et des interventions, ainsi qu’une collaboration étroite entre les équipes d’anesthésie et de chirurgie. Les contre-indications à cette technique ainsi que les motifs de conversion en anesthésie générale doivent être connus pour mieux en appréhender les risques. Les bénéfices potentiels (mais non encore démontrés) concernent le délai de récupération et la diminution des complications liées à l’intubation et la ventilation mécanique unipulmonaire. Son empreinte carbone est réduite, ce qui est également à prendre en considération.</p></div><div><p>Thoracic surgery is associated with significant morbidity and mortality. The recent development of minimally invasive surgical techniques has led to the emergence of Non-Intubated Video-Assisted Thoracic Surgery (NIVATS) as an alternative to general anesthesia with muscle relaxation and selective intubation for one lung ventilation in thoracic surgery. This method relies on maintaining spontaneous ventilation. Regional anesthesia is most often performed, thus limiting the level of sedation. The success of NIVATS requires careful patient and procedure selection, as well as close collaboration between anesthesia and surgical teams. Understanding the contraindications of this technique and the reasons for conversion to general anesthesia is essential to better manage its risks. The potential benefits include faster recovery time and a reduction in complications related to intubation and one-lung ventilation. Additionally, its carbon footprint is reduced, which is an important consideration.</p></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 4","pages":"Pages 205-213"},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}