Accessory myocardial pathway mimicking an inferior myocardial infarction after major vascular surgery.
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Aged↗
Biomedical subjects
Y Le Manach
Publications and source records attributed to Y Le Manach.
Anaphylaxis to rocuronium.
Reports about anaphylactic and anaphylactoid reactions to rocuronium have increased recently. We report two new cases of documented grade III anaphylaxis, leading to death in one patient. The first case occurred in an 81-year-old ASA II woman scheduled for emergency abdominal surgery. Severe hypotension and tachycardia were observed after rocuronium, without bronchospasm. Neosynephrine allowed rapid resuscitation, and the patient recovered fully. The second patient was a 64-year-old ASA II man scheduled for abdominal surgery. Severe haemodynamic instability and bronchospasm occurred after rocuronium. Despite immediate life support, the postoperative period was complicated by persistent low systolic pressure, acute respiratory distress syndrome, acute renal failure, disseminated intravascular coagulation and pancreatitis, leading to the death of the patient.
Aged↗
Complications of percutaneous tracheostomy.
Percutaneous tracheostomy is a technique that, reputedly, is simple to perform and causes few complications. It is routinely used in intensive care. We present two patients with tracheal stenosis. In one patient, we had to perform an anastomotic resection to cure the patient; in the other patient, we had to place an endoluminal conformer. To our knowledge, this complication has not been reported in association with the use of this technique.
Adult↗
[Treatment of acute colonic pseudoobstruction (Ogilvie's syndrome) by cisapride].
A case is reported of a 68-year-old woman admitted in the ICU for acute exacerbation of a chronic obstructive respiratory disease. The trachea was intubated and the lungs ventilated mechanically. She received sedation including midazolam and phenoperidine 1 mg.h-1. On the 6th day, she experienced a massive colonic dilation (caecal diameter of 10 cm at X-ray examination). A colonoscopy was performed which showed the absence of obstruction, confirmed the diagnosis of pseudo-obstruction of the colon and allowed a decompression which was inefficient. A new colonoscopic decompression was performed on the 8th day, without prolonged effect. At that time, the patient was given cisapride in her gastric tube (80 mg). This treatment restarted the bowel movements within 48 hours and the caecal diameter decreased immediately to 7 cm. Cisapride was maintained for 10 days and mechanical ventilation for 30 days. No further dilation occurred during this time and the patient was discharged from the ICU. Few cases of Ogilvie's syndrome successfully treated with cisapride have been reported in the literature. The efficacy of this agent for the treatment of Ogilvie's syndrome remains to be assessed in a controlled study.
Aged↗
[The value and limitations of autotransfusion in traumatology].
29 autotransfusions were realised in severe cases of trauma (20% of a sample of 143 traumatic emergencies). The recovery of haemothorax blood as well as the peroperative collection by a Cell Saver allowed the retransfusion of 1989 +/- 1,838 ml (225-7070 ml) of autologous blood, amounting to 56% of the average blood loss. A total of 69% of the patients received homologous blood. Eight patients (where the haemorrhage amounted to 143% of the blood volume) showed some coagulation troubles. Autotransfusion assures the immediate availability of blood while reducing the immunological and viral transfusion risks. Therefore haemothorax autotransfusion should be used systematically. Peroperative recollection by a cell-separator works well but is technically more tedious.
Adult↗
[Methods of reducing peroperative bleeding].
The reduction of bleeding during surgery can be aimed at for two reasons: to facilitate the operation by providing a bloodless field and/or to avoid blood loss requiring compensation by transfusion. These aims can be reached by reducing blood pressure or by acting on blood-clotting. For inducing hypotension sodium nitroprussiate and isoflurane are mainly used. Complex and precise monitoring is required for patient safety. Two drugs have been used to diminish bleeding: desmopressin and aprotinin. With the latter an important reduction (40 to 50%) of the blood loss has been achieved.
Blood Loss, Surgical↗