Severe anterior post-burn contracture PBC of the neck poses the anaesthesiologist some difficult problems and results in difficult intubation when extension of the atlanto-occipital joint is impaired. Such patients must therefore have the PBC scar released before other procedures are performed, in order to ensure airway control. To show our experience with quick surgical neck release of patients with severe anterior PBC of the neck to facilitate direct laryngoscopy and orotracheal intubation OTI. The patients were given ketamine, after which a release incision was made over the anterior PBC of the neck scar.
Telephonefaxe-mail ac. Fluid management of the surgical patient has undergone a paradigm shift over the past decade. The fluid management of patients undergoing free flap reconstruction is particularly challenging.
This is typically a long operation with minimal surgical stimulation, and hypotension often ensues.
The use of vasopressors in these cases is contraindicated to maintain adequate flow to the flap. Hypotension is often treated with intravenous fluid boluses. However, aggressive fluid administration to maintain adequate blood pressure can result in flap edema, venous engorgement and, ultimately, flap loss.
Twenty female patients undergoing simultaneous microvascular free flap reconstruction immediately following mastectomy were studied. Preoperative and intraoperative care were standardized. Each patient received intra-arterial blood pressure monitoring. In all patients, cardiac output measurement occurred throughout the intraoperative period using the arterial pulse contour device.
Control patients had their fluid administered at the discretion of the anesthesiologist blinded to results from the cardiac output device. There was no difference in heart rate or mean arterial pressure between groups at the end of the operation.
The intervention group required less postoperative fluid resuscitation during the early postoperative period total fluid administered from end of operation to midnight of the operative day, 6. Since the s, the prevailing wisdom regarding the amount of fluid to administer to surgical patients has undergone several paradigm shifts 1 — 4.
The fluid management of patients undergoing microvascular free flap reconstruction is particularly challenging. This is typically a long operation with minimal surgical stimulation. The use of vasopressors in these cases is contraindicated so as not to compromise blood flow to the flap.
Inadequate volume replacement in these patients can potentially lead to poor flow in the flap with resultant ischemia and flap loss. Aggressive fluid administration in these patients, to maintain adequate blood pressure, can result in flap edema, venous engorgement and, ultimately, flap loss.
There have been several retrospective studies that have examined fluid administration in these patients and found that excessive perioperative fluid administration has been associated with flap loss 56.
Tailoring fluid management for these patients, by using a goal-directed approach, may be the most beneficial. In this context, administering fluids based on need as determined by an upper limit of stroke volume variation SVV is an approach with potential merit.Le Dr Bouarroudj Noreddine est un médecin anesthésiste réanimateur et urgentiste.
Il a suivi ses études médicales (Doctorat en médecine) et de spécialisation (Diplôme des études médicales supérieures) à l'Institut National des Études Médicales de l'université de pfmlures.com s'est spécialisé dans le traitement de la douleur et les blocs nerveux périphériques sous écho.
Vol 10 no 1 Le Spécialiste, Le magazine de la FMSQ, Vol. 10 no. 1 – mars Édition spéciale mettant en vedette des «Comportements Extrêmes», incluant l'alléguée «quérulence et ses impacts», et . عرض ملف Charbel BouSaba الشخصي على LinkedIn، أكبر شبكة للمحترفين في العالم.
لدى Charbel7 وظيفة مدرجة على الملف الشخصي عرض الملف الشخصي الكامل على LinkedIn وتعرف على زملاء Charbel والوظائف في الشركات pfmlures.com: Anesthesia Fellow chez Gustave .
IFNA History Book task force. The IFNA is preparing it's History Book. The History Book task force met in Park Ridge, USA, last summer at the AANA Headquarter.
Stephanie Pons profiles. Share on LinkedIn Share on Facebook Share on Twitter Share on Google+. Find your connection on LinkedIn. Join the world's largest professional network. Ingénieure Etudes de prix chez GCC.
Location France Industry Civil Engineering. Current: Ingénieur études de prix at GCC Construction / Energie. - Initative d'Excellence (IDEX), Projet de Recherche Exploratoire (PEPS): Etude exploratoire de la capacité de nouveaux composés neuroprotecteurs à contrecarrer les atteintes neuronales évoquées par la sclérose en plaques (Mensah-Nyagan AG) Sur le plan .