Search

Background The aim of our study was to describe the anatomic relationships in internal jugular (IJV), subclavian (SCV), and femoral (FV) vein sites. Methods One hundred and forty-two children had a two-dimensional (2D) ultrasound (US) evaluation of IJV, SCV, and FV sites. They were enrolled according to their age: 0–1 month old ( n =9), 1 month old to 2 yr old ( n =61), 2–6 yr old ( n =22), 6–12 yr old ( n =32), and 12–18 yr old ( n =18). Results We found about 7.7% variation for the IJV. The most common anatomic variations were a lateral (nine children) or anterior (nine children) position of the IJV to the carotid artery. Regardless of the age category, about 9.8% of the anatomic variations were found for the FV. The most common anatomic variation in our study was that the FV ran anteromedially to the femoral artery (17 children). Anatomic variation of the SCV, regardless of age category, was about 7.4%. The most common anatomic variation was the SCV, which ran medially (10 children) to the subclavian artery. Conclusions The relevant percentages of anatomic variations obtained for all these areas support at least a systematic US screening before attempting to obtain central venous access, ideally using a US-guided technique.

Resume Objectifs Conception et evaluation d'un programme d'aide a la prescription en nutrition artificielle, NutriPDA ® , dedie a la reanimation et a la periode peri-operatoire, fonctionnant avec le systeme d'exploitation Palm OS. Type d'etude Etude prospective de type avant–apres. Methodes Soixante et un patients admis en reanimation apres chirurgie cardiovasculaire et thoracique ont ete etudies (âge superieur a 17 ans, duree de nutrition artificielle superieur a trois jours, duree de sejour superieur a huit jours). Les patients ont ete repartis historiquement en deux groupes (avant et apres utilisation de NutriPDA) : groupe A : 32 patients (quatre mois en 2005) ; groupe B : 29 patients (quatre mois en 2006). Resultats Il n'y avait pas de difference significative concernant les caracteristiques demographiques et les scores de gravite entre les deux groupes. Les apports caloriques etaient inferieurs a 80 % des depenses energetiques de base chez 21 % des patients du groupe A, contre seulement 1 % des patients du groupe B ( p p Conclusion L'aide a la prescription de la nutrition artificielle par le logiciel NutriPDA ® a permis d'ameliorer les apports nutritionnels au lit du malade.

Resume Objectif. – Faire une revue de l’etat actuel des connaissances sur la variabilite de la frequence cardiaque et de la pression arterielle. Sources des donnees. – Recherche des donnees dans la banque de donnees Medline® des articles de langue francaise ou anglaise. Les articles originaux et les observations cliniques ont ete retenus. Extraction des donnees. – Les articles ont ete analyses de facon a extraire toutes les informations disponibles sur la variabilite de la pression arterielle et de la frequence cardiaque (ou de l’intervalle RR), en mettant l’accent sur l’analyse spectrale. La non stationnarite est abordee, cas ou les analyses temps–frequence et temps–echelle sont d’un interet particulier. Synthese des donnees. – En raison de sa capacite a moduler rapidement les niveaux de pression et la frequence cardiaque, l’activite du systeme nerveux autonome peut etre evaluee par la mesure de la variabilite de la pression arterielle et de la frequence cardiaque. Le baroreflexe appartient au systeme nerveux autonome, et est l’un des principaux mecanismes de controle a court terme de la pression arterielle. En faisant varier la frequence cardiaque et les resistances systemiques, le baroreflexe tend a maintenir le niveau de la pression arterielle. La variabilite de la pression arterielle et de la frequence cardiaque a aide a la comprehension des mecanismes physiopathologiques de certaines affections. Un nombre croissant de travaux suggere que les composantes spectrales de ces signaux, notamment la balance sympathovagale, peuvent avoir une valeur pronostique. Les differents types d’analyse spectrale des signaux biologiques, en particulier la transformee de Fourier rapide, peuvent etre utilises d’une facon facilement lisible et interpretable, en particulier en clinique. L’analyse spectrale des signaux non stationnaires a conduit a developper des outils specifiques adaptes a ces signaux, parmi lesquels emergent les methodes temps–frequence et temps–echelle qui prennent explicitement en compte une possible evolution temporelle du contenu frequentiel d’un signal.

BACKGROUND Lateral wall pressure may cause tracheal injury by affecting tracheal capillary blood flow. Damage to the trachea is less severe when lateral wall pressure exerted by the endotracheal tube cuff does not exceed the mean capillary perfusion pressure of the mucosa. The purpose of this study was to determine the effects of hypothermic and normothermic cardiopulmonary bypass (CPB) on tracheal tube cuff pressure dynamics. METHODS Twenty-two patients were studied during normothermic CPB (pulmonary artery blood temperature in the CPB period between 36 and 35 degrees C), and 22 patients during hypothermic CPB (pulmonary artery temperature in the CPB period between 32 and 28 degrees C). A Mallinckrodt Medical Lo-Contour Murphy tracheal tube, with high-volume, low-pressure cuff was used without lubricant. Intracuff pressure (ITCP) was recorded at end-expiration before, during and after cardiopulmonary bypass. RESULTS ITCP measurements were different between groups during CPB at aortic cross-clamping (13.9 +/- 0.8 mmHg in the normothermic group versus 11.3 +/- 0.4 mmHg in the hypothermic group, P < 0.05), and respectively during CPB after aortic declamping (15.3 +/- 0.8 mmHg and 12.6 +/- 0.8 mmHg, P < 0.05) and after CPB at the end of surgery (16.8 +/- 0.7 mmHg and 18.6 +/- 0.3 mmHg, P < 0.05). CONCLUSION We conclude that the ITCP is higher in normothermic CPB than in hypothermic CPB; however, the clinical significance of this observation needs further investigation.

A 62-year-old patient was scheduled for coronary artery bypass surgery because of tritroncular coronary artery disease. The early postoperative period was uncomplicated until the 10th postoperative day when purulent fluid appeared from the sternal wound. Cultures of blood, wound and mediastinal tissues yielded Streptococcus pneumoniae with decreased susceptibility to penicillin G. Despite prompt surgical debridement and appropriate antibiotics, a septic shock with multiorgan failure occurred and the patient died on the 19th postoperative day. Although Streptococcus pneumoniae is uncommonly implicated in postoperative mediatinitis, it frequently leads to multiple organ failure and death.

The arm is particularly vulnerable to neurological injury, due to the intimate anatomical relationship between the brachial plexus and the traction zones. Severe injuries of the brachial plexus can be caused by compression, traction or laceration. Fortunately, many deficits are superficial and permanent neurovascular deficits are rare. Nevertheless, it is important to identify the probable cause of the injury since the prognosis for recovery directly depends on the underlying nature of the neurological deficit. Two anaesthetised children who suffered brachial plexus injury during cardiac catheterisation are reported. The first, with Ebstein's anomaly and significant pulmonary valve stenosis, presented, after the procedure, with a right arm motor deficit with proximal predominance. The second patient, with tetralogy of Fallot and pulmonary atresia, presented difficulty in left arm abduction and external rotation on awakening. The risk factors for brachial plexus lesions during anaesthesia are discussed. These include improper positioning, anaesthetic agents, extreme variations of body mass index and anatomical anomalies. Prevention, evolution and treatment of the brachial plexus injury are also considered. With proper care by the cardio-radiologist and anaesthesiologist the frequency of this injury can be reduced.