[Admission modalities of brain dead patients at Ile de France hospitals which do not harvest organs. Cooperative Group for Transplantation of Ile de France (GCIF)]. / Modalités d'accueil des sujets en mort encéphalique dans les hôpitaux d'Ile-de-France ne réalisant pas de prélèvement d'organes. Groupe coopératif de transplantation d'Ile-de-France (GCIF).

In order to identify possible causes for the shortage in organ procurement today in France, a regional survey including 74 hospitals in the Paris area which are likely to receive brain dead patients (BDP) and in which there were neither harvesting nor transplantation activities was conducted. Of the 66 hospitals (89%) answering this survey, half of them were district general hospitals. In the 2 years before the survey, they received on average three BDP. Such a figure represents at least 10% of BDP seen in this area. For one half of the centres, care of these patients was difficult or impossible due to the available facilities. Organisational concerns were among the major problems raised by the transfer of these patients to harvesting centres. A preestablished geographical network would be of help for simplifying the transfer of these patients. Interestingly, about 50% of centres already had such links with a transplantation centre. This study provides information concerning logistics and possible points which could be improved in order to increase the number of BDP liable to be transferred to transplantation centres.

[Heat and moisture exchanging filters for conditioning of inspired gases in adult anesthesia and resuscitation]. / Filtres échangeurs de chaleur et d'humidité pour le conditionnement des gaz inspirés en anesthésie-réanimation de l'adulte.

OBJECTIVES: Heat and moisture-exchanging filters (HMEFs) are increasingly used in clinical practice. At the same time, new scientific data are available which clarify the benefits of these devices. DATA SOURCES: We searched in the Medline database for all papers written in English or French, without limiting date of publication, using the following key-words separately or in combination: humidity, temperature, mechanical ventilation, equipment. STUDY SELECTION: From the 200 articles provided by Medline, we selected those directly concerning HMEFs. Some older studies and those on HMEFs no longer available were excluded. DATA EXTRACTION: Principle data available from the literature were analysed. DATA SYNTHESIS: Humidification and warming of the inspired gas mixture is mandatory during mechanical ventilation. There is a direct link between HMEF performance and the characteristics of tracheal secretions. This justified the recommendation for the use of HMEFs with a humidity output above 30 mg of water per litre of gas mixture. In this case, HMEFs are as efficient as conventional heated humidifiers. HMEFs seem to decrease the rate of nosocomial pneumonia in comparison with heated humidifiers. HMEFs induce a slight increase of dead space which should be taken into consideration during weaning from mechanical ventilation. There are demonstrable data in the literature suggesting the possibility of cross viral infection via the anaesthetic machine when an HMEF is not used. There are no data which suggest a specific type of HMEF regarding viral filtration. CONCLUSION: According to the literature data, using an HMEF is essential in anaesthesia and is highly recommended in intensive care.

[Postoperative allergic complications: the role of the anesthetist in conducting the immuno-allergic investigation]. / Complications allergiques péri-opératoires: rôle du médecin Anesthésiste-Réanimateur dans la conduite du bilan immuno-allergique.

When peri-anaesthesia anaphylactic and/or anaphylactoid reactions occur, anaesthetist is the first investigator: the quality of immuno-allergological investigations depends on these initial investigational procedures. We have used sample kits for several years in order to make easier the immediate investigation. From retrospective analysis of the allergic complications which happened in 1997, the importance of these sample kits as well as the anaesthetist's part in the immuno-allergological management are examined. Nine observations were itemized (0.047%): 3 generalized erythema observations (grade I), in which atracurium was incriminated twice, and propacetamol once; 2 observations of grade II, in which vecuronium (elevated tryptase) and atracurium were incriminated; 4 anaphylactic shocks, in which three neuromuscular blocking drugs (suxamethonium, vecuronium and pancuronium), and one antibiotic (cloxacilline) were incriminated. The use of sample kits allowed an early diagnosis approach, confirmed by skin tests. Diagnosis should be thought closely between anaesthetists and immunologists for investigations.