Annales françaises d'anesthèsie et de rèanimation
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A rare case of post-traumatic pleural effusion is reported. A 19 year old male patient was admitted after a road traffic accident with a scalp wound, femoral shaft fracture and haematuria related to a ruptured bladder. Shortly after extubation following bladder surgical repair, the patient had to be reintubated because of acute respiratory failure. ⋯ The liquid was sero-haematic and contained a high concentration of creatinine (839 mumol.l-1). Thoracic CT scan and intravenous urography displayed a left epirenal collection and a dilatation of the upper urinary tract with rupture of the renal pelvis. The surgical treatment of this urinothorax consisted of the rupture repair of the posterior diaphragm and of the urinary tract.
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Four different techniques of retrograde tracheal intubation were studied in 77 cadavers (patients who had died less than 4 h before). None had any laryngeal disease or a previous intubation. Following techniques were evaluated: cricothyroid membrane puncture; infracricoid puncture; catheter guide inserted through the endotracheal tube; catheter guide only inserted through the distal lateral eye (Murphy eye) of the endotracheal tube. ⋯ All 20 attempts were successful when infracricoid puncture was used and the guide passed through the distal lateral eye of the endotracheal tube. The different techniques and equipment needed are discussed in the light of the available literature. Retrograde tracheal intubation seems to be an easy and useful technique, which all anaesthetists should know, in case of difficult intubation.
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Ann Fr Anesth Reanim · Jan 1989
Case Reports[Practical approaches for surgical procedures in congenital factor VII deficiency].
A 33 year old female with a congenital deficit in factor VII underwent four operations, all without any haemorrhage. One of then was carried out using substitutive therapy. She had a non-A non-B hepatitis one month after this treatment. ⋯ Such a dose should be administered in either one or several injections, according to whether the risk of haemorrhage is important or not. Substitutive therapy should be continued as long as the risk persists. Using a test dose of factor VII and, afterwards, measuring its biological activity can help to determine the best time for starting the treatment in order to obtain a level of factor VII greater than the minimum required for surgical haemostasis (10%).
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Ann Fr Anesth Reanim · Jan 1989
[Predictive value of intradermal tests using muscle-relaxing drugs].
A retrospective postal inquiry was carried out to find out a possible relation between the results of intradermal tests carried out for a previous anaesthetic and the course of a second anaesthetic performed afterwards. This study included 350 patients who have had an intradermal test to vecuronium, alcuronium, suxamethonium, gallamine, pancuronium, thiopentone, fentanyl and droperidol between March 1984 and November 1986. Eighty-nine did not reply (25.4%), 183 (52.3%) did not undergo new general anaesthetic since the skin tests, whilst 78 (22.3%) did. ⋯ No new anaphylactic reaction was observed. Three anaesthetists only were not aware of the results of the intradermal tests at the time of the new anaesthetic. These data tend to demonstrate that a muscle relaxant could be injected in a patient who has had a previous anaphylactic reaction with positive intradermal tests, provided that the drug chosen for the new anaesthetic does not give a positive intradermal reaction.
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Ann Fr Anesth Reanim · Jan 1989
[Truncal anesthesia of the foot at the level of the ankle: an additional reference mark for the approach to the posterior tibial nerve].
Nerve trunk blocks at the ankle could be a most interesting technique of regional anaesthesia. Unfortunately the posterior tibial nerve is difficult to locate with the usual recommended anatomical landmarks (the tibialis posterior artery). The use of the flexor hallucis longus tendon as an additional landmark has been tested in 71 patients scheduled for surgery on the foot (emergency trauma surgery, amputations, ingrowing toe-nails, removal of bedsores, verrucas). ⋯ Anaesthesia was obtained in 10 +/- 3 min, lasting from 180 to 240 min. There were 88.7% excellent results (n = 63), with 7% fair (n = 5) and 4.2% bad (n = 3) results. Failure concerned 5 cases of tibial nerve block, often due to landmark difficulties (great toe previously amputated, significant ankle oedema, lack of operator experience) and, in 3 cases, forgetting to block a nerve involved.(ABSTRACT TRUNCATED AT 250 WORDS)