Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1998
Case Reports[Total spinal anesthesia after posterior lumbar plexus block].
We report a case of total spinal anaesthesia which occurred after a lumbar plexus block using a posterior approach. After total hip arthroplasty under general anaesthesia, a lumbar plexus block was performed according to Winnie's landmarks at the L4 interspace using a nerve stimulator. ⋯ One minute after the injection of 27 mL of the same mixture, a complete anaesthetic block occurred with hypotension and loss of consciousness requiring intubation and controlled ventilation during 3h30, without sequelae. Lumbar plexus block using a posterior approach must be performed cautiously and a slow and fractionated injection of the full dose is recommended.
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Ann Fr Anesth Reanim · Jan 1998
Case Reports[Motor deficit of the lower limbs and urinary incontinence following peridural anesthesia].
Neurological complications of epidural anaesthesia are rare, but can be severe. We report the case of a 49-year-old man, with a history of non equilibrated diabetes, who experienced after an epidural anaesthesia for peripheral vascular surgery a polyneuropathy with muscle weakness of the lower extremities associated with a transient urinary incontinence. ⋯ An aggravation of a pre-existing diabetic and alcoholic polyneuropathy, associated with possible spinal ischaemia of multifactorial origin could be the cause of these complications. This case emphasizes the importance, during preanesthetic assessment of candidates for epidural or spinal anaesthesia, to search for a possible unrecognized neuropathy at risk of aggravation by regional anaesthesia.
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Ann Fr Anesth Reanim · Jan 1998
Case Reports[Sever acute pulmonary edema after peri-anesthetic laryngospasm in a newborn infant].
Severe acute pulmonary oedema following peranaesthetic laryngospasm in a newborn. The authors report a case of severe acute pulmonary oedema secondary to a laryngeal spasm in a 3-week-old neonate, immediately after induction of anaesthesia with halothane. ⋯ Such a secondary time course is unusual. Usually pulmonary oedema has a favourable outcome after oxygen administration and maintenance of positive expiration pressure, except in the neonate.
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Ann Fr Anesth Reanim · Jan 1998
Case Reports[Effectiveness of valproic acid for postanoxic action myoclonus (Lance-Adams syndrome)].
We describe the case of a patient who experienced postanoxic action myoclonus after a transient cardiopulmonary arrest. Whereas benzodiazepines (clonazepam, midazolam, diazepam) were inefficient, valproic acid allowed a full control of the myoclonus. It is essential that the distinction between postanoxic action myoclonus and posthypoxic seizures is made early to avoid a delayed appropriate therapy and erroneous prognostic conclusions.
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Ann Fr Anesth Reanim · Jan 1998
Case Reports[Massive gas embolism following lung inflation for thoracic tomodensitometry in a multiple trauma patient with lung contusions].
We report a case of gas embolism into both right and left circulation in a polytrauma patient with lung contusions, revealed by thoracic CT scan showing the heart and aorta filled with gas. It followed a lung inflation with a O2/N2O mixture for about 30 seconds at a pressure of at least 40 cmH2O in order to obtain apnoea for CT scan and to recruit atelectatic territories. ⋯ The patient recovered fully. Lung inflation manoeuvre to obtain a prolonged apnoea during CT scan examinations of thorax is contraindicated in case of thorax trauma, as it carries a risk of gas embolism.