Target-controlled induction with 2.5% sevoflurane does not avoid the risk of electroencephalographic abnormalities.

BACKGROUND: Epileptiform discharges (ED) can occur during sevoflurane induction, especially in young female patients and when high alveolar concentrations are used. The aim of this study was to evaluate whether low sevoflurane concentration reduces the occurrence of ED in female patients. METHODS: Thirty-four female patients scheduled for minor gynecological surgery were prospectively included and randomized in two groups. In group A, anesthesia was induced with sevoflurane inspired 8% manually set via the circuit of the Zeus(®) (Dräger Medical, Lübeck, Germany) anesthesia workstation (fresh gas flow 8L.min(-1)) for 2min and then 2.5%. In group B, induction was performed by target-controlled inhalation with a target end-tidal concentration of sevoflurane set at 2.5% (fresh gas flow in auto-control mode). Electroencephalogram (EEG) was recorded in the operating room throughout induction till two min after intubation and analyzed off-line by a neurophysiologist blinded to the randomization. RESULTS: ED occurred in five patients (15%): one in group A and four in group B (P>0.05). ED occurred with a median delay of 303 s [25-75 interquartiles: 135-418] and the median duration of ED episode was 13 s [3-78]. Fifteen patients had abnormal movements without simultaneous EEG abnormality. CONCLUSION: Induction of anesthesia with low target concentration of sevoflurane (2.5%) fails to totally prevent the occurrence of ED in young female patients and should be used carefully in this population.

[Epidural labor analgesia and parturient with type 2B von Willebrand disease]. / Analgésie péridurale obstétricale et maladie de Willebrand de type 2B.

Type 2B von Willebrand disease (vWD) is an inherited bleeding syndrome resulting from a qualitative abnormality of von Willebrand Factor with an increased affinity for the glycoprotein Ib platelet receptor. Pregnancy increases the severity of this disease by decreasing the platelet count restricting epidural anaesthesia because of adverse risk of spinal bleeding. There is a phenotypic variability of Type 2B vWD depending of the von Willebrand Factor mutation. We report here the strategy we used to administer epidural anaesthesia for a patient with Type 2B vWD resulting from the P1337L mutation of von Willebrand Factor.

Side effects of spiramycin masquerading as local anesthetic toxicity during labor epidural analgesia.

Significant fetal bradycardia occurred when a parturient receiving labor epidural analgesia experienced generalized numbness and tingling, a metallic taste and hot flushes. An emergent cesarean delivery under general anesthesia was performed with favorable outcomes for the mother and baby. The most likely source of the maternal symptoms was spiramycin, which was being administered for treatment of toxoplasmosis.

A new single use supraglottic airway device with a noninflatable cuff and an esophageal vent: an observational study of the i-gel.

BACKGROUND: The i-gel is a new single-use supraglottic airway device with a noninflatable cuff and an esophageal vent. METHOD: In this prospective, observational study, we evaluated the i-gel in 71 women. RESULTS: Insertion success rate was 97%. Insertion was easy and performed at the first attempt in every patient. Mean seal pressure was 30 +/- 7 cm H(2)O, and average peak pressure was 11 +/- 3 cm H(2)O. The gastric tube was inserted in 100% of cases. Only one case of coughing and one mild sore throat occurred. CONCLUSION: The i-gel is a reliable, easily inserted airway device that provides an adequate seal with a low morbidity rate.