[Pneumomediastinum: an aspect of pulmonary barotrauma during mechanical ventilation of acute respiratory distress syndrome]. / Le pneumomédiastin : un aspect du barotraumatisme pulmonaire au cours de la ventilation mécanique du syndrome de détresse respiratoire aiguë

Mechanical ventilation is a fundamental treatment of acute respiratory distress syndrome (ARDS). Despite compliance with the recommendations of protective mechanical ventilation, it can results in serious complications including the pulmonary barotrauma. This is often manifested by a pneumothorax. This observation describes an unusual aspect of barotrauma which is pneumomediastinum. The authors also point out the role of chest imaging in the management of mechanical ventilation during ARDS.

[A comparison of Airtraq™ laryngoscope and standard direct laryngoscopy in adult patients with immobilized cervical spine]. / Comparaison de l'Airtraq™ et du laryngoscope Macintosh pour l'intubation trachéale chez l'adulte avec stabilisation manuelle en ligne du rachis cervical.

INTRODUCTION: Airtraq laryngoscope is a new and single use device for endotracheal intubation. Few studies showed the superiority of the Airtraq comparing to Macintosh laryngoscope in the setting of difficult intubation. STUDY DESIGN: To compare the performance of these two laryngoscopes by simulating a situation of reduced mobility of the cervical spine by applying the Manual in-line stablization (MILS) maneuver. PATIENTS AND METHODS: After obtaining the approval of the ethic committee, we realized a prospective single blind randomized study. During a 6-month period, 120 consenting patients scheduled for ORL or ophthalmologic surgery were included. They all had general anesthesia and orotracheal intubation. These patients were randomly and equally divided in two groups (n=60), depending on the type of the laryngoscope used (Airtraq or Macintosh). Were excluded from the study the patients with history or criteria predicting difficult intubation. Each patient was intubated by one of the five experimented anesthetists selected for this work. The principle judgment criteria were: i) the time taken for the orotracheal intubation and ii) the intubation difficulty score (IDS). The secondary judgment criterion was the hemodynamic modifications after the endotracheal intubation. RESULTS: Demographic and upper airway track variables were comparable between the two groups. There was no case of failure of intubation in this serie. Nonetheless, all the patients of the Airtaq group were intubated from the first attempt, whereas half of the patients of the Macintosh group were intubated after the third attempt. Comparing to the Macintosh, the Airtraq reduces the time taken for the orotracheal intubation (14±1s vs 19±3s, P=0.01), the necessity of additional maneuver to facilitate the intubation, and the intubation difficulty score (0.7±0.3 vs 3.8±1, P<0.001). Orotracheal intubation using the Airtraq laryngoscope caused less hemodynamic stimulation than using the Macintosh. CONCLUSION: Our study showed the usefulness of the Airtraq laryngoscope for endotracheal intubation for patients presenting conditions of difficult intubation such as reduced mobility of the cervical spine.

[Ischaemic stroke secondary to viper envenomation in Morocco in the absence of adequate antivenom]. / Accident vasculaire cérébral ischémique à la suite d'une envenimation vipérine grave au Maroc, traitée par un antivenin inadapté

An ischaemic stroke is a rare complication of viper envenomation that is due to multifactorial pathophysiological mechanisms. The authors describe the case of a 55-year-old patient bitten by the viper Cerastes cerastes. The patient was admitted to the intensive care unit with multiple organ failure, disseminated intravascular coagulopathy, rhabdomyolysis, anuria and elevated troponin level. The persistent disturbance of consciousness has motivated a brain scan which has revealed a bifocal ischemic stroke. The complex venom of the species C. cerastes may induce hypotension, tissue necrosis, acute renal failure, bleeding disorders or DIC. With the cessation of a non-indicated heparintherapy and haemodialysis, the patient recovered in a few weeks despite the initial infusion of an unsuitable antivenom due to the late identification of the reptile. The preventive treatment of the complications of this envenomation is based on the infusion of the polyvalent antivenom Favirept(®).

Difficult intubation in a parturient with syringomyelia and Arnold-Chiari malformation: Use of Airtraq laryngoscope.

Anesthetic technique in parturient with syringomyelia and Arnold-Chiari malformation is variable depending on the teams. Difficult intubation is one of the risks when general anesthesia is opted. Different devices have been used to manage the difficult intubation in pregnant women. We report the use of Airtraq™ laryngoscope after failed standard laryngoscopy in a parturient with syringomyelia and Arnold-Chiari type I malformation.

Effect of the addition of rocuronium to local anesthetics for peribulbar block.

To test the hypothesis that rocuronium added to a mixture of local anaesthetics could improve akinesia in Peribulbar Block (PB) we designed this prospective, randomized, double-blinded study. Sixty ASA physical status I and II patients presenting for cataract surgery (manual extracapsular lens extraction) under PB were included. Patients were randomized to 2 groups: rocuronium group (n = 30) received PB with a local anesthetic mixture (Lidocaine 2% + Bupivacaine 0.5%) to which was added 0.06 mg/Kg of rocuronium and control group (n = 30) received PB with the same mixture to which was added saline. Akinesia was assessed with a 12-point scale at 2, 5 and 10 minutes after injection (each of the four rectus muscles and each lid was scored from 0 to 2; 0 = total akinesia, 1 = partial akinesia, 2 = no akinesia). The need for supplementary injection, adverse effects and complications were also recorded. Rocuronium group demonstrated significantly better akinesia scores than control group at 2, 5 and 10 minutes post PB (p < 0.05). Supplementary injection was necessary in 4 patients (13%) in rocuronium group versus 12 patients (40%) in control group (p = 0.039). No significant complications were recorded. Rocuronium added to a mixture of local anaesthetics at a dose of 0.06 mg/Kg improved the quality of akinesia in PB and reduced the need for supplementary injections.