[Non-steroidal anti-inflammatory agents and diuretics: a combination with nephrotoxic risks]. / Anti-inflammatoires non stéroïdiens et diurétiques: une association à risque néphrotoxique.

We report the case of a reversible postoperative acute renal failure in a 55-year-old woman without preoperative risk factors who underwent a retinal surgery. The association of diuretics with nonsteroidal antiinflammatory drugs was probably responsible of an ischaemic acute tubular necrosis. Vitreoretinal surgery's postoperative period might be associated with a specific risk for the kidney because of an usual intensive diuretic prescription. Nonsteroidal antiinflammatory drugs should be avoided if possible in this indication.

Comparison of the myocardial effects of desflurane and isoflurane in healthy patients: assessment by continuous oesophageal aortic blood flow echo-Doppler.

Experimentally, desflurane causes a moderate positive inotropic effect and a transient increase in arterial pressure with rapid increases in concentration compared with isoflurane. We used a continuous oesophageal aortic blood flow echo Doppler device to study the myocardial effects of equi-anaesthetic concentrations of isoflurane and desflurane in 32 healthy patients undergoing superficial surgery. After induction of anaesthesia with midazolam, etomidate and fentanyl general anaesthesia was maintained in 16 patients with 0.6% end-expired concentration of isoflurane and in 16 patients with 3% end expired concentration of desflurane. Isoflurane induced a rapid decrease in aortic blood flow (ABF) which remained almost stable whereas desflurane induced an early, moderate and transient increase in ABF (1 min after introduction of the halogenated agent, mean ABF was 107 (SD 3)% in the desflurane group vs 95 (9)% in isoflurane group compared with control values before introduction of the inhalation agent; P = 0.005), followed by a marked secondary decrease in ABF. The maximal decrease in ABF reached 71 (15)% of its initial value in the desflurane group compared with 80 (14)% in the isoflurane group (ns). Neither agent caused significant changes in other variables except for PE'CO2 which decreased in both groups. Continuous ABF echo-Doppler monitoring demonstrated an early transient positive inotropic effect of desflurane.