[Right subclavian catheterization. Misplaced insertion into the subclavian artery and the ascending aorta]. / Cathétérisme sous-clavier droit. Fausse-route dans l'artère sous-clavière et l'aorte ascendante.

The accidental subclavian artery puncture is usually obvious. We report a case of unrecognized arterial catheterisation. The catheter had been inserted during anaesthesia after return of dark and non pulsatile blood, and not controlled by a chest radiograph. During surgery, the injection of 40 mL isotonic saline containing 4 g of piperacillin for antibiotic prophylaxis resulted in a transient circulatory collapse associated with ECG tracing of myocardial ischaemia. Postoperative chest radiograph showed that the catheter was in a midsternal position, at the level of the ascending aorta. The intracoronary penetration of piperacillin was considered as the cause for the transient cardiocirculatory changes. The various diagnostic tools of the intra-arterial location of the catheter are discussed. All inadvertent subclavian artery catheterisations published in the literature have been carried out with multi-lumen catheters. The latter can contribute to the failure to recognize the arterial puncture and catheter insertion because of the use of a small bore needle (Seldinger's technique) and infusion with electrical pumps.

[The locked-in syndrome]. / Le syndrome de verrouillage.

The locked-in syndrome is poorly understood, and may be misdiagnosed as coma. The syndrome consists of complete paralysis of all four limbs and the lower cranial nerve pairs, associated with an unaltered consciousness. Vertical eye movements and blinking remain intact, so allowing some form of communication by way of eye codes. Obstruction of the vertebral and basilar vascular system is the major cause, but the six cases reported show the aetiological diversity of this syndrome. If the vascular obstruction is diagnosed within the first few hours, fibrinolytic therapy may be considered. Although the patients usually die within a few days or after several months, some rare cases of recovery after several weeks have been reported. Intensive care is required by these patients (tracheostomy, artificial ventilation, intensive nursing care); the physicians and nursing staff looking after them should always keep in mind that these patients are conscious and able to communicate.