[Post-transfusion thrombopenia treated with gammaglobulins]. / Thrombopénie post-transfusionnelle traitée par les gammaglobulines.

Thrombopenia and a haemorrhagic syndrome occurring on the eighth postoperative day were probably related to a post-transfusion purpura, confirmed by the discovery of antiplatelet antibodies not belonging to the PLA1 antigen system. The stabilization of this haemorrhage and a full recovery were obtained by giving high doses of intravenous human gammaglobulins. Blood replacement only rarely induces postoperative immuno-allergologic thrombopenia; heparin is the best known causative agent. It is concluded that platelets should never be given so long as the responsible agent is not formally identified.

[Giant subcutaneous emphysema, pneumothorax and pneumomediastinum occurring in a 4-month-old infant recovering from anesthesia following surgery of a cleft palate]. / Emphysème sous-cutané géant, pneumothorax et pneumomédiastin survenus au réveil d'un nourrisson de 4 mois opéré pour division palatine.

The authors mention the case of pneumomediastinum and major cervico-facial-thoracic subcutaneous emphysema in a 4 month baby recovering from early surgery for a cleft palate, caused by a barotrauma (positive, pressure ventilation). After an emergency draining of the two pneumothorax, the situation evolved quickly, favourably and with no after effects whatsoever. They insist on the necessity of a rapid diagnosis concerning this rare complication (which can quickly evolve dramatically) and on the importance of pediatric anesthesia facilities.

[Effects of enflurane and halothane on hepatic function in biliary surgery]. / Effets de l'enflurane et de l'halothane sur la fonction hépatique en chirurgie biliaire.

The effects of two volatile anaesthetics on hepatic function are compared in 80 patients in hepato-biliary surgery. 40 patients were anaesthetized either with enflurane or halothane. This study is based on the variations of blood levels of gamma GT, bilirubin, SGOT SGPT, alkaline phosphatase, L.D.H. Samples were taken the day prior to the operation, one, two and five days afterwards. The results show an increase in the levels of BD, SGPT, LDH no 5, less important with enflurane than with halothane, and mainly in patients with preoperative hepatic abnormalities. Enflurane appears to be preferable in such cases.

[Abortion and the use of anaesthesia. Observations after two years' experience (author's transl)]. / Anesthésie pour interruption volontaire de grossesse. Réflexion après deux ans d'activité.

The authors give an account of their experience of anaesthesia in 380 abortion cases. Two kinds of technique were used: --paracervical block: 10.2 p. cent of the cases, only one complication; --narco-analgesia: considered to be essential. Dextromoramide was the principal analgesic used, chosen for its pharmacodynamic properties. Three narcotic drugs used successively in conjunction with this were: propanidine, with this drug per-anaesthetic complications and post-operative vomiting proved excessive, C.T. 1341 considerably reduced the frequency of these complications, disodic penthiobarbital did not give rise to any problems.

PIP: The authors report on their experience with anesthesia in 380 cases of induced abortion. Paracervical block was used in 39 cases, (10.2%), with no complications. General anesthesia was used in 3 different ways: 1) narcoanalgesia combined with propanidid and dextromoramide, used on 103 women (21.1% of cases), resulted in a large number of cases of vomiting; 2) narcoleptoanalgesia with propanidid, dextromoramide and droperidol, used on 143 patients, (37.6%), resulted in fewer cases of vomiting; and, 3) narcoanalgesia with CT 1341 and dextromoramide, used on 79 patients, (20.7%), resulted in an even smaller number of cases of vomiting.

[Problems presented by closed laryngeal-tracheal injuries]. / Problémes posés par les traumatismes laryngo-trachéaux fermés

The authors consider the problems raised by severe closed laryngotracheal trauma and report 4 cases. -the immediate tisk to life is due to direct involvement of the respiratory tract requiring emergency measures including cardiorespiratory resuscitation in cases of acute asphyxia. -the origin of the initial respiratory distress, if not obvious from the start, may be suspected in view of the difficulties or impossibility of tracheal intubation, which is also liable to aggravate lesions due to trauma. It is one of these rare cases of resuscitation where emergency tracheotomy is essential. It permits also early, precise surgical exploration. -in cases of fracture of the larynx, a wound of the trachea or rupture and separation of the trachea, the reconstruction must be constructiononstruction must be considered within the first 48 hours. Provision of food and resting of the larynx may be conciliated by installing an esophageal catheter or performing a gastrostomy. Benign trauma, such as contusion or laryngeal commotion, requires close supervision association with medical treatment designed to prevent the onset of lesional oedema.

[Pulmonary edema in hangings]. / Oedème pulmonaire des pendus

The authors present two cases of unsuccessful hanging which hat lead to a very severe neurological picture and especially the very rapid appearance of acute pulmonary edema resulting in a vertiable flooding of the alveoli. The victims, aged respectively 21 and 15 years, were free from any pre-existing cardiopathy. These cases of pulmonary edema, resistant to depletive therapy (bleeding, diuretics) and cardiotonic agents (Cedilanid) should only be jugulated after a one hour session of oxygen at 3 ATA with a baro-assisted respirator. The following are discussed with reference to these two cases: 1- The mode of occurrence of this type of pulmonary edema: - implication of sub-acute anoxic cerebral damage; - high negative alveolar pressures owing to a gasp-type ventilation with a closed glottis. 2- The opportunity for the very early treatment of the oxygen deficit contracted by the brain and myocardium.

[Caudal block in the surgical repair of vesico-renal reflux]. / Intérêt de l'anesthésie caudale dans la cure chirurgicale du reflux vésico-rénal.

One hundred and twenty children have benefited from surgical cure for vesico-renal reflux under loco-regional anesthesia per caudal way, with use of a mixed solution of Lidocaine 1%, Bupivacaine 0.5%, with Adrenaline, along with a complementary narcosis. During the per operative time: the subsequent analgesia and muscular relief have always been excellent and lasted long enough. The hemodynamic status always showed a perfect stability. As to the ventilation, no deleterious effect could be demonstrated. Per operative blooding is reduced and central temperature is more easily controlled. During the post-operative time: the caudal anesthesia has allowed to maintain an efficient analgesia during a mean period of 12 hours which has been considered as sufficient. All the children went quickly back to a normal digestive function. There was no complication relevant to this technique.

[Pediatric ECG monitoring. 2,500 pediatric patients under anaesthesia (author's transl)]. / Intérêt du monitorage ECG systématique chez l'enfant. A propos d'une série de 2500 anesthésies monitorées.

The authors report 98 cases of cardiac arrhythmia observed in the course of 2,500 pediatric anesthesias performed with constant electrocardiographic monitoring. The patients, aged 0 to 18 years, were in most cases healthy. Anesthesia was performed by different techniques for both surgical and non-surgical interventions for a variety of conditions, both serious and routine. Other than 3 cases of cardiac arrest (1 death) cardiac arrhythmias usually followed a benign course without hemodynamic repercussions. The authors emphasize the value of early detection of cardiac arrhythmias as well as vigorous treatment of predisposing conditions such as inadequate ventilation, acidosis and pain. The absence of correlation between the degree of rick, as estimated preoperatively (related to patient or procedure risk factors), and the frequency of occurrence seems to point to the value of more widespread use of ECG monitoring of pediatric patients undergoing anesthesia.

[Clinical and therapeutic problems posed by hangings. Apropos of 67 cases]. / Problèmes cliniques et thérapeutiques posés par les pendaisons. A propos de 67 cas

Starting from a collection of 67 cases of hanging taken over by the Anesthesia Resuscitation Department belonging to Reims Hospital University Centre, the authors report their clinical observations and make an analytical confrontation of this type of accident according to various criteria such as: - the initial physical condition of the victims; - the evolution of the symptoms; - the various medical treatments used. The immediate consequences of miscarried hangings lead to a physio-pathological argument dealing mainly with the neurological and breathing manifestations. The elements of this argument enable the writers to back up certain therapeutic orientations among which hyperbaric oxygen therapy and early prescription of which seems to be wished for in the most severe forms of hanging.

[Electro-anaesthesia during neuro-surgery (author's transl)]. / Anesthésie électro-médicamenteuse en neuro-chirurgie.

The authors have performed 66 (cranial or spinal) operations with electro-anaesthesia supplemented by neuroleptics and pancuronium. In this technique, which respects the necessities of neurosurgical anaesthesia, analgesia is produced by means of Limoge's rectified high frequency currents. The protocol consists of: induction by a neuroleptic, application of the electrical current, intubation with benzodiazepin and succicurarium, controlled ventilation with a 50 p. cent oxygen/50 p. cent nitrous oxyd mixture and curare as required. The efficiency was estimated according to the necessity of a supplementary drug analgesia (fentanyl). The use of fentanyl, i.e. drug intoxication, was strongly reduced in 90 p. cent of the cases (average 0,46 micrograms/kg/hour). Absolute failures were encountered in 3 cases only. Patients waked up in very good conditions and extubation occurred on an average of 16 minutes. Reflexes of cough an deglutition are not depressed by electro-anaesthesia and we think this preservation of the respiratory function to be very profitable for such neurosurgical patients. Our opinion by now is that the best indications for electro-anaesthesia are high-risk patients, with a special mention for surgery of the posterior fossa.