Acute toxicity of local anesthetic ropivacaine and mepivacaine during a combined lumbar plexus and sciatic block for hip surgery.

Hip fracture is a common pathology in elderly patients. Intercurrent diseases, mainly cardiac and respiratory, often result in significant morbidity and mortality. Anesthesia for hip fracture can be provided by general or regional techniques. The combination of a lumbar plexus and posterior sciatic nerve block represents an alternative to neuraxial technique of anaesthesia such as spinal anesthesia (4, 6). We report a case of acute toxicity resulting in the injection of local anesthetics Ropivacaine and Mepivacaine in elderly patient. An elderly woman was scheduled for surgical repair of a fractured femur neck by dynamic hip screw synthesis. Anesthesia was realized by peripheral nerve bi-block (lumbar plexus and posterior sciatic block) (7). The patient experienced seizures and dysrhythmias twenty minutes after block completion and injection of the anesthetic solution [Ropivacaine 0.75%, administered for lumbar plexus block performed via the posterior approach (WINNIE) and Mepivacaine 1.5%, administered for posterior sciatic nerve block (LABAT)]. Cardiopulmonary resuscitation was successful. All signs of toxicity disappeared after injection of midazolam and atropine, intubation and 100% oxygen ventilation. We decided to proceed with surgery. The postoperative course was uncomplicated and made a full recovery.

Effects of consecutive protected specimen brushing and bronchoalveolar lavage on gas exchange and hemodynamics in ventilated patients.

OBJECTIVE: To assess cardiovascular effects and the oxygenation status of mechanically ventilated patients undergoing protected specimen brushing (PSB) and bronchoalveolar lavage (BAL) under fiberoptic bronchoscopy (FOB). DESIGN: A prospective study. SETTING: Polyvalent intensive care unit in a university hospital. PATIENTS: Twelve consecutive, critically ill, intubated, and mechanically ventilated patients with hemodynamic failure requiring invasive monitoring with an indwelling radial artery catheter and indwelling Swan-Ganz catheter were included in the study. INTERVENTIONS: Hemodynamic measurements, arterial and mixed-venous blood gas analyses, and arterial blood lactate analysis were performed before and at the end of a 10-min period of mechanical ventilation with a fractional concentration of oxygen in the inspired gas (FIO2) of 1.0. The same measurements and blood samplings were repeated at the end of the PSB procedure, at the end of the BAL procedure, and 1 h after the end of the BAL. During the study period the ECG, arterial oxygen saturation (SaO2), and mixed-venous oxygen saturation (SvO2) were continuously monitored. MAIN RESULTS: A moderate increase in both mean arterial pressure and mean pulmonary arterial pressure was observed during the FOB procedure (p < 0.05). One hour after the end of BAL, the PaO2 decreased when compared with values recorded at the beginning of the procedure with the same FIO2 (p < 0.05). An increase in intrapulmonary shunt was observed at the end of BAL (p < 0.01). A moderate increase in PaCO2 was also observed after PSB (p < 0.05) and after BAL (p < 0.01). Monitoring of SaO2 permitted us to observe a significant and sustained decrease after the end of the FOB procedure from 10 to 60 min. The decrease in SvO2 was less pronounced but reached statistical significance. CONCLUSIONS: We conclude that PSB and BAL under FOB are well tolerated in critically ill, mechanically ventilated patients with hemodynamic disturbances requiring inotropic or vasopressor agents (or both); however, a modest impairment in arterial oxygenation was observed after the end of the FOB procedure.

[Perioperative remote infections in neurosurgery. Role of antibiotic prophylaxis]. / Infections à distance du foyer opératoire en neurochirurgie. Rôle de l'antibioprophylaxie.

We report the results of a randomized, prospective study devised to assess the effectiveness of perioperative cefamandole prophylaxis on the remote infections rate in neurosurgery. Only two kinds of neurosurgical procedures were studied: shunt placement and craniotomy for brain tumour. In the treated patients cefamandole 1.5 g was given one hour before surgery, then repeated twice eight hourly. When the surgical procedure lasted more than three hours cefamandole 1.5 g was administered throughout the operation. No case of local infection was observed in either group, and the percentage of patients with remote infections was the same in both groups. Leucocytosis and temperature were measured during 15 days following the surgical procedure, and there were no differences between the treated and untreated groups in the evolution of these parameters. This study does not suggest that routine perioperative antibiotic prophylaxis is mandatory in neurosurgery.