[Anesthesia in the management of pyloric stenosis. Evaluation of the combination of propofol-halogenated anesthetics]. / Anesthésie pour sténose du pylore. Evaluation de l'association propofol-anesthésiques halogénés.

This study was aimed at evaluating haemodynamic changes during an anaesthetic sequence for full stomach, using propofol as induction agent and volatile anaesthetics for maintenance of anaesthesia in infants scheduled for surgical cure of hypertrophic pyloric stenosis. After correction of preoperative blood electrolyte and metabolic disturbances with appropriate i.v. hydrating solutions, anaesthesia was induced with propofol and suxamethonium. Infants were divided in two groups according to the volatile anaesthetic agent used for maintenance of anaesthesia after tracheal intubation: halothane (n = 16) or isoflurane (n = 15). The two groups were identical regarding weight (4.28 +/- 0.6 vs 4.14 +/- 0.76 kg), age (1.6 +/- 0.9 vs 1.5 +/- 0.6 months), preinduction heart rate (155 +/- 22 vs 151 +/- 22 b.min-1) and systolic-diastolic arterial pressure (96 +/- 18/58 +/- 12 vs 105 +/- 16/67 +/- 15 mmHg). Propofol and suxamethonium doses were identical, 3.9 +/- 1 mg.kg-1 and 1.3 +/- 0.6 mg.kg-1 respectively in halothane group, vs 4.3 +/- 0.8 mg.kg-1 and 1.3 +/- 0.4 mg.kg-1 in isoflurane group. Heart rate did not change after induction of anaesthesia, while arterial blood pressure decreased significantly (p < 0.001). However, blood pressure remained within the normal range for age throughout the procedure. Mean duration of surgery was shorter in halothane group (64 +/- 16 vs 79 +/- 17 min, p < 0.05), however time-interval from the end of surgery to tracheal extubation (12 +/- 6 vs 15 +/- 8 min) was short and identical in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[General anesthesia in pediatric radiotherapy]. / Anesthésie générale en radiothérapie pédiatrique.

BACKGROUND: The majority of children under 3 years require anesthesia for radiotherapy. METHODS: This work reports the experience of Paul-Strauss Center over a 4-year period on 15 children and covering 386 general anesthesia. RESULTS AND CONCLUSION: The rate of anesthesia-related complications was low (0.5%) subject to the experience of the anesthesiologists and follow-up recommendations.

Diagnosis of venous access port-related infections.

The accumulation of infected clots under the silicone septum of the reservoir of venous access ports (VAPs) has been reported. We analyzed the relationship between these deposits and the occurrence of VAP-related bloodstream infections (VAP-BSIs) by (1) evaluating the accuracy of paired quantitative blood cultures for diagnosing VAP-BSI before the removal of the device and (2) assessing the accuracy of cultures of the tip and septum (i.e., the internal lumen of the VAP) for diagnosing VAP-BSI after removal of the device. Over a 16-month period, all VAPs removed were prospectively investigated. Before VAP removal, paired quantitative blood cultures were 77% sensitive and 100% specific and had a positive predictive value of 100% and a negative predictive value of 98% for diagnosing VAP-BSI. After VAP removal, tip culture was only 46% sensitive, whereas septum culture was 93.3% sensitive for confirming the diagnosis of VAP-BSI. Thus infected deposits that accumulate under the VAP septum are the source of VAP-BSI.