[Anesthesia in the patient with a pacemaker or implanted automatic defibrillator]. / Anesthésie chez le patient porteur d'un pace-maker ou d'un défibrillateur automatique implanté.

Many patients carry pace-makers, and even automatic defibrillators. As anyone, these patients may develop surgical diseases and require surgery and anesthesia. The particularities of the anesthetic management of such patients are developed, as well as the needed surgical adaptations (particularly concerning electrocoagulation). Most of these patients can be operated on an anesthetized, taking certain precautions. In some difficult cases, it is necessary to collaborate with a cardiologist.

Assesment of the medical services'commitment capacity, of a disaster medical gravity index and of disaster preparedness

During a disaster, the synchronization of the different links in the rescue chain and their respective capacities is decisive if the progressive medical treatment is to be adequate. The calculation of a disaster's medical gravity index and the comparison of this with the total available capacity of medical services make it possible to assess the commitment required on the part of the emergency medical aid both in planning and managing the response to a disaster(AU)

Prevention of arrhythmias after noncardiac thoracic operations: flecainide versus digoxin.

Cardiac arrhythmias are known complications of thoracic operations. The prophylactic value of flecainide administered as a constant-rate, intravenous infusion (0.15 mg.kg-1.h-1) after a loading dose (2 mg.kg-1) was compared with digoxin (10 micrograms.kg-1 for 12 hours, then 0.25 mg.24 h-1) in a randomized study in 30 patients using Holter monitoring during the first 72 hours after operation. Drug monitoring was performed every day to keep a serum level of flecainide of 200 to 600 ng.mL-1 and a digoxin level of 0.8 to 2 ng.mL-1. Failure, defined as the appearance of atrial fibrillation or flutter or the development of complex ventricular arrhythmias (Lown IVb and V), was observed in one patient in the flecainide group (7%) and in 7 patients in the digoxin group (47%) (p less than 0.05). It is concluded that flecainide is more efficient than digoxin in preventing and treating cardiac arrhythmias after thoracic operations. At the dosage used side effects related to flecainide or digoxin were not observed.

Propofol and spontaneous movements: an EEG study.

Spontaneous movements during induction of anesthesia with propofol were studied in 21 children aged 6-12 yr. The children were randomly assigned to group A (propofol 3 mg.kg-1), B (propofol 5 mg.kg-1), or C (thiopental 5-7 mg.kg-1). A baseline electroencephalogram (EEG) was recorded during 10 min in children awake, supine with eyes closed and opened, and then from the beginning of induction until 5 min after tracheal intubation. Spontaneous movements were observed in all children in group A but only in 14% in groups B and C. The induction EEG sequences were similar for the three groups: after a mean latency of 12 s, the tracing showed an increase in frequency from 9 to 10 Hz (alpha waves) to more than 14 Hz (beta waves). This transition lasted approximately 2 s, followed by delta waves (2-3 Hz) that continued for 1-2 min. Finally, beta waves reappeared and progressively but incompletely replaced delta waves during the next 5 min. Neither spikes, spike-wave patterns, rhythmic theta waves, nor burst suppressions were observed. Spontaneous movements were recorded on videotape and analyzed after the completion of the study by a neurologist unaware of patient treatment. Videotape analysis of the periinduction period showed spontaneous movements to be dystonic and choreiform with flexion, twisting, or extension movements of all extremities. All movements occurred coincident with the appearance of delta waves on the EEG. Their dystonic nature and the absence of EEG abnormalities suggest a subcortical origin and argue against associated cortical epileptic activity.

[Heparin and spinal or epidural anesthesia: decision analysis]. / Héparine et anesthésies médullaires: analyse de décision.

The incidence of thromboembolism justifies prophylactic measures, the most efficient of which is the use of heparin. However this agent may be responsible for haemorrhagic complications during regional anaesthesia. The risk of bleeding in a poorly accessible area, e.g. the epidural space, the brachial plexus sheet, the space behind the eyeball, is one of the concerns of anaesthetists. A review of case reports of haemorrhagic complications of spinal anaesthesia shows that the risk of bleeding or of spinal haematoma is very low. In fact, a blood or epidural vessel is punctured in 2.8 to 11.5% of cases of epidural anaesthesia, without any sequelae. Some authors suggest that low molecular weight heparin may be given to patients before spinal anaesthesia. In all cases, patients should be carefully assessed before, during and after the procedure, clinically and biologically. The absolute contra-indications to these techniques are a refusal by the patient, an uncooperative patient, severe coagulation disorders, untreated hypovolaemia, infection of the puncture site, severe generalized infection, and raised intracranial pressure. Decision as to whether a regional anaesthetic technique should be used in a particular patient who is under anticoagulant treatment, or who is to receive such a treatment intra or postoperatively, must be made on an individual basis. The risk of thromboembolism must be weighted against the risk of haemorrhagic complications. Unfortunately, in the absence of relevant studies, anaesthetists can only rely on their clinical judgment.

[The Wolf-Parkinson-White syndrome and peroperative arrhythmias]. / Syndrome de Wolff-Parkinson-White et arythmies peropératoires.

The influence of anaesthetic drugs or techniques on the development of arrhythmias in patients with the Wolff-Parkinson-White syndrome still remains controversial. Most of the literature is based on single case reports from which no clear-cut attitude can be defined. In this retrospective study we tried to evaluate if a particular drug or technique could be recommended. We also discuss on the basis of electrophysiology of the Wolff-Parkinson-White syndrome situations in which the potential for arrhythmias is enhanced.

Comparison of propofol and thiopental/halothane for short-duration ENT surgical procedures in children.

Experiences with propofol in pediatric anesthesia are limited. We undertook a study to evaluate the quality of induction and recovery from anesthesia with propofol compared to thiopental/halothane. Twenty children received 3 mg.kg-1.min-1 of propofol as a loading dose followed by a maintenance dose of 0.1 mg.kg-1.min-1 (+/- 10%). Twenty children received 5-7 mg/kg of thiopental, and maintenance was provided with halothane (0.5%-1.5%). The interval between the end of the administration of propofol or thiopental/halothane and extubation, as well to discharge to the ward, was significantly shorter with propofol (4.4 versus 13.5 min and 7.22 versus 30.4 min, respectively). Spontaneous movements and pain on injection were seen significantly more frequently with propofol, whereas laryngospasm and hiccup were only observed with thiopental. During the first 6 h after the surgical procedure, analgesics were needed significantly more often in the thiopental group. Nausea and vomiting also were observed more frequently in the thiopental group. In conclusion, propofol used as a single anesthetic is a satisfactory technique for ENT surgery of short duration in children.

Acute pulmonary oedema following administration of ornithine-8-vasopressin.

We report the case of a patient who developed acute pulmonary oedema following a short and uneventful surgical procedure. Among the differential diagnoses, the role of ornithine-8-vasopressin is emphasized.

[An unusual anaphylactic reaction following succinylcholine chloride in a 21-month-old child]. / Réaction anaphylactoïde singulière après chlorure de succinylcholine chez un enfant de 21 mois.

An anaphylactoid reaction occurring after the intravenous administration of succinylcholine in a 21-month-old child is reported. The clinical manifestations and signs were limited to the upper airways and eyelids. The child was not known to be allergic or atopic. The IgE level was normal. The search for specific anti-choline IgE antibodies was negative. The skin tests were strongly positive for succinylcholine. The physiopathological and immunoallergic differences between anaphylaxis and anaphylactoid reaction are briefly discussed.

[The value of epidural analgesia in acute pancreatitis]. / Intérêt de l'analgésie par voie épidurale lors de pancréatite aiguë.

We report on a patient with acute pancreatitis whose pain was resistant to simultaneous administration of morphine, procaine and Buscopan. This episode was complicated by development of hypertension, tachycardia, angina pectoris, ventricular arrhythmias and electrocardiographic modifications. Analgesia was provided by epidural administration of fentanyl and bupivacaine and brought about rapid resolution of all symptoms. The usefulness of epidural analgesia in acute pancreatitis is discussed.