[Anaesthetic considerations for interventional radiology]. / Anesthésie pour imagerie interventionnelle.

OBJECTIVE: To describe the new procedures applied for interventional radiology leading to specific anaesthetic care and organization. DATA SOURCE: Record of references from national and international journals in Medline. STUDY SELECTION: All types of articles were selected including prospective studies, practice guidelines, reviews and case reports. DATA SYNTHESIS: During interventional radiology, anaesthesia should be adapted to the duration of the procedure, the pain induced by the radiologist, the position of the patient and its medical status. General anaesthesia would be preferred for long procedures, requiring total immobility. Locoregional anaesthesia can be proposed for some cases. Sedation associating hypnotics (propofol, midazolam, sevoflurane) and opioids (alfentanil, remifentanil) is commonly used according to different schemes, as discontinuous boluses, continuous infusion, target controlled intravenous sedation or patient controlled sedation. Monitoring of temperature and diuresis may be useful for long procedures. Haemodynamic monitoring (arterial catheter, central venous pressure) and haemostatic monitoring may be necessary for interventional neuroradiology and endovascular stenting. Radiofrequency and laser procedures are often painful, requiring the choice of adequate analgesic regimen. Hydratation associated with acetylcysteine seems to be able to prevent contrast induced nephropathy in patients with risk factors for chronic renal insufficiency. CONCLUSION: As advances in interventional radiology are obvious, general organisation as well as anaesthetic procedures should be adapted to these specific techniques.

[Post-traumatic myocardial injuries (author's transl)]. / Contusins myocardiques post-traumatiques.

Myocardial injuries are often misknown because of hard diagnosis. After presenting two clinical cases, this paper concerns clinical and biological criteria used to prove post-traumatic myocardial injury. Increased serum level of M.B. fractions of C.P.K. associated with typical electrocardiographic aspect is enough; other investigations are less specific and may be hasardous to attempt. Prognosis and therapy are close to acute myocardia infarction.