[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.

[The association of continuous peridural anesthesia with general anesthesia. Apropos of 2 accidents]. / Association anesthésie péridurale continue et anesthésie générale. A propos de deux accidents.

Continuous lumbar epidural anaesthesia combined with light general anaesthesia provides optimal anaesthetic conditions to realize major lower abdominal or pelvic surgical cases. However this technique may cause haemodynamic alterations due to the important vasoplegia and to the potential myocardial toxicity of the local anaesthetics. The authors report two accidents associated with this technique, one of them with lethal outcome.

[Heart arrest during spinal anesthesia for transurethral resection of the prostate. Apropos of a case]. / Arrêt cardiaque au cours d'une rachianesthésie pour résection transurétrale de prostate. A propos d'un cas.

We report a cardiac arrest in a 66 years healthy patient during a spinal anesthesia for a transurethral resection of prostate. The accident occurred one hour and fifteen minutes after the subarachnoidal injection of hyperbaric lidocaine 80 mg, at the end of surgery, but before any postural change. We attempt to elucidate the surgical or anesthesiologic precipitating factors that lead to the cardiac arrest in this patient. However, there was no real etiology that formally explained the genesis of the accident. This case is to add to a series of recently published accidents that occurred during spinal anesthesia in healthy patients.

[Our experience of spinal anesthesia for transurethral resection of the bladder and prostate. Retrospective study of 334 patients operated in 1986]. / Notre expérience de la rachianesthésie pour résection transurétrale de vessie et de prostate. Etude rétrospective de 334 patients opérés en 1986.

Retrospective study of one years is performed on 334 patients who undergo transurethral surgery. Spinal anesthesia is used in 263 cases, general anesthesia in 71. Spinal administration of local anesthetics (lidocaine hyperbaric 5% or bupivacaine 0.5%) or opioid (Pethidine 1 mg/kg) have been used in old patients without any complication. The advantages are less blood uses, early stand up, no discontinuity in oral nutrition. For our team there are only few contra-indications for spinal anesthesia: blood coagulation abnormalities or some very rare heart diseases.

[Hepatic mono-oxygenases]. / Les monooxygénases hépatiques.

Most drugs and xenobiotics are lipid-soluble compounds that need to be transformed into more polar water-soluble molecules by a system of hepatic monoxygenases in order to be excreted by the kidney and the liver. This system is also called cytochrome P-450. It is found in animals, as well as plants. It is located in the cellular endoplasmic reticulum of numerous tissues, but it is most active in the liver. It is made up of several isoenzymes differing from one another by the structure of their apoproteins, their immunological characteristics and their affinity for various substrates. Cytochrome P-450 has great variability, being influenced by exogenous factors (drug intake, ionizing radiation, stress, diet) and individual endogenous factors (age, sex, genetic factors). Several non specific tests exploring the system are available. They include: direct investigations carried out on liver biopsies, which are seldom used in clinical practice, and indirect investigations, such as the measurement of the clearance of exogenous substances, of urinary metabolites of endogenous substances and of specific enzymes. Induction and inhibition of microsomal activity are of the utmost interest to the clinician in various fields such as toxicology, carcinogenesis, drug interactions or drug habituation, metabolic regulations and maintenance of body homeostasis. Seven classes of enzyme inducers have been defined, but the exact mechanism of this has only been identified for two of them (the barbiturate and polycyclic hydrocarbon groups). Several drugs have been identified as enzyme inhibitors, the best known to the anaesthesiologist being macrolide antibiotics, imidazole derivatives, cimetidine, chloramphenicol and isonazide.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiac failure caused by an overdose of dantrolene]. / Insuffisance cardiaque par surdosage en dantrolène.

A case is reported of cardiac failure with repeated pulmonary oedema in a female patient suffering from renal failure and having been given incremental doses of dantrolene sodium. On withdrawal of the drug, all symptoms disappeared. This muscle relaxant was considered not to have any depressive myocardial side-effects. However, recent studies on isolated myocardial fibres showed the existence of a constant dose-dependent negative inotropic effect of dantrolene sodium, only noticeable with high concentrations of the drug.

[Acute fatal non-occlusive intestinal ischemia during treatment with a cardiotonic glucoside]. / Ischémie intestinale aiguë non occlusive mortelle au cours d'un traitement par glucoside cardiotonique.

After presenting the case of a 70 year old woman who presented a massive mesenteric infarction as a result of non-occlusive intestinal ischaemia ( NOII ), the authors review the principal features of this particular form of intestinal ischaemia. This condition is seen principally in elderly people with a syndrome of low cardiac output, resulting in marked mesenteric vasoconstriction. It is a complication of either severe decompensated heart disease treated with digitaloids or to a state of hypovolaemic or septic shock. The diagnosis of NOII should be suggested by the combination of abdominal signs with a state of shock and/or treated heart disease. The diagnosis is confirmed by selective mesenteric arteriography which reveals a patent but spastic vessel. The treatment is initially medical, consisting of the correction of haemodynamic disturbances and the in situ injection of vasodilator products, which may need to be completed by a surgical operation. However, the prognosis of NOII remains serious, particularly because of the frequent delay in making the diagnosis.