[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.

[Radical cystectomy for invasive tumors of the bladder in patients over 70 years of age]. / Cystectomie radicale pour tumeur infiltrante de vessie pour les patients de plus de soixante-dix ans.

The authors present a series of forty patients operated for invasive bladder tumors by radical cystectomy. All patients were older than 70 and had a complicated medical history. Mortality was 1 in 40 and the morbidity was low. The conclusion is that radical cystectomy is a safe procedure in elderly patients.

[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)