Immediate postoperative extubation in bilateral lung transplantation: predictive factors and outcomes.

BACKGROUND: We reviewed our experience with tracheal extubation in the operating room (E-OR) among cystic fibrosis patients requiring bilateral lung transplantation to evaluate safety and determine predictive factors of E-OR. METHODS: The charts of 89 recipients (from May 2007 to June 2013) were analysed. Patients were divided into E-OR and E-ICU (intensive care unit extubation) groups. Data are expressed as numbers (percentages) or medians [25th-75th percentiles]. RESULTS: There were 41 patients in the E-OR group (46%). Donor and recipient characteristics were similar between groups. Intraoperative complications occurred less frequently in the E-OR group, and fluid and transfusion requirements were lower. Postoperative courses were different in the E-OR group, including a lower rate of grade 3 primary graft dysfunction (0 compared with 19 patients, P<0.0001) and shorter ICU (5.0 [3.7-7.2] compared with 11.5 [7.0-15.5] days) and hospital stays (22.0 [18.0-25.5] compared with 33.0 [25.0-56.5] days, respectively; P<0.0001 for both). The 1 yr survival rates were similar: 95% in the E-OR group and 98% in the E-ICU group. A statistical model built on a development cohort of 60 randomly selected patients predicted 95% of E-OR instances in this cohort and 82% of E-OR instances in the validation cohort (28 patients). Predictive factors were complications during single-lung ventilation (second graft implantation), complications during bipulmonary ventilation (end of surgery), and the ratio of arterial partial pressure of oxygen to fractional inspired oxygen (end of surgery). CONCLUSIONS: Our protocol allowed for extubation of 46% of bilateral lung transplant patients without increased postoperative risks.

[Abdominal aorta lesion during surgical treatment of a foraminal disk hernia]. / Plaie de l'aorte abdominale au cours d'une cure de hernie discale.

We report a case of an abdominal aorta lesion on a 54-year-old woman, who underwent surgery for the treatment of a foraminal disk hernia. At the end of the hernia repair, a sudden hypovolaemic collapse occurred. A computed tomography revealed an abdominal aorta disruption and a retroperitoneal haematoma. An endovascular treatment was preferred to a surgical reintervention and an endoluminal stent-graft was inserted; the postoperative course was uneventful. This case report describes an example of vascular complications of disk hernia surgery which are rare but potentially serious. It emphasizes the increasing development of endovascular procedures and their utility in the treatment of acute contained aortic disruption.

[Obstetric analgesia in patients with Klippel-Trenaunay syndrome]. / Analgésie obstétricale chez des patientes atteintes d'un syndrome de Klippel-Trenaunay.

We report three cases of delivery in two parturients with a Klippel-Trenaunay syndrome. These patients have a rare hereditary disorder that results in three main features: haemangiomas, varicose veins, bone and soft tissue hypertrophy. In the absence of angiographic magnetic resonance imaging of the spinal cord and of perispinal tissues, arteriovenous malformations of the central nervous system could not been ruled out. Intravenous sufentanil and pudendal block were used for labour analgesia and vaginal delivery respectively; general anaesthesia was used for uterine revision and for caesarean section.

[Development of acute and chronic respiratory diseases during pregnancy]. / Evolution des pathologies respiratoires aiguës et chroniques au cours de la grossesse.

Physiological respiratory and hormonal changes occurring during pregnancy result in increased oxygen consumption related to fetal growth. The increase in the maternal basal metabolism leads to hyperventilation and increased cardiac output. This explains why pathological respiratory or cardiovascular conditions existing prior to pregnancy can rapidly worsen during the course of the pregnancy. However, even if no cardiorespiratory disease exists prior to pregnancy, an inhalation lung disease, pre-eclampsia or sepsis can lead to pulmonary edema due to the increased plasma volume in the pregnant woman. These different pathological situations as well as infectious lung diseases are discussed here. We examine the evolution of respiratory function during the course of labor, delivery and the post-partum period. In addition, pregnancy also has an effect on chronic respiratory disease, particularly asthma.