[Difficult intubation in patients with endotracheal prosthesis]. / Difficulté d'intubation imprévue mais prévisible.

We report a case of two consecutive episodes of difficult intubation in a patient with an endotracheal Dumon's prosthesis inserted two years before. Despite several preanaesthetic visits and ENT examination, the absence of recollection by the patient and the lack of information in her previous medical records led to the impossibility to introduce a normal tube into her trachea during two consecutive anaesthetic procedures. This case points out the limits of preanaesthetic visits. It allows to remind special measures that must be taken in patients having tracheal prosthesis and scheduled for anaesthesia and surgery.

[Postoperative intensive care after thymectomy for myasthenia gravis]. / La réanimation post-opératoire après thymectomie pour myasthénie.

The post-operative management of the myasthenic patient after thymectomy through sternotomy has changed in the last decades. After years of routine preoperative tracheostomies followed by routine prolonged intubation nowadays it is possible to wean the patients from the ventilation and to extubate them early after surgery while reintroducing the acetylcholinesterase inhibitors therapy. A series of 15 patients operated on between 1985 and 1988 for removal of thymic rests or thymoma is presented and confirms this evolution. The clinical and gazometric criteria allowing an early weaning from the ventilator are analyzed. However certain patients with the most severe forms of myasthenic still need prolonged ventilatory support.