[Anesthesia for video-assisted surgery of the thoracic and lumbar spine: a survey of 44 patients]. / Anesthésie pour chirurgie vidéoassistée du rachis thoracolombaire.

INTRODUCTION: The development of video-assisted surgery of the dorsolumbar spine has led to the need for adaptations for appropriate anesthetic management. Data concerning anesthesia for such surgery is very sparse in the literature. AIM OF THE STUDY: The aim of this retrospective study of 44 patients was to learn more about anesthesia practices used for patients undergoing this type of surgery. PATIENTS AND METHOD: The files of 44 patients were studied retrospectively. Epidemiologic data and the perioperative phase were analysed. RESULTS: The preoperative phase was not specific with preoperative assessment adapted to each patient. Similarly, monitoring practices during the surgical procedure were not specific. The choice of the anesthetic agents depended on the patient's clinical status. For tracheal intubation, care was taken to enable lung exclusion, even if not often used. Thoracic drainage at the end of the surgery was required in the event of imperfect hemostasis and in selected patients was replaced by pneumothorax exsufflation during closure. The postoperative period was uneventful and did not require admission to intensive care; non-specific analgesia was used. DISCUSSION: Adaptations of anesthetic practices are required each time a new surgical technique is developed. Excepting lung exclusion, anesthesia for video-assisted dorsolumbar spine surgery is not specific.

[Risk assessment before non-cardiac surgery: what do anesthesiologists expect from cardiologists?]. / Evaluation du risque cardiologique en vue d'une anesthésie pour une chirurgie non cardiaque: qu'attend le médecin anesthésiste-réanimateur de la consultation spécialisée auprès d'un cardiologue?

Patients with a cardiac pathology are at high risk of perioperative cardiac complications. Therefore, an evaluation of the cardiac risk before a non-cardiac surgery has to be performed. The importance of the risk depends on the type of surgery, the patient's clinical symptoms and his adaptation to a physical effort. Exams are chosen according to the pathology, the information searched for and should be non invasive. After the evaluation, a specific preparation of the patient and the institution or an adaptation of cardioprotective medications should be discussed. The cardiologic consultation also allows a better management of antithrombotic or antiplatelet therapy. Preoperative evaluation of the cardiac risk is based on the collaboration between cardiologist and anesthesiologist to select the patients to evaluate, optimize their management, and decrease the risk of complications.

[Fat embolism after total hip prosthesis replacement preserving the femoral stem]. / Embolie graisseuse après changement de prothèse de hanche avec conservation de la tige fémorale.

Fat embolism is a known complication of traumatology, especially in long bone fractures. It may also occur in liposuction and articular surgery (0.1%). Fat embolic events are most often clinically insignificant and difficult to recognize since clinical manifestations are varied and there is no routine laboratory or radiographic diagnosis. Classically, fat embolism syndrome presents with the triad of pulmonary distress, mental status changes, and cutaneous manifestations. We report the case of a 33-year-old woman who developed acute respiratory distress 10 days after hip arthroplasty. Several aetiologies such as fibrinocruoric pulmonary embolism, pulmonary aspiration and bacterial pneumonia were discussed. Fat embolism was diagnosed, based on suggestive clinical manifestations, radiographic and laboratory findings, although fat embolism after hip arthroplasty without intramedullary pressurization is infrequent.

[Bilateral pneumothorax and tamponade after acupuncture]. / Pneumothorax bilatéral et tamponnade après acupuncture.

INTRODUCTION: The "target" of acupuncture is usually the muscle, but it occasionally approaches other anatomical structures such as the pleura, which may subsequently suffer damage. OBSERVATION: During a session of acupuncture, a 25-year-old woman had a malaise with shock and neurological disorders. The initial examinations revealed a bilateral pneumothorax associated with pericardial and peritoneal effusions. Symptomatic reanimation combining dopamine, left pleural draining and pericardial puncture led to rapid haemodynamic improvement. The etiological exploration, having eliminated an underlying pathology, concluded in the diagnosis of tamponade and bilateral pneumothorax following a session of acupuncture. COMMENTS: Our patient presented the association of two traumatic complications of acupuncture: cardiac tamponade due to haemopericardium and bilateral pneumothorax. Although these complications are rare, they must be known.

[Evaluation of the learning curve of a new intubation technique: intubating laryngeal mask]. / Evaluation de l'apprentissage d'une nouvelle technique d'intubation: le ML-Fastrach.

OBJECTIVE: Assessment of the learning curve of a new device for blind orotracheal intubation: Intubating laryngeal mask. STUDY DESIGN: Prospective clinical study. METHODS: Ten persons practicing anaesthesia (specialist, fellow, nurse) underwent videotape learning and manikin training required with the device. Each person had to carry out a tracheal intubation in ten consecutive patients undergoing scheduled surgery. No patient presented history or clinical sign of difficult airway management. Results were expressed as mean +/- SD. Main percentages were provided with their 95% confidence interval; the percentage comparison were performed using Chi 2 test. The significance level for overall analysis was p < 0.05. RESULTS: One hundred patients were included. The overall success rate of tracheal intubation with the intubating laryngeal mask was 88%. An easy learning curve was obtained according to the low failure rate that was observed. No failure was noticed after eight procedures. Significant diminution of the delay for tube insertion was observed during the practice (3 +/- 1.30 min for the first procedure and 1.16 +/- 0.60 min for the tenth procedure). Circumstances of the oral intubation were improved with muscle relaxation. Finally, all failure with the intubating laryngeal mask were followed by successful intubation using direct laryngoscopy. CONCLUSION: The intubating laryngeal mask is a new device for blind orotracheal intubation with an easy learning curve in patients without difficulty in airway management, even for non-selected operators.