[Convulsions due to a postpartum cerebral angiopathy associated with the administration of bromocriptine]. / Crises convulsives révélant une angiopathie cérébrale du post-partum par prise de bromocriptine.

We report a case of postpartum convulsions due to a benign cerebral angiopathy occurring after bromocriptine therapy to suppress lactation. This case analyses the current knowledge concerning this rare entity. It allows pointing out special measures that must be taken with the administration of bromocriptine.

[Severe complications after a translaryngeal tracheotomy]. / Complication sévère après une trachéotomie translaryngée.

We report the case of a 71-year-old man receiving anticoagulant treatment because of a mechanical aortic valve. Because of an unsuccessful weaning after abdominal surgery, a translaryngeal tracheostomy was realised without incident. The patient died few days later after a hypoxic cardiac arrest due to a severe haemorrhage after the first recannulation. This case illustrates a severe complication because of the recannulation after a translaryngeal tracheostomy and how cautions one should be before realizing a percutaneous tracheostomy in a patient under anticoagulant treatment.

[Unusual complication after hip surgery under spinal anesthesia]. / Complication inattendue après chirurgie de hanche sous rachianesthésie.

The development of an acute respiratory distress syndrome following hip surgery in elderly patients is suggestive of thromboembolism in most instances. However, we must keep in mind the possibility of rarer complications, which can remain undiagnosed because they are hidden by prominent abnormal behaviours, which can develop following any type of anaesthesia. We report the case of a patient who developed a confusion following an orthopaedic surgery under spinal anaesthesia; this confusion concealed a penetration syndrome resulting from accidental inhalation of a dental crown. Because this patient was old and had previously developed chronic lung disorders, we selected a spinal anaesthesia for performing the surgery; these underlying respiratory disorders worsened the clinical consequences of the inhalation. The dental crown was removed under general anaesthesia with spontaneous ventilation using a bronchoscope after an unsuccessful attempt with a fibrescope due to the size of the foreign body.

[Difficult intubation: a prospective evaluation of the Mallampati and Wilson tests]. / Intubation difficile: évaluation prospective des tests de Mallampati et de Wilson.

This prospective study aimed to evaluate in 849 patients the Mallampati and Wilson scores for predicting a difficult intubation. All scheduled patients were included. Induction and tracheal intubation were carried out as usual. Intubation was deemed to have been difficult if any special procedure had been required (external compression excepted); difficult laryngoscopy was defined as grade 3 or 4 on the Cormack-Lehane scale. In accordance with these criteria, less than 36% of patients with difficult intubation or laryngoscopy were detected, with a high false positive rate (more than 75%) but a good negative predictive value (more than 90%). This study was not concordant with the results of the original studies. However, data from literature show a great variability of results between studies. Many factors may contribute to this variability: differences between samples of patients, evaluation of Mallampati or Wilson scale, protocols of induction and intubation or characterization of difficult intubation. This study suggests a poor reliability of the two tests.

[Quality of sedation and neurologic evaluation following surgery of the posterior cranial fossa: the importance of propofol]. / Qualité de la sédation et évaluation neurologique après chirurgie de la fosse cérébrale postérieure: intérêt du propofol.

Following cerebral posterior fossa surgery, 23 patients were admitted in Intensive Care Unit for postoperative mechanical ventilation. Mean age was 45 +/- 16 years. Mean duration of surgical procedure was 09 h 20 min +/- 04 h 45 min. Heart rate, blood pressure, coma Glasgow scale, pupil reaction, respiratory pattern were recorded throughout the study. Following recovery from anaesthesia sedation was initiated by an intravenous bolus injection of propofol 2 mg.kg-1 followed by a continuous infusion starting at 1 mg.kg-1.h-1. The infusion rate was adjusted thereafter to ensure that the patient was sedated (Glasgow coma scale less than or equal to 6), unable to react to tracheal suction, well adapted to mechanical ventilation with a cardiovascular stability. Mean duration of sedation was 27 h 45 min +/- 04 h 45 min. Mean infusion rate of 3.81 mg.kg-1.h-1 allowed good sedation in 22 patients. There were no clinical changes in arterial pressure and heart rate. Propofol infusion was stopped transiently to assess neurologic status at 18 h +/- 02 h 45, 33 h 45 +/- 08 h 15, 49 h 10 +/- 16 h 50 after sedation onset. During these interruptions, the speed of recovery was assessed and arterial blood samples taken simultaneously. When the infusion was discontinued, adequate recovery was obtained in 48 +/- 26 min for 17 patients of 23, 64 +/- 58 min for 7 of 12, 70 +/- 65 min for 3 of 3.(ABSTRACT TRUNCATED AT 250 WORDS)