[Peridural abscess complicating spinal anesthesia in a diabetic patient]. / Abcès péridural compliquant une rachianesthésie chez un patient diabétique.

Infectious complications of spinal or epidural anaesthesia are rare, particularly after spinal anaesthesia. Most of them consist of a meningitis. We report a case of epidural abscess due to Staphylococcus aureus following spinal anaesthesia in a 62-year-old diabetic patient, diagnosed 45 days after the puncture with bacterial samples and magnetic resonance imaging. The pejorative neurological outcome required a laminectomy in spite of an efficient anti-staphylococcal treatment.

[Value of in vivo NMR spectroscopy in the study of cerebral metabolism under inhalation anesthesia]. / Intérêt de la spectroscopie RMN in vivo pour l'exploration du métabolisme cérébral sous anesthésie volatile.

NMR in vivo spectroscopy is one of the few methods available for non-invasive investigations of cerebral metabolism in animals and humans. 31P and 1H spectroscopy are particularly suitable for monitoring the cerebral energy metabolism by determining the cerebral levels of ATP, ADP, phosphocreatine (PCr), inorganic phosphate (Pi), lactate and intracellular pH (pHi). These techniques also seem to be suitable for studying the effects of anesthetics by directly comparing the anesthetized and unanesthetized states in the same subject. The effects of halothane and isoflurane on the changes elicited in the cerebral energy metabolism by experimental hypercapnia were investigated by in vivo NMR spectroscopy. Halothane was found to aggravate the decrease in PCr attributed to the shift in creatine kinase equilibrium induced by the cerebral acidosis associated to hypercapnia, while the level of cerebral ADP was decreased to a lesser extent than in unanesthetized animals. In contrast isoflurane did not modify the changes in cerebral energy metabolism elicited by hypercapnia except that the decrease in PCr was significantly slowed, suggesting a lower creatine kinase activity. These data indicate that isoflurane and halothane act by two different mechanisms to produce a decrease in oxygen consumption. Halothane could interfere with oxidative metabolism by disturbing ATP metabolism, while isoflurane could decrease oxygen consumption by a general sedative action, slowing both cerebral functional activity and cerebral energy homeostasis.

[Technics and indications of general anesthesia for tonsillectomy and adenoidectomy. Apropos of an experience using anesthetic perfusion and cold loop technic]. / Techniques et indications de l'anesthésie générale pour amygdalectomie et adénoïdectomie. A propos d'une expérience d'utilisation d'un narcotique en perfusion et de la technique de l'anse froide

The authors present the results of an enquiry carried out in University and regional hospitals in France and recall the interest of general anaesthesia with tracheal intubation during tonsillectomy. This makes possible, even in young children, the use of the technique of cold loop dissection. Its main advantage is in the absolute control of the airways which permits the operator to carry out careful hemostasis. Propanidide used in perfusion, allows these patients to wake up rapidly and the awakening is of good quality; this is essential in this type of operation.

[Problems presented to the surgeon, anesthetist and resuscitation personnel by fractures of the malar bone (study of 100 cases)]. / Problèmes posés au chirurgien et à l'anesthésiste-réanimateur par les fractures du malaire (etude de 100 cas)

The authors emphasize the difficulties encountered with fractures of the zygomatic bone, both from the technical operative points of view and conditions of anaesthesia and intensive care. They distinguish in both fields, the so-called simple zygomatic fractures from fractures associated with multiple injuries of the face or skull. After recalling the surgical techniques, they consider routine management, from diagnosis to recovery from the anaesthetic, emphasizing the problem of the time of the operation, of the method ensuring freedom of the airways and anaesthetic indications used together with problems of intensive care.

[Seeking an ideal protocol for the stability of blood gases during general anesthesia for bronchosopies]. / A la recherche d'un protocole idéal pour la stabilité des gaz du sang au cours des anesthésies générales pour bronchoscopies

During general anesthesia for bronchoscopy, hypoxemia is a major risk, especially in patients with a severe intrapulmonary shunt. With the technique of apnea in pure oxygen, after one hour denitrogentation, and with an intake of 50 liters of oxygen per minute through the bronchoscope, the PaO2 was greater than 400 mm of Hg, but hypercapnia and acidosis occurred. To compensate the latter, five minute sessions of apnea, alternating with two minutes of jet hyperventilation, nevertheless, have the disadvantage of producing a Ventrui phenomena at the proximal end of the bronchoscope, hence a fall in FiO2 which was dangerous in these high risk patients. The authors propose a method so that the Venturi phenomenon, which cannot be prevented, occurs in pure oxygen.