Migrating grass awn within the intraconal part of the retrobulbar space in a dog.

A 1.5-year-old MC Cardigan Welsh Corgi was presented for a right oral fistula associated with left tonsil enlargement that responded to medical treatment. A first computed tomography scan was performed and showed no signs of a foreign body. Medical treatment was continued for 2 additional weeks and the dog was free of clinical signs for 3 months. The dog was presented again for a 3-day history of anorexia and marked pain when opening the jaw. The repeat computed tomography scan revealed a migrating foreign body near the optic canal of the right eye, and surgical exploration confirmed that it was trapped within the intraconal part of the retrobulbar space, abutting the optic nerve. The foreign body was surgically removed through an osteotomy of the zygomatic bone. The dog fully recovered with no vision loss. Based on the literature search, this is the first published report describing a migrating grass awn located in the intraconal part of the retrobulbar space, abutting the optic nerve.

[A traditional anesthesia consultation or a "telephone interview" within the framework of ambulatory surgery?]. / Consultation d'anesthésie traditionnelle ou "interview téléphonique" dans le cadre de la chirurgie ambulatoire?

UNLABELLED: Preoperative assessment for anaesthesia must detect in the setting of ambulatory surgery both medical and sociopsychologic problems which may contraindicate the ambulatory aspect of the procedure. The goal of our prospective study was to assess the efficacy of a preoperative telephone interview in screening the medical and sociopsychologic problems of ambulatory patients. 1,000 consenting consecutive outpatients participated to the study and were randomly allocated to one of two groups: patients in the standard group (STD) had a consultation a few days before surgery whereas those in the telephonic group (TEL) called the anesthetist a few days before, the physical exam being performed on the day of surgery. The cancellation of the ambulatory procedure was decided upon either medical criterias (MC) or sociopsychologic criterias (from Waetchler). RESULTS: both groups were comparable regarding SPC and MC but prescription of preoperative tests was more frequent in the STD group (result statistically significant). In conclusion, this new approach is as reliable as the standard consultation in screening the SPC which remain the most frequent cause of cancellation in ambulatory surgery. Therefore this telephonic interview which is simple and reliable for screening outpatients may represent a suitable alternative to a standard consultation.

Resistance to sodium nitroprusside in hypertensive patients.

Eleven patients in hypertensive crisis were treated with iv sodium nitroprusside (SNP). In all cases, rapid clinical improvement was obtained. Nevertheless, 9 patients developed progressive resistance to the hypotensive effect of the drug. For the first 2 h, the mean infusion rate was 1.68 +/- 0.64 micrograms/kg . min. For the next 6 h, the mean infusion rate had to be increased to 3.1 +/- 1.14 micrograms/kg . min in order to maintain diastolic blood pressure below 110 mm Hg. Hemodynamic measurements demonstrated that this resistance was related to a marked rise in cardiac index without tachycardia. In the 6 patients with pulmonary edema who developed resistance to SNP, blood pressure control was obtained by fluid depletion. In the 3 patients without pulmonary edema who developed resistance to SNP, blood pressure control was obtained by iv acebutolol. The authors conclude that SNP rapidly improves critical hypertension. Progressive resistance to the hypotensive effect of the drug can occur in some cases and is related to a marked rise in cardiac index, which can be rapidly antagonized with fluid depletion or a beta-blocking agent to avoid SNP accumulation and cyanide toxicity.

[Nitrous oxide and pressures exerted on the trachea by endotracheal tubes. Study on a tracheal model]. / Protoxyde d'azote et pressions exercées sur la trachée par les sondes d'intubation. Etude sur modèle trachéal.

The authors studied the effects of nitrous oxide diffusion, using a tracheal model, on the pressure of several endotracheal tube cuffs. Studies carried out showed an increase in volume and pressure of the cuffs related to time exposure and nitrous oxide concentrations used. Use of a self-controlled pressure cuff or filling the cuff with inspired gas composition should be of value to counteract or to prevent the diffusion effect.

[Droperidol. Action on hemodynamic and oxygen consumption changes (author's transl)]. / Le dropéridol. Effets sur les modifications hémodynamiques et la consommation d'oxygène post-opératoires.

Hemodynamic and oxygen consumption changes following general anesthesia were studied in 11 patients who did and in 11 patients who did not received droperidol at the end of operation. Both group were similar with respect to age, duration of anesthesia, doses of anesthetic drugs, and hemodynamic and oxygen consumption values immediately at the end of operation. The highest oxygen consumption measurements which were selected as representative of the maximal metabolism of the recovery period showed that the following parameters were lower in the droperidol group than in the non-droperidol group: oxygen consumption (162 +/- 12 and 238 +/- 19 ml/min/m2 respectively), cardiac index (3.0 +/- 0.2 and 4.4 +/- 0.4 l/min/m2), mean arterial pressure (11 +/- 6 and 129 +/- 5 torr), stroke index (27 +/- 3 and 46 +/- 4 ml/m2) left ventricular stroke work index (38 +/- 5 and 77 +/- 8 gm/m2) and PaCO2 (39 +/- 2 and 49 +/- 2 torr). The measurements performed after extubation were similar in both groups. These data show a metabolic and hemodynamic stabilizing effect of droperidol during recovery which may be useful in high-risk patients.

Cardiovascular response to the i.v. administration of morphine in critically ill patients undergoing IPPV.

The haemodynamic changes following the administration of morphine 0.15 and 0.30 mg kg-1 i.v. were studied in 11 patients, free from known cardiac disease. All patients were acutely ill and their lungs were being ventilated mechanically. In those patients receiving 0.15 mg kg-1, the only haemodynamic change was a slight and transitory decrease in the systolic arterial pressure. In contrast, several changes were observed in patients receiving 0.30 mg kg-1: an immediate and prolonged decrease in the cardiac index was noted along with transient decreases in heart rate, stroke volume index, arterial pressure and left stroke work index. These results suggest that the haemodynamic cost of morphine 10 mg is negligible but could be significant when 20 mg has been administered and must be weighed against its beneficial effects in the critically ill patient.

Hemodynamic effects of dopamine in septic shock with and without acute renal failure.

Hemodynamic response to dopamine hydrochloride in septic shock with myocardial dysfunction was studied in ten patients with normal renal function (group 1) and in ten patients with acute renal failure (group 2). The control hemodynamic data were similar in the two groups. Dopamine in groups 1 and 2 induced significant (P less than .01) and similar increases in cardiac index and mean aortic pressure. Group 1 had a smaller increase in heart rate (+ 16%), than group 2 (+ 24%), but this difference was not significant. Stroke volume index had a significant increase in group 1 (+ 18%), whereas it did not increase significantly in group 2 (+ 4%); this difference of changes in stroke volume index between the two groups was significant (P less than .01). This phenomenon suggests an increased chronotropic effect and/or a reduced inotropic effect of dopamine in patients with septic shock and acute renal failure.

Haemodynamic effects of dopamine in septic shock.

The Haemodynamic response to dopamine infusion has been assessed in 30 patients in septic shock with myocardial dysfunction. Dopamine infusion resulted in a haemodynamic improvement as indicated by significant increases in cardiac output of 38.4% (p less than .001), stroke volume 18.7% (p less than .001), and mean arterial pressure of 33% (p less than .001). Despite the inotropic effect, left ventricular filling pressure did not change in 20 cases and increased in 10 cases. Mean peripheral resistance remained unchanged with a scatter of individual responses depending upon factors such as dopamine dose and initial vascular resistance. Dopamine increased intrapulmonary shunting by 48% (p less than .001), insignificantly decreased PaO2, increased mixed venous oxygen saturation by 16% (p less than .02) and decreased pulmonary vascular resistance by 15% (p less than .02). Both isoprenaline and dopamine improve stroke volume by an inotropic action, with an increase in venous return in the case of the latter and a reduction in afterload in the former. It is concluded that the usefulness of dopamine in septic shock may be limited in patients with previous myocardial disease because of the risk of increasing preload and in hypoxaemic patients because of the risk of increasing intrapulmonary shunting.