[Comparative measurement of pressure in the abdominal inferior vena cava and in the superior vena cava in adults]. / Mesure comparée de la pression dans la veine cave inférieure abdominale et dans la veine cave supérieure chez l'adulte.

Abdominal inferior vena cava pressure was compared to intrathoracic central venous pressure in 30 adults admitted in an intensive care unit following coronary artery bypass grafting. Mean pressures were obtained during controlled ventilation with a positive end expiratory pressure (PEEP) of zero and 10 cmH2O respectively, and during spontaneous breathing as well. Ninety measurements were obtained. Limits of agreement between intra-abdominal and intrathoracic cava pressures were below 2.5 mmHg in all cases. In this study, inferior vena cava pressure has predicted central venous pressure in adults during both controlled and spontaneous ventilation.

[Complications and outcome of implantable infusion pumps: apropos of 60 cases]. / Complications et devenir des chambres implantables: à propos de 60 cas.

The aim of this study was to analyse the complications and the outcome in 59 patients with 60 implantable ports for cancer chemotherapy. Perioperative complications included: subcutaneous haematoma (n = 6), wrong position of the catheter tip (n = 2), accidental intravascular injection of lidocaine with adrenaline (n = 1), vagal reflex (n = 1) and pneumothorax (n = 1). Late complications included extravasation of drugs (n = 4), wound dehiscence (n = 1), spontaneous migration of the catheter tip (n = 2), venous thrombosis (n: = 2), septicaemia (n = 6), local discomfort (n = 6) and ports' obstruction (n = 15). In 11 cases, repermeabilization was possible with heparin or streptokinase. Patients were followed up to 40 months, 37% died with a patent port, 6% died with an obstructed port and 45% are still alive with a functional port. Twelve percent of the ports were removed. The lack of life-threatening complications, the high rate of satisfied patients (85%) and the long mean period of use (11 months) in this study are similar to those published in the literature and confirm the value of implantable ports for chemotherapy.

[Bilateral ilioinguinal nerve block for ambulatory varicocele surgery]. / Bloc ilio-inguinal bilatéral et cure de varicocèle en ambulatoire.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of bilateral ilioinguinal-iliohypogastric nerve blocks for pain relief following ambulatory bilateral varicocelectomy. STUDY DESIGN: Prospective and randomised. PATIENTS AND METHODS: Sixty adult men scheduled for bilateral varicocelectomy were included in this prospective study. All patients had a standardised general anesthesia. After surgical procedures, patients were randomized into two groups: patients in group I received a bilateral ilioinguinal nerve block with 15 ml x 2 of 0.25% bupivacaine; patients in group II received subcutaneously 1 mg kg-1 of tramadol. Visual analogue pain scores at rest and during mobilisation were recorded at 5 min and 1, 3, 5 postoperative hours. The side effects of analgesia and amounts of rescue analgesics were recorded. RESULTS: Pain scores at rest and during mobilisation, the incidence of postoperative nausea and vomiting and additional analgesics requirement were significantly reduced in group I. There was no complication. CONCLUSION: Ilioinguinal nerve block is effective in controlling pain after bilateral varicocelectomy in ambulatory surgery.

[Spinal anaesthesia and Moya Moya disease]. / Rachianesthésie chez un patient connu avoir une maladie de Moya Moya.

Moya Moya is a rare disease of uncertain origin, characterised by stenosis of one or both of the internal carotid arteries and responsible of several neurological signs. We present the case of a boy with Moya Moya disease who was scheduled for an epiphisiodesis of the lateral malleola and had a spinal anaesthesia with hyperbaric bupivacaine 0.5% 10 mg without any perioperative complications. Any anaesthetic method could be used, provided special attention is given to avoid changes of capnea and blood pressure to preserve cerebral blood flow and palliate to cerebral flow steal.

[Comparison of nicardipine and isradipine in hypertension following coronary artery bypass graft]. / Comparaison de la nicardipine et de l'isradipine dans l'hypertension artérielle observée après pontage aorto-coronarien.

OBJECTIVE: Compare the efficacy of isradipine to that of nicardipine for the control of arterial hypertension following coronary artery bypass graft (CABG). STUDY DESIGN: Clinical prospective, randomised study. MATERIAL AND METHODS: 40 patients ASA II or III, mean age 66 +/- 8 years, scheduled for elective CABG were included. If the mean arterial pressure (MAP) was > or = 100 mmHg within the first six post operative hours, the patients were included and randomly attributed to either one of the 2 groups: Gr I (n = 20) received nicardipine, Gr II (n = 20) received isradipine in bolus then in continuous perfusion. HR, MAP, MPAP, CVP, PCWP, CI, SVRI, PVRI and SVI were recorded at: T0 before administration of drugs, T1 = 2 min after the first bolus. T2 when MAP reached 85 +/- 5 mmHg. T3, T4, T5, T6, T7 and T8 at 5, 10, 30, 60, 90 and 120 min after the continuous perfusion. T9 before stopping the perfusion. RESULTS: No significant changes in HR, CVP, PCWP, MPAP or PVRI at any time in both groups. Significant increase in CI at T2 in both groups. Reduction of MAP at T2 was more important (-27%) in Gr I compared to that in Gr II (-22%). This was mainly due to a significant decrease in SVRI. CONCLUSION: Isradipine is effective in the treatment of arterial hypertension following CABG. However there is not any significant beneficial effect of isradipine over nicardipine.

[Anaphylactic shock due to modified fluid gels: 2 case reports]. / Choc anaphylactique aux gélatines fluides modifiées: à propos de deux cas.

UNLABELLED: Colloid solutions can give severe anaphylactic accidents. We are reporting two cases from our department. FIRST CASE: a sixty eight years old man perfused with Plasmion solution (Gelatin plasma substitute) before spinal anesthesia, presented sudden hypotension and diffuse skin rush. Second case: a twelve years old girl, receiving a Plasmion solution to correct a hypovolemic shock in I.C.U, presented a severe bronchospasm and a worsening of the hypotension. These accidents are explained by immunologic reactions or by direct histamine release. Their incidence is between 0.01 and 0.8 percent depending on the used solution. They are prevented by an antihistaminic premedication for the gelatin plasma substitutes and by an haptenic inhibition for Dextran (polysaccharide plasma substitutes). The new colloid solutions, based on hydroxyethylstarch, seems to give much less allergic reactions.

[Use of implantable chemotherapy reservoirs. Experience at the Hotel-Dieu of France]. / Utilisation des chambres implantables en chimiothérapie. Expérience de l'Hôtel-Dieu de France.

We are presenting our experience with 70 deep venous catheters for long term chemotherapy. Despite the well known complications of these procedures, the implantation of subcutaneous injection sites has facilitated the management and brought much more comfort to cancer patients. Strict measures of survey and meticulous nursing care are essential for optimal use of the injection sites.

Pediatric renal biopsy: ambulatory versus overnight hospitalization.

Renal biopsy may be safely performed on selected pediatric patients in an ambulatory care setting. In order to verify the safety of this new procedure, we performed 51 renal biopsies on an ambulatory care basis over a five-year period (from December 1993 to December 1998): twenty-eight biopsies on transplanted kidneys and twenty-three of native kidneys. During the same period, 56 renal biopsies were performed during a regular hospitalization of a minimum of 24 hours. We compared the two groups: Ambulatory procedure group and overnight hospitalization group. There were no significant differences between the two groups in mean age, adequacy of renal samples and complications such as post-biopsy pain or hematuria. After this encouraging experience, we are proposing the ambulatory procedure to all pediatric patients in our unit. Parents will be informed that if macroscopic hematuria is noted in the immediate post-biopsy period, hospitalization might be necessary.

[Intraoperative malignant hyperthermia: apropos of a case]. / Hyperthermie maligne per opératoire: à propos d'un cas.

Malignant hyperthermia (MHS) is a rare potentially fatal complication of general anesthesia. Anesthetic agents most frequently incriminated are succinylcholine and halogenated agents. Respiratory acidosis is the most specific and sensitive sign. Hyperthermia per se may occur secondarily or may stay totally absent. Tachycardia and/or arrhythmias often develop due to hyperkalemia and metabolic acidosis. Muscle rigidity whenever present is pathognomonic The "gold standard" test for the diagnosis of MHS is the halothane-caffeine contracture test. Dantrolene is the treatment of choice and prognosis depends on the early administration of this agent.

[Thermocoagulation in the treatment of facial neuralgia. Preliminary results in 22 cases]. / La thermocoagulation dans le traitement de la névralgie faciale. Résultats préliminaires de 22 cas.

Twenty-two patients suffering from trigeminal neuralgia were treated by thermocoagulation from June 92 to June 94 at Hôtel-Dieu de France Hospital. Epidemiological, clinical, para-clinical elements and the therapeutic approach were studied. The results after a median follow-up of one year were satisfactory in twenty patients (90.9%) who became asymptomatic. No major complication was noticed. Two recurrences occurred however, one responded to another thermolesion. We propose and discuss this technic for the treatment of the trigeminal neuralgia.

Mivacurium in an obese patient with myotonic dystrophy--a case report.

Mivacurium is a short-acting non-deplolarizing neuromuscular blocking agent. Its use in an obese patient with myotonic dystrophy undergoing laparoscopic cholecystectomy is reported. Mivacurium was used as a bolus dose of 0.07 mg. kg-1, followed by a continuous infusion at the rate of 0.003 mg. kg-1. min-1. Muscle relaxation, monitored by a train of four count, was adequate throughout the surgery. Spontaneous recovery of the neuromuscular function was obtained fifteen minutes after the end of mivacurium infusion. Neostigmine was not given. Postoperative mechanical ventilation and respiratory complications were avoided.

Hemodynamic effects of pressure support ventilation following cardiac surgery.

Hemodynamic effects of pressure support ventilation (PSV) were assessed in 33 patients, after cardiac surgery. The patients, selected for their stable left ventricular and respiratory functions, underwent uncomplicated coronary artery bypass grafting. They all underwent the same anesthetic protocol, and an invasive hemodynamic monitoring. Eight to ten hours postoperatively, while all patients were fully awake, normothermic and hemodynamically stable, controlled ventilation (CV) was replaced by 3 levels of PSV (20, 10, 5 cm H2O). These levels were applied consecutively for 20 minutes each, before extubation. Hemodynamic and gas exchange data were recorded on CV, on each level of PSV, and on spontaneous breathing. The results were analyzed using ANOVA and Bonfferoni methods. No statistical significance could be noted between the five modes of ventilation as to hemodynamic parameters, arterial and mixed venous blood gases, and oxygen consumption (VO2). The only 2 parameters that reached statistical significance were central venous pressure and respiratory rate. Our study demonstrates that patients with stable cardiovascular and respiratory function can adapt to different levels of PSV without hemodynamic modifications or an increase in their VO2.

[Laryngeal mask: a new tool for the anesthetist]. / Le masque laryngé: un nouvel outil pour l'anesthésiste.

The laryngeal mask airway avoids the need for laryngoscopy and for tracheal intubation which may be harmful to certain patients. It was used in 70 patients by anesthetists with no previous experience of its use. A clear and unobstructed airway was obtained in 97.2% of patients. An evident hemodynamic stability was observed following its insertion and few minutes later. Laryngospasm occurred in 8 cases during the course of anesthesia and it appeared to be a result of light anaesthesia or of a secondary displacement.

[Secondary migration of a central venous catheter linked to an implantable port]. / Migration secondaire d'un cathéter veineux central lié à une chambre implantable.

The secondary migration of the distal part of a central venous catheter with implantable port is rarely described. This study reports a case in which the distal part of a catheter with implantable port moved spontaneously, a month after its implantation in a branch of the internal jugular vein without any other complication. The discussion is about modalities, frequency and explanation mechanisms of the complications due to central catheters. The conclusion insists on systematical radiologic control of the position of implantable port with central venous access, and in case of bad working or any sign of thrombo-phlebitis.

[Intra-articular analgesia after arthroscopy of the knee]. / Analgésie intra-articulaire après arthroscopie du genou.

In 33 patients the authors compared two protocols for postoperative analgesia after elective arthroscopy of the knee. One group (n = 11) received plain bupivacaine 0.25% by intra-articular administration. Another group (n = 11) received by the same route a mixture of bupivacaine 0.25% with fentanyl 50 micrograms. The last group (placebo group: n = 11) received the same volume of saline. The combination of bupivacaine with fentanyl reduced postoperative pain more effectively than plain bupivacaine and the analgesic effect was still present 9 hours after the arthroscopy.

[Duplication of the vena cava]. / Duplication de la veine cave.

Bilateral superior vena cava is a congenital anomaly of which the anaesthesiologist and intensivist should be aware in order to not mistake catheters placed in the left superior vena cava as being malpositioned outside of the venous circulation. These malpositions generally require catheter removal and reinsertion. This anomaly although rare is not-so-unusual. It is generally well tolerated.

[A national survey of postoperative pain management in Lebanon]. / Enquête nationale sur la prise en charge de la douleur aiguë postopératoire dans les hôpitaux libanais.

INTRODUCTION: Postoperative pain relief in Lebanon is a public health problem because its coverage is insufficient. STUDY DESIGN: A survey was performed with a questionnaire distributed to anaesthesiologists during the Lebanese national meeting of anaesthesia in May 2006. RESULTS: A total of 106 out of the 230 distributed questionnaires were collected. The coverage of the postoperative pain is different in the university hospitals and others. A preoperative information and postoperative evaluation of pain are only performed by 26% of anesthesiologists. A multimodal analgesia is begun in the operative room or in postanaesthesist care unit for 92% of the patients. Only 71% of the anaesthesiologists have pumps for patient-controlled analgesia. Written protocols for postoperative analgesia are available in only 58% of the centres. Among anaesthesiologists, only 36% have an initial and/or continuous formation to treat the postoperative pain. The major obstacle for improvement of postoperative pain is the cost of such treatments, which must be supported by the patients. CONCLUSION: Even if there is a good awareness of the importance to relieve the postoperative pain, important efforts must be done in this domain in Lebanon.