[Influence of arteriovenous hemofiltration on teicoplanin pharmacokinetics]. / Influence de l'hémofiltration artérioveineuse sur l'elimination de la teicoplanine.

OBJECTIVE: To assess the pharmacokinetics of a single dose of teicoplanin in critically ill patients treated with continuous arteriovenous haemofiltration (CAVH). STUDY DESIGN: Prospective open clinical study. PATIENTS: Eleven patients with acute renal insufficiency and suspected of a Gram negative infection. METHOD: After injection of teicoplanin, 6 mg.kg-1 over 30 minutes the plasma and haemofiltrate concentrations were measured over 24 hours with high power liquid chromatography (HPLC). RESULTS: In plasma, the mean half-life of the first phase was 0.6 +/- 0.2 hour and terminal half-life was 16.4 +/- 5 8 hours, total clearance 30.4 +/- 7.1 mL.h-1.kg-1, volume of distribution was 0.7 +/- 0.3 L.kg-1 and the mean resident time 19.2 +/- 7.4 hours. In the haemofiltrate, the amount of teicoplanin eliminated after 24 hours was less than 1% in seven patients, between 1.8 and 3.7% in three and reached 7% in one patient. CONCLUSION: During CAVH, the elimination of a single dose of teicoplanin in the haemofiltrate is low.

[Esophageal perforation after transesophageal echocardiography]. / Perforation de l'oesophage après échocardiographie transoesophagienne.

Transoesophageal echocardiography (TOE) is increasingly used in cardiology, cardiac surgery and intensive care. Its complications are rare. We report a case of perforation of the oesophagus after TOE in a 71-year-old woman, scheduled for an elective aortic valve replacement. Her medical history included arterial hypertension but no pre-existing oesophageal disease. A Hewlett Packard ultrasound imaging system was used, with a 5 MHz single plane probe. After local anaesthesia, the transducer probe was inserted into the distal oesophagus, after three attempts, without any apparent incident. A few hours later, the patient complained of acute cervical and dorsal pain. Examination showed severe skin emphysema in of neck, but neither breathing difficulties, nor haemodynamic modifications. The EKG was normal and body temperature at 38.8 degrees C. The opacification of the oesophagus showed a passage of the contrast medium into the mediastinum. Emergency surgical exploration by left cervicotomy showed a perforation of 2 to 3 cm of the posterior wall of oesophagus, treated with terminal oesophagostomy and drainage. The pressure by the TOE probe on the oesophagus may explain this perforation. The outcome was uneventful. Although TOE is a semi-invasive technique with a low risks its benefit/risk ratio should be considered in each patients before using it.

[Laryngeal mask and reduction of nasal bone fractures]. / Masque laryngé et réduction des fractures des os propres du nez.

A retrospective study was conducted in 116 patients who underwent anesthesia for reduction of nasal fracture under laryngeal mask for ventilation and protection of the airways. One patient had secondary intubation due to difficult insertion of the laryngeal mask. No episode of hypoxemia related to blood inhalation occurred. The laryngeal mask may be proposed to maintain the airway in this surgical procedure.

Unexpected rhabdomyolysis with myoglobinuria in a patient in the supine position.

We report a case of post-operative rhabdomyolysis following transmandibular buccopharyngectomy without reconstruction in a patient remaining in the supine position throughout the procedure. Muscle compression induced by a cushion used during the procedure had probably contributed to the rhabdomyolysis. Outcome was favourable without acute renal failure. Prevention, early diagnosis and treatment are the keys to a successful recovery.