[Fastrach laryngeal mask and difficult intubation]. / Masque laryngé-Fastrach et intubation difficile.

OBJECTIVE: To evaluate the success rate of intubation through the intubating laryngeal mask airway (LMA-Fastrach) in patients with predictive signs of difficult airway or after intubation failure. STUDY DESIGN: Open prospective study. PATIENTS: The study included 33 adults, 21 with predictive signs of difficult airway and 12 after intubation failure. METHODS: After induction of anaesthesia, the intubating LMA was inserted. Proper insertion was confirmed by easy bag ventilation and capnography. Intubation through the intubating LMA was then carried out with an armoured endotracheal tube. If intubation failed, a second attempt was carried out after a gentle manipulation of the intubating LMA. After two attempts, if intubation remained impossible, fibrescopic intubation through the intubating LMA was carried out. In case of failure the usual tracheal intubation algorithms were used. RESULTS: Tracheal intubation through the intubating LMA was successful in all patients, in 32 on the first attempt and in one on the second. Successful tracheal intubation was possible on the first attempt in 25 patients (76%), on the second in four (12%) and after fibrescopic intubation through the intubating LMA in the four remaining (12%). CONCLUSION: The results of this study confirm that tracheal intubation through the intubating LMA can be recommended in patients with a difficult airway, whether foreseen or not.

[Normovolemic hemodilution in the treatment of sudden deafness]. / Apport de l'hémodilution normovolémique au traitement des surdités brusques.

After the apparition of a sudden deafness, 45 patients (22 men and 23 women, with a mean age of 44 +/- 14.9 years) were treated with normovolaemic haemodilution performed with dextran 60. They were placed into 4 groups depending on their hearing loss: total loss: 10 cases; severe loss: 90 to 70 db. 13 cases; moderates loss: 65 to 40 db, 14 cases, slight loss: less than or equal to 35 db, 8 cases. The mean time between the onset of the hearing loss and treatment was 9.3 +/- 12.4 days. The initial mean haematocrit was 44.8 +/- 3.8% and mean haematocrit after haemodilution was 33.1 +/- 2.8%. For 51% of the patients, an almost total recovery was obtained. In 15.5% of cases, recovery was between 25 to 50% of the hearing loss, and in 33.3% of the patients recovery was negligible. We did not find any relationship between hearing recovery and initial haematocrit. The best results were obtained in the group of patients treated early. Hearing gain was significatively better if delay in starting treatment was less than 7 days. There was a relationship between the initial hearing loss and the final recuperation. These results suggested that haemodilution increased labyrinth microcirculation and oxygenation of the cochlear sensory cells, reversing the ischaemic insult to these cells.

[Value of the association of normovolemic dilution and hyperbaric oxygenation in the treatment of sudden deafness. A retrospective study]. / Intérêt de l'association hémodilution normovolémique-oxygénothérapie hyperbare dans le traitement des surdités brusques à partir d'une étude rétrospective.

The multiple treatments of sudden deafness shows how this pathology still remains quite unknown. The authors present a retrospective study of 87 patients treated by normovolemic hemodilution associated to hyperbaric oxygenation. They obtain a total à 60% of significant recovery (ratio between hearing gain and initial hearing loss, above 25%) and in severe hearing loss (threshold between 70 and 90 dB) 60% of good results (ratio above 50%). The importance of the initial form of audiogram and the presence of dizziness as prognostic factors is not confirmed. On the other hand, the evolution of tinnitus is correlated with the deafness and it is a supplementary means to evaluate the therapeutic efficiency. Moreover the persistence of tinnitus represents an important after effect. Sudden deafness still remains a medical emergency and the delay for carrying out any treatment should be as short as possible. On the other hand it is possible to reduce hospital stay by two sessions of hyperbaric oxygenation per day.

[Sudden deafness: a randomized comparative study of 2 administration modalities of hyperbaric oxygenotherapy combined with naftidrofuryl]. / Surdités brusques: étude comparative randomisée de deux modes d'administration de l'oxygénothérapie hyperbare associée au Naftidrofuryl.

Hyperbaric oxygen therapy is one of the numerous therapies which have been proposed in the management of sudden deafness. It is presumptuous to claim the efficiency of any treatment in a pathology where both the origin and the actual rate of spontaneous recovery are unknown. The grounds of therapies are therefore empirical but the need of urgent therapy is dictated by ethics. This study compares the effects of hyperbaric oxygen therapy in two groups of patients; according ot their order in randomization the subjects were treated either at a rate of 1 session or 2 sessions per day. Hyperbaric oxygen therapy was associated with infusion of Naftidrofuryl to counteract the vasoconstrictive effect of increased oxygen pressure in blood. Steroids were also administered simultaneously to avoid, for the same reasons, cerebral oedema. Normovolemic hemodilution (Dauman et al. 1983) was systemically performed in all the patients preliminarily to hyperbaric oxygen therapy, in order to reduce the haematocrit and thus facilitate blood supply. The efficiency and the side effects were similar in the two groups, provided that some principles in the selection and the monitoring of the patients were respected. The rate of 2 sessions of hyperbaric oxygen therapy per day has obvious advantages in view of health policy, but it requires the hospitalization of the patient and should be restricted to the younger subjects.

[Unilateral recurrent laryngeal nerve palsy following brief periods of intubation. Two cases (author's transl)]. / Paralysie récurrentielle unilatérale après intubation de courte durée. Deux cas.

One of these two cases (1 h 30 and 48 hours) was permanent. The cause of the paralysis seems to be either from compression of the nerve between the endotracheal tube cuff and the cricoid, or from compression between the thyroid ala and a dislocated arytenoid cartilage from use of an unnecessarily large tube. An anatomical study has helped to confirm this hypothesis and shows the presence of an ischaemic aera overlying the nerve at the level of its entrance into the larynx due to the endotracheal cuff.