[Anaesthetic management for caesarean delivery and Creutzfeldt-Jakob disease].

Variant Creutzfeldt-Jakob disease (vCJD) is the only form of prion diseases linked to bovine spongiform encephalopathy (BSE). The surgical and anaesthetic management in patients having Creutzfeldt-Jakob disease is rare. Maternofoetal and human transmission of Creutzfeldt-Jakob disease is still unknown.

Airway management in children: ultrasonography assessment of tracheal intubation in real time?

Background: Pediatric tracheal intubation requires considerable expertise and can represent a challenge to many anesthesiologists. Confirmation of correct tracheal tube position relies on direct visualization or indirect measures, such as auscultation and capnography. These methods have varying sensitivity and specificity, especially in the infant and young child.

Minor increase of endtidal CO2 during sevoflurane-induced malignant hyperthermia.

Malignant hyperthermia (MH) in a pediatric patient during sevoflurane anesthesia with only a minor rise of endtidal CO(2) is described. MH was considered because of increased rectal temperature. The outcome was favorable after the initiation of a few simple measures (increased minute ventilation, cessation of sevoflurane).

A multicenter study of the Ambu laryngeal mask in nonparalyzed, anesthetized patients.

We designed this multicenter trial to evaluate the performance and safety of the Ambu laryngeal mask, a new disposable supraglottic airway device, in patients scheduled for elective surgery. One-hundred-eighteen nonparalyzed, anesthetized patients (ASA physical status I-II, age, 18-65 yr, body mass index, 18-30 kg/m(-2)) receiving total IV anesthesia were included in this study. After device insertion, fiberoptic position and oropharyngeal leak pressure were determined at an intracuff pressure of 60 cm H2O.

Correlations between genotype and pharmacological, histological, functional, and clinical phenotypes in malignant hyperthermia susceptibility.

Malignant hyperthermia susceptibility (MHS) is a subclinical pharmacogenetic disorder caused by an impairment of skeletal muscle calcium homeostasis in response to triggering agents. While in vitro contracture testing (IVCT) is the gold standard for defining MHS, molecular analysis is increasingly used to diagnosis MHS. Mutations associated with MHS have been reported in two genes: RYR1 and CACNA1S.

Hip-flexed postures do not affect local anaesthetic spread following induction of epidural analgesia for labour.

Hip-flexed postures enlarging the pelvic diameter are used to improve the obstetric course of labour. Although most investigations show that lateral and sitting positions do not affect the spread of epidural analgesia, the effect of recently introduced hip-flexed postures has yet to be confirmed. This prospective randomised study included 93 parturients.

Parturition and angioneurotic oedema.

Angioneurotic oedema is a rare disease caused by Cl esterase inhibitor deficiency. Hereditary angioneurotic oedema includes type I (quantitative and functional) deficiency and type 11 (functional) deficiency. Its prophylactic treatment during pregnancy, based on danazol therapy if the fetus is male, may avoid acute attacks of generalized or laryngeal oedema.

[Target-controlled infusion with propofol for neuro-anesthesia].

Propofol is an intravenous anaesthetic agent, which presents interesting features for its use in neuro-anaesthesia: it is a powerful hypnotic that does not increase the intracranial pressure. The delay of recovery is short even after several hours of continuous infusion. This is essential for a fast neurologic examination.

[Amniotic fluid embolism suspected in a case of seizure and mild uterine haemorrhage with activation of coagulation and fibrinolysis].

After a normal pregnancy and labour in a 29-year-old parturient, a single seizure followed by a transient headache was observed during the uterine revision for placental retention. Mild uterine haemorrhage of 150 ml per hour without any uterine atony was associated with activation of clotting and fibrinolysis (decrease of fibrinogen, elevated fibrin soluble complexes and D-dimers). A ten fold value of foetal blood cells in maternal serum suggested the diagnosis of amniotic fluid embolism.

[Obstetrical analgesia and anaesthesia in multiple sclerosis].

Objectives: The use of epidural analgesia and anaesthesia is controversial in patients with multiple sclerosis (MS) due to the potential neurotoxicity of local anaesthetics. The aim of this study was to evaluate the place and the safety of epidural obstetrical analgesia in these patients.

Patients And Methods: A consecutive series of 19 patients with MS was studied over 4 years, recording the type of anaesthesia and the obstetric and neurologic observations during the pregnancy and post-partum.

Thrombotic thrombocytopenic purpura: medical and biological monitoring of six pregnancies.

Background: Thrombotic thrombocytopenic purpura (TTP) is a rare cause of severe thrombocytopenia in pregnancy.

Methods: Six pregnancies in five patients with TTP were followed prospectively over 5 years. Ultralarge von Willebrand factor (ULvWF) multimers and cleaving protease (cp) levels were measured.

Presence of two different genetic traits in malignant hyperthermia families: implication for genetic analysis, diagnosis, and incidence of malignant hyperthermia susceptibility.

Background: Malignant hyperthermia susceptibility (MHS), an uncommon syndrome often inherited as an autosomal dominant trait, is characterized by a genetic and clinical heterogeneity. In this article, the authors described six pedigrees in which both parents of MHS patients were diagnosed with MHS by an diagnostic test. Haplotype and mutation analysis revealed that more than one MHS genetic trait was present in these families.

[Evaluation of verification of brain death and coordination with hospital organ procurement at the University Hospital at Lille].

Objectives: To determine the incidence of brain death (BD) and to evaluate the registration of potential organ donors (PD) by the organ procurement team (OPT).

Study Design: Two-year prospective audit in the French university hospital of Lille.

Patients And Methods: All deaths occurring in the intensive care units or the emergency department were studied.

[Contraction-relaxation coupling of skeletal muscle in patients susceptible to malignant hyperthermia].

Objective: To assess whether halothane exposure could influence contraction-relaxation coupling of human skeletal muscle with malignant hyperthermia susceptibility. STUDY DESIGNED: Laboratory investigation.

Material And Methods: Muscle biopsies from 14 patients, including six classified as susceptible to MH (MHS) and eight as classified as non-susceptible (MHN) according to criteria of the European MH group.

[Pneumocephalus after spinal anesthesia].

We report the case of a 76-year-old man who received a spinal anaesthesia for inguinal hernia repair surgery. A cranial CT scan which was performed because the patient complained of postoperative headache and hemiparesis showed an important pneumocephalus. Because postoperative questioning revealed that the patient had a chronic and neglected rhinorrhea, we hypothesise that this pneumocephalus was secondary to an old unknown osteodural leak with intracranial air entry secondary to the spinal anaesthesia-releated decrease in CSF pressure.

[Anesthetic particularities of stereotaxic neurosurgery].

Functional neurosurgery procedures are long and specific. Cooperation of the patient may be necessary during surgery. The interference of anaesthetic agents with electrophysiological monitoring should be as little as possible.

[Follow-up study of head-injured children].

The authors reviewed in a retrospective study 61 cases of severely head injury children who where admitted in the rehabilitation centre to evaluate the outcome 1 and 5 years after the brain injury. Neurologic and neuropsychologic status of children was assessed ad admission, 1 and 5 years later. Duration on intubation and age at time of head trauma were the worst functional prognosis.

[Postoperative analgesia in pediatric neurosurgery].

Pain management in paediatric neurosurgery must be a daily concern for surgeons and anaesthetists. Pain assessment in infants and small children is difficult to perform because of limitations associated with these patients. The association of safe and effective analgesics allows good pain relief together with good safety conditions.

[Malignant hyperthermia: new developments in diagnosis and clinical management].

Objective: To analyse the current knowledge concerning anaesthetic malignant hyperthermia.

Data Sources: References were obtained from computerized bibliographic research (Medline), recent review articles, the library of the service and personal files.

Data Synthesis: Knowledge to possess, about the diagnosis and treatment of the acute hyperthermia crises and about "safe-anaesthesia" for malignant hyperthermia susceptible patients, are explained.

Congenital myopathy with central cores and fingerprint bodies in association with malignant hyperthermia susceptibility.

A 26-year-old man had proximal weakness in the shoulder and the pelvic girdle since infancy. His sister, aged 16 years, presented a similar phenotype with more pronounced pelvic weakness. His muscle biopsy showed dense non-reducing inclusions which had a lamellar pattern at the ultrastructural level.

[Recombinant hirudin in neurosurgery].

We report the case of a 70-year-old woman with paraplegia resulting from spinal cord compression secondary to an epidural haematoma. Because of an arrhythmia, a mitral valve replacement and the high risk of venous thrombosis, an anticoagulant treatment was introduced postoperatively. The patient having previously developed an type II heparin-induced thrombocytopaenia, a treatment by lepirudine was established successfully.

Use of inhaled nitric oxide for emergency Cesarean section in a woman with unexpected primary pulmonary hypertension.

Purpose: Use of inhaled nitric oxide (iNO) could be of importance in emergency cases of primary pulmonary hypertension (PPH) in pregnant patients during labour and delivery. iNO acts as a selective pulmonary bed vasodilator avoiding systemic hemodynamic effects due to its ease of administration. Pulmonary bed vasodilation improves right ventricular function directly and left ventricular function indirectly.