[Exertional heat stroke: about 4 cases]

Exertional heat stroke is defined as hyperthermia associated with neurological signs related to intense physical activity performed in a hot environment. This is a medical emergency and life-threatening. In this study, we investigated four cases of exertional heat stroke hospitalized at the military hospital in Tunis [Tunisia] to describe the clinical, therapeutic and preventive characteristics and factors favoring this disease. Four young soldiers, 23 to 44 years older, have developed Exertional heat stroke after Intense and prolonged exercise. Exercises were performed in May and June, in high ambient temperature, high humidity and lack of wind. Three soldiers were in battle dress, a backpack and their weapon. Our four subjects had overweight, were not sufficiently trained and were highly motivated. Insufficient hydration and a diet rich in carbohydrates were noted. Upon hospitalization, patients were febrile and had neurological disorders, neuromuscular disorders, rhabdomyolysis and hemoconcentration. The medical care consisted of a rehydration and oxygen

[Iatrogenic gas embolism after use of hydrogen peroxide in the treatment of lung hydatid cyst: a report of 2 cases]

Echinococcus disease in endemic in our country. Surgical resection of the hydatid cyst with the use of a protoscolicidal solution in the operative field remains the standard treatment. The degradation of hydrogen peroxide results in considerable amounts of gaseous oxygen witch has proven protoscolicidal properties. This gas can enter the circulation and determine sever embolism. We report two cases of severe oxygen embolism with neurological signs during surgical treatment of thoracic hydatid cysts. We report 2 cases of embolic events with neurological signs. The first, during a pleural cleaning with hydrogen peroxide after cystectomy of a pulmonary hydatic cyst at the right upper lobe. The second case, after a pleural washing during the treatment of hepatitic hydatidosis complicated by a ruptured cyst in the thorax. The most important diagnostic criterion is the patient's history, because the clinical suspicion of embolism is based on the initial neurologic or cardio-respiratory symptoms and the direct relation between these symptoms and the use of hydrogen peroxide and imposes appropriate treatment before further examination including brain imaging. The treatment with hyperbaric oxygen in the first line treatment, thus, transfer to a hyperbaric oxygen facility should be accomplished without delay. The possibility of such serious complication leads us to use hydrogen peroxide with great care or to use other protoscolicidal solutions

Effect of intra and postoperative magnesium sulphate infusion on postoperative pain

Evaluate the effect of intra and postoperative magnesium sulphate infusion on postoperative pain in abdominal surgery. Prospective double-blind randomized controlled study. Forty eight patients were randomly allocated to receive in the induction of anaesthesia, intraoperatively and six hours postoperatively either magnesium sulphate M Group [bolus 50mg/kg and 0.5g/h] or placebo [P Group]. Patients were given a dose of morphine [0.l mg/kg] IV, 45min before the end of surgery. Sedation, pain scores, cumulative morphine consumption and adverse effects were recorded up to 24 hours postoperatively. The duration of anaesthesia was similar in both groups. The time of the first demand of morphine was significantly longer in M Group then in P Group, respectively [18 +/- 5min vs 7 +/- lmin, p = 0.03]. Morphine consumption was significantly higher in control group than M group on the first postoperative day [52 +/- 4mg vs 30 +/- 3mg, p = 0.0002]. Pain scores were significantly lower in M group than in P group. Serum magnesium concentration was significantly higher in the M group. The frequency of side effects was similar in the two groups. The results of the study support magnesium sulphate as useful adjuvant for postoperative analgesia in abdominal surgery

Spinal anesthesia for endoscopic urological surgery- low dose vs. varying doses of hyperbaric bupivacaine

The aim of this study is to compare the efficiency of low dose vs. varying doses of hyperbaric bupivacaine in spinal anesthesia for endoscopic urological procedures. Sixty consecutive patients were studied in a randomized prospective manner. They received either of 5 [Gr I], 7.5 [Gr II] or 10 mg [Gr III] of hyperbaric bupivacaine 0.5% combined with 25 micro g of fentanyl, through a 25-gauge W hitacre spinal needle placed in the L3-L4 interspace. Characteristics of sensory and motor block, dose of ephedrine required, secondary effects, the patients, and the surgeons, satisfaction, were noted. The maximum number of blocked segments was 14 +/- 1 [Gr I], 15 +/- 2 [Gr II] and 16 +/- 2 [Gr III]. Time to T12 regression was significantly shorter for Gr I [53 +/- 13 min] than for Gr II [69 +/- 20 min] or Gr III [94 +/- 14 min]. Bromage 3 block was not found in Gr I compared to 4 patients in Gr II and 15 patients in Gr III. The duration of motor block was shorter in Gr 1[51 +/- 18 min] than in Gr II [86 +/- 19 min] and in Gr III [138 +/- 21 min]. Ephedrine was used for 16 patients in Gr III [9.8 +/- 12.2 mg], 5 patients in Gr II [3.7 +/- 7.8 mg] and 2 patients in Gr I [0.5 +/- 1.5 mg]. The difference is statistically significant between Gr III and the other groups. These results suggest that the use of a low dose of bupivacaine [5 mg] added to fentanyl [25 micro g] for endoscopic urological surgery, resulted in short-acting sensory block, without motor block and a lower incidence of cardiovascular side effects, as compared to either of 7.5 or 10 mg bupivacaine with 25 micro g fentanyl

Analgesie peridurale pour accouchement par voie basse

Epidural analgesia is the gold standard of the methods of analgesia used in childbirth. Like any other medical technique, this method involves a certain number of questions. We have carried out a sample survey of 100 tunisian women. We have included 132 parturient women in a protocol of epidural analgesia associating the bupivacaine 0.25% and the fantanyl. It has been shown that 67% of the sample accpet the epidural analgesia if they are well informed. Analgesia proved to be successful in 84% of the sample. The epidural analgesia does not increase the risk of caesarian section which as reached 9% in both groups. On the other hand, the comparative analysis shows that the rate of instrumental extraction is likely to increase in childbirth with the epidural analgesia. This rise is significantly correlated with the degree of the motor block. The incidents have resulted either from low-blood pressure [17% of the cases] or from lumbago [18%]