Evaluation of a new supraglottic airway device in ambulatory surgery: the I-gel.

BACKGROUND: The I-gel® is a new single-use supraglottic airway device with a non-inflatable cuff. It is composed of a thermoplastic elastomer and a soft gel-like cuff that adapts to the hypopharyngeal anatomy. Its tube is profiled to facilitate and stabilize its insertion. aim : The aim of our study is to state the efficiency and the place of I-gel® in airway management in adult anaesthetic practice. methods: One hundred patients, ASA I-II, scheduled for shortduration elective surgery under general anaesthesia were included in this prospective study. Patients with neck pathology, previous or anticipated airway problems, increased risk of regurgitation or aspiration, ASA III and above and undergoing emergency surgery were not included in the study. We collected the following data: adequacy of the size recommended to the patient, ease in inserting the I-gel®, leak fraction, gastric leak, complications during insertion and removal, ease in inserting the gastric tube, haemodynamic and ventilatory parameters, stability during patient movement and satisfaction of the anaesthetists. results: The success rate of insertion and the use of the I-gel was respectively 99% and 96%. The device was inserted at the first attempt in 92% of cases. The introduction of the I-gel® was rated easy in 99% of cases taking a median of 13 seconds. Complications of insertion were restricted to coughing in 5 patients and hiccups in 7 patients. There were no significant increase in heart rate and mean arterial blood pressure compared to pre-insertion values. An audible leak was recorded in 14.6% of cases. The need for additional manoeuvres was less than or equal to 2 in 96.9 % of patients. The mean of the recorded peak airway pressure values was 18 cmH2O. After a fibreoptic exam via the airway tube, the glottis was completely seen in 74% of cases and partially seen in 14.6%. Two cases of gastric inflation were recorded. There was no case of regurgitation or hypoxemic episode during this trial. Post-operatively sore-throat was reported by one patient in recovery. After I-gel withdrawal, trace of blood was observed in 5 devices. One case of dental trauma was noted. 95% of the anaesthetists were satisfied with the use of the I-gel in their pratice. CONCLUSION: This study showed that I-gel® can be used safely and effectively in patients undergoing short-duration elective surgery because the I-gel® has a very good insertion success rate and few complications. The fibreoptic position of the device was correct and the ventilation was highly effective. These elements must be corroborated in larger series.

[Target-controlled intravenous anesthesia during laparoscopic surgery for obesity]. / Anesthesie intraveineuse a Objectif de Concentration durant la Chirurgie Laparoscopique de L'obesite.

BACKGROUND: The TCI is a mode of administration that provides greater security by allowing more accurate titration of the anesthetic agent. It leads to a better adaptation to the desired effects, and provide a great interest for the realization of anesthetic induction and the prediction of waking for a well- determined population. OBJECTIVE: The aim of our prospective study was to evaluate the feasibility of TCI in patients with morbid obesity undergoing laparoscopic surgery for obesity. METHODS: Thirty patients were included in this study. Age and BMI means were 32 years and 49.31 kg / m2. Our protocol was proposed to associate an hypnotic agent (propofol) to an opioid one (remifentanil) using the technique of the TCI, with respectively Schnider and Minto models. RESULTS: The induction protocol has brought good conditions for laryngoscopy with no hypertensive peak or desaturation episode. The period of unconsciousness was 89 seconds with an average target concentration of propofol of 5.1 mg / ml. We also noted hemodynamic stability in 79% of patients at induction. During both preparation phase and final installation of the patients, a low ERC to 2 hg / ml was consistent with a suitable hemodynami profile. We obtained hemodynamic stability by adapting target concentration of remifentanil at different operating times (Surgical incision: 3.64 hg / ml, insufflation of the peritoneum: 5.37 hg / ml, jejuno-jejunal resection anastomosis: 9 hg / ml, gastric resection and gastrojejunal anastomosis: 14.2 hg / ml). During this period, no episodes of bradycardia or hypotension were noticed. During the recovery phase and while doing the distribution of CEP and CER according to the BMI of patients, we identified two groups: Group 1 (BMI <49 kg / m2): fast time extubation (11 min) and target concentrations of propofol and remifentanil respectively at 1.3 mg / ml and 1.25 hg / ml which is similar to most publications on this subject and Group 2 (BMI> 49 kg / m2): time-delayed extubation (23 min) with very low values of CEP and CER inconsistent with the literature data.

[Rhino-orbito-cerebral mucormycosis in the diabetic: a better known pathology in Tunisia]. / La mucormycose rhino-orbito-cérébrale chez le diabétique: une pathologie mieux connue en Tunisie.

This is a retrospective study including 17 patients with rhino-orbito-cerebral mucormycosis diagnosed in a period of 16 years, between 1992 and 2007, in 8 men and 9 women. All patients were diabetic with ketoacidosis diabetes in 8 cases. Necrosis facial and ophthalmic symptoms were the most frequent presenting manifestations. The diagnosis was confirmed by mycological examination, with or without histopathology, identifying Rhizopus oryzae in 12 cases. Treatment consisted in systemic amphotericin B combined with surgical treatment in only 7 cases. The mortality rate was high (65%) due principally to the delay in diagnosis and absence of surgical treatment.