-Secondary cerebral stress of systemic origin in children with severe craniocerebral injuries-. / Agressions cérébrales secondaires d'origine systémique chez les enfants traumatisés craniocérébraux graves.

OBJECTIVE: To assess incidence of secondary brain insults of systemic origin (SBISOs) such as arterial hypotension, hypoxaemia, hypercarbia, and anaemia in severely head injured children; to assess their impact on mortality and morbidity in the short- and long-term. STUDY DESIGN: Prospective, open study covering a 24-month period. PATIENTS: Seventy-one children, under 15 years of age, admitted to a trauma centre for severe brain injury. METHOD: Analysis of SBISOs and outcome. RESULTS: Twenty-five children were admitted with SBISOs. The mortality rate was 37%. After hospitalization, 84% of the children with SBISOs vs 46% without SBISOs had severe disability (Glasgow outcome score = 1, 2 and 3). After 1 year, 20 out of the 45 children still alive were contacted. One of the four with SBISOs communicated a bad recovery. Fifteen children without SBISOs presented good recovery: GOS = 4-5, paediatric overall performance category (POPC scale) = 1-2. CONCLUSION: Hypotension was associated with significant increase in mortality (x 3.6) in children with severe head injury. The consequences were worse when anaemia was associated.

[Brachial plexus anesthesia via an axillary route for emergency surgery: comparison of three approach methods]. / Anesthésie du plexus brachial par voie axillaire pour chirurgie urgente: comparaison de trois méthodes d'approche.

OBJECTIVES: To compare three techniques of brachial plexus blockade for emergency surgery of the upper limb. STUDY DESIGN: Prospective, randomised study. PATIENTS: One hundred eleven patients admitted to an emergency surgical service, randomly assigned to three groups. METHODS: The patients were given 2% lidocaine with epinephrine 20 mL and 0.5% bupivacaine 20 mL. The three groups were as follows: brachial plexus block using a peripheral nerve stimulator (group St, n = 38); transarterial brachial plexus blockade with injection of 2/3 of the anaesthetic in back of and 1/3 in front of the artery (group TAP, n = 36); transarterial brachial plexus blockade with one single injection in back of the artery (group TP, n = 37). The success rate, time required to perform the technique, latency of analgesia, quality of motor blockade, and adverse effects were compared between the three groups. Analysis of variance was used to compare quantitative data and chi 2 test were used for qualitative data. RESULTS: Rates of success varied between 65 and 75%. Success rates, latency of analgesia and quality of motor blockade were not significantly different between groups. Time to perform the technique was longer when using a nerve stimulator. CONCLUSION: As these three techniques for brachial plexus block in emergency surgery are comparable, no one can be recommended instead of the others.

[Benzodiazepine withdrawal presenting as pseudo-surgical abdominal pain]. / Sevrage en benzodiazépines révélé par un syndrome douloureux abdominal pseudochirurgical.

A 39-year-old patient was admitted to the emergency department for acute abdominal pain. Physical examination showed a peritoneal syndrome. However, CT-scan, Doppler and blood analysis were unremarkable. As the patient had a history of auto-medication with benzodiazepines at high doses, a withdrawal syndrome was considered. An intravenous administration of 3 mg of midazolam determined the relief of all symptoms in a few minutes.

[Anesthesia for arthroscopy of the knee: propofol versus thiopental and halothane]. / Anesthésie pour arthroscopie du genou: propofol versus thiopental et halothane.

Sixty ASA I or II patients, who underwent general anaesthesia for arthroscopy of the knee, were separated into two groups. Induction was performed either with thiopentone 7 mg . kg-1 (group I) or with propofol 2.5 mg . kg-1 (group II). All patients were intubated and ventilated. Dextromoramide was used as analgesic. Maintenance of anaesthesia was obtained with halothane inhalation (group I) or by continuous automatic injection of propofol at a dose of 9 mg . kg-1 . h-1 (group II). Induction and maintenance were satisfactory in both groups. Pulse rate was stable at induction and intubation for the propofol group, whereas it increased at both stages of anaesthesia with thiopentone; it fell moderately in both groups afterwards. Systolic and diastolic blood pressures dropped more in the propofol group after induction, with a maximum decrease of 20%. Recovery was significantly more rapid and comfortable with propofol than with thiopentone.

[Hyperbaric spinal anesthesia with 0.5 percent bupivacaine in traumatological and orthopedic surgery]. / Rachianesthésie hyperbare à la bupivacaïne à 0,5% en chirurgie traumatologique et orthopédique.

Bupivacaine for spinal anesthesia produces operating conditions for over two hours. The onset of sensory block is rapid. Motor blockade is incomplete in 13% at the cases. The quality of anesthesia was judged very satisfactory. Adapting dosage to size (0.1 mg X cm-1) decreases the risk of excessive spread of the block. Simultaneous administration of dihydroergotamine and flunitrazepam enhances cardio-vascular stability and acceptance by patients.