[Retrospective study on six years of anaesthesia for reduction of shoulder dislocation in emergency]. / Etude rétrospective sur six années de l'anesthésie pour réduction de luxation d'épaule en urgence.

OBJECTIVE: The aim of this study was to assess the anaesthetic technique used for emergency shoulder luxation management in a university hospital. STUDY DESIGN: Retrospective observational study. PATIENTS AND METHODS: During a six-year period, all patients who were anaesthetized for shoulder luxation were included. Data were collected from administrative database and patient's files. RESULTS: Two hundred and twenty-four patients were included. Ninety-seven regional anaesthesias were performed (17 failures) and so, 144 general anaesthesias were performed. Among general anaesthesia, 89 patients were not fasten, only four rapid sequence inductions were performed. Sixteen (8%) complications occurred, all during general anaesthesia, among them one inhalation. In not fasten patients, anaesthesia was performed not in accordance with guidelines in 56% of cases of all anaesthetic technique and 96% for patient who had general anaesthesia. Accordance with guidelines was independent from the anaesthesiologist experience or the time of the anaesthesia (night/day). CONCLUSION: We must spread guidelines information to physicians because of the morbidity.

Hypotension during surgery for femoral neck fracture in elderly patients: effect of anaesthetic techniques. A retrospective study.

BACKGROUND: The aim of this retrospective study was to compare the incidence of hypotension between different anaesthetic techniques, including general anaesthesia (GA), spinal anaesthesia single injection (SA), continuous spinal anaesthesia with 2.5 mg bolus injections as needed (CSA 2.5) or 5 mg bolus injections as needed (CSA 5) in elderly patients (>75 yrs old) undergoing surgery for femoral neck fractures. METHODS: Demographic, surgical and hemodynamic data from 333 patients over a four year period within a single hospital were recorded and examined. RESULTS: Forty-two patients underwent GA, 109 underwent SA, 61 underwent CSA 5, and 121 underwent CSA 2.5. Patients receiving GA, SA or CSA 5 had a higher incidence of hypotension (83%, 68%, and 34%, respectively) than patients who underwent CSA 2.5 (4%; P<0.05). The CSA 2.5 group required less colloid infusion (490+/-50 mL) than the GA and SA groups (810+/-330 and 645+/-230 mL, respectively). The CSA 2.5 group also required less crystalloid infusion volume (760+/-371 mL) than the GA group (1140+/-770 mL). Ephedrine infusion was higher in the GA and SA groups (30+/-10 and 26+/-9 mg, respectively) than the CSA 2.5 (15+/-8 mg; P<0.05). CONCLUSION: This study demonstrated that CSA 2.5 causes fewer episodes of hypotension than other anaesthetic techniques for surgical repair of hip fracture in elderly patients.

[Interscalene brachial plexus block for glenohumeral luxation in prehospital medicine]. / Bloc interscalénique pour luxation glénohumérale en médecine préhospitalière.

We report the case of a successful interscalene block for the pain management of a glenohumeral luxation in prehospital care. Interscalene block is an attractive technique in prehospital pain management. However, this regional anaesthesia technique must be performed only by a skilled anaesthesiologist.

[Severe retrosacral hemorrhage without bone injury following defenestration]. / Hémorragie grave rétrosacrée sans lésion osseuse associée après défenestration.

We describe the case of original haemorrhagic shock after a 22-year-old woman suicidal jumping. The first radiological evaluation showed only a non-bleeding fracture of the first lumbar vertebra (CT-scan) and a calcaneum fracture. Pelvic ring was normal. The exploration of the abdominal system (sonographic evaluation) did not highlight any abnormality. There was no sign of haemodynamic shock and the biological results were normal. Nevertheless, three hours later, severe haemorrhagic shock appeared without organic explanation. After new research (thoracic and abdominal-pelvic CT-scan), the source of bleeding was found in the gluteal muscles without associated pelvic ring fracture. Several vascular haemorrhagic failures were found on little arteries related to the internal iliac left artery. Haemorrhagic loss was important. Radiological gluteal arteries embolisation could have been realized but finally not chosen. The haemorrhage stopped spontaneously after about 36 hours. The early diagnosis was difficult because of the vertebral fracture that constrained strict dorsal position. We could not see the important haematoma without moving the patient. We have not found any description of a severe haemorrhagic shock secondary to a single blunt gluteal muscle.

Heparin half-life and sensitivity in normal subjects and in patients affected by deep vein thrombosis.

In some patients affected with deep vein thrombosis (DVT) it is necessary to administer large doses of heparin to achieve proper anticoagulation. To investigate the clinical relevance of this phenomenon, we studied the heparin half-life and the heparin sensitivity after a bolus IV injection of 60 i.u. kg-1 in seven healthy volunteers and eight DVT patients investigated on day 1 or 2 and again between day 10 and 20 of the heparin therapy. The heparin half-life, the in vitro and ex vivo heparin sensitivity, were comparable in the healthy volunteers and in the patients at both times of investigation. However, there were large interindividual variations in the controls and in the patients, not correlated to the levels of any coagulation factors. Thus, the heparin hyperconsumption phenomenon occasionally observed in a given patient reflected individual characteristics and was no value in the diagnosis of DVT.