[Use of a single-use fiberscope for the training in tracheal intubation under fiberscopy on labyrinth]. / Utilisation d'un fibroscope à usage unique pour la formation sur labyrinthe à l'intubation sous fibroscope.

GOAL OF THE STUDY: To evaluate a single-use fiberscope, the Ascope-Trainer, for the training in the intubation under fiberscope. TYPE OF STUDY: Prospective randomized study approved by the local ethic committee. METHODOLOGY: After evaluation of their level of expertise, "experienced" or "novices" in intubation under fiberscope, the doctors attending the Training for Referents in Difficult Airway Management performed a test on labyrinth with a standard fiberscope (T1). After they were assigned to two groups, training with the Ascope-Trainer (group A, n=35) or with a classic fiberscope (group C, n=29), they trained during 15 minutes and performed a new test (T2). An analysis of variance was used to compare means. A goal for the training was determined according to the "experienced" doctors' mean T1. A test of Khi(2) was used for the comparison of the number of participants having reached this goal as well as the progress in both groups A and C. RESULTS: The T1 in the "experienced" group was 76 ± 31 s and the training improved significantly T2 (53 ± 17 s). Considering the novices, T2 was significantly lower than T1 in the group A (77 ± 38 s versus 135 ± 68 s) as well as in C (64 ± 28 s versus 122 ± 60 s), and the proportion of the novices having reached the goal of training was comparable in both groups. CONCLUSIONS: Because its use is similar to the standard fiberscope, the Ascope-Trainer may be interesting for this type of training.

Pregnancy is associated with a decrease in pharyngeal but not tracheal or laryngeal cross-sectional area: a pilot study using the acoustic reflection method.

BACKGROUND: The risk of difficult upper airway access is increased during pregnancy, especially in labor. Changes in upper airway calibre have been poorly studied during pregnancy. The acoustic reflection method is a non-invasive technique that allows a longitudinal assessment of the cross-sectional area of the upper airway from the mouth to carina. We used this technique to evaluate upper airway calibre during normal pregnancy. METHODS: We conducted a prospective, single centre, observational study with a clinical and upper airway acoustic reflection method evaluation of healthy women during the first, second and third trimesters of pregnancy, and up to two days and one month after delivery. RESULTS: Fifty women participated to the study. The mean pharyngeal cross-sectional area decreased between the first and third trimesters (P < 0.001) with no significant change of the minimal and mean tracheal cross-sectional areas. The Mallampati score increased during pregnancy between the first and third trimesters (P< 0.001). CONCLUSION: Using measurements with the acoustic reflection method, normal pregnancy is associated with a significant reduction in the cross-sectional area of the pharynx and a concomitant increase in the Mallampati score. No change was observed in the minimal and mean tracheal cross-sectional areas.

[Gestational diabetes insipidus during a twin pregnancy]. / Diabète insipide gestationnel au cours d'une grossesse gémellaire.

Gestational diabetes insipidus is an uncommon clinical disease whose prevalence is approximately two to three pregnancies per 100,000. It may be isolated or associated with preeclampsia. We report a case of gestational diabetes insipidus in a twin pregnancy, originally isolated during two months, and secondarily complicated by HELLP-syndrome. We recall the specific pathophysiology of polyuric-polydipsic syndrome during pregnancy and summarize its various causes. Finally, we discuss the indications, in case of isolated gestational diabetes insipidus, of treatment by dDAVP.