[Survey on anaesthetic practices for electroconvulsivotherapy in French university hospitals]. / Anesthésie pour électroconvulsivothérapie: résultats d'une enquête dans les CHU.

OBJECTIVES: To evaluate the anaesthetic management of electroconvulsive therapy (ECT) in French university hospitals. STUDY DESIGN: National survey in university hospitals by mail. MATERIALS AND METHODS: An email was sent to heads of department of anaesthesiology in French university hospitals to identify a referent practitioner, which we then sent a computerized quiz. The questions were about the volume and organization of the activity, pre-, per- and post-anaesthetic management of patients undergoing ECT. RESULTS: Of the 33 sites performing ECT, 28 (85%) responded. The anaesthesia consultation was systematic at least 48 hours before the start of treatment but the preanaesthetic visit was performed in 32% of the centers. A routine electrocardiogram was performed in 89% of patients. In four centers (25%), neuromuscular blockade was not systematic. Propofol was the agent most widely used (82%) and etomidate and thiopental in 11% and 7% respectively. In two centers, practitioners did not report using oral protection. The psychiatrist was present in 71% of cases. The electroencephalogram was continuously recorded in 45% of the centers. CONCLUSION: The recommendations remain valid while old and may be updated. They are not always followed by the teams. Continuing medical education should be promoted to a better understanding of the factors interfering between anesthesia and ECT.

Selective digestive decontamination by erythromycin-base in a polyvalent intensive care unit.

OBJECTIVE: To study the effect of selective digestive tract decontamination by erythromycin-base on the incidence of carriage and infection with MR Enterobacteriaceae producing an extended spectrum beta-lactamase (ESB). DESIGN: After a 10-week prospective survey to ascertain the baseline incidence in two bays (1 and 3) of the same ICU, bay 1 was compared with bay 3 during a further survey of 6 months. The patients in bay 1 received erythromycin-base. SETTING: Two non-contiguous bays, 1 and 3, of 4 beds, in the same polyvalent ICU of a university hospital. PATIENT: Consecutive patients with unit stay longer than 2 days; 34 patients were included during the control period, 43 in bay 1 (decontamination) and 46 in bay 3 (control) during the trial period. INTERVENTION: Erythromycin-base, 1 g t.i.d. in powder form administered by gastric tube to patients in bay 1 from admission to discharge. MEASUREMENTS AND RESULTS: Digestive tract carriage was monitored by cultures of gastric and rectal swab specimens, sampled twice a week. Enterobacteriaceae were isolated on Drigalski agar with incorporated ceftazidime (4 mg/l). In bay 1 there was a decrease in ESB producing Enterobacteriaceae (23% vs 10%, p = 0.0004) from rectal swab, especially in K. pneumoniae (15% vs 2%, p = 10(-5)), during the decontamination period in comparison to the control period. During the trial period the only differences observed between bays 1 and 3 were in the gastric samples: K. pneumoniae were less often isolated in bay 1 than in bay 3 (0% vs 3%, p = 0.03). Intestinal carriage with multiresistant Enterobacteriaceae occurred in 28% patients in bay 1 and 30% patients in bay 3 during the trial period (p = 0.79). Erythromycin-base did not delay the carriage by patients in bay 1 (log rank test p = 0.42). CONCLUSION: Erythromycin-base was not effective in preventing digestive tract carriage due to Enterobacteriaceae resistant to third generation cephalosporin by production of chromosomal cephalosporinase. The decrease in isolates containing K. pneumoniae in bay 1 cannot be definitively attributed to erythromycin-base, since the number of this species in bay 3 was low.

[Poisoning caused by Eau Ecarlate: apropos of a fatal case in a child]. / Intoxication par l'Eau Ecarlate: à propos d'un cas mortel chez l'enfant.

A 19 months child was accidentally poisoned by ingestion of "eau écarlate", a gasoline-based cleaner. He died half an hour later with an acute pulmonary necrosis, caused by inhalation of gasoline. The authors describe the toxicity of petroleum poisoning and attempt to edict standards for medical transportation of children with petroleum accidental absorption.

[Comparison of fentanyl and alfentanil in ambulatory anesthesia]. / Comparaison fentanyl-alfentanil lors d'anesthésies ambulatoires.

PIP: The development of ambulatory surgery has favored use of rapidly eliminated anesthetic agents or at least those whose clinical effects are easily predictable. Central analgesics such as fentanyl have not been very satisfactory; fentanyl is believed to have a short duration of action, but it has also been found to have a long half-life. A comparative study was conducted to determine whether the newer alfentanil would be more suitable for use in ambulatory surgery. 30 patients undergoing induced abortions arrived fasting at the hospital on the morning of the operation and were premedicated intravenously with .18 mg/kg midazolan and 2.2 mcg/kg of fentanyl or 24.2 mcg/kg of alfentanil. The efficacy of the premedication was assessed 5 minutes later just prior to anesthesia induction, which was achieved with 40 mcg/kg of alphadione. The delay to sleep was assessed by the disappearance of reflexes and of pain reaction. The delay to awakening was assessed by spontaneous opening of the eyes, response to a simple command, and unaided sitting up. Psychometric tests were administered 2 and 4 hours after anesthesia and compared to preoperative performance of the same tests. The 15 fentanyl and 15 alfentanil patients did not differ significantly in height, weight, or age. Premedication was considered good in the 15 fentanyl patients but excessive in 7 of the 15 alfentanil patients because of depressed respiration. There were no significant differences in pulse rate in the 2 groups. Systolic blood pressure diminished significantly in the 2 groups after induction but values returned to normal after 3 minutes. The respiratory response was significantly more marked and more prolonged in the alfentanil group, with respiratory frequency declining from 18 to 9 breaths/minute with 3 apnea episodes for 15 patients. Respiratory frequency declined from 19 to 15 breaths/minute in the fentanyl group. The average delay to sleep was shorter in the alfentanil group but the difference was not statistically significant. The duration of the operations was comparable in the 2 groups. Reinjection of analgesic was necessary for a few patients in each group. The difference was not statistically significant although the anesthesia appeared more stable in the alfentanil group. Awakening time appeared more rapid in the alfentanil group but the difference was not statistically significant. There was no significant difference in the test results for the 2 groups 2 and 4 hours after anesthesia. The results of this study do not appear to provide a decisive argument in favor or alfentanil for short term anesthesia.^ieng

[A simplified severity index in resuscitation. Validation by a prospective study (280 cases)]. / Un indice de gravité simplifié en réanimation. Validation par une étude prospective (280 cas).

The index studied (simplified acute physiology score, or SAPS) is calculated from 14 measurable clinical and laboratory data obtained during the first 24 hours from admission. It was tested in a prospective study involving 280 consecutive patients treated in a 16-bed intensive care unit. Good correlations were found between SAPS and mortality rate and between SAPS and the two most widely used scoring systems: the Knaus index or APS (acute physiology score) and the Cullen index or TISS (therapeutic intervention scoring system), both evaluating therapeutic effectiveness. SAPS data being easy to collect, the simplified index could be used in many intensive care units or even applied to old case-records. Its main value lies in comparisons between two groups of patients with the same death probability and in evaluations of activities in intensive care units.