[Ambulatory anesthesia in pediatrics. 2-year experience of performance at a day hospital]. / Anesthésie ambulatoire en pédiatrie. Expérience de deux années de fonctionnement d'un hôpital de jour.

Ambulatory pediatric anaesthesia is done within a well-organized medical and surgical structure. The anaesthesia consultation confirms the surgical indications, taking into account certain medical pathologies. 27% of elective surgery is done in day-hospital. The anaesthetic techniques described have been done in children from three weeks to sixteen years of age. Intubation was not an exclusion criterion. The major causes for transfer to the general hospital (2.9%) are given. Anaesthetic complications represent 0.1% of such transfers. Scrupulous respect of the selection criteria, competence of anaesthesiologists and of pediatric surgeons are prerequisites for good results.

[Ambulatory surgery in pediatrics. The value of caudal anesthesia]. / Chirurgie ambulatoire pédiatrique. Intérêt de l'anesthésie caudale.

Ambulatory surgery appears to minimize lasting psychological upset in children. Patients must be properly selected. It is essential that the children and their parents should have a visit with an anaesthetist prior to the patient's admission. Laboratory investigations should be prescribed at that time after questioning and examining the patient. Caudal anaesthesia is a useful regional technique for postoperative pain relief in children. Sacral canal puncture is carried out after the induction of general anaesthesia. Only a light state of general anaesthesia is required. The local anaesthetic mixture is made of equal volumes of 1% lidocaine and 0.5% bupivacaine without adrenaline. Rapid awakening, early feeding and pain relief increase reliability and comfort.

[Use of fiber optics in difficult intubations in young children]. / Utilisation du fibroscope dans les intubations difficiles chez le jeune enfant.

Difficulties in performing laryngotracheal intubation may arise in patients with cervicofacial anomalies, particularly when young children are involved. Technical artifices usually employed in adults, mainly intubation under fibroscopic guidance, cannot be used in these cases. Intubation was performed in three children aged between 3 to 4 years by means of a guide-catheter previously introduced into the trachea by using the fibroscope working canal, a method that is particularly recommended, even in younger children. The type of anesthesia used must be adapted to these circumstances.

[Association of posterior laryngeal cleft and atresia of the oesophagus. Two cases treated successfully (author's transl)]. / Association fente laryngée postérieure - atrésie d l'oesophage. A propos de 2 cas traités avec succès.

Two rare cases of oesophageal atresia associated with a posterior laryngeal cleft were treated successfully: a so-called "O" interarytenoid cleft recognised secondarily to the type II atresia, not treated surgically; a so-called II cricoid cleft recognised before the treatment of type I atresia was closed in a first stage by an anterior transl-laryngeal approach. A bibliographical review is followed by a discussion of the diagnosis aspects and therapeutic possibilities of laryngeal cleft, the approach, the timing of surgery on the basis of its type and the type of oesophageal atresia.

[Obstruction of the abdominal aorta and cyanotic heart disease in a 1 year old child (author's transl)]. / Oblitération de l'aorte abdominal et cardiopathie cyanogène chez un enfant de 1 an.

In a 1 year old child, cyanotic congenital heart disease was complicated by a severe obstruction of the abdominal aorta between the renal arteries and the bifurcation. The surgical treatment consisted of relief of the obstruction in the aorta and a Blalock-Taussig shunt. The general progress was good but there was a ischemia of the left leg for which amputation of the forefoot was required.

[Respiratory and swallowing difficulties after oesophageal atresia (author's transl)]. / Troubles respiratoires et de déglutition après cure chirurgicale de l'atrésie de l'oesophage.

The main reason for these problems is a tracheo-oesophageal fistula, either recurrence of the T.O. fistula, either persistance of a fistula which has been neglected during surgery. It has been observed in 7 infants from 19 operated atresias with such problems. These functionnal troubles may be produced by different other anomalies: oesophageal stenosis and or dyskinesia often observed, gastro-oesophageal reflux, associated anomalies of the larynx or trachea; laryngeal paralysis, tracheomalacia, tracheal epithelium metaplasia, tracheal compression by abnormal vessel, neurological dysmaturity, loss of swallowing reflex after a long postoperative course. Radiography and endoscopy are fundamental and complementary investigations. Endoscopy, under general anesthesia, must be minute (with optics), explore oesophageal and laryngo-tracheo-bronchic tract, and use several tests to demonstrate permeability of the fistula when it has been located. A special technique is presented. Several points must be outlined: 1--classical symptoms of persistant fistula are not reliable in authors' experience; any recurrent respiratory and swallowing problem requires investigations; 2--endoscopy and radiographic study have to be repeated sometimes to prove fistula; 3--responsability of some anomalies must be always discussed, because of their possible association with a fistula; several fistulas may also exist.

[Gastroschisis. Analysis of 19 cases (author's transl)]. / Laparoschisis: Analyse d'une série de 19 cas.

Since 10 years, 19 cases of gastroschisis have been observed in the surgical paediatric unit of Rouen. 12 children are alive and 7 died. It is possible to classify the lesions of the alimentary tract in four groups of increasing gravity. For the first two groups, survival is probable when the treatment is correct. The third group, including bowel resections and risk of short bowel is more difficult to treat. The last group, with necrosis of the main part of the bowel is uncurable. Surgical treatment of choice is immediate closure with small enlargement of the initial parietat defect. It was possible without complication in 8 cases (9 trials). Delayed closure is now employed when immediate closure is impossible. Post-operative treatment is marked by risks of infectious problems and chronic subocclusion. In this last occurence, reintervention must not be too much delayed. Parenteral feeding, with occasionnal continuous enteral feeding must be sufficient.