[Halogenated inhalation anesthesia with a semiclosed circle system]. / Anesthésie halogénée utilisant un respirateur muni d'un circuit-filtre.

Thirty-six patients were anaesthetized for a maxillofacial surgical procedure. Ventilation was controlled by a ventilator (Kontron ABT 4100) with a semi-closed circle system. The flow of fresh gases was 1,200 ml.min-1. The vaporizer for the halogenated anaesthetic agent was placed out of the circle before the ventilator. Halothane was used for maintenance of anaesthesia and isoflurane for induced hypotension in orthognathic surgery. The inspired concentration of the halogenated agent was monitored by an analyser. A linear correlation between the delivered and the inhaled concentration of halogenated agent was established, the latter never reaching the delivered concentration. Monitoring the inspired oxygen concentration was required, so as to maintain a constant value. Carbon dioxide absorption by soda lime was also studied. The known advantages were: substantial economies in nitrous oxide and halogenated agents, prevention of contamination of the operating theatre, humidification and warning of the inspired gases. The use of such a system with the vaporizer out of the circle was safe, all the more so as the concentration of inhaled halogenated agents could be predicted.

[An original intubation technic in a child with Pierre Robin syndrome]. / Technique originale d'intubation chez un enfant porteur d'un syndrome de Pierre Robin.

Infants with Pierre Robin syndrome often present the anaesthesiologist with the challenge of upper airway obstruction and difficult tracheal intubation. An unconventional method for solving this problem was used in a 2 week old 2.2 kg term male infant who presented with severe micrognathia, a widely cleft palate and extreme glossoptosis. Hyperextension of the head in the prone position distracted the epiglottis from the glottis. Blind nasotracheal intubation was then used. The curve of the nasotracheal tube made it pass behind the epiglottis into the larynx.

[Anesthetic aspects of the primary treatment of labio-maxillo-palatal clefts]. / Aspects anesthésiques du traitement primaire des fentes labio-maxillo-palatines.

This study of 97 operations discusses our anaesthetic experience for labio-maxillary clefts and the problems which arise for the anaesthetist during pre-inter and post surgical periods. This type of functional surgery is carried out on children between 4 and 23 months old, of which 22% presented with associated malformations. Paediatric anaesthetic characteristics in a maxillo-facial context are discussed in detail. We indicate the importance of installing the different surveillance elements before placement of the surgical fields. We treat the problems of drug interactions between the halogenic anaesthetics and vasoconstrictor used for local haemostasis, the limits of spontaneous ventilation and the secondary metabolic consequences of prolonged fasting.