[Conduction anesthesia on an outpatient basis]. / Anesthésie loco-régionale en milieu extrahospitalier.

Regional anaesthesia in the setting of pre-hospital trauma care implies adverse conditions. Therefore some practical advices may be useful; avoid spinal or epidural anaesthesia, prefer safer lidocaine. Aspiration test, test dose and slow injection are mandatory; so is a large experience in regional anaesthesia. Main usable blocks are: brachial plexus block (axillary or interscalenic approach), radial, medial and ulnar nerve blocks, intercostal and interpleural nerve blocks, sciatic and femoral nerve blocks, superior laryngeal nerve block. Using a nerve stimulator is strongly advised in most cases.

[A traditional anesthesia consultation or a "telephone interview" within the framework of ambulatory surgery?]. / Consultation d'anesthésie traditionnelle ou "interview téléphonique" dans le cadre de la chirurgie ambulatoire?

UNLABELLED: Preoperative assessment for anaesthesia must detect in the setting of ambulatory surgery both medical and sociopsychologic problems which may contraindicate the ambulatory aspect of the procedure. The goal of our prospective study was to assess the efficacy of a preoperative telephone interview in screening the medical and sociopsychologic problems of ambulatory patients. 1,000 consenting consecutive outpatients participated to the study and were randomly allocated to one of two groups: patients in the standard group (STD) had a consultation a few days before surgery whereas those in the telephonic group (TEL) called the anesthetist a few days before, the physical exam being performed on the day of surgery. The cancellation of the ambulatory procedure was decided upon either medical criterias (MC) or sociopsychologic criterias (from Waetchler). RESULTS: both groups were comparable regarding SPC and MC but prescription of preoperative tests was more frequent in the STD group (result statistically significant). In conclusion, this new approach is as reliable as the standard consultation in screening the SPC which remain the most frequent cause of cancellation in ambulatory surgery. Therefore this telephonic interview which is simple and reliable for screening outpatients may represent a suitable alternative to a standard consultation.

[Feasibility of calcium inhibitors in the treatment of brain disease following cardiac arrest]. / Possibilités des inhibiteurs calciques dans le traitement de l'encéphalopathie post-arrêt circulatoire.

One of the crucial factors affecting mortality and morbidity after circulatory arrest the ischemic neuronal damage following complete cessation of cerebral blood-flow. To date, no accepted pharmacologic neuroprotective therapy has emerged. Cerebral ischemia causes a rapid shift of Ca++ from the extracellular spaces into cells and it is assumed that this excessive entry of Ca++ is the final pathway of cell death. In addition, Ca++ is involved in the diffuse vasospasm which occurs after global cerebral ischemia. Therefore, calcium entry blockers such as dihydropyridines derivatives have sparked considerable interest especially because of their preferential cerebrovasodilating effects. In vivo studies have demonstrated protection from brain ischemia with calcium entry blockers. However no direct protective effect of these drugs has been shown on neurons. More recent results have underscored the importance of excitatory amino acid neurotransmitters and receptors (particularly N-Methyl-D-Aspartate receptors) in causing intracellular calcium overload and neuronal death after ischemia. Blockade of these receptors or their associated channels may be an interesting way to protect the brain against ischemic damage.

[Multiple laryngotracheal block for the biopsy of the base of the tongue and of the piriform sinuses during laryngoscopy]. / Multibloc laryngotrachéal pour biopsie de la base de langue et des sinus piriformes lors d'une laryngoscopie.

Most laryngoscopies with diagnostic biopsies are usually carried out under general anaesthesia. Multiple laryngotracheal blocks were used in the patient reported; this 55 year old man presented with cachexia and a history of severe angina, myocardial infarction, arterial hypertension and chronic bronchitis. The different nerve blocks were carried out with a total of 2 mg.kg-1 lignocaine: the superior laryngeal nerve trunk, the internal laryngeal nerve, the trachea (by an intratracheal injection) and the tongue (using a lignocaine gel). The whole procedure was well tolerated by the patient. The advantages and disadvantages of this technique are discussed.