Can we use the ankle non-invasive blood pressure during otolaryngologic surgery: an observational study.

INTRODUCTION: In otolaryngologic surgery, ankle is frequently used for monitoring anesthesia in place of brachial when the patient doesn´t need invasive arterial cannulation. If there is a clinically useful and Predictable link between the two readings in hemodynamic normal patient, this difference during otolaryngologic surgery, was not evaluated. We aimed to investigate the reliability and the acceptability of non invasive blood pressure measurements at the ankle compared to those obtained concurrently at the arm during otolaryngologic surgery. METHODS: Eighty ASA grade I and II patients who had to be operated under general anesthesia were taken as subjects for our study. Blood pressures were measured simultaneously in the 2 limbs before induction and then every 10 minutes until the end of the surgical procedure. Readings were initiated concurrently. Statistical analysis was performed with PASW Statistics 13. RESULTS: There were 41 males (51.2 %) and 39 females (48.8 %). Bland-Altman analysis of mean difference between the ankle and arm (95 % limits of agreement) was -11.47 (- 23.77 to 0.82) mmHg for systolic blood pressure (SBP), -7.89 (-19.16 to 3.36) mmHg for diastolic blood pressure (DBP) and - 9.09 (18.19 to 0.00) mmHg for mean arterial pressure (MAP). Non-parametric analysis showed that 67.5 % of SBP, 46.2 % of DBP and 56.2 % of MAP measurements differed by > 10mmHg. CONCLUSION: Ankle BP cannot be used routinely in otolaryngological surgery. Although, the ankle can be used as an alternative where the arm cannot be used taking into account a difference.

[Asystole during surgery to manage small intestine cancer: are we dealing with anaphylaxis or carcinoid crisis]. / Asystolie au cours d'une chirurgie pour tumeur de l'intestin grêle: anaphylaxie ou crise carcinoïde.

Cardiac arrest in the operating room is a life-threatening event with multiple causes. We report the case of a 53-year old female patient with no particular past medical history scheduled for surgery to manage small intestine cancer. Twenty minutes after anesthetic induction the patient had asystole rapidly reversible after resuscitation measures. The association of face rash with chest rash gave rise to suspicion of late anaphylactic reaction. Rapid patient recovery allowed to resume surgical procedure. Tumor manipulation immediately caused a second severe bradycardia rapidly reversible after the administration of 0.5 mg atropine. Skin rush at the level of the face and the chest occurred again. This second complication immediately gave rise to suspicion of carcinoid crisis. Sandostatine was then administered. No other complication occurred, the patient spent 24 hours in the Intensive Care Unit receiving sandostatine infusion. Urinary 5-HIAA values were very high and histological examination of the surgical specimen confirmed carcinoid tumor. This study aims to highlight the rarity of this entity and the importance of suspecting carcinoid crisis in patients with intraoperative complications during anesthesia for small intestine tumor surgery.

Tolerability and Plasma Drug Level Monitoring of Prolonged Subcutaneous Teicoplanin Treatment for Bone and Joint Infections.

Teicoplanin is a key drug for the treatment of multiresistant staphylococcal bone and joint infections (BJI), yet can only be administered via a parenteral route. The objective of this study was to evaluate the safety and tolerability of subcutaneous (s.c.) teicoplanin for that indication over 42 days. Thirty patients with Gram-positive cocci BJI were included. Once the target of 25 to 40 mg/liter trough serum concentration was achieved, treatment was switched from an intravenous to an s.c. route. No discontinuation of teicoplanin related to injection site reaction and no severe local adverse event were observed. On multivariate analysis, better tolerability was observed at the beginning of treatment, in patients over 70 years old, and for dosages less than 600 mg. In conclusion, we recommend s.c. administration of teicoplanin when needed.

[Faster double-lumen tube intubation with the videolaryngoscope than with a standard laryngoscope]. / Le vidéolaryngoscope permet une intubation avec un tube à double lumière plus rapide que le laryngoscope standard.

PURPOSE: This study was designed to compare videolaryngoscopy with direct laryngoscopy with respect to ease of intubation when inserting a double lumen tube (DLT). METHODS: In this prospective randomized study 68 patients American Society of Anesthesiologists (ASA) physical status I and II were included. Patients with criteria indicating possible difficult intubation were excluded. The patients were randomized into two groups, depending on the tool used to facilitate intubation: videolaryngoscope (VL group) or direct laryngoscopy (DL group). The time required for intubation was the primary endpoint. Cormack and Lehane glottic visualization (CL) scores, the need for external laryngeal maneuvers and the number of attempts were measured. RESULTS: Glottic visualization was better in the VL group than in the DL group. The CL scores were I, II and III in 24, eight and two patients, respectively, in the VL group compared with 13, 11 and eight in the DL group (P = 0.025). Patients in the VL group required fewer attempts than the DL group (P = 0.019). Intubation time was 39.9 ± 4.4 sec in the VL group and 47.9 ± 5.4 sec in the DL group (P < 0.001). No intubation failure was noted in group VL compared with two in the DL group (not significant). CONCLUSION: The use of a videolaryngoscope reduces the time required for intubation with a DLT compared with the direct laryngoscopy in elective thoracic surgery.