[Obstetrical anaesthesia and porphyrias]. / Anesthésie obstétricale et porphyries.

Acute hepatic porphyrias are genetic diseases, characterized by acute neurological symptoms, sometimes fatal, triggered by different factors, in particular by many anaesthetic drugs, and also by pregnancy. We report here the experience of three porphyric patients'deliveries, allowing us to consider a proposition of management in this context. After discussion between anaesthesiologist, obstetrician and porphyria specialist, two types of management of such patients can be foresee. Asymptomatic patients, or in long remission, can benefit from locoregional anesthesia techniques with bupivacaine for both labour analgesia and Caesarean section. Spinal anaesthesia is then the technique of choice, allowing using smaller quantity of local anaesthetic than epidural anaesthesia. For symptomatic patients, or in crisis, we have rather choose intravenous narcotics for labour analgesia, and general anaesthesia for Caesarean section. The hypnotic agent of choice for both induction and maintenance of such anaesthesia is then propofol.

[Fat embolism after total hip prosthesis replacement preserving the femoral stem]. / Embolie graisseuse après changement de prothèse de hanche avec conservation de la tige fémorale.

Fat embolism is a known complication of traumatology, especially in long bone fractures. It may also occur in liposuction and articular surgery (0.1%). Fat embolic events are most often clinically insignificant and difficult to recognize since clinical manifestations are varied and there is no routine laboratory or radiographic diagnosis. Classically, fat embolism syndrome presents with the triad of pulmonary distress, mental status changes, and cutaneous manifestations. We report the case of a 33-year-old woman who developed acute respiratory distress 10 days after hip arthroplasty. Several aetiologies such as fibrinocruoric pulmonary embolism, pulmonary aspiration and bacterial pneumonia were discussed. Fat embolism was diagnosed, based on suggestive clinical manifestations, radiographic and laboratory findings, although fat embolism after hip arthroplasty without intramedullary pressurization is infrequent.