[Anaphylactoid shock due to metabisulfites during cesarean section under peridural anesthesia]. / Choc anaphylactoïde aux métabisulfites au cours d'une césarienne sous anesthésie péridurale.

Sulfiting agents are antioxidants widely used in both food and pharmaceutical industries. They have been identified as responsible for adverse severe reactions. A case is reported of anaphylactoid shock during epidural anaesthesia for caesarean section. The responsible agent was metabisulfite, additive agent of local anesthetics containing epinephrine.

[Is it possible to avoid a penal offence in carrying out ambulatory anesthesia?]. / Peut-on éviter la faute pénale en réalisant une anesthésie ambulatoire?

French jurisprudence about outpatient anaesthesia is resolutely unfavorable. It is principally based on the June 22nd 1972 decision of the cessation court, the highest court of justice in France. Preoperative non hospitalisation has been considered as a fault by negligence/carelessness of the practitioners. It resulted in their penal condemnation for involuntary injuries and compensation for the harm. This decision is linked with the evolution of the fault and the responsibility share between surgeon and anaesthetist. The post-operative phase seems to involve "theory of missing luck" (causality linkage or the detriment in itself), excluding a penal condemnation but not a partial compensation. Though some new legal considerations could be put forward, a written contract between physicians and patients is necessary in outpatient surgery, whereas the medical files and the organisation of the unit can prove the quality of medical care.

[An unusual foreign body in the esophagus]. / Observation d'un corps étranger inhabituel de l'oesophage.

This is a case of oesophageal penetration by dental prosthesis probably brought on by alcoholism. No other classical complication occurred for three weeks. It was increasing dysphagia that led the patient to hospital. Endoscopy revealed an unfamiliar object and its nature, but did not enable it to be extracted. The object was taken out afterwards by cervicotomy.

[The ambulatory anesthesia unit: a problem of organization]. / L'unité d'anesthésie ambulatoire: un problème d'organisation.

A specialized unit in outpatient anaesthesia and surgery needs an adapted planning. During the preoperative period, it is particularly important to preserve the time of the patients. Different types of structures are possible for the intraoperative period depending on their degree of independence to a hospital. The hospital based unit, with independent facilities, offers various advantages. Its size and its conception must be adapted to the constraints of ambulatory technique, and to the expected needs. During the postoperative period, a special medical organization must be planned to help the patient if necessary. The part of the secretarial work is important for the success of such a unit. Its efficiency may be improved by computerised treatment of part of the information.