[Use of Diprivan in ENT and stomatology]. / Utilisation du Diprivan en ORL et stomatologie.

Irrespective of the type of surgery, patient monitoring, including ECG-automated non-invasive blood pressure measurements, SpO2, FIO2 and capnography, is compulsory. Sedation: no initial bolus injection of propofol; continuous infusion of propofol at a rate of 1 to 4 mg.kg-1.h-1, using a syringe pump, combined with a short-acting opioid such as alfentanil. General anaesthesia: initial bolus injection of propofol between 2 and 3.5 mg.kg-1, combined with 10 mg of lidocaine in the same syringe; maintenance with a syringe pump: 6 to 9 mg.kg-1.h-1 combined with an opioid, with or without coadministration of muscle relaxants. Intubation avoiding respiratory depression: syringe pump with a fast infusion rate (50 to 100 mg.min-1), which allows induction with propofol and intubation without co-administration of muscle relaxants.

[Comparison of propanidid with propofol for dental surgery of short or medium duration]. / Comparaison propanidide-propofol en chirurgie stomatologique de courte ou moyenne durée.

The properties of propofol in emulsion given by continuous intravenous infusion to spontaneously breathing patients have been well studied. Thirty randomized voluntary premedicated patients undergoing dental extraction were anaesthetized with propofol (2.5 mg X kg-1 IVD, and 9 mg X kg-1 X h-1) or with propanidid (9 mg X kg-1 IVD, and 60 mg X kg-1 X h-1), supplemented with nitrous oxide in oxygen and fentanyl. Induction, maintenance and recovery times had the same characteristics. Highly significant differences occurred between the two groups regarding the increase in heart rate, apnoea and recovery time. This study showed that propofol was an eminently suitable agent for continuous intravenous anaesthesia in spontaneously breathing patients for dental surgery.

[Apparently severe arterial hypertension: limitations of sphygmomanometry]. / Hypertension artérielle apparemment sévère: limites de la sphygmomanométrie.

Mönckeberg's sclerosis is characterized by medial arterial calcifications. This disease usually occurs in old people and the lesions are observed in distal lower limb arteries. The evolution is generally asymptomatic. The other arteries are uncommonly affected. This report concerns a patient with exceptionally extensive disease and simultaneous asymptomatic arterial hypertension. Blood pressure measured non invasively represents the force required to compress the brachial artery, and not the real blood pressure. In such patients, blood pressure should be monitored during anaesthesia through arterial cannulation.

[Fulminant infectious syndrome after post-traumatic splenectomy]. / Syndrome infectieux foudroyant après splénectomie post-traumatique.

A 49 year old woman presented a very serious infectious state with respiratory failure, on the third postoperative day following splenectomy for a traumatic ruptured spleen. Despite massive antibiotic treatment and treatment of the respiratory failure, the patient died. The responsibility of the splenectomy in this infection with many different organisms and the failure of antibiotics is discussed.

[Doppler velocimetric evaluation of the reliability of Allen's test for radial artery catheterization]. / Contrôle par la vélocimétrie Doppler de la fiabilité du test d'Allen pour le cathétérisme de l'artère radiale.

The result of Allen's test was compared with the variations in the Doppler flow recording of the thumb artery after compression of the radial artery in 76 volunteers. In five cases, manual compression let to a disappearance systolic flow, showing an absence of collateral ulnar circulation. In fifteen cases, the systolic flow was greatly reduced in the thumb. It is interesting to find that 14.6 per cent of the subjects have their two hands in a different classification (asymmetric subjects). In 99.34 per cent of the cases the results of these two methods was the same. The routine use of Allen's test before radial artery catheterization is fully justified by these results.

[Five cases of disseminated intravascular coagulation after peritoneojugular shunt by Le Veen valve]. / Cino cas de coagulation intravasculaire disséminée après shunt péritonéo-jugulaire par valve de Le Veen.

The authors report the cases of five cirrhotic patients who underwent peritoneo-venous bypass via a Le Veen valve. Coagulation studies revealed on the one hand a worsening in certain pre-existent abnormalities (thrombocytopaenia, decrease in plasma coagulation factor levels), and secondly a frank increase in F.B.P and positivation of the transfer test. Clinically, two haemmorrhagic syndromes were seen, one of which was fatal. At no time was euglobulin lysis time less than 30 minutes. The administration of small doses of heparin corrected these laboratory abnormalities in all patients and stopped haemorrhage in one. These findings as a whole indicate that in these five cases the bypassing of ascites fluid led to a state of disseminated intravascular coagulation.

[Use of the Cerebral Function Monitor in cardiac surgery]. / Utilisation du Moniteur de Fonction Cérébrale en chirurgie cardiaque.

Having employed routinely the monitor of cerebral function in cardiac surgery operations for about a year, the authors now present an analysis of the variations in the traces of a group of 57 patients. They have found, when there is no major haemodynamic consequence associated with the induction of anaesthesia, and when there are no difficulties of a surgical or a technical nature accompanying the artificial extra-corporeal circulation, that the monitor curve stays perfectly stable. On the other hand, all sudden haemodynamic changes result in hypotension (haemorrhage, dysrhythmia, and a fall in flow in the extracorporeal circulation) that is reflected in the level of the monitor curve which also falls. They conclude, using examples of certain variations, that the monitor curve is a supplementary form of surveillance and that the trace recorded simultaneously with the anaesthetic sheet allows retrospective analysis of the haemodynamic events to be performed for each operation.