[Tumescent infiltrative anaesthesia for mastectomy: about six cases]. / Anesthésie infiltrative tumescente et mastectomie : à propos de six cas.

OBJECTIVE: To assess safety and efficacy of tumescent infiltration of the supraclavicular nerve and the anterior and lateral branches of the intercostal nerves in major breast surgery. METHODS: A retrospective analysis of six selected patients undergoing mastectomy was performed. A mixture composed of 150mg ropivacaine, 400mg of lidocaine and 0.5mg epinephrine diluted in 500ml Ringer's were administered subcutaneously as follows: 80ml along the parasternal line from the second to the sixth intercostal space, 80ml along the mid axillary line from the second to the sixth intercostal space, 80ml along the infraclavicular line, 80ml in the space between the pectoralis muscle and the mammary gland and 80ml in the axilla in case of axillary dissection. RESULTS: This technique achieved effective analgesia in six patients associated with sedation or light anaesthesia; conversion to general anaesthesia or supplementation with local anaesthesia was not required. No complication was observed. No emesis was noted. CONCLUSION: This technique provides adequate peroperative analgesia and is a technically low-risk procedure. Further evaluation of this technique is recommended.

[A case of hypertriglycideremia-induced pancreatitis in pregnancy: value of heparin]. / Héparinothérapie: une alternative à la plasmaphérèse au décours de la pancréatite aiguë hyperlipidémique gravidique. A propos d'un cas.

We report the case of a 28-year-old secundipari with a history of severe hypertriglycideremia-induced pancreatitis 3 years ago who was admitted in the 37th week of gestation with abdominal pain. A blood sample had a milky aspect and plasma concentrations were as follows: triglycerides 8,5g/l, cholesterol 1000 mg/dl, amylase 574 IU/l, lipase 1310 IU/l. Acute pancreatitis was diagnosed, a caesarean was performed under spinal anaesthesia. The diagnosis was confirmed by CT-scan. Treatment with 15,000 IU heparin per day and intravenous nutrition decreased triglycerides level to less than 1g/l within 48 h. She was discharged 28 days later. Heparin could be a low-cost alternative to plasmapheresis in hypertriglycideremia-induced pancreatitis.

Glucose and insulin responses after commonly used sport feedings before and after a 1-hr training session.

This investigation examined the plasma glucose and insulin response in 6 trained athletes after consumption of four commercially available sport feedings 2 hr before as well as immediately after 1 hr of running under common training conditions. Four feedings were compared: Feeding 1, 160 g CHO/400 ml; Feeding 2, 69 g CHO/400 ml; Feeding 3, 69 g CHO + 6 g protein/400 ml; and Feeding 4, solid 69 g CHO + 5 g protein + 4 g fat. Before the training session, there were no differences between the four sport feedings in the area under the glucose and insulin curves and the insulin/glucose ratio. However, after exercise, Feeding 2 resulted in a significantly greater area under the glucose curve compared with Feedings 1, 3, and 4 (respectively, 352 vs. 241, 251, and 182) and a significantly lower insulin/glucose ratio compared with Feeding 1 (respectively, 6.2 vs. 15.8). Therefore, it is concluded that the kind of sport feeding may influence postexercise glucose and insulin responses.

Overtraining following intensified training with normal muscle glycogen.

The purpose of this study was to determine if consumption of appropriate amounts of carbohydrate during a period of increased exercise training would protect the athletes from becoming overtrained. Eight male competitive cyclists were monitored and tested during three training periods: a) normal training (moderate intensity, long duration, 7 d, NORM); b) overtraining (high intensity training, 15 d, OVER); and c) recovery (minimal training, 6 d, REC). Throughout the training 160 g of liquid carbohydrate were consumed within the first 2 h after the daily exercise bout. Mean dietary intake (NORM = 13.7 +/- 1.6, OVER = 14.1 +/- 1.0 MJ.d-1) and carbohydrate percent (NORM = 64.0 +/- 2.1, OVER = 67.4 +/- 2.5%) were not different during the different training periods. Similarly, resting muscle glycogen levels were not different (NORM = 530.9 +/- 42.5, OVER = 571.2 +/- 27.5 mumol.g-1 dry weight). Five criteria were used to determine if overtraining occurred in a subject (decreased maximal workload, maximal heart rate, ratio of maximal lactate to rating of perceived exertion (HLa:RPE), and resting plasma cortisol levels, increased affirmative response to a daily questionnaire). All subjects met at least three of the five criteria and thus were classified as overtrained. Therefore, short-term overtraining may occur even when resting muscle glycogen levels are maintained.

Sequential spinal epidural analgesia for pain relief in labour: an audit of 620 parturients.

This investigation was designed to evaluate sequential spinal epidural analgesia with a needle through needle technique for pain relief in labour. The spinal injection was made using a Becton Dickinson 29 gauge Quincke point needle. Bupivacaine 1 mg, sufentanil 5 microg and adrenaline 25 microg (2 ml) were injected intrathecally. Analgesia was maintained using bupivacaine 12.5 mg, sufentanil 10 microg and adrenaline 12.5 microg in a 10 ml bolus given through an epidural catheter in the epidural space. This dosage was also used for the test dose. Pain relief was obtained in less than ten minutes and lasted for a mean of 134 min. Of the 620 parturients in the investigation, 500 had a mean dose of 4.3 mg bupivacaine per hour. Hypotension and paresis were of no concern. Patient satisfaction was excellent, 85% of the parturients being very satisfied and 10% satisfied.