Cardiac arrest after tourniquet deflation in upper limb.

Pneumatic tourniquet is a technique widely used in orthopedic surgery, in particular, for reducing intraoperative bleeding and facilitation of surgery. That said, it may cause local and systemic complications which can be life-threatening. The description of this kind of complications is usually made after lower limb utilization. We report the case of a patient, operated for fractures of the two upper limbs, who presented after the second tourniquet deflation, a cardiac arrest with a good recovery after cardio-pulmonary resuscitation. The most likely cause of this cardiac arrest, is the ischemia reperfusion syndrome caused by successive excessively inflated tourniquet, since pulmonary embolism and myocardial infarction are eliminated. In the light of this exceptional clinical observation, we insist on the respect of usual recommendations of use, such as duration and inflation pressure, especially when successive upper limbs tourniquets are used.

[Submental intubation in maxillofacial traumatology]. / L'intubation sous-mentonnière en traumatologie maxillofaciale.

INTRODUCTION: Free access to the upper respiratory tract may be a challenge for the management of severe facial trauma. Tracheotomy is routinely used in this case. Submental intubation is little used, but it is an alternative to tracheotomy. MATERIAL AND METHOD: A retrospective study was made over 1 year. Sixteen patients with facial smash were included. Patients who had undergone an immediate tracheotomy or a long-term intubation were excluded. Submental intubation was used in all patients with the same protocol. The studied data was: operative time, duration of ventilator disconnection, postoperative complications, and scar assessment. RESULTS: The average operative time was seven minutes. No speech disorder, hematoma, or postoperative infection was observed. The scar was barely visible in 13 cases out of 16. DISCUSSION: Submental intubation seems to be a reliable, simple and easy to learn technique. A perfect knowledge of the local anatomy allows opening the airway without any risk of hematoma. Incision packing reduces the bacterial inoculum and infectious risk. The residual scarring is minimal.