-The clinical use of the cuffed oropharyngeal airway (COPA)-. / Utilisation clinique du COPA (cuffed oropharyngeal airway).

OBJECTIVE: To assess the performance of the COPA device during general anaesthesia. STUDY DESIGN: Prospective, clinical, open study. PATIENTS: Eighty patients scheduled for short elective surgical procedures under general anaesthesia not requiring tracheal intubation. METHOD: After premedication (midazolam, atropine), anaesthesia was induced with propofol (154 +/- 40 mg = 2.47 +/- 0.8 mg.kg-1) and alfentanil (1.14 +/- 0.43 mg). The COPA device was inserted in a fashion similar to a Guedel airway device. The device was evaluated on the following criteria: correct choice of COPA size, ease of insertion, ability to obtain or maintain patent airway. Adverse reactions were noted, such as coughing, nausea, regurgitation, inhalation, and sore throat. The overall rating of the COPA as a "hand free device" was evaluated on the basis of excellent, good, fair, and poor. RESULTS: Insertion of the device was easy and in 70 cases successful on the first attempt. Jaw thrust on head tilt was necessary in half the cases. No patient necessitated intubation because of hypoxaemia or airway obstruction. Adverse reactions occurred in few cases and consisted of sore throat (always moderate) in 10% of the cases. COPA was evaluated as excellent or good in 80% of the cases. CONCLUSION: COPA is a convenient device for airway management in fasting patients undergoing general anaesthesia for elective surgery in the supine position, in whom tracheal intubation is not indicated.

[Management of neurologic manifestations after obstetrical epidural anesthesia]. / Conduite à tenir devant une symptomatologie neurologique après anesthésie péridurale obstétricale.

Epidural anaesthesia is commonly used in obstetrics (70% of all deliveries in the maternity units of Lille University Hospital). Four cases are reported: headache followed by diplopia and amaurosis, delayed lumbosacral paraesthesia, early paraesthesia of the left lower limb, severe cephalalgia. Etiological analysis allowed to find the causes of these disorders and to exclude any anaesthesia responsibility, moreover permitting adapted treatments. The medicolegal aspect must be emphasized and also the need of an extensive medical investigation to find out the aetiology and propose an appropriate management.

[Accidental spinal anesthesia in obstetrics. Limits of epidural test-dose]. / Rachianesthésies accidentelles en milieu obstétrical. Limites de la dose-test péridurale.

Two cases of accidental spinal anaesthesia occurring in obstetrical patients are reported and discussed. Epidural anaesthesia had been asked for by the women, both being free from any significant medical history. A Tuohy needle was inserted in the midline between L3 and L4 with the patient sitting. The extradural space was identified by the loss of resistance using saline. The test-dose (2 ml and 4 ml of 1% lignocaine respectively) was administered five minutes before changing the patient to the supine position. In the first case, after a test-dose had remained without any effect, 8 ml of 0.25% bupivacaine were injected, about one hour later. The patient rapidly complained of paralysis of her legs and difficulties in breathing. Her blood pressure decreased from 120/80 mmHg to 90/60 mmHg. The upper level of analgesia reached T4. She improved after infusion of 1.51 of lactated Ringer's solution. Endotracheal intubation was not required. Delivery was assisted with a vacuum extractor. In the other patient, when the extradural space had been located, there was a small reflux of clear fluid which did not contain any glucose. As the test-dose did not result in any effect. 2 ml of 2% lignocaine with adrenaline were injected. This was followed by an immediate sensory loss in the legs, extending up to T10. Caesarean section was decided on, without any further injections (foetal macrosomia, breech presentation). Both patients totally recovered without any sequela. Both children had an Apgar score of 10 at 1 and 5 minutes. The type of test-dose is discussed. Smaller volumes of more concentrated solutions are recommended.

Are haemostatic and fibrinolytic parameters predictors of preeclampsia in pregnancy-associated hypertension?

The plasma levels of several haemostatic and fibrinolytic parameters were measured before and after delivery in 61 hypertensive pregnant women of whom 22 developed preeclampsia, and compared to the results obtained in 42 normal pregnant women. In the two last weeks before delivery (D less than or equal to -15) tPA antigen, PAI-1 activity, vWF:Ag/FVIII:C ratio, ATIII activity and platelet count were found to be significantly different in the hypertensive pregnant women with and without preeclampsia. Combined all together, an association of three of these five parameters were found to be pathological (i.e.:tPA:Ag greater than or equal to 19 ng/ml, PAI-1 activity greater than or equal to 58 IU/ml, vWF:Ag/FVIII:C ratio greater than or equal to 2.6, ATIII activity less than or equal to 73%) in none of the hypertensive women without preeclampsia and in only 35% of the preeclamptic group. A positive correlation was demonstrated between vWF:Ag/FVIII:C ratio and tPA:antigen levels suggesting that both tPA and vWF:Ag could be considered as early indicators of a possible micro angiopathy occurring in preeclampsia. However, due to the high dispersion of the results, it appears that the investigated haemostatic and/or fibrinolytic criteria give only presumptive arguments before assigning risk for preeclampsia development among hypertensive pregnant women.

[Peridural anesthesia for all women in labor: utopia or reality?]. / L'anesthésie péridurale pour tous les accouchements: utopie ou réalité?

Peridural anesthesia in obstetrics is more and more widely used, improving comfort and security for delivery. In 1989, 74% of the deliveries occurred under peridural anesthesia in our unit. In order to assess if this percentage can be increased, we analysed during one month the reasons why some women did not get a peridural anesthesia.

[Computerized records for obstetrical epidural analgesia]. / Dossier informatique d'analgésie péridurale obstétricale.

An original recording and exploiting data programme has been built. It is in Basic language for Apple II. The data programme allows the care of obstetric peridural analgesic records. The medical interest is the record edition which is possible when the patient comes back. The scientific interest is statistics produced quickly from a great number of records. The record, record edition and statistical edition are described.

[Anesthetic management for delivery of 38 cardiac patients (author's transl)]. / L'anesthésie chez la parturiente cardiaque. Trente-huit cas.

The choice of anesthesia is discussed in connection with a serie of 38 women cardiac and pregnant cared from 1976 to 1979, 32 of them having delivered a child. Peridural analgesia improves the labour and the delivery without inconveniene for either mother of child, but general anesthesia must be prefered for cesarean section. Anticoagulant therapy is a contra-indication for peridural analgesia.