[Assessment of anesthesiologist intervention during cataract surgery under topical anesthesia]. / Évaluation du recours à l'anesthésiste-réanimateur lors de la chirurgie de la cataracte réalisée sous anesthésie topique.

OBJECTIVES: The current demographic situation in France regarding anesthesiologists calls for a reconsideration of anesthesia management for patients undergoing cataract surgery under topical anesthesia. This prospective observational study aimed to assess the requirement for anesthesiologist intervention during cataract surgery performed under topical anesthesia. PATIENTS AND METHODS: Patients operated between November 2, 2011 and July 31, 2012 were included after indication of topical anesthesia for phacoemulsification proposed by the surgeon and confirmed by the anesthesiologist. Each patient was premedicated. All patients were monitored and supervised during the surgery by a nurse anesthesiologist. An anesthesiologist could be called at any time at the request of the surgeon or nurse anesthesiologist. For each patient, medical histories were recorded as well as the event "anesthesiologist called", along with the reason and the treatment performed. RESULTS: Five hundred and seventy-five phacoemulsifications were performed in 486 patients. The event "anesthesiologist called" was recorded 20 times: 18 times for hypertension, once for anxiety and once for non-emergent conversion to general anesthesia after a surgical complication. Each episode of hypertension was successfully treated by following the nicardipine protocol. Preoperatively uncontrolled hypertension was the only significant predictive risk factor for anesthesiologist requirement. CONCLUSIONS: These results question the usefulness of preoperative anesthesia consultation for all patients who underwent phacoemulsification under topical anesthesia, since this consultation does not lead to an anesthesiologist service. Intraoperative medical complications may be treated according to medical protocols developed jointly by surgeons and anesthesiologists. This practice may free up anesthesiologists' time, without compromising patient safety.

Ultrasound-guided intermediate cervical plexus block for carotid endarterectomy using a new anterior approach: a two-centre prospective observational study.

The aim of this prospective, double-centre, observational study performed in 116 patients was to describe a new anterior approach of ultrasound-guided intermediate cervical plexus block for carotid endarterectomy. The median (IQR [range]) volume of ropivacaine 0.5% administered was 30 (25-30 [20-45]) ml. Supplemental local anaesthesia (infiltration and topical) was needed in 66 (57%) patients. Overall, 41 (35%) patients needed additional sedation (18 midazolam; 23 remifentanil). There was no intra-operative complication or systemic toxicity of ropivacaine. One regional anaesthesia procedure was converted to general anaesthesia because of patient agitation. Adverse effects were of short duration and did not affect surgery. Satisfaction scores were high for 92 (79%) patients (63 satisfied; 29 very satisfied) and 104 (90%) surgeons (51 satisfied; 53 very satisfied). This study shows that the ultrasound-guided intermediate cervical plexus block using an anterior approach is feasible and provides similar results to other regional techniques during carotid endarterectomy.

Immediate allergic cross-reactivity to levobupivacaine and ropivacaine.

Allergic reactions to amide local anaesthetic agents are rare. We report the case of a 74-year-old man who suffered anaphylaxis, presenting with cardiovascular collapse, immediately after receiving regional anaesthesia on two separate occasions, the first involving the use of levobupivacaine and the second using ropivacaine. Skin testing revealed positive reactions to both levobupivacaine and ropivacaine, and negative reactions to articaine and lidocaine. Severe allergic reactions can be caused by the amide local anaesthetic drugs, levobupivacaine and ropivacaine.

Effects of estradiol benzoate and castration on LH in experimental hyperprolactinemia.

Female rats of the Wistar strain were rendered hyperprolactinemic by grafting one additional pituitary gland under the right kidney capsule at various ages (5 days group A; 30 days group B and 90 days group C). Age matched animals were sham operated to serve as controls. Plasma levels of PRL and LH were measured by specific double antibody RIA. Basal preoperative PRL levels were increased rapidly after grafting, reaching values over 100 ng/ml, in front of the 20 ng/ml showed by sham operated controls. Plasma LH levels were significantly decreased in all hyperprolactinemic groups as compared to controls. After Estradiol Benzoate (EB) administration all control rats showed an increase in PRL levels in a pulsatile manner with higher values found in the afternoon. PRL response in transplanted rats was less evident and with absence of pulsatility. LH responses to EB in control animals showed a biphasic pattern, with a negative feed-back in the first hours followed by a positive effect at 31 or 55 h after the injection. This pattern of response started in the control rats from group A at 19 days of age. Before that, only the negative feed-back effect was present. In grafted animals from the same group no positive feed-back effect could be detected at any time studied. In group B, a reduction in the positive feed-back effect, more evident after 90 days of hyperprolactinemia was detected. Animals of group C on the contrary showed an increased positive feed-back effect 40 days after grafting. Eight days after castration a reduction in PRL levels was detected in all groups, together with an increase in LH values. PRL values after ovariectomy were less reduced in grafted animals, and these rats also showed a less marked LH increase. This effect is more evident in group B. All these data seem to point out that hyperprolactinemia is capable of modifying the feed-back system between E2 and LH, and that the age at which hyperprolactinemia starts has a profound effect.