[Prevention of pulmonary collapse during bronchography under general anesthesia in children]. / Prophylaxie du collapsus pulmonaire lors des bronchographies sous anesthésie générale chez l'enfant.

The inhalation of halothane with oxygen and air facilitates bronchography without pulmonary collapse or alveolar obstruction by contrast medium. This anaesthetic technic used in 15 paediatric investigations is more secure under transcutaneous PO2 and PCO2 monitoring.

[EEG recordings in prolonged hypercapnia during surgery of a cervico-mediastinal tumor in a 3-year-old child]. / Enregistrement EEG pendant une hypercapnie prolongée au cours d'une intervention pour tumeur cervico-mediastinale chez un enfant de 3 ans.

An EEG has been recorded during surgery for a cervico-mediastinal desmoid fibroma in a 3-year-old child. Soon after anesthetic induction a bronchospasm occurred, followed by major respiratory difficulties. During more than 3 h, hypercapnia reaching 15-24 kpa was noted without hypoxia. Meanwhile the EEG recording was inactive. The respiratory difficulties subsided only with the surgical liberation of the trachea. As the hypercapnia decreased, the EEG began to show "burst suppressive" activity. Progressively the tracing was more and more continuous with slow waves until complete recovery. The following day the EEG was quite normal. The mechanisms of these EEG features are discussed with regards to anesthetic drugs and to brain hypercapnic edema.

[Siamese twins: anesthesia, pre-per- and post-operative care (author's transl)]. / L'anesthésie et la réanimation des monstres doubles.

The authors relate the anesthetic and pre-, per- and post-operative care problems they had to meet with six pairs of siamese twins separated at the Hôpital des Enfants Malades (Paris), between 1960 and 1978. 77 cases of such anomalies have been reported since the beginning of the XXth century. The authors point out the importance of: 1) a precise pre-operative assessment of the anatomo- and physiopathological status of the conjoined twins, 2) an outstanding technical organization, 3) a medical and nursing team specialized in pediatric anesthesia and intensive care to face with the predictable and unpredictable problems which may occur, specially those which the clinical and paraclinical investigations have not been able to discover before the operation.

[Blood pressure during pediatric anesthesia. Four methods of peroperative indirect measurement. Comparison (author's transl)]. / Pression artérielle en anesthésie pédiatrique. Comparaison de quatre méthodes indirectes de mesure peropératoire.

During general anesthesia blood pressure levels have been recorded for 35 children (10 aged 1-12 months, 15 aged 12-24 months, 10 more than 24 months). Four different methods of indirect measurement were used: pulse palpation, flush technique, ausculatory determination by mean of a conventional sphygmomanometer, Doppler ultrasonic technique by mean of arteriosonde. The pulse palpation is the easiest method at any age, during pediatric anesthesia but does not give values of diastolic blood pressure. The flush technique quite convenient for infants less than 24 months gives values lying midway between systolic and diastolic blood pressure. Ausculatory determination in operating room is difficult especially with small infants less than 12 months. During anesthesia longer than thirty minutes, monitoring blood pressure by Doppler ultrasound sphygmomanometer can be fairly available. Even in case of difficulties to detect clear signals of systolic and diastolic blood pressure the sphygmomanometer can be used to obtain blod pressure determination by flush technique or pulse palpation.

[Therapeutic testing. Procedure in pediatric anaesthesia (author's transl)]. / L'essai thérapeutique. Conditions en anesthésie pédiatrique.

In pediatric anaesthesia, the therapeutic research raises ethical, moral and legal problems. The reexamination of three personal experimental procedures: ketamine (1970), propanidide (1971), etomidate (1978) yields suggestions concerning the use of new anesthetic drug in children. The experimental procedures in pediatric anesthesia need: --a great number of experimental results in "adults" animals but also in "growing" animals, --sufficient experiments in human adults, --an anesthetic medical staff especially trained in practice of pediatric anesthesia, --a special care for th convenient protocol. Moral and ethical problems concern: --the direct benefit, --the discernible risk, --the inclusion of non critically ill minor children in the procedure and the legal right of "informed consent". The approval of the design, details and ethical criteria of the research by a medical ethics committee seems the only judicious way.

[The tracheal intubation of children suffering from congenital cranio-facial anomalies. Pre-operative anticipation of its technical problems (author's transl)]. / L'intubation trachéale chez les enfants atteints de dysmorphies cranio-faciales congénitales. Détection pré-opératoire des difficultés.

In order to anticipate the technical problems of the tracheal intubation of children suffering from congenital cranio-facial anomalies, the authors suggest, in addition to the routine examination of the nasal and buccal cavities, different clinical and radiological measurements such as mandible angle, maxillo-pharyngeal angle and the mouth opening. These parameters explore the extent of the mandibular asymmetry and hypoplasia, the limits of the mouth opening and the cervical spine extension. Three data are reported, showing the interest of the scheme of examination proposed.

[The E.E.G. during althesin anaesthesia in paediatrics (preliminary study) (author's transl)]. / Etude de l'E.E.G. au cours de l'anesthésie par l'alfatésine en pédiatrie.

The authors studied 11 children (mean age 5 1/2 years) before and during anaesthesia, and then several times from 1 to 6 hours after the injection of althesin. The anaesthetic agent was either pure althesin or althesin combined with dextromoramide. The electroclinical correlations described for adults are also found in children: slow waves, discontinuous and then isoelectric recording during the operation stage, then rapid recovery after ending drug administration. The special interest of this study was the analysis of E.E.G. recordings during the hours following clinical recovery: only once was the recording like that of full consciousness. Repeated recordings were all of drowsiness and even sleep, despite the clinical state of the subject. A short associated study concerns the E.E.G. of neonates during their first 24 hours, born to mothers anaesthetised with alfathesin.