[Assessment of the use of transfusion therapy and complications in orthopedic surgery in patients with sickle-cell anemia: retrospective study]. / Analyse des pratiques transfusionnelles et complications chez le patient drépanocytaire en situation de chirurgie orthopédique: étude rétrospective.

Red blood cells (RBCs) transfusion is a common practice in the treatment or for the prevention of complications of patients with sickle-cell disease. In surgery, pre-operative transfusions are frequently given to prevent peri-operative complications. There is no consensus however on the best regimen of transfusion for this purpose. The transfusion techniques are muliple. In addition, pre-operative transfusion therapy is reported to be largely responsible for an increased morbidity and mortality in patients with sickle cell anemia undergoing surgery. During the period 1990-2000, 16 patients (4 men and 12 women) with a mean age of 37 years and various major sickle cell hemoglobinopathies underwent 32 total hip arthroplasty for femoral head necrosis. Nine patients with sickle-cell trait were included as control group. Twelve of them had haemoglobin SS (HbSS), 2/16 had HbSC, 2/16 had HbS/betathalassemia. Operative transfusion were given in only 12/32 procedures, 4 were performed pre-operatively and 8 intra-operatively. Simple transfusion (mean: 2.5 packed red cells) were administered in all the procedures. The main complications observed in our patients were anemia by hemolysis and haemorrhagic shock, vaso-occlusive crisis and chest syndrome. Anemia requiring transfusions was significatively related to the procedures with pre-operative transfusion. In the light of our result, we would like to propose transfusional protocol--if needed--only intra-operatively.

[Evaluation of single-injection caruncular sub-Tenon's anesthesia]. / Evaluation de l'anesthésie caronculaire sous-ténonienne en une seule injection.

INTRODUCTION: Because of its complications, particularly globe perforation, retrobulbar injection has been progressively replaced by peribulbar anesthesia. However, with peribulbar anesthesia, the excessive rate of imperfect blockade requires supplemental injection. We have been performing local anesthesia using caruncular sub-Tenon single injection for many years. This technique is evaluated. PATIENTS AND METHODS: A prospective study has been carried out on 183 eyes. Regional anesthesia was given by a caruncular sub-Tenon single injection. For each case, we studied akinesia, analgesia, pain before, during, and after surgery, the number of supplemental injections, eyeball orientation, and surgical conditions. RESULTS: A total motor blockade was obtained in 157 cases (85.8%) and total lid akinesia in 176 patients (96.2%). Eight patients (4.4%) needed a second injection. During surgery, 10 patients complained of pain (5.5%). We found 27 eyes (14.7%) were divergent and 12 (6.5%) were convergent. Surgical conditions were good or very good in 90% of cases. No complications due to the injection (perforation or lesion of the eyeball or the optic nerve) were noted. CONCLUSION: Single-injection caruncular sub-Tenon anesthesia is an alternative technique to classical peribulbar anesthesia. This technique is efficient, simple, easy to learn, reproducible, and seems to have a low rate of complications.

Are branched chain amino-acids beneficial for nutrition of severe surgical patients with sepsis?

UNLABELLED: This study investigated in severe sepsis the metabolic effects of two amino acid diets, including the same protein (0.3 gN/kg/day) and caloric intake (2g/kg/day glucose) but with different amino acid composition, 24% branched chain amino-acids (B.C.A.A.) for diet A (8 cases), 41% B.C.A.A. for diet B (11 cases). The two groups were obtained by randomisation at the operative day (D0) and were observed six days (D1-D6). During study, total nitrogen using a Kjeldhal method was measured. At D0 and D6, albumin, total hemolytic complement, transferrin, cholesterol, ammonaemia, insulin and amino acid pattern were studied in blood and skin tests were performed. The data were analysed by Mann-Whitney test. RESULTS: 1) The cumulative nitrogen balances of the six days are not significantly different, but at day 6 in diet B, patients started to be in an anabolic state (+3.7 gN) and in diet A catabolism persisted (-12 gN) (p<0.02). 2) Plasma B.C.A.A. are significantly higher and aromatic acids significantly lower in diet B. In order, Fischer ratio is also significantly different between the two regimens. All the other measured parameters are not significantly different. In this study, the B.C.A.A. enriched diet seems to be beneficial in surgical patients with severe sepsis.