[Difficult intubation: a prospective evaluation of the Mallampati and Wilson tests]. / Intubation difficile: évaluation prospective des tests de Mallampati et de Wilson.

This prospective study aimed to evaluate in 849 patients the Mallampati and Wilson scores for predicting a difficult intubation. All scheduled patients were included. Induction and tracheal intubation were carried out as usual. Intubation was deemed to have been difficult if any special procedure had been required (external compression excepted); difficult laryngoscopy was defined as grade 3 or 4 on the Cormack-Lehane scale. In accordance with these criteria, less than 36% of patients with difficult intubation or laryngoscopy were detected, with a high false positive rate (more than 75%) but a good negative predictive value (more than 90%). This study was not concordant with the results of the original studies. However, data from literature show a great variability of results between studies. Many factors may contribute to this variability: differences between samples of patients, evaluation of Mallampati or Wilson scale, protocols of induction and intubation or characterization of difficult intubation. This study suggests a poor reliability of the two tests.

[Acute silicosis caused by intentional inhalation of scouring powder]. / Silicose aiguë par inhalation volontaire de poudre à récurer.

A case of acute silicosis due to intentional inhalation of the scouring powder Ajax in a female patient suffering a sickle-cell trait (30% of S haemoglobin) is reported. It consisted of an acute immuno-allergic pneumonitis with fever and a respiratory distress syndrome. It was associated with a severe biological inflammatory syndrome and immunological disturbances with circulating immune complexes and antinuclear antibodies. The assessment of respiratory function demonstrated the presence of a restrictive syndrome with hypoxaemia and decreased CO transfer. The anatomopathological and mineralogical exams confirmed the diagnosis of silicosis and elicited birefringent particles in polarized light, some nodules, interstitial fibrosis and proteic deposits in favour of alveolar lipoproteinosis. The treatment included mechanical ventilation with PEEP, antibiotics and corticosteroids. Two pulmonary lavages were performed. The patient died of septic shock before a lung transplantation could be obtained.

Nosocomial maxillary sinusitis during mechanical ventilation: a prospective comparison of orotracheal versus the nasotracheal route for intubation.

Nosocomial maxillary sinusitis during mechanical ventilation may cause life-threatening complications in ICU patients. The aim of this prospective study was to compare the incidence of maxillary sinusitis according to the route of intubation. 111 consecutive adult patients (mean age: 53, mean SAPS: 12) were randomly assigned to receive either orotracheal (n = 53) or nasotracheal (n = 58) intubation. All had a nasogastric feeding tube. Patients with head trauma or mechanical ventilation for less than 48 h were excluded. Sinusitis diagnosis was made by radiography (waters' view) at the bedside. The two groups were similar in age, SAPS, duration of ventilation. Maxillary sinusitis occurred in 1/53 (1.8%) of the orotracheal group (on the nasogastric tube side), and in 25/58 (43.1%) of the nasotracheal group (7 on the nasogastric tube side, 11 on the endotracheal tube side, 7 bilateral; p less than 0.001). Nine of the 26 cases of sinusitis were initially treated by sinus drainage because of signs of infection (3 failures) and the 17 others were treated by tube removal. This procedure proved successful in 12 out of 17 cases but secondary drainage was performed in 5 cases (1 failure). Incidents related to the route for long-term intubation were significantly (p less than 0.001) more frequent in the orotracheal group (8/53 vs 2/58), however no patient died because of them. In this study, long-term orotracheal intubation reduced significantly the incidence of maxillary sinusitis in comparison with nasotracheal intubation.

[The pharmacokinetics of propofol used in cesarean section; a preliminary study in the newborn infant]. / Etude de la pharmacocinétique du propofol pour l'intervention césarienne; étude préliminaire chez le nouveau-né.

A prospective study was carried out: 1) To compare the pharmacokinetics of propofol in two groups of patients: group 1 (eight pregnant women undergoing a prophylactic caesarean section at term), group 2 (control group: eight non pregnant women anaesthetized for short gynaecological procedures). 2) To study the kinetics of this agent in five newborns. Both groups were similar for weight, age, ASA I, oral premedication, anaesthetic method and duration. Dosages were performed using HPLC and results were statistically compared by Student's t-test. The haemodynamic parameters did not show large variations during induction. Propofol plasma levels were high (4,600 +/- 2,200 ng/ml-1) at intubation time; however, at extraction time (group 1) or 25 minutes after induction (group 2), plasma levels were close to anaesthetic threshold. The decreasing slopes were similar in the two groups. The quality of recovery in both groups was satisfactory. The first measured level in umbilical cord blood after birth was low, close to half of the maternal level, without any constant correlation. During the first hour of life, the drug catabolism is lesser in the newborn than in its mother, then plasmatic concentrations decrease similarly. Apgar scores were excellent in four of the five studied newborns; one child had a mean score notwithstanding a low propofol level (171 ng/ml-1), but recovery was perfect after a short oxygenation. There was no significant difference between pregnant women and control group with the propofol dose of 4 mg/kg-1 used for anaesthesia. Thus propofol appears to be convenient for prophylactic caesarean section without damage for the newborn.