Arrêt cardiaque sur dysfonction de pacemaker au cours d’une anesthésie générale chez un adulte jeune

The number of patients with cardiac pacemaker is continuously increasing. The anesthetic management of these patients is often trivialized, particularly during minor surgery. However there is always a potential risk of dysfunction during anesthesia. Perioperative management of these patients must be careful and standardized to avoid accidents. We report a case of cardiac arrest during general anesthesia for a day-surgery secondary to pacemaker dysfunction by increasing pacing thresholds in a young adult patient. Rapid onset after induction, without any surgical stimulation, has raised the question of the involvement of anesthetic drugs like propofol.     

Syndrome du QT long acquis et arrêt cardiorespiratoire post-anesthésie générale. À propos d’un cas et revue de la littérature

A 30-year-old woman, with no medical history, is operated on for breast implants. In recovery room, an episode of torsade de pointes occurs, progressing to ventricular fibrillation. The ECG after cardiopulmonary resuscitation and conversion to a normal sinus rhythm shows a corrected QT interval prolongation, whereas it is normalized after 48 hours. We hypothesize that a ventricular fibrillation occurred after a torsade de pointes, due to drug-induced long QT syndrome during general anesthesia, with probably drug interaction.     

Crise d’hyperthermie maligne de l’anesthésie après cinq heures d’anesthésie avec le sévoflurane et plusieurs anesthésies antérieures avec halogénés

We report a case of per anaesthesia malignant hyperthermia (MH) arisen in a 16-year-old young man presenting antecedents of five anaesthesia with use of halogenated agents without complication and having started a typical crisis of MH after five hours of anaesthesia with sevoflurane and with recurrence of the crisis after 14 hours in ICU. The association in the same clinical case of these three peculiarities of the crisis of MH already described separately in the international literature allows us to insist on their importance, with the French-speaking anaesthesiologists community.     

Rôle de la génétique dans la variabilité interindividuelle en anesthésie

Objective

This review discusses variability among patients in anesthesia, due to genetic polymorphisms.

Data sources

Articles in French and English languages were retrieved from PubMed database. The initial request was “anesth* and (genotyp* or polymorphism* or genetic*)”.

Study selection

Original articles, general reviews and one case report. Letters were excluded.

Data extraction

Rare genetic diseases were excluded from the scope of this review. We stressed on frequent genetic polymorphisms that may have a daily impact in anesthesiology.

Data synthesis

Most results were related to pain studies. We selected various examples to describe how genetic polymorphisms impacts the pharmacology of a given drug, and what are the clinical consequences.

Conclusion

There is a growing field of pharmacogenetic related evidences in anesthesiology. The results from various animal and human studies underline the genetic origin of variability among individuals. How anaesthesists have to integrate these parameters for their daily practice is still unclear, but pharmacogenetic will obviously be a leading field of anesthesia research in the future.     

Assistance par extracorporeal membrane oxygenation au cours d’un syndrome de tako-tsubo après césarienne en urgence

Tako-tsubo syndrome is a rare cardiomyopathy secondary to catecholamine toxicity responsible of myocardial stunning. Severe complications such as cardiogenic shock or ventricular arrhythmia can occur. We presented the case of a 32-year-old woman victim of a tako-tsubo syndrome with severe cardiogenic shock during surgical procedure for urgent caesarean section. After refractory haemodynamic failure, the patient benefits from extracorporeal membrane oxygenation support device with success.     

Avantages décisifs,indications et limites de l’anesthésie au xénon

Objective

To analyze the current knowledge related to xenon anaesthesia.

Data sources

References were obtained from computerized bibliographic research (Medline^®), recent review articles, the library of the service and personal files.

Study selection

All categories of articles on this topic have been selected.

Data extraction

Articles have been analyzed for biophysics, pharmacology, toxicity and environmental effects, clinical effects and using prospect.

Data synthesis

The noble gas xenon has anaesthetic properties that have been recognized 50 years ago. Xenon is receiving renewed interest because it has many characteristics of an ideal anaesthetic. In addition to its lack of effects on cardiovascular system, xenon has a low solubility enabling faster induction of and emergence from anaesthesia than with other inhalational agents. Nevertheless, at present, the cost and rarity of xenon limits widespread use in clinical practice. The development of closed rebreathing system that allowed recycling of xenon and therefore reducing its waste has led to a recent interest in this gas.

Conclusion

Reducing its cost will help xenon to find its place among anaesthetic agents and extend its use to severe patients with specific pathologies.     

Organisation de l’anesthésie des enfants dans un hôpital non pédiatrique

The author reviews the guidelines and the possible organization of anaesthesia and surgery in a non-paediatric hospital.     

Intérêt de l’anesthésie péridurale cervicale dans la gestion périopératoire d’une thyroïdectomie chez une patiente à haut risque anesthésique

Cervical epidural anesthesia is an anesthetic technique that can be useful in patients with high perioperative risk undergoing to cervical surgery. We report the case of a patient of 49 years old with hypertension, diabetes mellitus, epilepsy, left hemiparesis sequelae of stroke and congestive left ventricular failure. The patient underwent total thyroidectomy under cervical epidural anesthesia. No difficulty breathing or decompensation of chronic underlying diseases were noted in the postoperative.     

Deux utilisations consécutives de l’Airtraq néonatal chez un nourrisson d’un mois présentant une intubation difficile prévue

We used successfully Airtraq-combined to a gum-elastic boogie to intubate twice a dysmorphic infant with mucolipidosis, in whom direct laryngoscopy failed. If this result is confirmed by prospective studies, Airtraq could be a first-line device to intubate infants with difficult intubation.     

Expérience d’un système de recueil d’évènements indésirables en anesthésie

Objectives

This article summarizes functioning and results of anaesthesia adverse effects reporting system over its first 18 months, from August 2006 to February 2008.

Study design

Monocentric retrospective study.

Methods

Reporting system is available 24/24 h, 7/7 to every employee with an individual password. A committee with anaesthesiologists, nurses and risk management engineer examines every notification by two months. We evaluated number of reports, type of reporter, type of dysfunction reported and solutions. Numerical data are compared with a Student t test or X² test. A p-value of less than 0.05 g being considered as statistically significant.

Results

One hundred and eighty-five reports were registered for the first 18 months (1% of anesthesia activity) with a slowdown with time (p = 0.02). Eighty-six percent of the statements were made by anesthesiologists, but some physicians had never reported. Malfunctions shared between different services (identity, operating room organisation) are rarely solved (67%) compared to specific anesthesia problems (93%) (p < 0.001).

Conclusion

The reporting system is simple and available but some professionals don’t declare, generating reporting bias. This network underlines major general dysfunctions (identity) but ways to solve are limited to date.     

Impact de la diminution d’utilisation du protoxyde d’azote sur la consommation d’agents halogénés

Objective

Nitrous oxide (N₂O) toxicity and its impact on pollution lead to restrict its use. A decrease of N₂O consumption should increase the hypnotic inhaled consumption. This monocentric study estimated consumptions and costs of halogenated agents (HA) and N₂O over 5 years when the N₂O consumption was reduced.

Study design

Retrospective from a computerized database.

Patients

Between 2006 and 2010, 34,097 procedures were studied after two meetings exposing the risks of the N₂O.

Methods

At the end of anesthesia, consumptions of hypnotic agents (millilitres transmitted by the injectors and the blender) were archived in the database. The annual consumption of agents was obtained by adding the individual consumptions, then divided by the annual number of cases. The costs were given by the hospital pharmacy from invoices.

Results

N₂O consumption per anesthesia constantly decreased during the study, from 75.1 L by act to 22.7 L. The sum of the annual consumptions of N₂O and air did not change suggesting that total fresh gas flow remained stable. Between 2006 and 2010, the sevoflurane consumption by act increased by 25%, from 16.5 to 20.6 mL, and desflurane consumption by 37%, from 46.1 to 63.1 mL by patient. The costs of the administration of hypnotic agents remained stable.

Conclusion

N₂O consumption decrease had an impact on the consumption of HA. The cost reduction of the N₂O was counterbalanced by the increase of halogenated vapor cost. The profit of the ecological impact of the reduction in N₂O use could be quantified.     

Hypothermie profonde après rachianesthésie et morphine intrathécale après césarienne : un nouveau cas clinique

After an uneventful caesarean delivery under spinal anaesthesia (hyperbaric bupivacaine 10 mg, sufentanil 5 μg and morphine 50 μg), hypothermia (nadir 34 °C) was recorded in a ASA 1 patient. Partial recovery was rapidly obtained with 400 μg of naloxone but full recovery was obtained after seven hours of active rewarming with a forced-air warming blanket. Suggested pathophysiology and incidence of this hypothermia are described.     

Organisation des soins en analgésie,anesthésie et réanimation en maternité en France métropolitaine : résultats comparés des enquêtes nationales périnatales 2003 et 2010

Objective

The equipment and practices in obstetric analgesia, anaesthesia and intensive care, as well as their evolution between 2003 and 2010 in metropolitan France, were described.

Population and methods

Data were derived from two representative samples of births in 2003 and 2010, based on all births in France during one week. The sample included 534 maternity units and 14,903 births in 2010 and 618 maternity units and 14,737 births in 2003.

Results

The caesarean operating room was adjacent or inside the labour ward in 66% of maternity units in 2010 vs 56% in 2003. An anaesthetist was appointed permanently to the labour ward in 38.9% of maternity units in 2010 vs 21.5% in 2003. Locoregional analgesia or anaesthesia rate increased significantly: 81.5% in 2010 compared to 74.9% in 2003. Almost all operative vaginal deliveries were performed under epidural anesthesia in 2010. Patient controlled epidural analgesia (PCEA) was available in 58% of the units in 2010 but only 34.2% of women had PCEA. Newborn's resuscitations were performed mainly by paediatricians in 2010, but 11.4% of children were resuscitated by an anaesthetist in level 1 maternity units.

Conclusion

The conditions required to ensure anaesthetic care safety in maternity units has improved since 2003. Improvements in quality of care are still possible.     

Complications neurologiques de l’anesthésie locorégionale : analyse des expertises et conclusions des CRCI

All the files of complications of regional anaesthesias requiring an expertise for a Regional Commission for Conciliation and Compensation for medical accidents (CRCI) between 2003 and 2008 were analyzed. The objective was to estimate the homogeneity of the appointed experts, their opinions and the opinions of the CRCI. Querying the database, shared by the National Office for Compensation for Medical Accidents (ONIAM) and the CRCI, and identified 40 files corresponding to the selection criteria. The expertise carried out involved an anaesthetist in 27 cases, always registered, either on the national list of the experts in medical accidents, or on one list of court-appointed experts. Conversely, in 13 cases, no specialist performing himself the technique in question was involved in the expertise, and sometimes the expert was registered on any list. Mostly, the non-specialists do not conclude to medical malpractice. This was not the case in a single file, where the anaesthetist sought and obtained the addition of an anaesthetist in a new expertise, which concluded differently. Damages assessed were highly variable, but the given evidence provided to understand why. The CRCI have generally followed the opinions of the experts, except in a few cases where the evidence allowed a different opinion without requiring a new expertise. In conclusion, the abnormalities in the appointment of experts do not seem to have had consequences in terms of damage assessment, but may alter the balance between causes faulty and not faulty, in favour of the latter.