Saad Zidouh

Effet de l'éphédrine sur les conditions d'intubation après bloc neuromusculaire par le rocuronium versus succinylcholine

OBJECTIVE The goal of this study was to determine if ephedrine could improve intubating conditions when it is administered before the muscle relaxant (rocuronium and succinylcholine). PATIENTS AND METHODS In this prospective randomized double-blind study, 80 patients ASA I- II, scheduled for elective surgery, were allocated randomly to receive: succinylcholine 1mg/kg+ephedrine 70 microg/kg (Group I, n=20); rocuronium 0.6 mg/kg+ephedrine 70 microg/kg (Group II, n=20); succinylcholine 1mg/kg+0.9% saline (Group III, n=20); rocuronium 0.6 mg/kg+0.9% saline (Group IV, n=20). Induction of anaesthesia started with administration of the first syringe containing either ephedrine or saline, then 30s later propofol 2.5mg/kg and fentanyl 3 microg/kg, were administered followed by the contents of the second syringe containing either rocuronium or succinylcholine. Thirty seconds after injection of the muscle relaxant, another blinded staff anaesthetist performed intubation of the patient. Intubating conditions were evaluated according to criterias of the conference of Copenhagen. Heart rate, systolic blood pressure and diastolic were also noted. Kruskall-Wallis test for non-parametric variable and Student t test for quantitative variables were used for statistical analysis. RESULTS There was no significant difference between the groups concerning age, sex, BMI and ASA status. Pretreatment by ephedrine improved significantly (p<0.0001) intubating conditions after succinylcholine and rocuronium. CONCLUSION Use of ephedrine 30 seconds before induction with propofol, fentanyl followed by rocuronium or succinylcholine provides faster good conditions of intubation.

Intubation chez une adolescente souffrant du syndrome Rubinstein-Taybi en utilisant le vidéolaryngoscope

CAN J ANESTH 55: 1 www.cja-jca.org January, 2008 Usually operators introduce the blade of the GlideScope® into the patient’s mouth along the midline of the tongue, and either the blade or the handle is raised in a plane perpendicular to the patient’s mandible to expose the larynx. The styletted ETT is then introduced between the space made by the blade of the GlideScope® and the patient’s mouth. In a patient with a small mouth, the space created by the blade and the patient’s mouth may be narrow, rendering difficulties with ETT insertion (Figure A, B). If the blade of the GlideScope® is inserted nearer to the left corner of the mouth, the operator can attain a larger space for ETT insertion (Figure C) potentially avoiding oropharyngeal mucosal injury. Although the laryngeal inlet may be exposed in a slightly deviated position with this approach (Figure D), visualization of the ETT tip on the video screen will enable easy insertion of the ETT. We have found that this maneuver allows easy introduction of the ETT into the glottis, and have observed no evidence of palatopharyngeal trauma.

Does intranasal fentanyl provide efficient analgesia for renal colic in adults

Introduction Intranasal fentanyl provides rapid and powerful analgesia which is particularly interesting in patients without intravenous access. We propose to use it for analgesia in adults presenting renal colics. Methods A prospective study was conducted from the 2nd January to February 2013 in our emergency department. Patients aged up to 18 years old who presented with renal colic were included in this audit. Patients were excluded if they had loss of consciousness, cognitive impairment, acute or chronic nasal problems. A formal written consent was obtained from patients. The research team was alerted by medical and nursing staff. A member of the research team would check with medical or nursing staff whether administration of Intra nasal (IN) fentanyl was required. It was administered at a pre-calculated dose of 1.5 mg/kg and 50 mg/ml concentration was used. Data was prospectively collected by one of the researchers at various intervals during the patients presentation and recorded on a pre-formatted data sheet. Pain scores were collected at 5, 15, 30, 45 and 60 minutes following IN fentanyl using a visual analogue scale pain. Observations routinely collected for patients receiving IV opiates and any adverse events were also recorded. Results 23 eligible patientswere enrolled; median age was 51,3years. 47,8% were women and the mean weight was 73 kg. Median dose of IN fentanyl was 106 μg. Two patients have required morphinic analgesia despite having received adapted dose of IN fentanyl. The initial pain scores before IN fentanyl were high with a median of 82,2 mm (59-100). Five minutes after IN fentanyl administration the median pain score dropped to 48mm(36-63) and achieved the lowest score of 8mm(0-22) at 30 min. Pain scores were significantly lower at 5 min (P < 0.001) and at all subsequent time points (P < 0.001). No side effects were recorded. Conclusion Intranasal fentanyl seems to be efficient for analgesia in adult patients with renal colic.

Dyspnoea caused by a Chilaiditi syndrome: contribution of the non-invasive ventilation

A 49-year-old man presented to the emergency department with respiratory distress and extreme abdominal distension, with a history of chronic constipation. His chest auscultation was normal and the patient experienced drowsiness and showed signs of respiratory fatigue. He experienced severe disturbances in blood gas tensions (pH 7.28, PaO2 65 mm Hg, PaCO2 76 mm Hg); …

Takayashu et grossesse

Takayashu arteritis is a chronic inflammatory disease of the large arteries, usually affecting the aorta and its large branches and the pulmonary arteries, with a higher incidence during the childbearing years. We report the case of a 33-year-old patient, primigravida with Takayashu arteritis diagnosed three years ago. At 37 weeks of gestation, she was admitted for a pre-eclampsia and a left ventricular insufficiency. Elective caesarean section under general anesthesia after joint decision between the attending obstetrician and the medical and anesthetic consultants, and allowed the extraction of a hypotrophic baby. The association of pregnancy with Takayashus arteritis is almost always uneventful. It is associated with high values of maternal blood pressure and severe intra-uterine growth retardation.

[Intubation using a videolaryngoscope in an adolescent girl with Rubinstein-Taybi syndrome].

CAN J ANESTH 55: 1 www.cja-jca.org January, 2008 Usually operators introduce the blade of the GlideScope® into the patient’s mouth along the midline of the tongue, and either the blade or the handle is raised in a plane perpendicular to the patient’s mandible to expose the larynx. The styletted ETT is then introduced between the space made by the blade of the GlideScope® and the patient’s mouth. In a patient with a small mouth, the space created by the blade and the patient’s mouth may be narrow, rendering difficulties with ETT insertion (Figure A, B). If the blade of the GlideScope® is inserted nearer to the left corner of the mouth, the operator can attain a larger space for ETT insertion (Figure C) potentially avoiding oropharyngeal mucosal injury. Although the laryngeal inlet may be exposed in a slightly deviated position with this approach (Figure D), visualization of the ETT tip on the video screen will enable easy insertion of the ETT. We have found that this maneuver allows easy introduction of the ETT into the glottis, and have observed no evidence of palatopharyngeal trauma.

Complication rare et grave de la rachianesthésie: la méningite bactérienne (à propos d’un cas et revue de la littérature)

Spinal anesthesia (SA) is the first locoregional anesthesia. It can cause side effects and carry risks that need to be avoided, prevented or treated early. We here report the case of a female patient operated under spinal anesthesia who had intense headache associated with nausea and vomiting evolving in the context of fever within a few days after surgeryLumbar puncture showed cloudy liquid revealing Gram + cocci on direct examination. This allowed the diagnosis of bacterial meningitis. Patients evolution was favorable after antibiotic therapy.

Akinetic mutism revealing an ischemic stroke

ABSTRACT We describe a 44‐year‐old man who developed akinetic mutism following a cerebrovascular accident involving his left middle cerebral artery. We discuss this rare condition and its unusual clinical picture.

Spontaneous splenic rupture from Plasmodium ovalae malaria

A patient of 42 years old, with no specialmedical history, repatriated in the last 2 months from Central Africa, consulted at the emergency service for a fever up to 39.2°C with chills, diffuse abdominal pain and vomiting. Clinical examination found a sensitive abdomen, with hepatosplenomegaly. Laboratory tests with blood smear came back positive for Plasmodium ovalae (0.01% of parasitemia). The blood count formula was found a leukopenia at 3800/mL, anemia at 11 g/dL and thrombocytopenia at 77 000/mL. The C-reactive protein was at 86.4 mg/L. The diagnosis of malaria was retained, and treatment with the combination of Artemether and Lumefantrine was undertaken. We note that, the malaria chemoprophylaxis was based on Mefloquine during the stay and continued until a month of returning from the endemic country. An abdominal scanner has been done and has objectified hepatosplenomegaly with presence of a peri-splenic and peri-hepatic hematoma and abundant effusion inter-hepatorenal, inter intestines, in the para-colic gutter and the Douglas (Figs. 1-3). The patient was admitted to the operating room for an exploratory coelioscopy, which revealed a presence of an intra-peritoneal hematic effusion due to a splenic rupture. Splenectomy aftermedian laparotomy conversion was carried out for the patient to facing the installation of the shockwith low blood pressure at 95/45mmHg requiring vasoactive drugs for its stabilization (Noradrenaline). The patients evolution after the operation was simple.

Spinal hydatidosis mimicking Guillain Barre syndrome: in case of doubt there is no rush to perform lumbar puncture

Guillain Barre Syndrome (GBS) is a challenging pathology which diagnosis is based essentially on the clinical examination and the results of lumbar puncture. Differential diagnosis must be discussed if the clinical picture is not complete. We present the case of a patient who presented to the emergency department with symptoms evoking both GBS and spinal cord compression. The Radiology showed a diffused spinal hydatidosis. The lumbar puncture must be carefully considered. In this case, it would have exposed the patient to hydatid dissemination.