Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1989
[Prospective preoperative survey of 300 patients using prick tests with muscle relaxants].
It is now well established that the retrospective diagnosis of anaphylaxis to muscle relaxants may be based on skin prick testing. These tests, which use undiluted solutions of muscle relaxants, are as sensitive, specific and reproducible as intradermal tests for the diagnosis of IgE related adverse reactions to muscle relaxants. The rate of muscle relaxant anaphylaxis (1/1 500 to 1/5 000) justifies its prevention based on a possible latent sensitization. ⋯ Muscle relaxants were subsequently used in 58 patients (80% vecuronium) without any problem. Skin prick testing should be used on a larger scale to detect latent sensitization. However, predictive skin tests with atracurium should be avoided, as wheal reactions with this drug are probably due to non-specific histamine release.
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Ann Fr Anesth Reanim · Jan 1989
Case Reports[A mistake in the filling of a vaporizer detected by an infrared analyser of halogenated anesthetic agents].
An anaesthetic pitfall related to an incorrectly filled vaporizer, without harmful effects on the patient, is reported. A halothane specific vaporizer has been accidentally partially filled with enflurane. The incident was suspected when the Datex Normac infrared analyser, calibrated for halothane, displayed an inspired concentration of 0.83% v/v, whereas the Dräger Vapor 19 vaporizer dial was set to deliver 0.4% v/v with a fresh gas flow of 2.7 l.min-1 to a circle system. ⋯ It may therefore be possible to detect a vaporizer filling error when the values "measured" by the analyser are not in concordance with those set on the vaporizer. Filling an enflurane vaporizer with halothane is more dangerous, as it results in a high halothane output with a Normac "enflurane" inspired concentration remaining very low. The indexed pin safety system remains the best means of avoiding wrong vaporizer filling.
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Ann Fr Anesth Reanim · Jan 1989
Case Reports[An unusual failure of the 900 C Siemens Servo ventilator].
Lung overinflation was observed in a patient ventilated by a Siemens Servo Ventilator 900 C. The expiratory valves failure to open was related to a transducer disconnection in the expiratory limb. This transducer controls opening of the expiratory valve and when disconnected expiratory valve remains closed.
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Ann Fr Anesth Reanim · Jan 1989
[Predictive value of intradermal tests using muscle-relaxing drugs].
A retrospective postal inquiry was carried out to find out a possible relation between the results of intradermal tests carried out for a previous anaesthetic and the course of a second anaesthetic performed afterwards. This study included 350 patients who have had an intradermal test to vecuronium, alcuronium, suxamethonium, gallamine, pancuronium, thiopentone, fentanyl and droperidol between March 1984 and November 1986. Eighty-nine did not reply (25.4%), 183 (52.3%) did not undergo new general anaesthetic since the skin tests, whilst 78 (22.3%) did. ⋯ No new anaphylactic reaction was observed. Three anaesthetists only were not aware of the results of the intradermal tests at the time of the new anaesthetic. These data tend to demonstrate that a muscle relaxant could be injected in a patient who has had a previous anaphylactic reaction with positive intradermal tests, provided that the drug chosen for the new anaesthetic does not give a positive intradermal reaction.
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Ann Fr Anesth Reanim · Jan 1989
[Truncal anesthesia of the foot at the level of the ankle: an additional reference mark for the approach to the posterior tibial nerve].
Nerve trunk blocks at the ankle could be a most interesting technique of regional anaesthesia. Unfortunately the posterior tibial nerve is difficult to locate with the usual recommended anatomical landmarks (the tibialis posterior artery). The use of the flexor hallucis longus tendon as an additional landmark has been tested in 71 patients scheduled for surgery on the foot (emergency trauma surgery, amputations, ingrowing toe-nails, removal of bedsores, verrucas). ⋯ Anaesthesia was obtained in 10 +/- 3 min, lasting from 180 to 240 min. There were 88.7% excellent results (n = 63), with 7% fair (n = 5) and 4.2% bad (n = 3) results. Failure concerned 5 cases of tibial nerve block, often due to landmark difficulties (great toe previously amputated, significant ankle oedema, lack of operator experience) and, in 3 cases, forgetting to block a nerve involved.(ABSTRACT TRUNCATED AT 250 WORDS)