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Introduction: in otolaryngologic surgery, ankle is frequently used for monitoring anesthesia in place of brachial when the patient doesn't need invasive arterial cannulation. If there is a clinically useful and Predictable link between the two readings in hemodynamic normal patient, this difference during otolaryngologic surgery, was not evaluated. We aimed to investigate the reliability and the acceptability of non invasive blood pressure measurements at the ankle compared to those obtained concurrently at the arm during otolaryngologic surgery. Methods: eighty ASA grade I and II patients who had to be operated under general anesthesia were taken as subjects for our study. Blood pressures were measured simultaneously in the 2 limbs before induction and then every 10 minutes until the end of the surgical procedure. Readings were initiated concurrently. Statistical analysis was performed with PASW Statistics 13. Results: there were 41 males (51.2 %) and 39 females (48.8 %). Bland-Altman analysis of mean difference between the ankle and arm (95 % limits of agreement) was -11.47 (- 23.77 to 0.82) mmHg for systolic blood pressure (SBP), - 7.89 (-19.16 to 3.36) mmHg for diastolic blood pressure (DBP) and - 9.09 (18.19 to 0.00) mmHg for mean arterial pressure (MAP). Non-parametric analysis showed that 67.5 % of SBP, 46.2 % of DBP and 56.2 % of MAP measurements differed by > 10mmHg. Conclusion: ankle BP cannot be used routinely in otolaryngological surgery. Although, the ankle can be used as an alternative where the arm cannot be used taking into account a difference. [ABSTRACT FROM AUTHOR]

Many neurosurgical procedures involve the use of a pin-type headrest to immobilize the patient's head. We report the case of depressed skull fracture in an adult patient secondary to the use of Mayfield headrest. The diagnosis was based on postoperative CT scan of the brain following surgical resection of medulloblastoma. Several factors seem to increase the risk of complications due to Mayfield headrest use. Preventive measures are outlined in our literature review. [ABSTRACT FROM AUTHOR]

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Introduction: emergency surgery for pertrochanteric femoral fractures (PFF) in patients at high risk of anaesthetic complications is a real challenge for surgeons due to the increased intraoperative risk. We report our experience with combined lumbar plexus-sciatic nerve block as an alternative anesthetic technique for these fractures., Methods: we conducted a three-year descriptive, single-center, cross-sectional study including patients with a history of recent pertrochanteric femoral fractures (PFF) at high risk anaesthetic complications. Combined lumbar plexus-sciatic nerve block was performed using the common neurostimulation technique. A mixture of 20ml of lidocaine 2% and bupivacaine 0.5% (50/50) was injected into each block. The primary endpoint was the effectiveness of lumbar plexus-sciatic nerve block assessed through the rates from anesthesia-related failures defined as need for conversion into general anaesthesia (GA). The secondary endpoints were: 1) anesthetic technique, 2) intraoperative hemodynamic, respiratory and neurological impairment, and 3) outcomes and potential postoperative complications., Results: the study included 30 patients. The average age of patients was 74 ± 10 years. The average admission time in the Department of Emergency Surgery was 12(5-36) hours. The average duration of the procedure was 15.20 ± 3.45 minutes. No conversion into GA was necessary. There were no statistically significant differences between the various recorded intraoperative hemodynamic and respiratory parameters (MAP, HR, SpO2) (p > 0,05). Surgical procedure duration was 46 ± 5 minutes. Surgical satisfaction was 9.7 ± 0.1. The first post-operative analgesic treatment was started after 8(1-24) hours. All patients had complete sensorimotor recovery., Conclusion: combined lumbar plexus-sciatic nerve block is an anesthetic alternative for urgent PFF surgery in patients at high risk of anaesthetic complications: reduced operative delays, anesthetic efficiency, hemodynamic and intraoperative respiratory stability, absence of complications due to other anesthetic techniques, rapid admission to recovery room, and good postoperative analgesia., Competing Interests: Les auteurs ne déclarent aucun conflit intérêts., (Copyright: Ismail Aissa et al.)

Cardiac arrest in the operating room is a life-threatening event with multiple causes. We report the case of a 53-year old female patient with no particular past medical history scheduled for surgery to manage small intestine cancer. Twenty minutes after anesthetic induction the patient had asystole rapidly reversible after resuscitation measures. The association of face rash with chest rash gave rise to suspicion of late anaphylactic reaction. Rapid patient recovery allowed to resume surgical procedure. Tumor manipulation immediately caused a second severe bradycardia rapidly reversible after the administration of 0.5 mg atropine. Skin rush at the level of the face and the chest occurred again. This second complication immediately gave rise to suspicion of carcinoid crisis. Sandostatine was then administered. No other complication occurred, the patient spent 24 hours in the Intensive Care Unit receiving sandostatine infusion. Urinary 5-HIAA values were very high and histological examination of the surgical specimen confirmed carcinoid tumor. This study aims to highlight the rarity of this entity and the importance of suspecting carcinoid crisis in patients with intraoperative complications during anesthesia for small intestine tumor surgery.

Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.

Inflammatory fibroid polyp (IFP) is a rare benign lesion, originating from the submucosa in the gastrointestinal tract. It generally appears as an isolated benign lesion, rarely located at the level of the ileum. Its origin is controversial. Clinical presentation varies depending on its location; invagination and obstruction are the most common indicative symptoms when the polyp is located at the level of the small intestine. We report the case of a 22-year old patient with abdominal pain, nausea and vomiting and a personal history of intermittent constipation and a weight loss during the previous year. Radiological imaging objectified ileo-ileal invagination completely obstructing the ileum light. Segmental resection of the obstructed ileal segment and termino-terminal anastomosis were performed. The final diagnosis of IFP was established using histological examination and immunohistochemical investigation., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.

Spontaneous pneumomediastinum is a rare disease. It especially affects young adults. The onset is usually sudden, involving chest pain, subcutaneous emphysema and dyspnea. We report the case of a 24-year old asthmatic patient with pneumomediastinum after coughing effort. The patient presented with acute respiratory failure associated with retrosternal chest pain. Chest X-ray confirmed the diagnosis of pneumomediastinum. The patient evolved favorably within 4 days after exsufflation, oxygen therapy and conventional medical treatment., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêt.

The number and the overall survival rate of heart transplant patients are increasing. Some of these patients undergo general surgery other than heart transplant on a regular basis. Anesthesia may be difficult in these patients because of the physiological characteristics of the denervated heart and of the management of immunosuppressive therapy on the basis of the risk of rejection and infection. Our study aims to discuss the anesthetic management of a 60-year-old heart-transplant patient undergoing abdominal hernia repair surgery and to write a literature review., Competing Interests: Conflits d’intérêts Les auteurs ne déclarent aucun conflit d'intérêt.

Many neurosurgical procedures involve the use of a pin-type headrest to immobilize the patient's head. We report the case of depressed skull fracture in an adult patient secondary to the use of Mayfield headrest. The diagnosis was based on postoperative CT scan of the brain following surgical resection of medulloblastoma. Several factors seem to increase the risk of complications due to Mayfield headrest use. Preventive measures are outlined in our literature review.