GRAND MAL SEIZURE AFTER EXTRADURAL MORPHINE ANALGESIA

SUMMARY Following an elective Caesarean section under extradural anaesthesia, a 30-yr-old known epileptic woman (gravida 4, para 3) developed a tonic-clonic seizure, 6 h after the administration of morphine 3 mg into the extradural space. Possible aetiological factors are discusse

Grand mal seizure after extradural morphine analgesia

Following an elective Caesarean section under extradural anaesthesia, a 30-yr-old known epileptic woman (gravida 4, para 3) developed a tonic-clonic seizure, 6 h after the administration of morphine 3 mg into the extradural space. Possible aetiological factors are discussed

Regard sur le paysage. Un projet pour Lavaux (VD)

Le projet questionne la manière d'intervenir dans un paysage protégé, fragile et figé par les récents processus de patrimonialisation et de protection. Il se concentre sur le rapport entre l'objet architectural et territorial afin d'établir quelle doit être la formule expressive de l'objet pour acquérir une dimension territoriale.  Le développement du projet se situe à l'intermédiaire de deux attitudes antinomiques: le mimétisme et l'opposition. Par l'affirmation, il présente une manière d'intervenir aujourd'hui dans un tel lieu. Ainsi, les motivations du choix des matériaux, de la géométrie, de la technique de mise en œuvre et de l'expression, tantôt s'assimilent, tantôt contrastent avec celles des bâtisseurs de Lavaux. La recherche de sites appropriés à la concrétisation de projets met en évidence une série d'opportunités. Les communes de Lavaux prévoient la réalisation de plusieurs parkings ‘‘camouflés'' sous la vigne dans le but de conserver le paysage intact. Le travail critique cette idée simpliste d'intégration. Il étudie les potentiels inexploités et tire avantage des problématiques liées à de telles réalisations

Percutaneous transtracheal jet ventilation for paediatric endoscopic laser treatment of laryngeal and subglottic lesions

Percutaneous transtracheal high frequency jet ventilation (TTJV) in adults is frequently used during anaesthesia for laryngeal microsurgery. It provides excellent surgical operating conditions and safety for the patient. The technique has not been evaluated in infants and children. Accordingly, we studied 16 infants and children (mean age 5.5 +/- 3.8 yr, range 6 wk-12 yr) who underwent 28 consecutive endoscopic procedures with laser microsurgery of the glottic or subglottic space under general anaesthesia using a TTJV technique. All patients had a severe obstructive lesion of the larynx and/or upper trachea. The mean duration of the procedure was 70 +/- 27 min (range 30-140 min). Indications for TTJV were: subglottic stenosis: 5, haemangioma: 4, laryngeal papillomatosis: 5, pharyngeal cyst: 1, laryngomalacia: 1. Adequate control of the airway and satisfactory gas exchange were obtained in all cases. Surgery was performed without being impeded by anaesthetic equipment. Three complications occurred: one extensive surgical emphysema; one bilateral pneumothorax; one severe vagus-induced cardiovascular depression. Prompt and complete recovery without sequelae followed appropriate treatment. In 32% of the cases, the children were outpatients and in about half of the procedures (13/28) they left the hospital between the first and the third day. We conclude that percutaneous transtracheal jet ventilation is effective in paediatric endoscopic surgery. Procedures that might otherwise require a tracheostomy can be performed safely with this minimally invasive technique. Adequate indications and appropriate understanding of the technique and its potential problems are required for its correct application and successful use