[Stellate ganglion radiofrequency neurolysis under CT guidance. Preliminary study]

Sympathetically maintained pain syndrome of the upper limb is difficult to treat even with high doses of specific medication. Stellate ganglion block by in situ injection of a local anesthetic is an efficient and accepted method for diagnosis and treatment. The sedative effect is however transitory linked to the short effect of the drug. CT guidance, displaying an excellent contrast between soft tissues, bones, vessels and nerves, is a well suited and safe mean of guidance. Seven patients suffering from reflex sympathetic dystrophy were treated by stellate ganglion radiofrequency (RF) neurolysis at two sites (C7 and T1). Patients were evaluated for pain before and immediately after the procedure and at three months. Four patients had a significant (50%) pain relief lasting at 3 month. One patient had a temporary pain (one week) and 2 no pain relief. No patient had a Horner syndrome. One patient had a temporary neuralgia of surrounding nerves (brachial plexus). RF neurolysis of stellate ganglion under CT-guidance is precise and appears efficient but further investigation on a larger cohort of patients is needed.

[Stellate ganglion radiofrequency neurolysis. Report of a case followed over a 3-year period]

We present the case of a patient who experienced residual ischemic symptoms and invalidating chronic pain after an injury where three fingers of his left hand were sliced off by a chain saw. He underwent 5 stellate ganglion RF neurolysis over a two year period, followed by progressive and complete pain relief. We will underscore the value of CT guidance during needle placement and the efficacy of RF neurolysis.

[Value of the radionetwork of the transportation company in Besançon for alarm forwarding]

The C.B. users offered for a few years a way for putting-out the distress on the highway. There were 2,000 in Besançon and surroundings in 1982. Today they are becoming no existent. Since then a new system of alarm run is born with 150 buses, 178 kilometers of net-travel and a sweep frequency of 10 min from 6h30 a.m., to 8h p.m, and of 30 min until 12h p.m. The 250 "C.T.B." drivers assume a regular surveillance of the urban and suburban highways. A standard message in used between the C.T.B. (Besançon Company of Buses.) regulation and Samu 25, regulation which allows to fix circumstances, place of road accident and inventory of casualties: 27 emergency calls are received in 1987, 50 in 1988. It might be possible to use other private or public radiotelephonic network.

[Monitoring of gases and vapors in the anesthesia system]

By now inhalation anesthesia makes anesthetic gaz and vapours analysis compulsory. This paper give an account of numerous gaz analyzers which are available today. Different kinds of oximeters (galvanic, polarographic, paramagnetic) carbon dioxide analysers, halothane, enflurane or isoflurane-meters are reviewed. Advantage/cost ratio of mass spectrometer is discussed too. Practical advices on use and site of slow and fast analysers are recalled.

[Flowmeters and safety rotametric mixers]

Rules and principles in choice of flowmeter take in account the advices of French National Approval Committee. Several and more frequently used and modern flowmeters are discussed, authors wishing an European harmonization of the safety guidelines in anaesthesia for 1993.

[Prevention of early respiratory complications in esophageal surgery by ventilation of the independent lungs]

Independent lung controlled ventilation by a double lumen tube has a beneficial effect in oesophagus surgery. Use of a tidal volume and an end-expiratory pressure different for each lung produces a drastic reduction of chest-X-ray abnormalities. In an homogen group of ten patients studied before and treated with conventional respiratory support, chest-X-ray abnormalities were seen in 80% cases. In this group of 34 patients treated with independent lung ventilation the rate of abnormalities is only of 20%. Independent lung ventilation decreases early pulmonary complications in dependent regions of the lungs, and late pulmonary complications in non dependent regions. This form of mechanical ventilation is performed with a "prototype" ventilator of small size, which permits synchronized or independent ventilation of the lungs.

[Choice of a central analgesic for anesthesia with spontaneous respiration]

The ventilatory effects of tramadol (T) and nefopam (N) are evaluated in anesthetized patients with enflurane in a closed circuit breathing system and compared with the effects of pentazocine (P). The following parameters tidal volume (VT), minute ventilation (V), CO2 (capnometry) occlusion pressure (OP), ventilatory response to hypercarbia are recorded after 30 minutes of anaesthesia, before and after repeated injections of the analgesics, P: 15 mg, N: 40 mg, T: 100 mg are injected I.V., and analgesics administration is repeated at 30 minutes interval, so that the patients receive a total P dose of 30 mg, a total N dose of 60 mg and a total T dose of 200 mg. The administration of 15 mg of P induces a change in VT (-24%), ventilatory frequency (-40%), OP (-18) OP only returns to basal values after a second dose. The ventilatory response to hypercarbie is indeed satisfying (increase of 61% in V). After N and T, ventilatory frequency is not disturbed. V increases of 16% and 11% respectively after the first injection, and of 31% and 2% after the second injection. OP increases by 39% and 56% respectively after the first injection and gets better over time with nefopam (+ 58%), 30 mg of P. 20 mg of N and 100 mg of T are equivalent for analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)