The aim of the present study was to determine whether free thyroxine (FT4) and calculated thyroid parameters predict the incidence of ventricular arrhythmias in euthyroid heart failure patients with implantable cardioverter-defibrillators (ICD). In this open-label prospective cohort study, 115 consecutive euthyroid patients (mean age 62.9 ± 1.3 years; 87% male; ischemic cardiomyopathy 63%) scheduled for primary prevention ICD implantation or exchange were enrolled. Serum concentrations of thyrotropin (thyroid-stimulating hormone) and FT4 were measured 1 day before device operation. Primary and secondary end points were defined as occurrence of appropriate ICD therapy (AIT) and cardiovascular death, respectively. During a mean follow-up of 1,191 ± 35 days, 24 patients (21%) experienced AIT, and cardiovascular death was observed in 10 patients (9%). Patients with AIT had higher FT4 concentrations compared with those without AIT (18.9 ± 0.48 vs 16.2 ± 0.22 pmol/L, p <0.001). FT4 was an independent predictor of AIT in an adjusted Cox regression (hazard ratio = 1.47, p <0.001). Kaplan-Meier analysis demonstrated that Jostel's thyroid-stimulating hormone index, reflecting the central component of the hypothalamus-pituitary-thyroid loop, and SPINA-GT as surrogate markers for thyroid's secretory capacity predicted AIT incidences. None of the indices predicted cardiovascular death. In conclusion, FT4 concentration predicts an increased incidence of ventricular arrhythmias in euthyroid patients receiving ICDs for primary prevention. Our data suggest that both impending primary hyperthyroidism and an increased thyroid homeostasis set point may increase the rate of AIT in this patient population.

Les auteurs rapportent le cas d’un adolescent de 14 ans admis pour coma brutal sans signe de localisation avec pour seule orientation étiologique le décès d’un oncle maternel âgé de 30 ans dans un contexte de trouble de conscience inexpliqué. Ce coma était associé à une hyperammoniémie à 344 μmol·l–1 et a rapidement évolué vers la mort cérébrale malgré les traitements entrepris et la normalisation de l’ammoniémie. Le diagnostic de déficit héréditaire en ornithine carbamyl transférase a été confirmé par une ponction biopsie hépatique en post-mortem immédiat. Les auteurs recommandent le dosage de l’ammoniémie devant tout coma sans étiologie évidente, quel que soit l’âge du patient. Le traitement doit être mis en œuvre d’extrême urgence.The authors report the case of 14-year-old boy admitted for acute coma without neurological focal symptom. The only relevant finding was the death of one uncle after a coma in the year 1992. This coma was associated with an ammonia blood level of 344 μmol l–1 and it rapidly lead to cerebral death despite a symptomatic treatment. The diagnosis of hereditary ornithine transcarbamylase deficiency was confirmed by liver biopsy in the immediate post-mortem period. The authors recommend the measurement of blood ammonia in every coma without diagnosis, whatever patient’s age.

Gas embolism at the end of infusion is a well known hazard, that should have disappeared with the use of flexible bags. However, some cases have been reported after pressure infusion. This experimental study evaluates the risk for gas embolism with Ecoflac type flexible bags. These bags are safe under normal pressure infusion conditions with a pneumatic sleeve, because of their texture and pliability; indeed, only minimal air volumes could be expelled, without any risk even in children. However, to be on the safe side, the manufacturer recommends to expel any residual air before pressure administration. This recommendation applies to any bag containing residual air, and since many people are not aware of this, it is rarely put into practice.

A case of intraoperative subtotal obstruction of a reusable coiled expiratory breathing tube is reported. Partial occlusion by twisting was made possible by detachment of the coil from the external face of the tube after multiple reprocessings with high drying temperatures. A technique for tube checking before reuse is described.

Un cas d’obstruction sub-totale peropératoire d’un tuyau expiratoire réutilisable est rapporté. Cette occlusion partielle par torsion est rendue possible par le décollement de la spirale de la paroi externe du tuyau du fait de son exposition répétée à des températures de séchage élevées. Une technique de vérification du tuyau avant réutilisation est proposée.

UNLABELLED:This article reviews the development of STANDARDS, Recommendations and Guidelines for practice in anaesthesiology in France and other countries. The French society for anaesthesia and intensive care (Sfar) has published, since 1989, 11 basicSTANDARDS:1) Recommendations for the monitoring of patients during anaesthesia (June 1989, amended on January 1994) [APSF Newsletter, Summer 1990, page 22]; 2) Recommendations for postanaesthesia monitoring and care (September 1990); 3) Recommendations for preanaesthesia care (September 1991); 4) Recommendations for anaesthetic apparatus and checking before use (January 1994); 5) Recommendations for the equipment of anaesthesia working places (January 1995); 6) Recommendations for the tasks of the nurse anaesthetist (January 1995); 7) Recommendations for hygiene standards in anaesthesia practice (December 1997); 8) Recommendations for outpatient anaesthesia (September 1990); 9) Recommendations for the practice of obstetrical analgesia (September 1992); 10) Recommendations for interhospital physician-accompanied transfers (December 1992); 11) Recommendations for intrahospital physician-accompanied transfers (February 1994). Additionally the Sfar produced or coproduced 9 Experts' conferences, 15 Consensus conferences and 5 Guidelines for clinical practice.

À partir des années 1980, les sociétés d’anesthésie-réanimation ont produit des Recommandations ou Standards s’appliquant à la pratique de l’anesthésie et dont le principal est consacré à la surveillance du patient en cours d’anesthésie. Ils ont été suivis de textes d’aide à la décision, sous forme de conférences d’experts, de conférences de consensus et de recommandations pour la pratique clinique. Ce travail fait le point sur les publications françaises et les compare aux principaux textes étrangers.

Le « facteur d’impact » (FI) d’une revue scientifique est le rapport entre le nombre de citations pendant une année donnée d’articles parus pendant les deux années précédentes dans cette revue et celui des articles publiés dans celle-ci pendant ces deux années. Le FI, initialement mis au point pour servir d’indicateur de la qualité d’un journal, est actuellement surtout utilisé comme indicateur de la qualité d’un article qui y a été publié. Mais l’impact d’un journal n’est pas l’équivalent de celui d’un article donné. C’est pourquoi le FI n’est pas un outil précis pour évaluer la qualité scientifique de l’auteur de cet article.

The <<impact factor>> (IF) of scientific journals is defined as the number of citations obtained over a one-year period of articles published during the two previous years in a journal, divided by the number of articles published in that journal during the preceding two years. The IF, initially devised as an indicator of the quality of a journal, is at present mainly considered as an indicator of the quality of an article contained in that journal. However the IF of a journal is not equivalent to the actual impact of an article. Therefore the IF is not an accurate tool for assessment of the scientific quality of the author of that article. The Ifs of journals published in English are significantly higher than the Ifs of those in another language, mainly as English is the language used for international communication and as English speaking authors rarely cite articles published in another language, The IF of the journal of the French society for anaesthesiology and intensive care, the Annales francaises d'anesthesie et de reanimation (Afar), is about seven times below the IF of Anesthesiology, which has the highest IF in the category <<Anesthesiology>>. From 1992 to 1998, the relative impact value of the Afar has increased by 429%. However the absolute value remains low. (C) 2000 Editions scientifiques et medicales Elsevier SAS.

Les valves de non reinhalation, associaes a un ballon reservoir, ont ete developpees a partir de 1946 pour l'anesthesie pediatrique. Elles ont ensuite aussi ete utilisees comme circuit accessoire chez l'adulte. En anesthesie elles ont ete progressivement abandonnees dans la decennie 1960-1970, sauf en France et dans quelques pays voisins. A partir de 1957 elles ont ete associees a un ballon autoremplisseur pour former les insufflateurs manuels qui sont le dispositif de base de la reanimation respiratoire et du transport des patients.

OBJECTIVES:To analyse the design, performance, failures, the checking before use of mechanical fresh gas delivery units (FGDUs) equipped with bobbin or ball-flowmeters delivering a continuous gas flow and calibrated vaporizers, marketed in France in 1999.DATA SOURCES:Articles were obtained from a Medline review (1960-1999; search terms: anaesthetic machine, flowmeter, vaporizer), textbooks and personal files; specific data were provided by manufacturers.STUDY SELECTION AND DATA EXTRACTION:The articles were considered for performance data, benefits and drawbacks, and characteristics, as well as the risks carried by mechanical FGDUs.DATA SYNTHESIS:Seven anaesthetic machines out of 11 are equipped with mechanical FGDUs, including rotameters delivering a gas mixture up to 30 L.min-1, calibrated vaporizers and an O2-flush valve delivering at least 500 mL O2 per second (30 L.min-1). These units allow closed circuit anaesthesia. They carry a risk for barotrauma as three out of them can deliver at the gas outlet of the FGDUs a gas mixture at a pressure reaching 3.5 bars and four others at a pressure of 150-200 mmHg. They also carry a risk for hypoxia, either from a preferential leak of oxygen at the corresponding rotameter or the O2-flush valve, or from a leak of fresh gas mixture either in a vaporizer or the selectatec manifold. The vaporizers carry a risk for vapor delivery at a concentration differing notably from the value set on the concentration dial. Therefore their accuracy must be checked periodically and the FGDUs checked for a leak after the addition to or the removal of a vaporizer from the selectatec manifold. The optimal technique for leak detection is the negative pressure test.

Accessory or ancillary anaesthesia breathing systems can be defined as all those connected to the fresh gas outlet of the anaesthetic apparatus and used instead of the circle system associated with the ventilator, which is the main circuit. They include: the Mapleson systems, the systems with a nonrebreathing valve and the disposable systems with a carbon dioxide absorber. They can be a cause of major accidents when not checked before and monitored during use. This technical note describes techniques of preanaesthetic checking and monitoring during anaesthesia. (C) 1999 Elsevier, Paris.

To analyse the design, performance, failures, the checking before use of mechanical fresh gas delivery units (FGDUs) equipped with bobbin or ball-flowmeters delivering a continuous gas flow and calibrated vaporizers, marketed in France in 1999.Articles were obtained from a Medline review (1960-1999; search terms: anaesthetic machine, flowmeter, vaporizer), textbooks and personal files; specific data were provided by manufacturers.The articles were considered for performance data, benefits and drawbacks, and characteristics, as well as the risks carried by mechanical FGDUs.Seven anaesthetic machines out of 11 are equipped with mechanical FGDUs, including rotameters delivering a gas mixture up to 30 L.min-1, calibrated vaporizers and an O2-flush valve delivering at least 500 mL O2 per second (30 L.min-1). These units allow closed circuit anaesthesia. They carry a risk for barotrauma as three out of them can deliver at the gas outlet of the FGDUs a gas mixture at a pressure reaching 3.5 bars and four others at a pressure of 150-200 mmHg. They also carry a risk for hypoxia, either from a preferential leak of oxygen at the corresponding rotameter or the O2-flush valve, or from a leak of fresh gas mixture either in a vaporizer or the selectatec manifold. The vaporizers carry a risk for vapor delivery at a concentration differing notably from the value set on the concentration dial. Therefore their accuracy must be checked periodically and the FGDUs checked for a leak after the addition to or the removal of a vaporizer from the selectatec manifold. The optimal technique for leak detection is the negative pressure test.

Objectives: To analyse the design, functioning, benefits and drawbacks of electronic fresh gas delivery units (FGDUs) included in anaesthetic machines marketed in France in 1999.Data sources: Articles were obtained from a Medline(R) review (1980-1999; search terms: anaesthetic machine, flowmeter, vaporizer), textbooks and personal files; specific data were also provided by manufacturers.Study selection and data extraction: The articles were analysed in considering the differences between mechanical and electronic FGDUs.Data synthesis: Four anaesthetic machines out of 11 are equipped with electronic FGDUs. In comparison to mechanical units, they include the following benefits:wide range of accurate gas flow, especially in the tow flow range, with analog and digital display; intermittent delivery of each gas, which is essential for automated gas delivery and quantitative anaesthesia or target controlled (FET vapor) inhatational anaesthesia; facilitated oxygen ratio control; possibility to print the gas and vapor flows on the automated anaesthetic record; interruption of gas flow when the main switch of the machine is set to off; and absence of risk for retropollution. Three FGDUs out of four are adapted for gas delivery to an accessory (ancillary) anaesthetic circuit. However, only one of them delivers a gas flow up to 30 L.min(-1). The specificity of the ADU AS/3(TM) (Datex-Ohmeda) is the bypass vaporizer included in the FGDU with an exchangeable vaporizing chamber (cassette). The specificity of the Julian(TM) (Drager) is the delivery of fresh gas limited to the expiratory phase during mechanical ventilation. The specificity of the the FGDU from Kion(TM) (Siemens) is the possibility to act as an open circuit ventilator, similar to a Servoventilator(TM). The specificity of the PhysioFlex(TM) is an FGDU included in the circle circuit, each gas and liquid anaesthetic being directly injected into the circuit. Data from the French medical device surveillance commission indicate that the main failures occur in the power supply device and the microprocessor. (C) 1999 Editions scientifiques et medicales Elsevier SAS.