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J M Devys

Publications and source records attributed to J M Devys.

7 recordsLinked to original sources
PubMed2004

Early exploration of diplopia with magnetic resonance imaging after peribulbar anaesthesia.

We report the cases of five patients who have experienced postoperative diplopia after cataract surgery under peribulbar anaesthesia and in whom orbital Magnetic Resonance Imaging was performed immediately after the diagnosis. In four patients, the imaging study showed a T2 hyper-intensity signal and swelling of one extraocular muscle that was interpreted as oedema. Therefore, these cases were most probably a result of an accidental i.m. injection of local anaesthetics. In the other patient, the imaging study revealed no abnormality.

Aged↗
PubMed2003

[Neuromuscular blockade monitoring at the corrugator supercilii and ocular myasthenia gravis].

A 67-year-old patient suffering from an ocular myasthenia gravis was scheduled for an elective ENT surgery. General anaesthesia was induced intravenously. Neuromuscular responses after train-of-four stimulation were normal at both the adductor pollicis (T(4)/T(1) = 1) and the corrugator supercilii (4 visual responses). Then cisatracurium (0,15 mg kg(-1)) was administered to allow tracheal intubation. The laryngoscopy attempted 45 s after cisatracurium injection (no response at the supercilii, T(1)/T(0) = 1 at the adductor pollicis) was unsuccessful because of closing and moving vocal cords. The second attempt was successful 4 min after cisatracurium injection (no response at the corrugator supercilii, T(1)/T(0) = 0.05 at the adductor pollicis). Residual neuromuscular blockade was antagonized at the end of surgery (1 h long) allowing an uneventful extubation. We concluded that monitoring neuromuscular blockade at the corrugator supercilii to assess the intubating conditions is not recommended in a case of ocular myasthenia gravis.

Aged↗
PubMed2003

[Pressure-volume relationship for paediatric cuffed tracheal tube].

OBJECTIVE: Define the pressure-volume relationship of the cuff of paediatric cuffed tracheal tubes. STUDY DESIGN: Experimental study. MATERIALS AND METHODS: The cuff pressure was measured after incremental 0.1 ml filling volumes for 6 sizes (3.0 to 5.5 mm of internal diameter) of paediatric high volume-low pressure cuffed-tracheal tubes. The pressure-volume relationship of the cuff was assessed with and without resistance to the filling. Results were expressed with medium +/- SD. RESULT: Each increment increased the cuff pressure, without resistance, of 7.3 +/- 1.7 mmHg for sizes 3.0, 3.5 and 4.0, 4.8 +/- 1.6 mmHg for size 4.5, and 2.3 +/- 0.9 mmHg for sizes 5 and 5.5. The resistance decreased the filling volume of the cuff for each size of tracheal tubes. CONCLUSION: The margin of safety provided by cuff of smallest cuffed tracheal tubes is too small. Then, the smallest sizes (3.0 to 4.5) should not be called low pressure-high volume cuff.

Air Pressure↗
PubMed2002

[Orbital exenteration: an unusual cause of failure of assisted ventilation from a face mask].

Orbitary exenteration for tumor may concern ethmoidal wall, and may create a large communication between the orbital cavity and the cavum. We present the case of a patient scheduled for ocular prosthetic surgery after an unilateral orbitary exenteration. After intravenous induction of the general anaesthesia, anaesthesiologist failed to achieve adequate facial mask ventilation because of a great gas leakage from cavum to orbital cavity. Inserting packing in the orbitary cavity allowed to decrease gas leakage and to get adequate facemask ventilation. We recommend orbitary radiographic and clinical evaluations for patient with orbitary exenteration before general anaesthesia to evaluate the communication between the orbital cavity and the cavum. Such an anatomic communication may result in inefficient facial mask ventilation.

Anesthesia, General↗
PubMed2000

Biting the laryngeal mask: an unusual cause of negative pressure pulmonary edema.

PURPOSE: To describe negative pressure pulmonary edema due to biting of the laryngeal mask tube at emergence from general anesthesia. CLINICAL FEATURES: A healthy patient underwent general anesthesia using a laryngeal mask airway and mechanical ventilation. During recovery, the patient strongly bit the laryngeal mask and made very forceful inspiratory efforts until the mask was removed. Five minutes later, the patient developed dyspnea and had an hemoptysis of 50 ml fresh blood. Chest radiograph showed bilateral alveolar infiltrates. Pharyngo-laryngeal examination was normal. Bronchoscopy revealed no injury but diffuse pink frothy edema fluid. Clinical examination and chest radiograph became normal after 12 hr of nasal oxygen therapy confirming airway obstruction as the most available cause of this pulmonary edema. CONCLUSION: Airway obstruction due to biting of a laryngeal mask tube may result in negative pressure pulmonary edema.

Adult↗