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M Lamy

Publications and source records attributed to M Lamy.

348 records · Page 20Linked to original sources
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[Traumatic subcutaneous ruptures of the cervical trachea (author's transl)].

Traumatic subcutaneous rupture of the cervical trachea is a rare but serious lesion that may cause death of the patient. Few cases come to treatment. This lesion results from a contusion to the anterior neck during hyperextension. It consists in a straight transection between larynx and trachea or between one of the 4 first tracheal rings, and is usually associated to multiple trauma involving the chest and head. Specific symptoms are often blurred by those of the associated lesions making diagnosis complex. This should ideally be confirmed by endoscopy or, if not feasable by cervicotomy. Emergency treatment is directed to restablishment of an adequate ventilation. Direct anastomosis by separate resorbable sutures yields excellent long-term results without stenosis. Creation of a transitory tracheotomy, when commanded by regional atresion, sometimes induces late stenosis; secondary repair is then less favorable. The rate of definitive recurrent nerve paralysis is high. There are also frequent distortions of the vocal cords with modifications of the voice and transitory palsy of the phrenic nerve. The authors draw these conclusions from one personal case and from the literature.

Accidents, Traffic↗
PubMedDate not supplied

Hypnosis as adjunct therapy in conscious sedation for plastic surgery.

BACKGROUND AND OBJECTIVES: Sedation is often requested during local and regional anesthesia. However, some surgical procedures, such as plastic surgery, require conscious sedation, which may be difficult to achieve. Hypnosis, used routinely to provide conscious sedation in the authors' Department of Plastic Surgery, results in high patient and surgeon satisfaction. The authors conducted a retrospective study to investigate the benefits of hypnosis in supplementing local anesthesia. METHODS: The study included 337 patients undergoing minor and major plastic surgical procedures under local anesthesia and conscious intravenous sedation. Patients were divided into three groups depending on the sedation technique: intravenous sedation (n = 137) using only midazolam and alfentanil; hypnosis (n = 172), during which patients achieved a hypnotic trance level with age regression; and relaxation (n = 28), comprising patients in whom hypnosis was induced without attaining a trance level. In all three groups, midazolam and alfentanil were titrated to achieve patient immobility, in response to patient complaints, and to maintain hemodynamic stability. Midazolam and alfentanil requirements; intra- and postoperative pain scores; as well as pre-, intra-, and postoperative anxiety score, reported on a 10-cm visual analog scale, were recorded and compared in the three groups. RESULTS: Intraoperative anxiety reported by patients in the hypnosis group (0.7 +/- 0.11) and in the relaxation group (2.08 +/- 0.4) was significantly (P < .001) less than in the intravenous sedation group (5.6 +/- 1.6). Pain scores during surgery were significantly greater in the intravenous sedation group (4.9 +/- 0.6) than in the hypnosis group (1.36 +/- 0.12; P < .001) and the relaxation group (1.82 +/- 0.6; P < .01). Furthermore, midazolam requirements were significantly lower in the hypnosis group (P < .001) and in the relaxation group (P < .01) as compared with the intravenous sedation group: respectively, 0.04 +/- 0.002, 0.07 +/- 0.005, and 0.11 +/- 0.01 mg/kg/h. Alfentanil requirements were significantly decreased in the hypnosis group, as compared with the intravenous sedation group: 10.2 +/- 0.6 microgram/kg/h versus 15.5 +/- 2.07 micrograms/kg/h; P < .002. In the relaxation group, alfentanil requirements were 14.3 +/- 1.5 micrograms/kg/h (ns). Postoperative nausea and vomiting were reported by 1.2% of patients in the hypnosis group, 12.8% in the relaxation group and 26.7% in the intravenous sedation group. Greater patient satisfaction with the anesthetic procedure and greater surgical comfort were also reported in the hypnosis group. CONCLUSIONS: Successful hypnosis as an adjunct sedation procedure to conscious intravenous sedation provided better pain and anxiety relief than conventional intravenous sedation and allowed for a significant reduction in midazolam and alfentanil requirements. Patient satisfaction was significantly improved.

Adult↗