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The occurrence of tension pneumopericardium in patient in spontaneous ventilation after blunt trauma is rare. The diagnosis is difficult and it may remain unrecognized. The authors reported the case of a 50 year-old trauma patient with a tension pneumothorax associated with a pneumopericardium. The patient was not mechanically ventilated at any time. Pericardial relief was obtained by insertion of a chest tube. [Copyright &y& Elsevier]

Abstract: Background: Intrathecal morphine (IT) is commonly used for postoperative analgesia after caesarean section. The addition of intrathecal (IT) magnesium to spinal bupivacaine-fentanyl anaesthesia increases the duration of spinal analgesia for labour without additional side effects. In this prospective, randomized, double blind, controlled study, we evaluated whether adding intrathecal magnesium could prolong spinal morphine analgesia after caesarean section. Parturient and methods: After ethics committee approval and obtaining written consent, one hundred and five (ASA I or II) adult patients undergoing caesarean section were recruited. They were randomly allocated to one of three groups: (1) group Morphine (M): 10mg of isobaric bupivacaine 0.5% (2ml)+100μg morphine (1ml)+10μg fentanyl (0.1ml)+1ml of isotonic saline solution, (2) group Magnesium (Mg): 10mg of isobaric bupivacaine 0.5% (2ml)+100mg of magnesium sulphate 10% (1ml)+10μg fentanyl (0.1ml)+1ml of isotonic saline solution, (3) group Morphine+Magnesium (MMg): 10mg of isobaric bupivacaine 0.5% (2ml)+100mg of magnesium sulphate 10% (1ml)+100μg morphine (1ml)+10μg fentanyl (0.1ml). We recorded the following: time to the first analgesic request, pain scores with the visual analogic scale at rest and in movement at h0, h1, h2, h4 and then every 4h for the first 36 postoperative hours, the occurrence of adverse events and patients’ satisfaction. Results: Time of the first analgesic request was 28±8h in group MMg versus 19±6h in group M and 7±6h in group Mg (p <0.01). Pain scores were statistically lower in group MMg (9±7 and 17±9mm respectively) compared to group M (16±9 and 28±11mm respectively) and Mg (21±9 and 37±13mm respectively) (p <0.01). There was no difference in adverse events among the three groups. Patients satisfaction was better in group MMg (p <0.01). Conclusion: In patients undergoing caesarean section under spinal anaesthesia, the addition of IT magnesium sulphate (100mg) to morphine 100μg improved the quality and the duration of postoperative analgesia without increasing the incidence of adverse effects. [Copyright &y& Elsevier]

Abstract: Objective: Opioids are routinely omitted at the induction of general anesthesia for Caesarean delivery because of the risks of respiratory neonatal depression. The short-acting opioid remifentanil may afford advantages at the induction and surgical stimulation, without subsequent neonatal depression. Patients and methods: In this double-blinded study, 40 at term women undergoing elective Caesarean section and requiring general anaesthesia were allocated randomly to receive either remifentanil (0,5 μg/kg) at the induction of anaesthesia (G1, n=20) or placebo (G2, n=20). Induction of anaesthesia was performed with propofol 2 mg/kg and succinylcholine 1 mg/kg. Anaesthesia was maintained with nitrous oxide in oxygen (50/50%, v/v), propofol (100 μg/kg/min), remifentanil (0.2 μg/kg/min) and atracurium. Neonates were assessed by using Apgar scores, possible respiratory depression, with or without ventilation in the mask or intubation and umbilical cord blood gas (artery: UA and vein: UV). Values are expressed as mean values ±SD. Pearson''s Chi squared and t-test were used for statistical analysis P <0.05 was considered significant. Results: Maternal systolic pressure, mean pressure and heart rate were significantly higher in G1 at induction. Apgar scores, heart and respiratory rate were similar between groups. Seven episodes of respiratory depressions were noted (3 in G1, 4 in G2). Five neonates required only brief assisted ventilation by face-mask (2 in G1, 3 in G2). Conclusion: Remifentanil (0.5 μg/kg) at the induction of anaesthesia in elective Caesarean section under general anaesthesia can be used without subsequent neonatal depression. However, we believe that further research is necessary to extrapolate these results to a pregnancy carrying an acutely distressed foetus. [Copyright &y& Elsevier]