RESUMEN
A day case surgery unit offers unquestionable benefits to patients reluctant to hospitalization. Also this practice may contribute to reduce septic risks. However starting it requires clearly defined basis and a very strict selection of patients and procedures. It needs a perfect organization and adapted premises, as well as a thorough collective reflection about patients deep motivations and the whole team ability to accept such constraining activities.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Servicio Ambulatorio en Hospital/organización & administración , Francia , HumanosRESUMEN
A case is reported of an acute onset of previously undiagnosed multiple sclerosis, revealed by an oculomotor paralysis following spinal anaesthesia performed for minor orthopaedic surgery. The need for a complete preoperative physical examination is underlined by this case, looking for latent neuromuscular disorders before undertaking such techniques, and for a thorough neurological work-up should such a complication arise. The harmlessness of regional anaesthesia in multiple sclerosis patients is controversial; without entering into such a debate, the direct relationship between spinal anaesthesia and acute exacerbation of the disease in our patient seemed more than likely.
Asunto(s)
Anestesia Raquidea/efectos adversos , Enfermedades de los Nervios Craneales/etiología , Esclerosis Múltiple/diagnóstico , Parálisis/etiología , Adulto , Femenino , Humanos , Periodo PosoperatorioRESUMEN
The authors report a case of severe Guillain-Barre syndrome that appeared during the eighteenth week of a second gestation which evolved to full term without complication. The particularity of this observation was that the follow-up of the foetus was made possible for the first time by echography which showed normal active foetal movements even during maximum maternal paralysis. From of review of thirty three cases recorded in the literature, it seems clear that the interrelationship between the neurological disorder and pregnancy is nil or minimal beside an increased risk of prematurity childbirth can proceed normally and cesarean section is not indicated. Plasmapheresis proposed as an early treatment is discussed in the case of pregnant women. Today pregnancy is no longer a particular contraindication of such management.