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Nantes, France

After knee and hip surgery, lower limb blocks impair deambulation due to a decrease in quadriceps muscle strength (femoral nerve block) or gluteal, hamstring and leg muscles strength (sciatic nerve block). The risk of fall is close to 1% after hip and knee surgery. The role of continuous femoral block is still debated. The risk of fall must be prevented by a careful evaluation of walking and muscle strength and by a material support combined with the help of health care providers. © 2014 Elsevier Masson SAS.

Colchen A.,Unite dendoscopie | Fischler M.,Service dAnesthesie
Revue de Pneumologie Clinique | Year: 2011

An emergency interventional endoscopic procedure is often the only way to overcome an asphyxic or pre-asphyxic situation. From November 1978 to June 2010 we performed 9950 interventional endoscopies among which 20% were performed in an emergency context. To obtain a homogeneous study group, we reviewed the last four years. 344 interventional emergency endoscopies were done for the following indications: cancers (n=240, 70%), iatrogenic stenosis (n=63, 18%), foreign bodies (n=29, 8.5%), hemoptysis (12, 3.5%). The same technique was used in all cases: operating room, general anesthesia, rigid bronchoscope, laser, cryotherapy. Outcome was favorable in 85% of cancers and 100% in all other indications. Apart from clear-cut cases, it remains difficult to define the true emergency. Whatever the definition retained, a well-trained anesthetic and endoscopic team is crucial for proper intervention in these potentially life-threatening situations. © 2011 Elsevier Masson SAS.

Alfonsi P.,Service Anesthesie Reanimation | Slim K.,Estaing University Hospital Center | Chauvin M.,Service Anesthesie Reanimation | Mariani P.,University Pierre and Marie Curie | And 2 more authors.
Journal of visceral surgery | Year: 2014

Enhanced recovery after surgery provides patients with optimal means to counteract or minimize the deleterious effects of surgery. This concept can be adapted to suit a specific surgical procedure (i.e., colorectal surgery) and comes in the form of a program or a clinical pathway covering the pre-, intra- and postoperative periods. The purpose of these Expert Panel Guidelines was firstly to assess the impact of each parameter typically included in the fast-track programs on six foreseeable consequences of colorectal surgery: surgical stress, postoperative ileus, fluid and electrolyte imbalances, decreased postoperative mobility, sleep disorders and postoperative complications; secondly, to validate the value of each parameter in terms of efficacy criteria for success of rapid rehabilitation programs. Two primary endpoints were selected to evaluate the impact of each parameter: the duration of hospital stay and rate of postoperative complications. For some of the parameters, the lack of information in the literature forced the experts to assess the parameter using different criteria (i.e., the duration of postoperative ileus or quality of analgesia); improvement in endpoints favored the implementation of a rapid rehabilitation program. After analysis of the literature, 19 parameters were identified as potentially impacting at least one of the foreseeable consequences of colorectal surgery. GRADE(®) methodology was applied to determine a level of evidence and the strength of recommendation regarding each parameter. After synthesis of the work of experts on the 19 parameters using GRADE(®) methodology, the organizing committee reached 35 formal recommendations. The recommendations were submitted and amended by a group of reviewers. After three rounds of Delphi quotes, strong agreement was obtained for 28 recommendations (80%) and weak agreement for seven recommendations. Consensus was reached among anesthesiologists and surgeons on a number of tactics that are insufficiently applied in current rehabilitation programs in colorectal surgery such as: pre-operative intake of carbohydrates; optimization of intra-operative volume control; resumption of oral feeding within 24 hours; gum chewing after surgery; getting the patient out of bed and walking on D1. The panel also clarified the value and place of such approaches as: patient information; pre-operative immunonutrition; laparoscopic surgery; antibiotic prophylaxis; prevention of hypothermia; systematic medication to prevent nausea and vomiting; morphine-sparing analgesia techniques; indications and techniques for bladder catheterization. The panel also confirmed the futility of other methods such as: bowel preparation for colon surgery; maintaining a nasogastric tube; surgical drainage for colorectal surgery. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Gicquel-Schlemmer B.,Service dOrthopedie Traumatologie | Beller J.-P.,Service dAnesthesie | Mchalwat A.,Service dAnesthesie | Gicquel P.,Service de Chirurgie Pediatrique
Orthopaedics and Traumatology: Surgery and Research | Year: 2015

The authors report a case of a shoulder arthroscopy in which epinephrine saline irrigation was held responsible for acute hypertension followed by fatal Takotsubo cardiomyopathy. © 2015 Elsevier Masson SAS.

Bouzinac A.,Service dAnesthesie
Praticien en Anesthesie Reanimation | Year: 2016

Ultrasonography allows developing new techniques of regional anesthesia in the setting of postoperative pain control after breast surgery: the PEC 1 and 2 blocks, and the serratus plane block. The PEC block 1 provides pectoralis major muscle relaxation that is useful for reconstructive breast surgery or complete mastectomy. The PEC block 2 and the serratus plane block concerning the lateral endings of the intercostal nerves could be promoted asalternative to the paravertebral block. These blocks can be performed under general anesthesiaor sedation. They can be combined depending on the surgical area and the extension of sensoryblock required. © 2015 Elsevier Masson SAS.

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