Service danesthesie reanimation

Le Kremlin-Bicêtre, France

Service danesthesie reanimation

Le Kremlin-Bicêtre, France
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Mertes P.M.,Nancy University Hospital Center | Alla F.,University of Lorraine | Trechot P.,Nancy University Hospital Center | Auroy Y.,Service dAnesthesie Reanimation | And 3 more authors.
Journal of Allergy and Clinical Immunology | Year: 2011

Background: More attention should be paid to rare serious adverse events such as anaphylaxis to increase the safety of anesthesia. Objective: To report the results of an 8-year survey of anaphylaxis during anesthesia in France. Methods: Data from patients who experienced anaphylaxis between January 1, 1997, and December 31, 2004, were analyzed. Estimated incidences were obtained by combining this database with data from the French pharmacovigilance system by using a capture-recapture method. The number of patients exposed to the offending agents was obtained from data collected during the national survey of anesthesia practice. Results: A total of 2516 patients was included. A diagnosis of IgE-mediated reaction was established in 1816 cases (72.18%). The most common causes were neuromuscular blocking agents ([NMBAs]; n = 1067; 58.08%), latex (n = 361; 19.65%), and antibiotics (n = 236; 12.85%). The median annual incidence per million procedures was higher for females 154.9 (5th-95th percentile, 117.2-193.1) than for males 55.4 (5th-95th percentile, 42.0-68.0). It reached 250.9 (5th-95th percentile, 189.8-312.9) for women in cases of allergic reactions to NMBAs. In children, a diagnosis of IgE-mediated reactions was obtained in 122 cases (45.9%). The most common causes were latex (n = 51; 41.8%), NMBAs (n = 39; 31.97%), and antibiotics (n = 11; 9.02%). In contrast with adults, no female predominance was observed. Conclusion: The incidence of allergic reactions during anesthesia, estimated on a national basis, is higher than previously estimated. These results should be taken into account in the evaluation of the benefit-to-risk ratio of the various anesthetic techniques in individuals. The similar incidence of reactions according to sex before adolescence suggests a role for sex hormones in the increase of anaphylaxis observed in women. © 2011 American Academy of Allergy, Asthma & Immunology.

Maurice-Szamburski A.,Service dAnesthesie Reanimation | Auquier P.,Aix - Marseille University | Viarre-Oreal V.,Service dAnesthesie Reanimation | Cuvillon P.,Montpellier University | And 7 more authors.
JAMA - Journal of the American Medical Association | Year: 2015

IMPORTANCE Sedative premedication is widely administered before surgery, but little clinical evidence supports its use. OBJECTIVE To assess the efficacy of sedative premedication on perioperative patient experience. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial, the PremedX study, enrolled 1062 adult patients who were younger than 70 years and had been scheduled for various elective surgeries under general anesthesia at 5 French teaching hospitals (in Marseille, Montpellier, Nimes, and Nice) between January 2013 and June 2014. Neurosurgery, obstetrical, cardiac, and outpatient surgery were excluded. INTERVENTIONS Patients were randomized to 3 groups of 354 participants each to receive 2.5mg of lorazepam, no premedication, or placebo. MAIN OUTCOMES AND MEASURES The primary outcomewas perioperative patient experience assessed 24 hours after surgery with a validated questionnaire (Evaluation du Vécu de l'Anesthésie Generale; EVAN-G) describing 6 domains of satisfaction and a global index (score range, 0-100; high scores represent high satisfaction); secondary outcomes included time to extubation and early cognitive recovery. A subgroup analysis was planned a priori in patients with a high level of preoperative anxiety. RESULTS Premedication with lorazepam did not improve the EVAN-G mean global index for overall level of patient satisfaction (72 [95%CI, 70-73]; n = 330) compared with no premedication (73 [95%CI, 71-74]; n = 319) or placebo (71 [95%CI, 70-73]; n = 322) (P = .38). Among patients with heightened preoperative anxiety, there were no significant differences found in the EVAN-G mean global index between the lorazepam group (68 [95%CI, 65-72]; n = 87) and the no premedication group (73 [95%CI, 69-77]; n = 57) or the placebo group (70 [95%CI, 67-72]; n = 87) (P = .18). Time to extubation was 17 minutes (95%CI, 14-20 minutes) in the lorazepam group, 12 minutes (95%CI, 11-13 minutes) for the no premedication group, and 13 minutes (95%CI, 12-14 minutes) for the placebo group (P < .001) and the rate of early cognitive recovery was 51% (95%CI, 45%-56%), 71%(95%CI, 66%-76%), and 64% (95%CI, 59%-69%), respectively (P < .001). CONCLUSIONS AND RELEVANCE Among patients undergoing elective surgery under general anesthesia, sedative premedication with lorazepam compared with placebo or no premedication did not improve the self-reported patient experience the day after surgery, but was associated with modestly prolonged time to extubation and a lower rate of early cognitive recovery. The findings suggest a lack of benefit with routine use of lorazepam as sedative premedication in patients undergoing general anesthesia. Copyright © 2015 American Medical Association. All rights reserved.

The occurrence of an event planned or unplanned during anesthesia is a concern for staff. This event may jeopardize the success of surgery gesture. Pediatric Surgery therefore has its own specific complications that it requires anesthesia. To evaluate the incidence of adverse events during anesthesia in pediatric surgery scheduled. Descriptive non-randomized study. Descriptive non-randomized study on adverse events related to anesthesia in children over a period of seven months. It took place in the anesthesia and intensive care unit and the pediatric surgery unit of Gabriel Toure hospital in Bamako. It focused on patients aged 0 to 12 years scheduled for surgery under general anesthesia during the study period. Sixty six percent of patients selected was male gender with a sex ratio of 3 in favor of males. The average age was 2 years with extremes of 16 days and 12 years and a standard deviation of 2.93. The old history of premature was found in 36% of patients and 2% of asthmatic. The number of patients experiencing an adverse event is 42 on a total of 107 patients collected either 39.25%. When the children were younger than one year adverse events occurred with 30, 76%. The occurrence of adverse events was more frequent when the child was not intubated with P < 0.05. All adverse events have received support except tachycardia, late revival but all developed positively. This study estimates the incidence of adverse events in anesthesia during pediatric surgery. The overall rate of patients experiencing an adverse event is relatively high. Children age less than or equal to one year are most vulnerable.

Clau-Terre F.,Vall dHebron Research Institute | Sharma V.,St Georges Healthcare Nhs Trust | Cholley B.,Service dAnesthesie Reanimation | Gonzalez-Alujas T.,University of Barcelona | And 3 more authors.
Anesthesiology | Year: 2014

There has been a recent explosion of education and training in echocardiography in the specialties of anesthesiology and critical care. These devices, by their impact on clinical management, are changing the way surgery is performed and critical care is delivered. A number of international bodies have made recommendations for training and developed examinations and accreditations. The challenge to medical educators in this area is to deliver the training needed to achieve competence into already overstretched curricula. The authors found an apparent increase in the use of simulators, with proven efficacy in improving technical skills and knowledge. There is still an absence of evidence on how it should be included in training programs and in the accreditation of certain levels. There is a conviction that this form of simulation can enhance and accelerate the understanding and practice of echocardiography by the anesthesiologist and intensivists, particularly at the beginning of the learning curve. © 2013, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.

Ambulatory surgery is associated with a very low incidence of thromboembolic events. New oral direct anticoagulants (NOAC) have been launched for thromboprophylaxis exclusively for total hip and knee replacement. Their use in ambulatory surgery is consequentlynot recommended so far. In patients taking NOAC, treatment must be interrupted 3 (xabans) orat least 4 (dabigatran) days before surgery and start again after 48 to 72 hours. © 2016 Elsevier Masson SAS.

In France, 20% of deliveries are performed under cesarean section. Spinal anaesthesia is the gold standard for planned C-section and epidural anaesthesia is performed in case of C-section for dystocia. Pain after C-section is considered as severe during 48h. Management of postoperative pain is an integral part of the rehabilitation process in this setting. Pain management is supported by the use of systemic administration of non-opioid analgesics associated with perimedullar opioids and surgical scare infiltration with local anesthetics. © 2014 Elsevier Masson SAS.

Cholley B.P.,Service dAnesthesie Reanimation
Intensive Care Medicine | Year: 2011

Training in ultrasound techniques for intensive care medicine physicians should aim at achieving competencies in three main areas: (1) general critical care ultrasound (GCCUS), (2) "basic" critical care echocardiography (CCE), and (3) advanced CCE. A group of 29 experts representing the European Society of Intensive Care Medicine (ESICM) and 11 other critical care societies worldwide worked on a potential framework for organizing training adapted to each area of competence. This framework is mainly aimed at defining minimal requirements but is by no means rigid or restrictive: each training organization can be adapted according to resources available. There was 100% agreement among the participants that general critical care ultrasound and "basic" critical care echocardiography should be mandatory in the curriculum of intensive care unit (ICU) physicians. It is the role of each critical care society to support the implementation of training in GCCUS and basic CCE in its own country. © 2011 Copyright jointly held by Springer and ESICM.

Sleth J.-C.,Service dAnesthesie Reanimation
Praticien en Anesthesie Reanimation | Year: 2011

Most breast surgical procedures can be performed in ambulatory patients due to significant changes in surgical techniques and practices. Regional anaesthesia is adapted to ambulatory management and could be introduced as an alternative to general anaesthesia. Optimization of care organization and appropriate patients selection are the cornerstones of ambulatory management. © 2011 Published by Elsevier Masson SAS.

Venipuncture, insertion of a nasogastric tube, blood gas tests, etc. Many nursing procedures can cause moderate to severe pain. How can these forms of pain be anticipated, assessed and relieved in emergency situations? © 2015 Elsevier Masson SAS.

Pessayre J.,Service dAnesthesie reanimation
Praticien en Anesthesie Reanimation | Year: 2015

Spinal cord injury induces dysautonomia and impair ventilation. The severity of the disorders depends on the level of the spinal cord trauma. In the perioperative period, patients are prone to develop acute hypertensive crisis and/or respiratory failure. The risk must be evaluated preoperatively and patients must be prepared to surgery. The choice of the anaesthetic technique depends on the level of the spinal cord injury and surgery. Neuroaxial blocks are not contra-indicated in patients with previous spinal cord injury.

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