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Nicolet J.,Service danesthesie reanimation chirurgicale | Poulard F.,Service danesthesie reanimation chirurgicale | Baneton D.,Service de kinesitherapie | Rigal J.-C.,Service danesthesie reanimation chirurgicale | Blanloeil Y.,Service danesthesie reanimation chirurgicale
Annales Francaises d'Anesthesie et de Reanimation | Year: 2011

Objectives: High-flow nasal oxygen (Optiflow™) is validated in paediatric intensive care but not in adults' patients for severe hypoxemia. The aim of this study was to evaluate this oxygen system delivery in adults' patients for postoperative hypoxemia after cardiac surgery. Study design: Prospective, open study for evaluation of medical practice. Patients and methods: Patients operated upon for cardiac surgery with immediate postoperative hypoxemia characterized by SpO2 <0.96 with 50% oxygen with a Venturi mask were treated with the high-flow nasal oxygen system (O group) when it was available or with the classical high-flow oxygen face mask (M group). Gas exchanges were measured at the end of the surgery, at the beginning of the treatment and 1 hour, 6 hours after the inclusion and at day 1 and 2 post-treatment. Parameters studied were: duration of hypoxemia, duration of ICU stay, postoperative pneumonia occurrence, requirement of re-intubation, non invasive ventilation and catecholamine. Tolerance was evaluated with measurement of pain (visual scale), satisfaction (visual scale), and dryness of mouth. Results: Forty patients were included, 19 in group O, 21 in group M. Patient's characteristics did not differ between the two groups before treatment. There were no significant differences between groups for duration of hypoxemia (3.8 ± 2.2 days in O group versus 4.3 ± 2.3 days in M group), duration of hypoxemia, duration of ICU stay, postoperative pneumonia occurrence, requirement of re-intubation, non invasive ventilation and catecholamine. Pain was not significantly different between groups, satisfaction was better (P< 0.001) and mouth drier (P< 0.001) in group O than in group M. Conclusion: These results give good arguments for an improvement in gas exchange and better tolerance of high-flow nasal oxygen (Optiflow™) versus classical high-flow oxygen face mask in postoperative cardiac patients. These results must be confirmed by a randomised study with a larger population. © 2011 Elsevier Masson SAS.


Diemunsch P.,Service dAnesthesie reanimation Chirurgicale | Pottecher J.,Service dAnesthesie reanimation Chirurgicale | Chassard D.,Anesthesie reanimation Chirurgicale
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2012

An efficient communication between the obstetrics and anesthesiology teams is a prerequisite for an optimal management of a woman with a previous cesarean section (professional agreement). Epidural analgesia should be encouraged in this context due to a high risk of emergency obstetrical procedures, in order to avoid general anesthesia (professional agreement). When possible, spinal anesthesia is the technique of choice for elective repeat cesarean delivery even in case of morbidly adherent placenta (professional agreement). © 2012 Elsevier Masson SAS. All rights reserved.


Journois D.,Service dAnesthesie Reanimation Chirurgicale | Journois D.,University of Paris Descartes
Praticien en Anesthesie Reanimation | Year: 2011

Continuous hemofiltration has gained from more than 20 years experience in intensive care unit and the use of sophisticated techniques. A series of pitfalls leads to frequently asked questions. A better understanding of filtration fraction, specific to hemofiltration technique, allows avoiding circuit obstruction, while patients are effectively anticoagulated. Restitution and maintenance of hydroelectrolytic equilibrium are critical. Clinical practice requires the definition of procedures and protocols concerning alarm settings, the use of catheters, pre- and post-dilution, and the choice of the most appropriate technique. © 2011 Elsevier Masson SAS. All rights reserved.


Martinez V.,Service dAnesthesie Reanimation Chirurgicale | Martinez V.,French Institute of Health and Medical Research | Ben Ammar S.,Service dAnesthesie Reanimation Chirurgicale | Judet T.,Service de Chirurgie Orthopedique et Traumatologique | And 9 more authors.
Pain | Year: 2012

Nerve lesions and secondary hyperalgesia may both be present after surgery, and their relative contributions to chronic postsurgical neuropathic pain (CPSNP) remain unclear. This prospective study explored the roles of these factors in the development of CPSNP after iliac crest bone harvest. CPSNP was defined as pain in the area of hypoesthesia, with a positive Douleur neuropathique 4 questionnaire (DN4) score 3 months after iliac crest bone harvest. The location, intensity, and neuropathic characteristics of pain were evaluated in 82 patients who were followed for 6 months. Neuropathic characteristics were assessed by clinical examination and DN4 questionnaire. The area of secondary hyperalgesia was evaluated 48 h and 1 month after surgery. The area of mechanical hypoesthesia, detection, and mechanical pain threshold were evaluated at 48 h and at 1 and 3 months. Nineteen patients (23%) had CPSNP at 3 months. The patients who developed CPSNP had a larger area of secondary hyperalgesia at 48 h (88 cm 2 vs 33 cm 2; P = .001), higher pain intensity (numerical rating scale 6.7 vs 4.7; P = .02), and higher neuropathic characteristics score on the DN4 questionnaire (4.3 vs 2.3; P = .001). However, neither the area nor the severity of hypoesthesia differed significantly between patients with and without CPSNP. Two independent, additive predictors of CPSNP were identified: area of secondary hyperalgesia (odds ratio 1.02; P = .004) and DN4 score (odds ratio 1.94; P = .001). These findings suggest that both nerve lesions and central sensitization are involved in CPSNP development and could be seen as early warning signs. © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.


Dupont X.,Service dAnesthesie Reanimation Chirurgicale
Praticien en Anesthesie Reanimation | Year: 2011

Hallux valgus is a deformation of the first beam of the forefoot that can be surgically corrected. Postoperative pain is commonly severe. Peripheral nerve blocks provide effective analgesia with fewer side effects. Patients can be treated at home during several postoperative days. Popliteal sciatic nerve block is currently the gold standard, however less invasive surgical procedures may allow using distal blocks. © 2010 Elsevier Masson SAS. All rights reserved.


Hina N.,Service dAnesthesie Reanimation Chirurgicale | Fletcher D.,Service dAnesthesie Reanimation Chirurgicale | Fletcher D.,French Institute of Health and Medical Research | Fletcher D.,University of Versailles | And 3 more authors.
European Journal of Anaesthesiology | Year: 2015

BACKGROUND Chronic pain and opioid consumption may trigger diffuse hyperalgesia, but their relative contributions to pain vulnerability remain unclear. OBJECTIVES To assess preoperative opioid-induced hyperalgesia and its postoperative clinical consequences in patients with chronic pain scheduled for orthopaedic surgery. DESIGN A prospective observational study. SETTINGS Raymond Poincare teaching hospital. PATIENTS Adults with or without long-term opioid treatment, scheduled for orthopaedic surgery. PRIMARY OUTCOME MEASURE Preoperative hyperalgesia was assessed with eight quantitative sensory tests, in a pain-free zone. SECONDARY OUTCOME MEASURES Postoperative morphine consumption and pain intensity were evaluated using a numerical rating scale (NRS) in the recovery room and during the first 72h. RESULTS We analysed results from 68 patients (28 opioid-treated patients and 40 controls). Mean daily opioid consumption was 42±25mg of morphine equivalent. The opioid-treated group displayed significantly higher levels of preoperative hyperalgesia in three tests: heat tolerance threshold (47.1°C vs. 48.4°C; P=0.045), duration of tolerance to a 47°C stimulus (40.2 vs. 51.1s; P=0.03) and mechanical temporal summation [1.79 vs. 1.02 (ΔNRS 10-1); P=0.036]. Patients in the opioid-treated group consumed more morphine (19.1 vs. 9.38mg; P=0.001), had a higher pain intensity (7.6 vs. 5.5; P=0.001) in the recovery room and a higher cumulative morphine dose at 72h (39.8 vs. 25.6mg; P=0.02). CONCLUSION Chronic pain patients treated with low doses of opioid had hyperalgesia before surgery. These results highlight the need to personalise the management of patients treated with opioids before surgery. TRIAL REGISTRATION ID-RCB 2011-A00304-37. © © 2015 Copyright European Society of Anaesthesiology.


Aveline C.,Service danesthesie reanimation chirurgicale
Praticien en Anesthesie Reanimation | Year: 2015

Anticipating the treatment of pain is one of the keys to allow relief from prolonged pain. Analgesic protocol should be initiated preoperatively, favoring synergistic combinations. It is mandatory not to interrupt chronic analgesic treatments if any. A prescription must be issued before the procedure with clear and detailed explanations of the oral doses, time of administration, and rescue medication. Peripheral nerve blocks and/or infiltration with a long-acting local anaesthetic combined with multimodal analgesia prolong analgesia beyond the immediate perioperative period. Dexamethasone, whatever the route of administration, prolongs the duration of analgesia produced by local anaesthetics. Antihyperalgesics, such as gabapentinoids or ketamine, are useful, but associated with side effects. Intravenous lidocaine is effective but has been little evaluated during ambulatory surgery. The development of a monitoring system for ambulatory patients is one way to determine the effectiveness of outpatient process. These networks can also integrate the feedback provided from continuous perineural analgesia and help increase the number of surgical and ambulatory patients. © 2015 Elsevier Masson SAS.


Anticipating the treatment of pain is one of the keys to allow relief from prolonged pain. Analgesic protocol should be initiated preoperatively, favoring synergistic combinations. It is mandatory not to interrupt chronic analgesic treatments if any. A prescription must be issued before the procedure with clear and detailed explanations of the oral doses, time of administration, and rescue medication. Peripheral nerve blocks and/or infiltration with a long-acting local anaesthetic combined with multimodal analgesia prolong analgesia beyond the immediate perioperative period. Dexamethasone, whatever the route of administration, prolongs the duration of analgesia produced by local anaesthetics. Antihyperalgesics, such as gabapentinoids or ketamine, are useful, but associated with side effects. Intravenous lidocaine is effective but has been little evaluated during ambulatory surgery. The development of a monitoring system for ambulatory patients is one way to determine the effectiveness of outpatient process. These networks can also integrate the feedback provided from continuous perineural analgesia and help increase the number of surgical and ambulatory patients. © 2015 Elsevier Masson SAS.


PubMed | Service dAnesthesie Reanimation Chirurgicale
Type: Journal Article | Journal: Journal of visceral surgery | Year: 2016

The prevention of post-operative risk of venous thrombo-embolism (VTE) is of fundamental importance, but preventive methods have progressed with the introduction of direct oral anticoagulants (DOAC), the development of ambulatory surgery and enhanced recovery programs (ERP) after surgery. Surgery is, inherently a trigger for venous thrombo-embolic disease, as is prolonged immobilization. However, the risk of VTE is very low following ambulatory surgery, especially in this selected population. ERP, consists of a set of measures to optimize the patients peri-operative management while reducing length of stay, costs and morbidity and mortality; one measure is the encouragement of early ambulation. This will undoubtedly have an impact on the incidence of VTE and lessen the need for prolonged thrombo-prophylaxis.


PubMed | American hospital of Paris, University of Versailles, University of Paris Pantheon Sorbonne and Service dAnesthesie Reanimation Chirurgicale
Type: Journal Article | Journal: British journal of anaesthesia | Year: 2016

Morphine, and analgesics other than morphine (AOM), are commonly used to treat postoperative pain after major surgery. However, which AOM provides the best efficacy-safety profile remains unclear.Randomized trials of any AOM alone or any combination of AOM compared with placebo or another AOM in adults undergoing major surgery and receiving morphine patient-controlled analgesia were included in a network meta-analysis. The outcomes were morphine consumption, pain, incidence of nausea, vomiting at 24h and severe adverse effects.135 trials (13,287 patients) assessing 14 AOM alone or in combination were included. For all outcomes, comparisons with placebo were over-represented. Few trials assessed combinations of two AOM and none the combination of three or more. Network meta-analysis found morphine consumption reduction was greatest with the combination of two AOM (acetaminophen+nefopam, acetaminophen+NSAID, and tramadol+metamizol): -23.9 (95% CI -40;-7.7), -22.8 (-31.5;-14) and -19.8 (35.4;-4.2) mg per 24h, respectively. For AOM used alone, morphine consumption reduction was greatest with -2 agonists, NSAIDs, and COX-2 inhibitors. When considering the risk of nausea, NSAIDs, corticosteroids and -2 agonists used alone were the most efficacious (OR 0.7 [95% CI: 0.6-0.8], 0.36 [0.18-0.79], 0.41 [0.15-.64], respectively). The paucity of severe adverse effects data did not allow assessment of efficacy-safety balance.A combination of aetaminophen with either an NSAID or nefopam was superior to most AOM used alone, in reducing morphine consumption. Efficacy was best with three AOM used alone (-2 agonists, NSAIDs and COX-2 inhibitors) and least with tramadol and acetaminophen. There is insufficient trial data reporting adverse events.PROSPERO: CRD42013003912.

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