ANESTHESIOLOGIE REANIMATION HAITI (HUEH)

BONNE FETE DR. ENA ROSIER (R3) : 30 AVRIL

Background  A means of identifying the presence and severity of pain that is not reliant on the subjective assessment of pain is desirable whenever a patient self-rating of pain cannot be easily obtained (e.g. sedated patients, very young children, individuals with learning difficulties). The heart rate variability based analgesia nociception index (ANI) has been proposed to reflect different levels of acute pain. The aim of this study was to compare ANI scores with a numeric rating scale (NRS, 0–10) based on self-assessment of pain in the recovery room. Methods  One hundred and twenty patients after non-emergency surgery were included. On arrival in the post-anaesthesia care unit (PACU) and subsequently at 5 min intervals, patients were asked to rate their level of pain on a 0–10 NRS. ANI values 0–100 points (low values indicating higher levels of pain) were recorded simultaneously. Results  Eight hundred and sixteen pain ratings from 114 patients were included in the analys

Cerebral blood flow (CBF) is regulated by vasomotor, chemical, metabolic, and neurogenic mechanisms. Even though the innervation of cerebral arteries is quite extensively described and reviewed in the literature, its role in regulation of CBF in humans remains controversial. We believe that insufficient attention has so far been focused on the potential role of the innervation of the cerebral vasculature in cerebral autoregulation in humans. We have performed an extensive search and selection of available literature on electrical, chemical, and surgical manipulations of the sympathetic innervation of cerebral arteries, and the effects of circulation sympathetically active agents on CBF. Studies on (surgical) ganglion block show a role of sympathetic tone in preventing increases in CBF in humans, which are consistent with the view based on animal studies. Both direct innervation of the cerebral arteries from cervical ganglia and stimulation of adrenergic receptors by circulating sympath

OBJECTIVE: To investigate the effect of postoperative gum chewing on bowel motility after laparoscopic gynecologic surgery. METHODS: In this randomized controlled trial, patients were allocated to either postoperative gum chewing every 2 hours for 15 minutes or standard postoperative care without gum chewing. The study's primary end points were time to first regular bowel sounds and time to first passage of flatus after surgery. Secondary end points were time of operation to first defecation, patient satisfaction concerning postoperative gum chewing, potential side effects of postoperative gum chewing, and potential effect of gum chewing on postoperative pain therapy. RESULTS: One hundred seventy-nine patients were included in this trial. We found a significantly shorter interval between surgery and passage of first flatus in the intervention group compared with the control group (median 6.2 hours compared with 8.1 hours;  P =.002) and a significantly higher rate of regular bo

New guidelines on the diagnosis, classification, and treatment of true hypotonic hyponatremia have been  published online  in the  European Journal of Endocrinology . The guidelines focus on managing patients, rather than on treating absolute sodium levels, the authors emphasize. "Hyponatremia, defined as a serum sodium concentration of less than 135 mmol/L, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice," write Goce Spasovski, MD, PhD, from the State University Hospital Skopje, Macedonia, and colleagues from the Hyponatremia Guideline Development Group. "It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life-threatening, and is associated with increased mortality, morbidity, and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic," they stress. SOURCE

Anesthesia and surgery significantly increase the risk for dementia, new research suggests. A large population-based study conducted by investigators at the Neurological Institute in Taipei Veterans General Hospital, in Taipei City, Republic of China, showed that the risk of developing dementia nearly doubled within 3 to 7 years of anesthesia and surgery. In addition, the average time to dementia diagnosis was shorter in patients who had anesthesia and surgery compared with their counterparts who did not undergo these procedures. The study adds to "growing concerns that anesthetic agents may have neurodegenerative complications," study investigator Jong-Ling Fuh, MD, of the Neurological Institute, told  Medscape Medical News . "In vitro and animal studies showed that inhaled anesthetic drugs can promote amyloid beta oligomerization and impair memory. However, it remains controversial whether anesthesia and surgery contribute to the development of dementia in hum

A   continuous supply of oxygen, the gaseous waste product of plant photosynthesis, is essential to sustain cellular metabolism in all aerobic organisms, including humans. Oxygen is a highly reactive gas that is capable of combining with most other elements because of the avidity with which it attracts electrons. This process may occur slowly and remorselessly, as is seen when iron rusts, or rapidly and catastrophically, as occurs during forest fires. Controlled oxidation of glucose, and other substrates, to carbon dioxide with the consequent reduction of oxygen to water is the basis of aerobic cellular metabolism, one of the hallmarks of vertebrate physiology. Reactive oxygen species (ROS), also known as oxygen free radicals, contain one or more unpaired electrons and, as their name suggests, are considerably more reactive than their corresponding non-radical form. They are generated within mitochondria during normal cellular metabolism. ROS generation may be accelerated under certa

Measurement of intraocular pressure (IOP) in children requires examination under anesthesia (EUA). The ideal anesthetic agent for this purpose is ketamine because it does not affect patient's IOP.  Previous studies have shown ketamine to be safe.  However, other studies have also noted that ketamine is sometimes associated with respiratory complications (RCs) and emesis.  At our institution, perioperative staff noted that children who received intramuscular (IM) ketamine appeared to experience RCs more frequently than those who received intravenous (IV) ketamine or no ketamine. The aim of this study was to compare the occurrence of RCs between patients who received IM ketamine versus IV ketamine or no ketamine. SOURCE

Background In type 2 diabetic patients, cardiac events in the perioperative period may be associated with diminished myocardial vasomotor function and endothelial dysfunction. The influence of sevoflurane anaesthesia on myocardial endothelial dysfunction in type 2 diabetic mellitus is investigated in this pilot study. Methods Six males with type 2 diabetes mellitus and eight healthy controls were included. Using myocardial contrast echocardiography, myocardial blood flow (MBF) was measured at rest, during adenosine-induced hyperaemia (endothelium-independent vasodilation) and after sympathetic stimulation by the cold pressor test (endothelium-dependent vasodilation). Measurements were performed before and after induction of sevoflurane anaesthesia. Results Sevoflurane anaesthesia decreased resting MBF in diabetics but not in controls (P = 0.03), while baseline MBF did not differ between diabetics and controls. Without anaesthesia, adenosine-induced hyperaemia increased MBF i

Perioperative cerebral damage may be associated with surgery and anaesthesia. Pharmacological perioperative neuroprotection is associated with conflicting results. In this qualitative review of randomized controlled clinical trials on perioperative pharmacological brain neuroprotection, we report the effects of tested therapies on new postoperative neurological deficit, postoperative cognitive decline (POCD), and mortality rate. Studies were identified from Cochrane Central Register and MEDLINE and by hand-searching. Of 5904 retrieved studies, 25 randomized trials met our inclusion criteria. Tested therapies were: lidocaine, thiopental,  S (+)-ketamine, propofol, nimodipine, GM1 ganglioside, lexipafant, glutamate/aspartate and xenon remacemide, atorvastatin, magnesium sulphate, erythropoietin, piracetam, rivastigmine, pegorgotein, and 17β-estradiol. The use of atorvastatin and magnesium sulphate was associated with a lower incidence of new postoperative neurological deficit. The use o

Obstructive sleep apnea (OSA) has been reported to be a risk factor for cardiovascular (CV) disease. Although the apnea-hypopnea index (AHI) is the most commonly used measure of OSA, other less well studied OSA-related variables may be more pathophysiologically relevant and offer better prediction. The objective of this study was to evaluate the relationship between OSA-related variables and risk of CV events. SOURCE

The party drug ketamine could one day be used to help some people suffering from severe depression, according to British scientists who gave infusions of the narcotic nicknamed "special K" to patients. Researchers who tested the drug on 28 people with major depressive disorder found ketamine quickly helped relieve the condition for some - and made a number of them completely well again for up to several weeks. "It's dramatic and it's exciting, and it is a novel mechanism. But it's not about to become a routine treatment," Rupert McShane, a consultant psychiatrist and researcher at Oxford University who led the study, told reporters. He said the discovery that ketamine worked, even for a short period, had been enough to give new hope to some of the patients in the study - many of whom had in the past considered suicide. SOURCE

Background Factors capable of impacting hospital mortality in patients with septic shock remain uncertain. Our objective was to identify predictors of hospital mortality among patients who received appropriate antimicrobial therapy for bacteremic septic shock after accounting for severity of illness, resuscitation status, and processes of care. Methods We conducted a secondary subgroup analysis of a prospective severe sepsis cohort study. Patients with septic shock and positive blood cultures who received appropriate antimicrobial therapy were included. Univariable analyses were used to identify differences between hospital survivors and non-survivors, and a multivariable logistic regression model revealed independent determinants of hospital mortality. Results From January 2008 to December 2010, 58 of 224 included patients died in the hospital. Multivariable logistic regression analysis demonstrated 2 independent predictors of hospital mortality. These included continuous r