ANESTHESIOLOGIE REANIMATION HAITI (HUEH)

BONNE FÊTE  FERNANDE JOSEPH R3 (SARHUEH) : 23 DECEMBRE

BONNE FETE DR. GARTIANA GASTON R3 (SARHUEH) :7 NOVEMBRE

BONNE FETE DR. JUDITH SALOMOM R2 (SARHUEH) : 19 NOVEMBRE

BONNE FETE DR. STEPHANIE BLOT (R1)

Many questions have arisen and much controversy has emerged regarding how much fluid should be given perioperatively, which fluids should be given, when they should be given, and whether outcomes can be influenced. It’s been called the “Great Fluid Debate.” In fact, one might ask whether the anesthesiologist can even make a difference in the long run. Several goals of fluid administration have been identified: Tissue perfusion should be optimized; and heart rate, stroke volume, hemoglobin, and oxygen saturation should be appropriately manipulated. But just how to achieve these end points, and whether they can be done by fluid administration, remains unclear. Our current standard therapy—cannulate a vein, give fluids to maintain blood pressure, and make up for supposed losses—has been challenged for almost a century. Canon noted that fluids administered before operative control of an injury were ineffective, 1  an observation emphasized by Bickell and others some 70 years later. ...

The number of deaths involving commonly prescribed painkillers is higher than the number of deaths by overdose from heroin and cocaine combined, according to researchers at McGill University. In a first-of-its-kind review of existing research, the McGill team has put the spotlight on a major public health problem: the dramatic increase in deaths due to prescribed painkillers, which were involved in more than 16,000 deaths in 2010 in the U.S. alone. Currently, the U.S and Canada rank #1 and #2 in per capita opioid consumption. “Prescription painkiller overdoses have received a lot of attention in editorials and the popular press, but we wanted to find out what solid evidence is out there,” says Nicholas King, of the Biomedical Ethics Unit in the Faculty of Medicine. In an effort to identify and summarize available evidence, King and his team conducted a systematic review of existing literature, comprehensively surveying the scientific literature and including only reports with quant...

BONNE FETE DR. DAPHNE N. PIERRE (R2)

Pregnancy causes anatomical and physiological changes that have implications for the anaesthetist not only for intrapartum management but also when surgery is required incidentally to pregnancy. These adaptations primarily occur, so that the metabolic demands of the growing fetus may be met. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> SOURCE

Ketamine, an injectable anesthetic that has been shown to exert a rapid but short-lived antidepressant effect, may reduce suicidal ideation independently of a reduction in depressive symptoms, new research suggests. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> SOURCE

Tracheal intubation without muscle relaxants is usually performed with remifentanil and propofol or sevoflurane. Remifentanil 1.0 to 4.0 μg·kg −1  and propofol 2.0–3.0 mg·kg −1  or sevoflurane up to 8.0 Vol% provide acceptable, i.e. excellent or good intubating conditions. We hypothesized that sevoflurane 1.0 MAC would provide acceptable intubating conditions when combined with propofol and remifentanil. Methods . Eighty-three patients to be intubated were randomised to two groups. The SEVO group received propofol 1.5 mg kg −1 , remifentanil 0.30 μg kg min −1  and sevoflurane 1.0 MAC; the MR group received the same doses of propofol and remifentanil plus rocuronium 0.45 mg kg −1 . We evaluated intubation and extubation conditions, mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS). The vocal cords were examined for injury by videolaryngoscopy before and 24 hours after surgery. Results . Acceptable intubating conditions were seen more frequently ...

Use of benzodiazepines to treat  insomnia  or  anxiety  may increase the risk for Alzheimer's disease (AD), new research suggests. Dr. Sophie Billioti de Gage A case-control study of nearly 9000 older individuals showed that risk for AD was increased by 43% to 51% in those who had "ever used" benzodiazepines in the previous 5 years. The association was even stronger in participants who had been prescribed benzodiazepines for 6 months or longer ― and in those who used long-acting versions of the medications. Lead author Sophie Billioti de Gage, PharmD, who is also a PhD student and researcher at INSERM Unit 657–Pharmacoepidemiology at the University of Bordeaux, France, told Medscape Medical News  that the overall results were not a surprise because the short-term deleterious effects of these medications on memory are well documented. A study published by the same researchers last year showed a 50% increased risk for dementia in patients using ...

A s you fumble through the anesthesia drug tray, you begin to sweat. You notice that some drugs are missing. You quickly move to open the Pyxis machine but those drugs are missing, too. You swing open the heavy door to the operating room next door. Before you can speak through your mask, your colleague frames the question as a bewildered statement: “Let me guess, where’s the succinylcholine?” Jerry A. Cohen, MD, past president of the American Society of Anesthesiologists (ASA), noted in 2012, “When I started practicing, I thought whatever drugs I needed would always be there. Now I open the drawer and occasionally something isn’t there.” In the past five years, according to the ASA, the United States has experienced shortages of an array of vital anesthetic drugs such as propofol, succinylcholine, even epinephrine. The FDA began tracking drug shortages in 1999 in anticipation of possible manufacturing interruptions that might be caused by the Y2K computer scare. During the first ...

A pilot study has concluded that 0.5 mg of the blood pressure drug metaraminol has a variable effect on cardiac output and oxygen delivery in patients who develop hypotension during induction of anesthesia. The researchers said they planned to test the drug at different doses as a treatment for hypotension in surgical patients. In the study, Scottish researchers set out to test how effective metaraminol would be as a treatment. This commonly used blood pressure medication directly stimulates vascular α-receptors and indirectly stimulates noradrenaline. To find out if the drug could improve cardiac index and oxygen delivery index in a group of hypovolemic, vasodilated patients, the investigators conducted a prospective observational trial of 11 patients undergoing major colorectal surgery with or without synchronous liver resection. “This is a group purposefully dehydrated to reduce blood loss. They were vasodilated because the anesthetist involved establishes an epidural pre-i...

The recent arrest of a former New York hospital pharmacy director for pilfering nearly 200,000 oxycodone pills underscores the need for facilities to shore up their operations, making sure there are safeguards in place so that no one employee has enough power to divert controlled substances and other in-demand medications, according to pharmacists skilled in preventing the criminal activity. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> SOURCE

CASE A 22-year-old man was brought to the ED complaining of abdominal pain after a rollover motor vehicle accident. He was the front seat passenger and was wearing a seat belt. Although he was trapped in the vehicle and it caught on fire, he did not suffer any cutaneous burns. History  The patient's past medical history was significant for attention-deficit hyperactivity disorder. He admitted to using tobacco and alcohol socially, but denied illicit drug use. He denied any medication use or drug allergies. A review of systems was positive for complaints of abdominal pain and anxiety. Physical examination  The patient's vital signs were: BP, 112/51 mm Hg; heart rate, 110 beats/minute; respirations, 23; SpO 2 , 95% on room air; and temperature, 37.4° C (99.3° F). On ED arrival, he was awake, alert, and oriented but appeared anxious and agitated. His pupils were equal, round, and reactive to light. His head was normocephalic with a 2-cm laceration on the left ear. The pati...

  Videolaryngoscopie Haiti   needs more fans .. Good morning I suppose you have a facebook page ? What if I told you that you could get more fans for your facebook page, to raise your social media reach ? We can do that for you, Introducing our service, that will get you thousands of real fans for your facebook page. Safe and complying with social media's terms of use, you will receive 1000 real likes for usd 29.90, or the same number of twitter followers for usd 12.90. You can reach us on Live chat or using our contact form on our  website ! Copyright © QF 2014, All rights reserved. unsubscribe from this list       

  Videolaryngoscopie Haiti   needs more fans .. Good morning I suppose you have a facebook page ? What if I told you that you could get more fans for your facebook page, to raise your social media reach ? We can do that for you, Introducing our service, that will get you thousands of real fans for your facebook page. Safe and complying with social media's terms of use, you will receive 1000 real likes for usd 29.90, or the same number of twitter followers for usd 12.90. You can reach us on Live chat or using our contact form on our  website ! Copyright © QF 2014, All rights reserved. unsubscribe from this list       

Recent federal legislation and changes to the U.S. Medicare program have expanded opportunities for certified registered nurse anesthetists (CRNAs) to provide care to more patients and receive reimbursement for their services, yet many states still restrict their scope of practice and limit their pay. A special section in the current issue of  Clinical Scholars Review , the journal of advanced practice nursing published by Columbia Nursing, explores how the Affordable Care Act (ACA) empowers CRNAs to help make anesthesia services more accessible to patients; it also highlights laws in New York and other states that may impede the expanded access to care envisioned by ACA. FULL ARTICLE

Background The abdominal insufflation and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure. However, associated effects on changes of endotracheal tube cuff pressure are not well established. Methods 70 patients undergoing elective laparoscopic colorectal tumor resection (head-down position, n = 38) and laparoscopic cholecystecomy (head-up position, n = 32) were enrolled and were compared to 15 patients undergoing elective open abdominal surgery. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analysed and compared. Results There was no significant cuff and airway pressure changes during the first fifteen minutes in open abdominal surgery. After insufflation, the cuff pressure increased from 26 +/- 3 to 32 +/- 6 and 27 +/- 3 to 33 +/- 5 cmH2O in patients receiving laparoscopic cholecystecomy and laparoscopic colorectal...

DURHAM, NC  - Duke University researchers have found an antibody that simultaneously blocks the sensations of pain and itching in studies with mice. The new antibody works by targeting the voltage-sensitive sodium channels in the cell membrane of neurons. The results appear online on May 22 in Cell. Voltage-sensitive sodium channels control the flow of sodium ions through the neuron's membrane. These channels open and close by responding to the electric current or action potential of the cells. One particular type of sodium channel, called the Nav1.7 subtype, is responsible for sensing pain. Mutations in the human gene encoding the Nav1.7 sodium channel can lead to either the inability to sense pain or pain hypersensitivity. Interestingly, these mutations do not affect other sensations such as touch or temperature. Hence, the Nav1.7 sodium channel might be a very specific target for treating pain disorders without perturbing the patients' ability to feel other sensations...

Science, Medicine, and the Anesthesiologist: Key Papers from the Most Recent Literature Relevant to Anesthesiologists. LIEN

Thirty volunteers randomly received either mild or deep propofol sedation, to assess its effect on explicit and implicit memory. Blood oxygen level-dependent functional magnetic resonance during sedation examined brain activation by auditory word stimulus and a process dissociation procedure was performed 4 h after scanning. Explicit memory formation did not occur in either group. Implicit memories were formed during mild but not deep sedation (p = 0.04). Mild propofol sedation inhibited superior temporal gyrus activation (Z value 4.37, voxel 167). Deep propofol sedation inhibited superior temporal gyrus (Z value 4.25, voxel 351), middle temporal gyrus (Z value 4.39, voxel 351) and inferior parietal lobule (Z value 5.06, voxel 239) activation. Propofol only abolishes implicit memory during deep sedation. The superior temporal gyrus is associated with explicit memory processing, while the formation of both implicit and explicit memories is associated with superior and midd...

San Francisco—Although general anesthesia and conscious sedation seem to equally affect functional independence at discharge in patients with acute ischemic stroke undergoing endovascular intervention therapy, patients who received general anesthesia experienced significantly greater mortality than their counterparts, researchers have found. Whether this difference is directly attributable to anesthesia type, however, is unclear, as the duration of intra-arterial therapy and time to revascularization from symptom onset were both significantly longer in patients who received general anesthesia, according to the study. “Ischemic stroke has an extremely high mortality rate—16%—in patients presenting for first-time stroke,” said Kathryn Rosenblatt, MD, an anesthesiology resident at SUNY Upstate Medical University, in Syracuse, N.Y., who helped conduct the study. “Endovascular clot retrieval helps remove intracranial clot occlusions in ischemic stroke patients. Although the therapy can...

For women giving birth, nitrous oxide may be a viable alternative to having an epidural block, a recent study has found. Although the researchers were quick to point out that nitrous oxide (N2O) may not be for everyone, it could stand in when an epidural block is contraindicated, or for women who simply do not wish to receive one. Likewise, they note that NO offers a safe alternative to IV narcotics. The retrospective cohort study, presented at the 2014 Pregnancy Meeting (abstract 598), examined the outcomes of 6,192 laboring women at the University of California, San Francisco Medical Center (UCSF) between 2007 and 2012. The investigators focused on single-child, head-down births with no unusual complications. NO was administered using an FDA-approved device called the Nitronox (Porter Instruments). The researchers accounted for the effects of age, ethnicity, insurance status and the length of each stage of labor in their comparison of outcomes between women who received N2O an...

Article Outline Abstract 1. Introduction 2. Pathogenesis 2.1. Genetic factors 2.2. Molecular alterations 2.2.1. Calcium channels 2.2.2. Nitric oxide 2.2.3. Endothelin-1 2.2.4. Cytokines 2.2.5. Toll-like receptors 2.3. Metabolic alterations 2.3.1. Ischemia 2.3.2. Mitochondrial dysfunction and oxidative stress 2.3.3. Autonomic dysregulation 2.4. Structural modifications 2.5. Hemodynamic alterations: from sepsis to myocardial dysfunction 2.5.1. Decreased intravascular volume (reduced preload) 2.5.2. Decreased vascular tone (reduced afterload) 2.5.3. Microcirculatory alterations 2.5.4. VO2/DO2 dependency 2.5.5. Lactate 2.5.6. Mechanical ventilation and septic cardiomyopathy 3. Left and right ventricular dysfunction: double trouble 3.1. Septic cardiomyopathy 3.2. Diagnostic tools 3.2.1. Pulmonary artery catheter 3.2.2. Tissue D...