ANESTHESIOLOGIE REANIMATION HAITI (HUEH)

Recently, the incidence of awareness data from NAP5 project (the national UK survey of intraoperative awareness during general anaesthesia) have been published in this journal.  These baseline data offer an estimated incidence of awareness with recall, as reported by participant anaesthetists, as low as 1:15 414. However, due to the characteristics of the survey, that is, voluntary report by doctors, the results should be considered with caution. SOURCE

Methods  Parturients undergoing elective Caesarean delivery under spinal anaesthesia with hyperbaric bupivacaine 10 mg and fentanyl 20 μg were enrolled in this prospective study. The correlation between baseline PI and the degree of hypotension during spinal anaesthesia and also the predictability of spinal anaesthesia-induced hypotension during Caesarean delivery by PI were investigated. Results  Baseline PI correlated with the degree of decreases in systolic and mean arterial pressure ( r =0.664,  P <0.0001 and  r =0.491,  P =0.0029, respectively). The cut-off PI value of 3.5 identified parturients at risk for spinal anaesthesia-induced hypotension with a sensitivity of 81% and a specificity of 86% ( P <0.001). The change of PI in parturients with baseline PI≤3.5 was not significant during the observational period, while PI in parturients with baseline PI>3.5 demonstrated marked decreases after spinal injection. Conclusions  We demon...

L’objectif de ces recommandations était de faire le point sur les pratiques de remplissage vasculaire (RV) périopératoire ayant démontré un bénéfice pour les patients, afin de les utiliser en pratique quotidienne. Chez les patients chirurgicaux considérés « à haut risque », il est recommandé de titrer le RV peropératoire en se guidant sur une mesure du volume d’éjection systolique (VES) dans le but de réduire la morbidité postopératoire, la durée de séjour hospitalier, et le délai de reprise d’une alimentation orale des patients de chirurgie digestive. Il est recommandé de réévaluer régulièrement le VES et son augmentation (ou non) en réponse à une épreuve de RV, en particulier lors des séquences d’instabilité hémodynamique afin de s’assurer de la pertinence de cette thérapeutique. Au cours de la chirurgie « mineure », pour diminuer l’incidence des nausées, des vomissements, le recours aux antiémétiques et la prescription de morphine postopératoire, il est probablement reco...

Coughing during emergence from general anesthesia may be detrimental in children. We compared the effect of a small dose of propofol or ketamine administered at the end of sevoflurane anesthesia on the incidence or severity of coughing in children undergoing a minimal invasive operation. SOURCE

Coughing during emergence from general anesthesia may be detrimental. Propofol is known to inhibit airway reflexes. We evaluated the incidence and severity of coughing in adults who received a subhypnotic dose of propofol at the end of sevoflurane-remifentanil anesthesia. SOURCE

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections. SOURCE

Patients with perforated peptic ulcer (PPU) often present with acute, severe illness that carries a high risk for morbidity and mortality. Mortality ranges from 3-40% and several prognostic scoring systems have been suggested. The aim of this study was to review the available scoring systems for PPU patients, and to assert if there is evidence to prefer one to the other. SOURCE

Fibreoptic intubation has long been considered the gold standard intubation technique in patients with an anticipated or known difficulty airway or as a rescue device in failure to intubate but able to ventilate scenarios [ 1 ]. Fibreoptic intubation can be a difficult skill to teach, learn and maintain [ 2 ]. Since the late 1990’s advances in video technology and fibreoptics has resulted in an increasing number of commercially available video laryngoscopes. Several studies have demonstrated that video laryngoscopes generally provide a better view of the glottis and have higher success rates of intubation compared with the traditional Macintosh blade in patients with a predicted difficult airway. Video laryngoscopes have the additional advantage of less movement of the cervical spine, and are potentially less traumatic; however, these devices may fail secondary to trismus and oropharyngeal tumors, infection or foreign bodies resulting in difficulty inserting the blade. Active bleeding...

Fifty four percent of all infant deaths in the United States occur among the 2 percent of infants born at less than 32 weeks’ gestation (2007). 1  The optimal route of delivery for the early preterm fetus remains controversial. Some observational studies have shown a lower neonatal mortality for planned cesarean delivery as compared with vaginal delivery for vertex  2 – 4  and breech early preterm pregnancies  2 ,  4 – 9 whereas other studies do not show a difference by route of delivery for vertex 10 – 12  or breech presentation. 13 – 15 The vertical uterine incision often required for cesarean delivery at this gestational age increases the risks of hemorrhage, bladder injury and other complications. There is also an increased risk of uterine rupture, placenta previa and placenta accreta in subsequent pregnancies. 16 – 17 Six trials have attempted to randomize the route of delivery for women in preterm labor at high risk for delivery. Recruitment dif...

Although the incidence of extrapyramidal reactions associated with metoclopramide has been reported to be approximately 0.2%, such reactions are rare in the anesthetic field. Several anesthetic adjuvants, including ondansetron and pregabalin, have also been associated with extrapyramidal side effect. Here, the authors report the case of a 47-year-old patient, previously administered pregabalin and ondansetron, who developed extrapyramidal side effects after a single injection of metoclopramide (10 mg) in a post-anesthesia care unit. SOURCE

Obstructive sleep apnea (OSA) has been linked to a myriad of chronic diseases with physically serious and economically draining consequences. There has been a substantial increase in its prevalence over the last two decades and up to one-quarter of the elective surgical patients have been found to be at high risk for OSA. These patients are at an increased risk for perioperative adverse events such as cardiac and pulmonary complications as well as postoperative delirium. This review addresses the screening methods such as the STOP-Bang questionnaire for the undiagnosed and the preoperative management of the known and at-risk patients. Recommendations for the evaluation of the systemic complications and its management are included. Recent suggestions for the intraoperative management and risk mitigation methods are reviewed, such as the role of regional anesthesia and non-opioid analgesics. Special focuses on postoperative issues such as pain control, oxygenation, positioning, and pat...