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Resume Objectifs : Preciser les habitudes en matiere de prescription de bilan de coagulation preoperatoire et evaluer l’impact sur les habitudes de prescription de la prise de connaissance des resultats de la premiere partie de l’enquete et d’une information medicale repetee. Type d’etude : Etude epidemiologique descriptive et comparative. Patients et methodes : L’etude a ete menee en deux temps sur deux journees au cours de deux annees consecutives (1998 et 1999). Elle concernait 22 cliniques privees de la region Nord-Pas-de-Calais. Un questionnaire facile et bref etait a completer par les anesthesistes des cliniques participantes pour chacun des patients admis au bloc operatoire. Celui-ci s’interessait notamment a la presence ou non d’un bilan d’hemostase, a son prescripteur eventuel et aux examens biologiques demandes. Les resultats de la premiere partie de l’enquete (1998) ont ete presentes a plusieurs reprises aux anesthesistes concernes. Ils ont ete discutes et confrontes aux recommandations d’experts avant que la meme enquete ne soit repetee en 1999. Resultats : En 1998, un bilan a ete prescrit pour 81 % des patients ( n = 662) et plus d’une fois sur deux a l’initiative d’un anesthesiste. Dans moins de 5 % des cas il existait une ou plusieurs anomalies dont la moitie etaient previsibles au vu des antecedents des patients. Un seul des patients enrole dans l’enquete a presente un probleme hemorragique alors qu’il avait un bilan de coagulation normal. Un an apres, la prescription d’un bilan de coagulation preoperatoire concernait 75 % des patients ( n = 400), ce qui represente une diminution faible mais significative du nombre de prescriptions par rapport a 1998 ( p Conclusions: Dans cette etude, l’information medicale repetee des praticiens entre les deux temps de l’enquete n’a pas permis de diminuer de facon importante le nombre de prescriptions de bilan de coagulation preoperatoire. Ces resultats plaident en faveur d’une approche differente de l’expose des connaissances scientifiques pour esperer modifier les comportements.

Resume Objectif : Faire le point sur les connaissances actuelles de l’anesthesie au xenon. Sources des donnees : References obtenues dans la banque de donnees Medline®, les revues generales recentes, la bibliotheque du service et les documents personnels. Selection des travaux : L’ensemble des categories d’articles sur le theme a ete retenu. Extraction des donnees : Les articles ont ete analyses pour l’historique, la biophysique, la pharmacologie, la toxicite et les effets environnementaux et les perspectives d’utilisation. Synthese des donnees : Le xenon, dont les effets anesthesiques sont connus depuis plus de 50 ans, est decrit comme un gaz ayant beaucoup des caracteristiques de l’agent anesthesique ideal. Depourvu de toxicite, neutre sur le plan hemodynamique, il possede une cinetique d’action qui autorise des reveils anesthesiques extremement rapides. Le xenon est reste neanmoins peu utilise en pratique quotidienne du fait de sa rarete entrainant un cout tres eleve. L’interet pour l’anesthesie au xenon est recemment reapparu pour deux raisons : a) la prise de conscience de la toxicite pour l’individu et l’environnement des anesthesiques par inhalation ; b) le developpement de nouveaux systemes d’anesthesie en circuit ferme permettant la recuperation du gaz utilise. La diminution importante de la quantite de xenon necessaire pour la realisation de l’anesthesie rend ainsi son utilisation financierement acceptable. Le xenon pourrait donc trouver sa place dans l’arsenal des produits anesthesiques, dans des indications qui restent a preciser. Une etude multicentrique europeenne de phase III en cours permettra de mieux evaluer l’interet clinique de ce gaz.

Objective To investigate whether changes in gastric intramucosal pH (pHim) occur during major abdominal surgery, and if so, to determine the relationship between classic global indices of tissue perfusion such as mean arterial blood pressure (MAP), heart rate (HR), central venous pressure (CVP), urine flow (UF) and arterial pH (pHa).

The case of a 34-year-old woman who experienced a biological haemostasis disorder, without clinical manifestations, is reported. The disorder was caused by a factor V inhibitor induced by a prolonged administration of antibiotics required by a postoperative biliary peritonitis. Therapeutic strategies in patients with an acquired factor V inhibitor are reviewed.

This study aimed at: i) stating what the routines are regarding ordering of preoperative coagulation test; ii) evaluating the impact on the use of pre-operative orders from the data obtained during the first and the second parts of the study.Descriptive and comparative epidemiologic study.This study was performed twice, and lasted for one day each during two consecutive years (1998 and 1999). It concerned 22 private clinics in the French region 'Nord-Pas-de-Calais'. The anaesthesiologists who took part in the project had to fill out an easy and brief questionnaire concerning each patient who had been admitted to the operating area. It dealt mainly with the presence or the absence, of a preoperative laboratory screening, and with who ordered the test and which tests. The results of the first part of the study (1998) have been evaluated several times with the involved anaesthesiologists. Before repeating the study in 1999, the results were first discussed and compared to the recommendations of the experts.In 1998, preoperative coagulation tests were ordered for 81% of the patients (n = 662), which in more than half the cases were ordered by an anaesthesiologists. In less than 5% of the cases, one or more abnormalities were detected out of which half were predictable because of the patients previous medical history. Only one of the patients in the study suffered from an haemorrhagical problem although he had a normal coagulation screening. A year after, the ordering of a preoperative coagulation check included 75% of the patients (n = 400), which represents a small but nonetheless significant decrease of the number of orders compared to 1998 (p0.05). The proportion of preoperative laboratory screening prescribed by an anaesthesiologist remained the same. There were one or more abnormalities in 1% of the screening tests that were obtained. A patient had a haemorrhagical problem while she had a normal coagulation screening.In this study, repeated feed-back to the writers of the preoperative orders in the time interval between the two parts of the study did not induce a noticeable decrease in the number of preoperative coagulation tests ordered. The results show the necessity of a different approach to present scientific knowledge in order to modify medical behaviour.

To analyze the current knowledge concerning xenon anaesthesia.References were obtained from computerized bibliographic research (Medline), recent review articles, the library of the service and personal files.All categories of articles on this topic have been selected.Articles have been analysed for history, biophysics, pharmacology, toxicity and environmental effects and using prospect.The noble gas xenon has anaesthetic properties that have been recognized 50 years ago. Xenon is receiving renewed interest because it has many characteristics of an ideal anaesthetic. In addition to its lack of effects on cardiovascular system, xenon has a low solubility enabling faster induction of and emergence from anaesthesia than with other inhalational agents. Nevertheless, at present, the cost and arety of xenon limit its widespread use in clinical practice. The developement of closed rebreathing system that allowed recycling of xenon and therefore reducing its waste has led to a recent interest in this gas. Reducing its cost will help xenon to find its place among anaesthetic agents. An European multicentric clinical trial under submission will contribute to the discussion of the opportunity for xenon introduction in anaesthesia.

To investigate whether changes in gastric intramucosal pH (pHim) occur during major abdominal surgery, and if so, to determine the relationship between classic global indices of tissue perfusion such as mean arterial blood pressure (MAP), heart rate (HR), central venous pressure (CVP), urine flow (UF) and arterial pH (pHa).Prospective descriptive study.Seven ASA2 patients undergoing major abdominal surgery.After induction of anaesthesia and endotracheal intubation, a tonometer nasogastric tube was positioned in the stomach. Measurements of tonometric PCO2 (PCO2ss), end-tidal PCO2 (PETCO2), PaCO2, bicarbonates [bicarb], pHa, MAP, HR, CVP and UF were collected at baseline (HO), and one, two, three, and 24 hours (H1, H2, H3, and H24) after the beginning of surgery.Haemodynamics did not significantly change during anaesthesia. During recovery HR increased and CVP decreased significantly. The pHim decreased significantly from 7.42 +/- 0.03 at H0 to 7.30 +/- 0.02 at H3. This was associated with a significant decrease in pHa (from 7.43 +/- 0.02 at H0 to 7.33 +/- 0.02 at H3) and in [bicarbo] from 22 +/- 1 mmol at H0 to 20 +/- 1 mmol at H3). The PaCO2 increased significantly from 33.5 +/- 1.5 mmHg at H0 to 39.5 +/- 2.8 at H3. On the other hand, pHimcorr (7.40- (pHa-pHim) and delta CO2 (PCO2ss-PETCO2) did not vary during anaesthesia. Postoperative organ failure did not occur in these patients.The pHim may decrease during anaesthesia without evidence of abnormal tissue perfusion. In order to avoid.

The case of a 34-year-old woman who experienced a biological haemostasis disorder, without clinical manifestations, is reported. The disorder was caused by a factor V inhibitor induced by a prolonged administration of antibiotics required by a postoperative biliary peritonitis. Therapeutic strategies in patients with an acquired factor V inhibitor are reviewed.