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The aim of this survey was to describe existing perioperative care standards and best practices in the Netherlands and Belgium. An online survey was followed up by an in-depth personal interview. The main outcomes were the existing standards of perioperative care for patients undergoing cardiac surgery. The online survey and subsequent interviews were targeted to one representative in the intensive care unit (ICU), cardiac surgery, and anesthesiology department from each cardiac surgical center in the Netherlands and Belgium. A representative intensive care physician, cardiac surgeon, and cardiac anesthesiologist. None. The response rate was 60% (71% for the Netherlands, and 44% in Belgium). Agreement across centers was found for discontinuation of proton-pump inhibitors (80%) and avoiding intra- and postoperative (92%) nonsteroidal antiinflammatory drugs. Additionally, 98% of respondents stated that physiotherapy should be started immediately in the ICU. Major divergence was found for elements such as the discontinuation of angiotensin-converting enzyme inhibitors (55%) or the postoperative use of chest support vests (44%). The authors demonstrated a wide range of different local protocols. Strategies differed among disciplines, hospitals, and countries. This emphasized the need for the implementation of a more universal protocol to further reduce variance and improve recovery practices. This nationwide survey was the first of its kind simultaneously studying best practices for cardiac surgery through the entire care pathway at the advent of Enhanced Recovery After Surgery (ERAS) Cardiac implementation. A multinational randomized controlled trial to test the implementation of an evidence-based ERAS Cardiac protocol is the next step to pave the way for further outcome improvements in this high-risk population. [ABSTRACT FROM AUTHOR]

This review describes the steps and conclusions from the development and validation of an artificial intelligence algorithm (the Hypotension Prediction Index), one of the first machine learning predictive algorithms used in the operating room environment. The algorithm has been demonstrated to reduce intraoperative hypotension in two randomized controlled trials via real-time prediction of upcoming hypotensive events prompting anesthesiologists to act earlier, more often, and differently in managing impending hypotension. However, the algorithm entails no dynamic learning process that evolves from use in clinical patient care, meaning the algorithm is fixed, and furthermore provides no insight into the decisional process that leads to an early warning for intraoperative hypotension, which makes the algorithm a "black box." Many other artificial intelligence machine learning algorithms have these same disadvantages. Clinical validation of such algorithms is relatively new and requires more standardization, as guidelines are lacking or only now start to be drafted. Before adaptation in clinical practice, impact of artificial intelligence algorithms on clinical behavior, outcomes and economic advantages should be studied too. [ABSTRACT FROM AUTHOR]

For 30 years, transfusion-associated circulatory overload (TACO) has been recognized as a serious transfusion complication. Currently, TACO is the leading cause of transfusion-related morbidity and mortality worldwide which occurs in 1% to 12% of at-risk populations. Despite an incomplete understanding of the underlying pathophysiology, TACO is defined as a collection of signs and symptoms of acute pulmonary edema due to circulatory overload occurring within 6 to 12 hours of transfusion. In the past decade, large observational cohort studies resulted in better insight into the associated transfusion risk factors leading to the development of TACO. In this clinical review, we critically analyze the pathogenesis of TACO, associated risk factors, clinical presentation, diagnostic modalities, and treatment options to guide clinicians with early detection of this syndrome and intervention to improve clinical outcomes. Future research should focus on better understanding of the pathogenesis to help advance the field of volume kinetics and endothelial barrier function. • Preventive measures for mitigation of TACO incidence and severity • Strict adherence to restrictive RBC transfusion strategy • Single-unit RBC transfusion policy • Identification of at-risk patients (using electronic algorithms or checklist) • Intensive monitoring of at-risk patients [ABSTRACT FROM AUTHOR]

Abstract Background Fluid and pain management during liver surgery (eg, low central venous pressure) is a classic topic of controversy between anesthesiologists and surgeons. Little is known about practices worldwide. The aim of this study was to assess perioperative practices in liver surgery among and between surgeons and anesthesiologists worldwide that could guide the design of future international studies. Methods An online questionnaire was sent to 22 societies, including 4 international hepatopancreatobiliary societies, the American Society of Anesthesiologists, and 17 other (inter-)national societies. Results A total of 913 participants (495 surgeons and 418 anesthesiologists) from 66 countries were surveyed. A large heterogeneity in fluid management practices was identified, with 66% using low central venous pressure, 22% goal-directed fluid therapy, and 6% normovolemia. In addition, large heterogeneity was found regarding pain management practices, with 49% using epidural analgesia, 25% patient-controlled analgesia with opioids, and 12% regional techniques. Most participants assume that there is a relation between perioperative pain management and morbidity and mortality (78% of surgeons vs 89% of anesthesiologists; P <.001). Both surgeons and anesthesiologists have the highest expectations for minimally invasive surgery and enhanced recovery pathways for improving outcomes in liver surgery. No clear differences between continents were found. Conclusion Worldwide there is a large heterogeneity in fluid and pain management practices in liver surgery. This survey identified several areas of interest for future international studies aiming to improve outcomes in liver surgery. [ABSTRACT FROM AUTHOR]

Study Objective: The mini-fluid challenge may predict fluid responsiveness with minimum risk of fluid overloading. However, the amount of fluid as well as the best manner to evaluate the effect is unclear. In this prospective observational pilot study, the value of changes in pulse contour cardiac output (CO) measurements during mini-fluid challenges is investigated.Design: Prospective observational study.Setting: Intensive Care Unit of a university hospital.Patients: Twenty-one patients directly after elective cardiac surgery on mechanical ventilation.Interventions: The patients were subsequently given 10 intravenous boluses of 50mL of hydroxyethyl starch with a total of 500mL per patient while measuring pulse contour CO.Measurements: We measured CO by minimal invasive ModelflowR (COm) and PulseCOR (COli), before and one minute after each fluid bolus. We analyzed the smallest volume that was predictive of fluid responsiveness. A positive fluid response was defined as an increase in CO of >10% after 500mL fluid infusion.Main Results: Fifteen patients (71%) were COm responders and 13 patients (62%) COli responders. An increase in COm after 150mL of fluid >5.0% yielded a positive and negative predictive value (+PV and -PV) of 100% with an area under the curve (AUC) of 1.00 (P<0.001). An increase in COli >6.3% after 200mL was able to predict a fluid response in COli after 500mL with a +PV of 100% and -PV of 73%, with an AUC of 0.88 (P<0.001).Conclusion: The use of minimal invasive ModelflowR pulse contour CO measurements following a mini-fluid challenge of 150mL can predict fluid responsiveness and may help to improve fluid management. [ABSTRACT FROM AUTHOR]

Hypovolemia is a common clinical problem. The Trendelenburg position and passive leg raising (PLR) are routinely used in the initial treatment while awaiting fluid resuscitation. In this metaanalysis, we evaluated the hemodynamic effects of PLR and Trendelenburg positioning to determine which position had the most optimal effect on cardiac output (CO). Databases were searched for prospective studies published between 1960 and 2010 in normovolemic or hypovolemic humans; these studies had to investigate the hemodynamic effects within 10 minutes of a postural change from supine. Twenty-one studies were included for PLR (n=431) and 13 studies for Trendelenburg position (n=246). Trendelenburg position increased mean arterial pressure (MAP). Cardiac output increased 9%, or 0.35 L/min, at one minute of head-down tilt. Between 2 and 10 minutes, this increase in CO decreased to 4%, or 0.14 L/min, from baseline. Cardiac output increased at one minute of leg elevation by 6%, or 0.19 L/ min. The effect persisted after this period by 6%, or 0.17 L/min. Both Trendelenburg and PLR significantly increased CO, but only PLR seemed to sustain this effect after one minute. Although the Trendelenberg position is a common maneuver for nurses and doctors, PLR may be the better intervention in the initial treatment of hypovolemia. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess both level and type of the initial training on regional anesthesia for French residents after the publication of formalized recommendations of experts on training and practice in regional anesthesia in 2006. Study design: Practical statement enquiry. Material and methods: A multiple choice questionnaire was sent to all the French residents in anesthesiology. Questions are focused on demographic data (year of training, university hospital origin, theoretical training, type and length of practical courses) and regional anesthesia practice, particularly about the essentials of regional anesthesia techniques for initial training, level of practice and degree of autonomy, especially for the 5th and the 3rd years students. After sending, two follow-ups were done, responses were obtained by mail or post. Results: The global answer rate was 29.1% (25.3% and 23.4% for the 5th and the 3rd years respectively). Concerning theoretical training, 29% of responders had anatomy course, 33% dissection and 38% a supplemental training. At the end of initial training, the official goal (30 acts for a specific technique) was achieved in 98% of cases for epidural anesthesia, 95% for spinal anesthesia, 82% for both axillary and humeral block and 72% for femoral block, with a declared 100% autonomy at this level. Conclusion: The main goal of the formalized recommendations on training and practice in regional anesthesia is partially reached. This apparent failure can be due to both a lack of regional anesthesia exposure, inadequate faculty training, usual slavery to routine, or technical evolution of medical practice. [Copyright &y& Elsevier]

Summary: Purpose: To determine the extent to which younger COPD patients improve their cardiorespiratory function during exercise in comparison with older COPD patients, as a result of exercise training. Methods: Thirty-nine COPD patients underwent an exercise program. They were divided into two groups: a younger group (57.2±1.0 years, n=18 patients) and an older group (68.8±0.6 years, n=21 patients). Forced expiratory volume in 1s was lower than 55% of the predicted value for all patients. Results: After training, V˙O2 symptom-limited significantly improved by 10.3% and 8.4% for the younger and older COPD patients, respectively (P<0.05). Peak power significantly improved by 25.2% and 17.8% in the younger and older groups, respectively (P<0.05) with a greater improvement for the younger group (P<0.05). At submaximal exercise, ventilation and heart rate significantly decreased after training in the younger COPD patients (P<0.05) with no significant modification in the older COPD patients. Conclusions: The results suggest that all patients with COPD benefit from exercise rehabilitation at maximal exercise workload, however, according to their age, submaximal cardiorespiratory adaptations were greater in younger patients. [Copyright &y& Elsevier]

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Introduction Le monitorage du volume d’éjection systolique (VES) est recommandé en chirurgie abdominale lourde pour optimiser le remplissage vasculaire. Le Doppler œsophagien (DO) (CombiQ ® , Deltex Medical ® , Angleterre), recommandé par plusieurs référentiels [1] , est le monitorage de référence dans notre institution. L’EsCCO ® (Nihon Kohden ® , Tokyo, Japon) est un nouveau moniteur non invasif du VES basé sur l’analyse du temps de transit des globules rouges estimé à partir du décalage entre le complexe QRS et le signal de pouls donné par la saturation [2] . Notre travail évalue la concordance des variations de VES mesurées par l’EsCCO ® et le DO lors d’injection de vasopresseurs ou d’expansion volémique. Matériel et méthodes Étude prospective monocentrique, observationnelle, de soins courants au bloc opératoire de chirurgie digestive de Lariboisière effectuée de novembre 2013 à mars 2014 (CERB CE SRLF 11-356). Les patients inclus nécessitaient pour leur chirurgie un monitorage du VES par DO (décidé en consultation d’anesthésie) auquel était ajouté l’EsCCO ® . Les hypotensions peropératoires étaient traitées par des épreuves de remplissage vasculaire (cristalloïdes uniquement) ou des vasopresseurs, selon le choix de l’anesthésiste responsable du patient. Avant (T0) et après (T1) chaque épreuve thérapeutique, les paramètres suivants étaient recueillis : la pression artérielle moyenne (PAM), la fréquence cardiaque (Fc), le VES (VES_EsCCO et VES_DO) de l’EsCCO ® et du Doppler œsophagien. La concordance entre les méthodes était évaluée par représentation en 4 quadrants avec pourcentage de concordance et graphique de Bland et Altman. Résultats Dix-sept patients ont été inclus : 53 % d’hommes, âge moyen 52 ± 14 ans, 15 patients ASA 2 et 2 patients ASA 3. Une résection digestive étendue avec chimiothérapie intrapéritonéale hyperthermique (CHIP) étaient réalisées chez 13 patients et sans CHIP pour 4 patients. La durée médiane de chirurgie était de 360 min [300–600] avec un remplissage médian par cristalloïdes de 6000 mL [4000–8500]. À T0 : PAM médiane = 63,3 mmHg [57,7–68,3], Fc = 69 bpm [60–82], le VES EsCCO = 59 mL [51–74] et VES DO = 90 mL [74–99]. L’analyse de Bland et Altman pour mesures répétées de l’ensemble des épreuves thérapeutiques retrouve un biais moyen de –22,14 mL et des limites d’agrément de–80,38 mL à 36,10 mL ( Fig. 1 ). Cinquante-huit épreuves de remplissage et 37 administrations de vasopresseurs ont été effectuées ( Tableau 1 ). Discussion Pour les épreuves de remplissage, l’EsCCO surestime les variations de VES évaluées par le DO avec un biais faible, un taux de concordance acceptable mais un agrément large. Lors d’injection de vasopresseurs, l’EsCCO sous-estime les variations de VES mesurées par le DO avec un biais plus élevé, des limites d’agrément plus larges et un taux de concordance inacceptable. Ces premiers résultats doivent être confirmés sur une population plus importante. L’EsCCO ne semble pas être adapté lors de l’utilisation de vasopresseurs. [ABSTRACT FROM AUTHOR]

Background: Intraoperative and postoperative hypotension are associated with morbidity and mortality. The Hypotension Prediction (HYPE) trial showed that the Hypotension Prediction Index (HPI) reduced the depth and duration of intraoperative hypotension (IOH), without excess use of intravenous fluid, vasopressor, and/or inotropic therapies. We hypothesised that intraoperative HPI-guided haemodynamic care would reduce the severity of postoperative hypotension in the PACU.Methods: This was a sub-study of the HYPE study, in which 60 adults undergoing elective noncardiac surgery were allocated randomly to intraoperative HPI-guided or standard haemodynamic care. Blood pressure was measured using a radial intra-arterial catheter, which was connected to a FloTracIQ sensor. Hypotension was defined as MAP <65 mm Hg, and a hypotensive event was defined as MAP <65 mm Hg for at least 1 min. The primary outcome was the time-weighted average (TWA) of postoperative hypotension. Secondary outcomes were absolute incidence, area under threshold for hypotension, and percentage of time spent with MAP <65 mm Hg.Results: Overall, 54/60 (90%) subjects (age 64 (8) yr; 44% female) completed the protocol, owing to failure of the FloTracIQ device in 6/60 (10%) patients. Intraoperative HPI-guided care was used in 28 subjects; 26 subjects were randomised to the control group. Postoperative hypotension occurred in 37/54 (68%) subjects. HPI-guided care did not reduce the median duration (TWA) of postoperative hypotension (adjusted median difference, vs standard of care: 0.118; 95% confidence interval [CI], 0-0.332; P=0.112). HPI-guidance reduced the percentage of time with MAP <65 mm Hg by 4.9% (adjusted median difference: -4.9; 95% CI, -11.7 to -0.01; P=0.046).Conclusions: Intraoperative HPI-guided haemodynamic care did not reduce the TWA of postoperative hypotension. [ABSTRACT FROM AUTHOR]

Low central venous pressure (low-CVP) is the clinical standard for fluid therapy during major liver surgery. Although goal-directed fluid therapy (GDFT) has been associated with reduced morbidity and mortality in major abdominal surgery, concerns remain on blood loss when applying GDFT in liver surgery. This randomized trial compared outcomes of low-CVP and GDFT during major liver resections. In this surgeon- and patient-blinded RCT, patients undergoing major open liver resections (≥3 segments) were randomized between low-CVP (n = 20) or GDFT (n = 20). Primary outcome was intraoperative blood loss. Secondary outcomes included the quality of the surgical field (VAS scale 0 (worst)-100 (best)) and major morbidity (≥grade 3 Clavien-Dindo). During surgery, CVP was 3 ± 2 mmHg in the low-CVP group vs. 7 ± 3 mmHg in the GDFT group (P < 0.001). Blood loss (1425 vs. 1275 mL; P = 0.640) and the rate of major morbidity (40% vs. 50%, P = 0.751), did not differ between low-CVP and GDFT, respectively. The quality of the surgical field was comparable between groups (low-CVP 83% vs. GDFT 80%, P = 0.955). In major open liver resections, GDFT was not associated with differences in intraoperative blood loss, major morbidity or quality of the surgical field, compared to low-CVP. Larger RCTs are needed to confirm this finding. Registration number: NTR5821 (www.trialregister.nl). [ABSTRACT FROM AUTHOR]

Background. Maintaining adequate organ perfusion during high-risk surgery requires continuous monitoring of cardiac output to optimise haemodynamics. Oesophageal Doppler Cardiac Output monitoring (DCO) is commonly used in this context, but has some limitations. Recently, the cardiac output estimated by pulse pressure analysis- (PPCO) was developed. This study evaluated the agreement of cardiac output variations estimated with 9 non-commercial algorithms of PPCO compared with those obtained with DCO. Methods. High-risk patients undergoing neurosurgery were monitored with invasive blood pressure and DCO. For each patient, 9 PPCO algorithms and DCO were recorded before and at the peak effect for every haemodynamic challenge. Results. Sixty-two subjects were enrolled; 284 events were recorded, including 134 volume expansions and 150 vasopressor boluses. Among the 9 algorithms tested, the Liljestrand- Zander model led to the smallest bias (0.03 litre min-1 [-1.31, +1.38] (0.21 litre min-1 [-1.13; 1.54] after volume expansion and 20.13 litre min-1 [-1.41, 1.15] after vasopressor use). The corresponding percentage of the concordance was 91% (86% after volume expansion and 94% after vasopressor use). The other algorithms, especially those using the Winkessel concept and the area under the pressure wave, were profoundly affected by the vasopressor. Conclusions. Among the 9 PPCO algorithms examined, the Liljestrand-Zander model demonstrated the least bias and best limits of agreement, especially after vasopressor use. Using this particular algorithm in association with DCO calibration could represent a valuable option for continuous cardiac output monitoring of high risk patients. [ABSTRACT FROM AUTHOR]

Background: Respiratory variation in pulse pressure (ΔPP) is commonly used to predict the fluid responsiveness of critically ill patients. However, some researchers have demonstrated that this measurement has several limitations. The present study was designed to evaluate the proportion of patients satisfying criteria for valid application of ΔPP at a given time-point.Methods: A 1 day, prospective, observational, point-prevalence study was performed in 26 French intensive care units (ICUs). All patients hospitalized in the ICUs on the day of the study were included. The ΔPP validity criteria were recorded prospectively and defined as follows: (i) mechanical ventilation in the absence of spontaneous respiration; (ii) regular cardiac rhythm; (iii) tidal volume ≥8 ml kg(-1) of ideal body weight; (iv) a heart rate/respiratory rate ratio >3.6; (v) total respiratory system compliance ≥30 ml cm H2O(-1); and (vi) tricuspid annular peak systolic velocity ≥0.15 m s(-1).Results: The study included 311 patients with a Simplified Acute Physiology Score II of 41 (39-43). Overall, only six (2%) patients satisfied all validity criteria. Of the 170 patients with an arterial line in place, only five (3%) satisfied the validity criteria. During the 24 h preceding the study time-point, fluid responsiveness was assessed for 79 patients. ΔPP had been used to assess fluid responsiveness in 15 of these cases (19%).Conclusions: A very low percentage of patients satisfied all criteria for valid use of ΔPP in the evaluation of fluid responsiveness. Physicians must consider limitations to the validity of ΔPP before using this variable. [ABSTRACT FROM AUTHOR]

Summary: Objective: The objective was to examine the relationship between rating of perceived exertion (RPE) at the point of maximal lipids oxidation (LIPOXmax), physiological responses and psychological profile in trained competitive cyclists. Patients and methods: Twenty-one competitive cyclists performed an exercise test in order to determine RPE at LIPOXmax. During this exercise test, physiological responses at LIPOXmax were measured. Moreover, a psychological profile for each cyclist has been evaluated from questionnaires (levels of anxiety, desire for success, self-esteem, psychological resistance and endurance, dynamism, competitiveness, activity control, risk-taking, emotional control, extroversion–introversion, leadership, aggressiveness, sociability, cooperation, acceptance of a judgment, and social desirability). Multiple linear regression analysis was performed to determine the physiological and psychological factors linked to RPE at LIPOXmax. Results: Only the percentage of maximal oxygen uptake (), leadership and psychological endurance explained significantly the RPE at LIPOXmax. Conclusion: More the cyclists have a low RPE at LIPOXmax, more their LIPOXmax () was low. Cyclists with high level of leadership (i.e., persuasive, with command ability) and/or psychological endurance (i.e., persistent, obstinate) have lower RPE at LIPOXmax than the cyclists with lower level of leadership and/or psychological endurance. [Copyright &y& Elsevier]

Summary: Objectives: The main objectives of this study were: (1) to test the effect of performance level on the maximum lipids oxidation flow rate (LIPOXmax) in trained cyclists, and (2) to identify the target exercise intensities corresponding to LIPOXmax. Patients and methods: Twenty-four trained cyclists were distributed in two groups according to their performance level (G1: 17 cyclists with local level versus G2: seven cyclists with elite level). All cyclists performed the same exercise test. Cardiorespiratory data and rating of perceived exertion (RPE) were measured during each stage. LIPOXmax was determined, and then expressed in terms of percentage of maximal aerobic power (MAP), maximal oxygen uptake (), reserve oxygen uptake (), maximal heart rate (HRmax), reserve heart rate (HRreserve), and RPE. These values were compared from one-way ANOVA (G1 versus G2). Results: Confidence intervals (CI95%) of LIPOXmax corresponded to 37–44% MAP, 41–47% , 35–42% , 44–59% HRreserve, and to RPE 8–10, independently of group (p >0.05). However, group effect was noticed when LIPOXmax was expressed in terms of HRmax (CI95%=56–61% and 60–70% HRmax for G1 and G2, respectively; p =0.03). However, a large part of the interindividual variation of LIPOXmax was noticed. Conclusion: The performance level do not influence the LIPOXmax in trained cyclists (except if it is expressed in % HRmax). It seems difficult to use common target exercise intensities in order to prescribe exercise intensity corresponding to LIPOXmax in trained cyclists. [Copyright &y& Elsevier]

Abstract: Lead phosphovanadates can be used as reactants for the synthesis of iodoapatite. Because of its high chemical durability, iodoapatite has considerable potential interest for immobilizing radioactive iodine. Iodine-bearing compounds must be synthesized and consolidated at low temperatures to avoid iodine volatilization. Spark plasma sintering (SPS) thus appears to be a suitable sintering process because of its short processing time. This paper deals with spark plasma sintering of lead phosphovanadate powder prepared mechanically by attrition and planetary ball milling. The influence of sintering parameters such as the heating rate, temperature, and holding time on the degree of densification and the microstructure of bulk materials is discussed. The bulk characteristics were directly correlated with the shrinkage curves. The powder characteristics were determined (grain size and size distribution, specific area, crystallite size, etc.) to explain the singular sintering behavior of the attrited powder; we also investigated whether the latter exhibited the same singular behavior during conventional sintering and hot pressing. [Copyright &y& Elsevier]

Abstract: In contrast with dermatomyositis and polymyositis, inclusion body myositis is unresponsive to glucocorticoid treatment. Glucocorticoid action is mediated through an active glucocorticoid receptor-α and negatively regulated by another glucocorticoid receptor isoform. In several autoimmune diseases glucocorticoid receptor-β up-regulation is involved in glucocorticoid resistance. We studied glucocorticoid receptor distribution in normal and inflammatory myopathy muscle and investigated whether differences in glucocorticoid receptor-α and glucocorticoid receptor-β protein expression are involved in the differential glucocorticoid sensitivity in inclusion body myositis versus polymyositis. Multistep immunofluorescence and Western blotting on fractionated cytoplasmic or nuclear muscle samples were used. Glucocorticoid receptor-α was the predominant receptor subtype in muscle and occurred abundantly in myonuclei of control and diseased muscle alike. Glucocorticoid receptor-β was constitutively expressed on a subset of endothelial cells. No differences between dermatomyositis and the other idiopathic inflammatory myopathies were observed. Increased nuclear glucocorticoid receptor that has dissociated from heat shock protein 90 was found in glucocorticoid treated subjects. Glucocorticoid receptor-α and -β isoform levels were unaltered in muscle tissues from control subjects that had received glucocorticoid treatment prior to biopsy. No differences in relative glucocorticoid receptor-α and glucocorticoid receptor-β protein expression were seen in inclusion body myositis versus polymyositis specimens. Our study indicates that the different glucocorticoid sensitivity in the idiopathic inflammatory myopathies is not related to up- or down-regulation of a given glucocorticoid receptor isoform at the protein level. [Copyright &y& Elsevier]

Aim. – A comparison of cycle and rowing ergometer, the heart rate values at ventilatory threshold 1 (SV1) for healthy elderly people. The derived regression between the two ergometers would make it possible to carry out only one test on either ergometer to set individualized training loads.Methods. – A group of 18 healthy subjects aged 64.4 ± 4.7 years carried out two triangular tests on cycle ergometer and rowing ergometer.Results. – At SV1, heart rate was not significantly different between the two ergometers (118.3 ± 13.0 batt.min–1 on cycle ergometer; 120.9 ± 15.3 batt.min–1 on rowing ergometer) and no difference either for the oxygen uptake (17.1 ± 6.2 ml.min–1.kg–1 on cycle ergometer; 17.8 ± 6.2 ml.min–1.kg–1 on rowing ergometer). On cycling and rowing ergometers, at maximum exercise, the maximum oxygen uptake and maximum ventilatory did not present a significant difference and were represented, respectively, by: 26.5 ± 8.7, 26.1 ± 7.7 ml.min–1.kg–1 and 69.5 ± 8.7, 70.3 ± 7.7 l.min–1.Conclusion. – There was no differences between HR at SV1, no regressions necessary to estimate one HR value from the other and, only one ergometer test is necessary to determine individualized training HR at SV1 in elderly people. [Copyright &y& Elsevier]

Introduction Les vasopresseurs sont fréquemment utilisés pour traiter les hypotensions artérielles en anesthésie. Ceux-ci ont pour objectif de corriger l’hypotension par vasoconstriction plus ou moins associée à un effet inotrope positif. Habituellement, l’éphédrine est utilisée en première intention, puis la phényléphrine lors d’hypotension persistante. Cependant, la vasoconstriction induite par la phényléphrine s’accompagne d’une augmentation de la postcharge ventriculaire gauche et peut avoir un effet délétère notamment chez le patient à risque cardiovasculaire. L’utilisation de noradrénaline à petite dose a été décrite dans ce contexte [1,2] pour son effet sur le retour veineux et son effet moindre sur la postcharge ventriculaire gauche. L’objectif de cette étude était de comparer les variations de la rigidité artérielle et du débit cardiaque après injection d’éphédrine, de phényléphrine et de noradrénaline lors d’hypotensions au cours de l’anesthésie générale. Matériel et méthodes L’étude a été menée sur des patients majeurs de neurochirurgie, après accord du comité d’éthique (CE SRLF 11-356). Les patients ont bénéficié d’un monitorage hémodynamique comprenant un dispositif de mesure continue de la pression artérielle invasive et du débit cardiaque par Doppler œsophagien (CombiQ ® , Deltex Medical). Un tonomètre artériel (Sphygmocor ® , Atcor Medical) a été utilisé pour obtenir des courbes de pression artérielle centrale et des indices de rigidité artérielle. Lors de la survenue d’une hypotension artérielle, il était fait selon les habitudes du service, soit 9 mg d’éphédrine (EPH), soit 50 μg de phényléphrine (NEO), soit 5 μg de noradrénaline (NOR). Les mesures étaient effectuées avant chaque injection, et au moment du pic d’effet. Les paramètres recueillis étaient : la fréquence cardiaque (FC), la pression artérielle moyenne (PAM), le volume d’éjection systolique (VES), le débit cardiaque (DC), l’Augmentation Index (Aix) et l’élastance artérielle (Ea). Résultats Trois cent seize injections de vasopresseurs (EPH : 47 ; NEO : 120 ; NOR : 149) chez 44 patients (âge médian : 53 ± 15 ans, sex-ratio : 17H/27F) ont été étudiés. Pour une augmentation de PAM équivalente (+20 %), l’EPH est associée à une stabilité du VES et à une absence d’augmentation de l’Aix. Les deux autres vasopresseurs conduisent à une diminution significative du VES associée à une augmentation de l’Aix et de l’Ea. Cependant, la baisse du VES est significativement plus importante dans le groupe NEO que dans le groupe NOR. Inversement, la NEO conduit à une augmentation nettement plus importante de l’Aix que la NOR ( Figure 1 ). Aucun effet indésirable lié à l’injection des vasopresseurs n’a été relevé durant la période de l’étude. Discussion Cette étude semble indiquer que, en comparaison avec la phényléphrine, l’utilisation de noradrénaline à petite dose permet de restaurer la pression artérielle des patients sous anesthésie générale en préservant le débit cardiaque. La noradrénaline pourrait être utilisée en relais de l’éphédrine notamment chez le patient à risque cardiovasculaire. Il est nécessaire de compléter ces résultats par un essai contrôlé [ABSTRACT FROM AUTHOR]