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OBJECTIFS : Les résections endoscopiques entraînent la combustion de tissus organiques qui pourraient induire la formation de méthémoglobine (MetHb) et de carboxyhémoglobine (COHb). L’objectif de ce travail est d’évaluer en quelles proportions celle-ci sont formées chez les patients bénéficiant d’une chirurgie endoscopique de la prostate ou de la vessie. MÉTHODE : Un dosage de COHb et de MetHb a été réalisé chez 44 patients en début et en fin d’intervention. Un troisième prélèvement a été réalisé chez les patients ayant séjourné plus d’une heure en salle de réveil. Les moyennes ont été comparées avec des tests de Student. Des régressions simples ont été utilisées pour les variables quantitatives et des Anova pour les variables qualitatives. Des régressions linéaires multiples ont été utilisées pour les analyses multivariées. RÉSULTATS : L’élévation moyenne de COHb était de 0,5 ± 0,9 % (IC95 % : 0,2 à 0,7 % p = 0,001) tandis que celle de MetHb était de 0,0 ± 0,4 % (IC95 % : −0,1 à 0,2 % p = 0,552). En analyse univariée, les variables corrélées à l’élévation de COHb sont la durée de l’opération, la quantité de liquide d’irrigation et la localisation (prostate ou vessie). Dans le modèle multivarié, l’élévation de COHb est associée à la quantité de liquide d’irrigation et au site de la résection. CONCLUSION : Nous n’avons pas mis en évidence d’augmentation de MetHb au cours de la chirurgie endoscopique. En revanche, COHb augmente, et peut, chez certains patients, devenir supérieure à 2–4 %. Ceci pourrait être responsable d’une diminution du seuil angineux chez des patients souffrant d’une cardiopathie ischémique. NIVEAU DE PREUVE : 4., [Evolution of the carboxyhemoglobinemia and methemoglobinemia during endoscopic resection: An observational study] AIM OF THE STUDY: Combustion of organic tissues due to endoscopic resection could induce methemoglobin (MetHb) and carboxyhemoglobin (COHb) formation. The aim of this study is to evaluate MetHb and COHb formation in patients undergoing prostatic or bladder endoscopic procedures. METHODS: COHb and MetHb measurements were performed in 44 patients at the beginning and end of the procedure. A third measurement was done in patients who stayed more than one hour in the recovery room. Means were compared using Student t-test, simple regressions were used for quantitative variables and ANOVA for categorical variables. Multiple linear regressions were used for multivariate analysis. RESULTS: COHb increased by 0.5±0.9 % (95 % CI: 0.2 to 0.7 % P=0.001). MetHb increase was 0.0±0.4 % (95 % CI: -0.1 to 0.2 % P=0.552). In univariate analysis, the variables associated with COHb increase are the length of surgery, the amount of irrigation fluid and location (prostate or bladder) of the procedure. In the multivariate model, COHb increase is associated with the amount of liquid and the location. CONCLUSION: MetHb did not increase during endoscopic surgery. In contrast, COHb increases, and can, in some patients, exceed 2-4 %. This could be responsible for a decreased angina threshold in patients with ischemic heart disease. LEVEL OF EVIDENCE: 4.

BACKGROUND: Deliberate hypotension is one way to achieve a bloodless surgical field in endoscopic sinus surgery (ESS). We compared two anaesthesia regimens to induce deliberate hypotension and attempted to determine the most efficient one. METHODS: Fifty-nine patients undergoing ESS were minimized into two groups. In the CLO group, patients received I.V. sufentanil 0.15 µg/kg together with I.V. clonidine 2-3 µg/kg. In the REMI group, patients received remifentanil at a rate of up to 1 µg/kg/min. Fromme scores were collected 15 min after the incision and at the end of the procedure. Mean arterial pressure readings (MAP), heart rate readings, time to eyes opening, time to extubation, pain scores, analgesic requirements, and oxygen needs were collected and compared. RESULTS: There were no significant differences in Fromme scores between the two groups. The averaged MAP from 15 min to the end of the procedure was significantly lower in the REMI group; these patients also received more ephedrine. Significantly fewer patients in the CLO group needed oxygen therapy to keep their Pulse Oximeter Oxygen Saturation within 3% of their preoperative values. Patients in this group also needed less piritramide in the recovery room, and their pain scores were lower at discharge from the recovery room. DISCUSSION: Although both anaesthesia regimens offered a similar quality of surgical field, this study suggests that clonidine had a better average safety profile. Furthermore, patients who received this regimen required fewer painkillers immediately after surgery.

Objectives: To determine the main causes for unplanned admission of children to the paediatric intensive care unit (PICU) following anaesthesia in our centre. To compare the results with previous publications and propose a data sheet for the prospective collection of such information. Methods: Inclusion criteria were any patient under 16 years who had an unplanned post-anaesthetic admission to the PICU from 1999 to 2010 in our university hospital. Age, ASA score, type of procedure, origin and causes of the incident(s) that prompted admission and time of the admission decision were recorded. Results: Out of a total of 44,559 paediatric interventions performed under anaesthesia during the study period, 85 were followed with an unplanned admission to the PICU: 67% of patients were younger than 5 years old. Their ASA status distribution from I to IV was 13, 47, 39 and 1%, respectively. The cause of admission was anaesthetic, surgical or mixed in 50, 37 and 13% of cases, respectively. The main causes of anaesthesia-related admission were respiratory or airway management problems (44%) and cardiac catheterisation complications (29%). In 62%, the admission decision was taken in the operating room. Conclusion: Unplanned admission to the PICU after general anaesthesia is a rare event. In our series, most cases were less than 5 years old and were associated with at least one comorbidity. The main cause of admission was respiratory distress and the main type of procedure associated with admission was cardiac catheterisation.

The treatment of symptomatic uretropelvic junction obstruction (UPJO) has evolved towards minimal invasive endourologic and laparoscopic techniques. Robotic assisted laparoscopic pyeloplasty has achieved outcomes comparable to those corresponding to open and laparoscopic techniques. The objective of this work is to demonstrate that the transition between open to robotic surgeries is straightforward. We analysed retrospectively "our initial results" in robotic assisted UPJ reconstruction procedures. Technical and convalescence aspects for 17 reconstructive robotic procedures performed by 2 surgeons in a 5 years period have been evaluated. Success consisted of no postoperative symptoms, no evidence of obstruction on mercaptoacetyltriglycine-3 diuretic renal scan or computed tomography (CT) and non-further treatment.