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1. The impact of iron store on red blood cell transfusion: a multicentre prospective cohort study in cardiac surgery

Author

Baptiste Gaudriot, Jean-Ferreol Oilleau, Thomas Kerforne, Claude Ecoffey, Olivier Huet, Alexandre Mansour, Jean-Philippe Verhoye, Nicolas Massart, Nicolas Nesseler, and for the AtlanRea Study Group

Subjects
Cardiac surgery, Cardiopulmonary bypass, Iron deficiency, Anaemia, Transfusion, Patient blood management, Anesthesiology, RD78.3-87.3
Abstract

Abstract Background Anaemia is common prior to cardiac surgery and contributes to perioperative morbidity. Iron deficiency is the main cause of anaemia but its impact remains controversial in the surgical setting. We aimed to estimate the impact of iron deficiency on in-hospital perioperative red blood cell transfusion for patients undergoing elective and urgent cardiac surgery. Secondary objectives were to identify risk factors associated with in-hospital red blood cell transfusion. Methods We conducted a prospective multicentre observational study in three university hospitals performing cardiac surgery. We determined iron status prior to surgery and collected all transfusion data to compare iron-deficient and iron-replete patients during hospital stay. We performed a multivariable logistic regression to compare transfusion among groups. Results Five hundred and two patients were included. A trend of low haemoglobin levels associated with iron deficiency persisted until discharge. Red blood cell transfusion was significantly higher in the group of iron deficient patients during surgery (22% vs 13%, p = 0.017), however the incidence during the whole hospital stay was 31% in the iron-deficient group, not significantly different with the non-deficient group (26%, p = 0.28). Iron deficiency was not independently associated with in-hospital red blood cell transfusion (adjusted OR = 0.85 [0.53–1.36], p = 0.49). Conclusions In-hospital red blood cell transfusion was not significantly higher in iron-deficient patients and iron deficiency was not associated with in-hospital red blood cell transfusion in patients undergoing elective and urgent cardiac surgery. Iron deficiency was the main cause of anaemia and anaemia was a strong driver of red blood cell transfusion. Further studies should identify sub-population of iron-deficient patients which may benefit from preoperative iron deficiency management and explore the long-term impact of lower haemoglobin levels at discharge in the iron deficient population.

Published
2022
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2. Epinephrine administration in venoarterial extracorporeal membrane oxygenation patients is associated with mortality: a retrospective cohort study

Author

Nicolas Massart, Alexandre Mansour, James T. Ross, Claude Ecoffey, Caroline Aninat, Jean‐Philippe Verhoye, Yoann Launey, Jean‐Marc Tadie, Vincent Auffret, Erwan Flecher, and Nicolas Nesseler

Subjects
Extracorporeal life support, Vasopressors, Inotropes, Catecholamines, Cardiogenic shock, Outcome, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Aims Knowledge about the impact of epinephrine on the outcome in venoarterial (VA) extracorporeal membrane oxygenation (ECMO) patients is limited, and existing data are conflicting. Methods and results We conducted a retrospective cohort study in a 1500 bed tertiary university hospital. Five hundred and eighty‐nine VA‐ECMO patients were analysed. The median age was 57 years [47–65], 68% of male. The major indications for ECMO were post‐cardiotomy cardiogenic shock (CS) (38%) and medical CS (36%). Two hundred and sixty‐two (44.5%) patients received epinephrine alone or associated with another catecholamine while on ECMO. Baseline factors significantly associated with epinephrine administration were younger age, higher sequential organ failure assessment score, cardiac arrest at implantation, and intra‐aortic balloon pump support at implantation, whereas medical CS and dobutamine administration were significantly associated with a lower risk of epinephrine administration. Epinephrine administration was independently associated with death [hazard ratio = 1.68 (1.44–2.23); P

Published
2021
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4. Is intravenously administered, subdissociative-dose KETAmine non-inferior to MORPHine for prehospital analgesia (the KETAMORPH study): study protocol for a randomized controlled trial

Author

Clément Le Cornec, Said Lariby, Vivien Brenckmann, Jean Benoit Hardouin, Claude Ecoffey, Marion Le Pottier, Philippe Fradin, Hélène Broch, Amine Kabbaj, Yannick Auffret, Florence Deciron, Céline Longo, François Javaudin, Quentin Le Bastard, Joël Jenvrin, and Emmanuel Montassier

Subjects
Ketamine, Morphine, Pain, Traumatic and non-traumatic, Medicine (General), R5-920
Abstract

Abstract Background Acute pain is a common condition among prehospital patients and prompt management is pivotal. Opioids are the most frequently analgesics used in the prehospital setting. However, opioids are highly addictive, and some patients may develop opioid dependence, even when they are exposed to brief opioid treatments. Therefore, alternative non-opioid analgesia should be developed to manage pain in the prehospital setting. Used at subdissociative doses, ketamine, a noncompetitive N-methyl-D-aspartate and glutamate receptor antagonist, provides analgesic effects accompanied by preservation of protective airway reflexes. In this context, we will carry out a randomized controlled, open-label, multicenter trial to compare a subdissociative dose of ketamine to morphine to provide pain relief in the prehospital setting, in patients with traumatic and non-traumatic pain. Methods/design This will be a multicenter, single-blind, randomized controlled trial. Consecutive adults will be enrolled in the prehospital setting if they experience moderate to severe, acute, non-traumatic and traumatic pain, defined as a numeric rating scale score greater or equal to 5. Patients will be randomized to receive ketamine or morphine by intravenous push. The primary outcome will be the between-group difference in mean change in numeric rating scale pain scores measured from the time before administration of the study medication to 30 min later. Discussion This upcoming randomized clinical trial was design to assess the efficacy and safety of ketamine, an alternative non-opiate analgesia, to manage non-traumatic and traumatic pain in the prehospital setting. We aim to provide evidence to change prescribing practices to reduce exposition to opioids and the subsequent risk of addiction. Trial registration ClinicalTrials.gov, ID: NCT03236805. Registered on 2 August 2017.

Published
2018
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7. Faisabilité d’une téléconsultation d’anesthésie en chirurgie orthopédique programmée

Author

Frédéric Le Saché, Claude Ecoffey, Cécile Naudin, David Barouk, Mario Bucciero, Cyril Quemeneur, Sébastien Bloc, and Guillaume Dufour

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Third party, business.industry, General surgery, Attendance, Emergency Nursing, Poor quality, Single centre, Anesthesiology and Pain Medicine, Orthopedic surgery, Emergency Medicine, medicine, In patient, business, Prospective cohort study
Abstract

The COVID-19 pandemic has motivated the development of teleconsultation in anaesthesia. We have conducted a single centre prospective study in patients scheduled for planned orthopaedic surgery during 9 weeks between may and july 2020 to assess its practicability. The quality of the consultation and patients' satisfaction, were evaluated during this period. The teleconsultation was successful in 90% of the patients without the need of attendance to the hospital for assessment before anaesthesia. The process was satisfactory for 97% of these patients. The mean duration was 15 minutes. The support of a third party was required in 46% of patients older than 65 years. The main cause of failure was the poor quality of the connection. Only two patients were cancelled for surgery because they did not understand fasting rule. The teleconsultation is now an integral part of preoperative assessment of patients for anaesthesia with good practicability and reliability.

Published
2021
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8. Clinical Benefit of Extubation in Patients on Venoarterial Extracorporeal Membrane Oxygenation

Author

Nicolas Massart, James T. Ross, Erwan Flecher, Alexandre Mansour, Yoann Launey, Vincent Auffret, Claude Ecoffey, Jean-Philippe Verhoye, Nicolas Nesseler, CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), University of California [San Francisco] (UCSF), University of California, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of California [San Francisco] (UC San Francisco), University of California (UC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)

Subjects
medicine.medical_treatment, Shock, Cardiogenic, Critical Care and Intensive Care Medicine, Lower risk, Extracorporeal, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Extracorporeal membrane oxygenation, medicine, Humans, Cardiac Surgical Procedures, Retrospective Studies, Mechanical ventilation, business.industry, Hazard ratio, 030208 emergency & critical care medicine, Retrospective cohort study, Odds ratio, Oxygenation, 3. Good health, 030228 respiratory system, Anesthesia, Airway Extubation, [SDV.IB]Life Sciences [q-bio]/Bioengineering, business
Abstract

International audience; OBJECTIVES: Although patients on venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock are usually supported with mechanical ventilation, it is not clear whether sedation cessation and extubation might improve outcomes. DESIGN: Retrospective cohort study with propensity score overlap weighting analysis. SETTING: Three ICUs in a 1,500-bed tertiary university hospital. PATIENTS: From an overall cohort of 641 patients with venoarterial-extracorporeal membrane oxygenation support, the primary analysis was performed in 344 patients who had been successfully decannulated in order to reduce immortal time bias. MEASUREMENTS AND MAIN RESULTS: Seventy-five patients (22%) were extubated during extracorporeal membrane oxygenation support and were subsequently decannulated alive. Forty-nine percent received noninvasive ventilation, and 25% had emergency reintubation for respiratory, neurologic, or hemodynamic reasons. Higher Simplified Acute Physiology Score II at admission (odds ratio, 0.97; 95% CI [0.95-0.99]; p = 0.008) was associated with a lower probability of extubation, whereas cannulation in cardiac surgery ICU (odds ratio, 3.14; 95% CI [1.21-8.14]; p = 0.018) was associated with an increased probability. Baseline characteristics were well balanced after propensity score overlap weighting. The number of ICU-free days within 30 days of extracorporeal membrane oxygenation decannulation was significantly higher among extubated patients compared with nonextubated patients (22 d [11-26 d] vs 18 d [7-25 d], respectively; p = 0.036). There were no differences in other outcomes including ventilator-associated pneumonia (odds ratio, 0.96; 95% CI [0.51-1.82]; p = 0.90) and all-cause mortality within 30 days of extracorporeal membrane oxygenation decannulation (5% vs 17%; hazard ratio, 0.54; 95% CI [0.19-1.59]; p = 0.27).As a secondary analysis, outcomes were compared in the overall cohort of 641 venoarterial extracorporeal membrane oxygenation-supported patients. Results were consistent with the primary analysis as extubated patients had a higher number of ICU-free days (18 d [0-24 d] vs 0 d [0-18 d], respectively; < 0.001) and a lower risk of death within 30 days of extracorporeal membrane oxygenation cannulation (hazard ratio, 0.45; 95% CI [0.29-0.71]; p = 0.001). CONCLUSIONS: Extubation during venoarterial-extracorporeal membrane oxygenation support is safe, feasible, and associated with greater ICU-free days.

Published
2021
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9. Guidelines: Anaesthesia in the context of COVID-19 pandemic

Author

Lionel Velly, Etienne Gayat, Hervé Quintard, Emmanuel Weiss, Audrey De Jong, Philippe Cuvillon, Gérard Audibert, Julien Amour, Marc Beaussier, Matthieu Biais, Sébastien Bloc, Marie Pierre Bonnet, Pierre Bouzat, Gilles Brezac, Claire Dahyot-Fizelier, Souhayl Dahmani, Mathilde de Queiroz, Sophie Di Maria, Claude Ecoffey, Emmanuel Futier, Thomas Geeraerts, Haithem Jaber, Laurent Heyer, Rim Hoteit, Olivier Joannes-Boyau, Delphine Kern, Olivier Langeron, Sigismond Lasocki, Yoan Launey, Frederic le Saché, Anne Claire Lukaszewicz, Axel Maurice-Szamburski, Nicolas Mayeur, Fabrice Michel, Vincent Minville, Sébastien Mirek, Philippe Montravers, Estelle Morau, Laurent Muller, Jane Muret, Karine Nouette-Gaulain, Jean Christophe Orban, Gilles Orliaguet, Pierre François Perrigault, Florence Plantet, Julien Pottecher, Christophe Quesnel, Vanessa Reubrecht, Bertrand Rozec, Benoit Tavernier, Benoit Veber, Francis Veyckmans, Hélène Charbonneau, Isabelle Constant, Denis Frasca, Marc-Olivier Fischer, Catherine Huraux, Alice Blet, Marc Garnier, Assistance Publique - Hôpitaux de Marseille (APHM), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)-Université Sorbonne Paris Nord, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut de pharmacologie moléculaire et cellulaire (IPMC), Centre National de la Recherche Scientifique (CNRS)-Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service d'Anesthésie et Réanimation [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Mutualiste de Montsouris (IMM), Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases, Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Neuro-imagerie fonctionnelle et métabolique (ANTE-INSERM U836, équipe 5), Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie-réanimation, Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Clermont-Ferrand, CHU Toulouse [Toulouse], Service Anesthésie - Réanimation [Bordeaux], CHU Bordeaux [Bordeaux], Physiopathologie et Pharmacologie Clinique de la Douleur, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Clinique Juge - Clinique du sport [Marseille], Pôle d'Anesthésie-Réanimation [CHU Rangueil], CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Hôpital de Rangueil, Hôpital de la Timone [CHU - APHM] (TIMONE), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Département d'Anesthésie Réanimation, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de réanimation médicale [CHU de Carémeau, Nîmes], Institut Curie [Paris], Réanimation Médico-Chirurgicale, Service d'Anesthésie Réanimation, CHU Necker - Enfants Malades [AP-HP], Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], Mitochondries, stress oxydant et protection musculaire (Strasbourg), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), Physiopathologie et Epidemiologie de l'Insuffisance Respiratoire, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Service de soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Groupe d’Anesthésie-Réanimation Chirurgie cardio-thoracique et vasculaire [Toulouse], Clinique Pasteur [Toulouse], CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Département d'anesthésiologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Physiopathologie et Epidémiologie des Maladies Respiratoires (PHERE (UMR_S_1152 / U1152)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Sorbonne Université (SU), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Rennes (UR)-Hôpital Pontchaillou, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Pôle Anesthésie Réanimation [CHU de Toulouse], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS), Histoire et Cultures de l'Antiquité et du Moyen Âge (HISCANT-MA), Université de Lorraine (UL), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Emergency Department, Université Bordeaux Segalen - Bordeaux 2-Hôpital Pellegrin - Bordeaux, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM), Anaesthesiology, Robert Debré Hospital, Service d'anesthésie réanimation chirurgicale, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Physiopathologie mitochondriale, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherches sur les Herbivores - UMR 1213 (UMRH), Institut National de la Recherche Agronomique (INRA)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire d'Anesthésiologie, Université Pierre et Marie Curie - Paris 6 (UPMC), and Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis - Lariboisière, AP-HP, Paris, France.

Subjects
Infection prevention and control, [SDV]Life Sciences [q-bio], Psychological intervention, Airway management, Context (language use), Critical Care and Intensive Care Medicine, Article, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, 030202 anesthesiology, Informed consent, Personal protective equipment, Pandemic, Health care, Medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Modalities, SARS-CoV-2, business.industry, COVID-19, 030208 emergency & critical care medicine, General Medicine, Guideline, 3. Good health, Anesthesiology and Pain Medicine, Universal precautions, Anesthesia, Viruses, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

Objectives The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. Methods The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions. Results The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms. Conclusion We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context.

Published
2020
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12. Démographie médicale en réanimation et unités de soins continus en France en 2018. Quels sont les besoins ?

Author

Benoit Veber, Karim Asehnoune, Jean Louis Gérard, Serge Molliex, Mathieu Raux, Benoit Plaud, Claude Ecoffey, and Laurent Heyer

Subjects
03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, 030208 emergency & critical care medicine
Abstract

Resume Les besoins de formation en anesthesistes-reanimateurs (AR) sont eleves pour la valence anesthesie de la specialite. Ils sont moins bien identifies pour la reanimation (rea) et restent debattus. L’objectif de cette enquete pilotee par le College national des enseignants d’anesthesie et de reanimation (CNEAR) etait d’etayer, sur la base d’elements chiffres, les decisions des pouvoirs publics concernant la determination du nombre d’etudiants affectes a l’issue des ECN pour le Co-DESAR-MIR avec une vision nationale et regionale des besoins de sante publique. Dans ce but, une evaluation des besoins en medecins dans les unites de reanimation et les USC en France a ete conduite. Les coordonnateurs de subdivision du DESAR (n = 28), ont complete un questionnaire portant sur les unites de surveillance continue (USC) et de reanimation incluant les CHU, les CHG, les ESPIC et les structures liberales. Pour chaque unite de reanimation et d’USC en France quel qu’en soit le type (medical, chirurgical, mixte), les donnees suivantes etaient colligees : nombre de lits, de medecins y exercant (âge ≥ 58 ans, non-AR et non-MIR) et prevision d’ouverture de lits. Les resultats montrent un ratio lits/medecin de 2 en reanimation et de 4,3 en USC, considere comme satisfaisant aux regards des besoins fonctionnels. La proportion de medecins anesthesistes-reanimateurs âges de plus de 58 ans etait de 66 % en rea et de 69 % en USC. Les donnees demographiques objectives sur les besoins de formation de la filiere du Co-DESAR-DESMIR devront etre prises en compte par les pouvoirs publics pour determiner dans l’avenir les flux de formation dans ces deux disciplines dans une vision de sante publique.

Published
2019
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13. Sédation pour actes interventionnels en pédiatrie

Author

Emilie Langlais and Claude Ecoffey

Subjects
03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, Emergency Medicine, 030208 emergency & critical care medicine, Emergency Nursing
Abstract

Resume Une sedation est de plus en plus frequemment requise pour effectuer des gestes interventionnels chez l’enfant. Cette pratique implique la realisation d’une consultation anesthesique au prealable. Les moyens non pharmacologiques de la sedation (hypnose) ont un fort impact sur la qualite de la sedation et du confort de l’enfant. Les avantages et les effets secondaires des agents sedatifs (ketamine, propofol, protoxyde d’azote) sont discutes.

Published
2018
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14. Recommandations pour le fonctionnement des unités de surveillance continue (USC) dans les établissements de santé, 2018

Author

Jean Reignier, Philippe Guiot, René Robert, Pierre-François Perrigault, Didier Honnart, Dominique Pateron, Marc Beaussier, Sébastien Kerever, Fanny Denys, Bertrand Guidet, Claude Ecoffey, Benoit Misset, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Institut Mutualiste de Montsouris (IMM), Service d'Urgences Adultes [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], CHU Rouen, Normandie Université (NU), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Roger Salengro [Lille], Service d'anesthésie et réanimation chirurgicale [Nantes], Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier universitaire de Nantes (CHU Nantes), Département de Médecine d'Urgence - Centre Régional Universitaire des Urgences (CRUU) (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé (CRESS - U1153), Université Paris Diderot - Paris 7 (UPD7)-Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Charleville-Mezières, Service d'Anesthésie Réanimation [Rennes], CHU Pontchaillou [Rennes], and Gestionnaire, Hal Sorbonne Université

Subjects
03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 030208 emergency & critical care medicine, 030212 general & internal medicine, 3. Good health
Abstract

International audience; Près de 20 ans après la mise en place des premières unités de surveillance continue (USC), des réflexions sur la typologie de patients à y admettre (seuls 60 à 65 % des patients admis), la densité de personnels nécessaire et le dimensionnement de ces unités sont apparues. Les conseils professionnels de la Médecine Intensive Réanimation, de l’Anesthésie Réanimation et de la médecine d’urgence ont constitué un groupe de travail afin d’analyser les conditions de fonctionnement des USC et de proposer des recommandations pour un fonctionnement optimisé de ces unités en adéquation avec les nouvelles organisations du système de santé. En utilisant une méthodologie de type recommandations formalisées d’experts (RFE), cinq champs de réflexion ont été définis : rypologie de patients, structure des USC, organisation et management paramédical, organisation et management médical, USC et groupements hospitaliers de territoire (GHT). Vingt-six recommandations ont été proposées, toutes assorties d’un accord fort après cotation collective établie selon une méthodologie dérivée de la RAND/UCLA (deux tours de cotation).

Published
2018
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15. La démographie actualisée en anesthésie-réanimation

Author

Claude Ecoffey

Subjects
03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, Emergency Medicine, 030208 emergency & critical care medicine, Emergency Nursing
Abstract

Resume La reduction du nombre d’anesthesistes-reanimateurs formes est la resultante de l’institution d’un numerus clausus en 1971 fixe trop bas et la mise en place de l’internat dit « qualifiant » pour tous en 1984, qui a conduit a une baisse brutale du nombre d’anesthesistes-reanimateurs en formation. Le temps medical disponible s’est reduit a partir de 2002 du fait de la reforme de l’amenagement et la reduction du temps de travail, par la mise en place du repos de securite post-garde et par l’integration des gardes dans le temps de travail. Les mesures correctrices, filialisation de la specialite et augmentation du numerus clausus, ont permis de retrouver des niveaux de formation identiques a ceux d’avant la suppression du CES. La procedure d’autorisation d’exercice, reservee aux medecins a diplome extra-communautaire, a egalement fortement contribue a preserver le nombre d’anesthesistes-reanimateurs. L’augmentation de la demande de soin en anesthesie-reanimation a favorise le developpement de la pluriactivite des anesthesistes-reanimateurs travaillant sur plusieurs sites, tandis que le recours a l’interim a ete une solution pour maintenir ouvert des plateaux techniques a faible activite. Le champ du metier des anesthesistes reanimateurs s’est recentre sur les activites de bloc operatoire avec un retrait des secteurs d’urgence extra- et intra-hospitalieres. Les anesthesistes reanimateurs sont toujours majoritairement presents en reanimation et developpent le domaine de la medecine peri-operatoire, complement indispensable a une prise en charge de qualite pour l’opere.

Published
2018
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16. Télémédecine et consultation d’anesthésie : mode d’emploi

Author

Claude Ecoffey

Subjects
03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 020205 medical informatics, 030202 anesthesiology, 0202 electrical engineering, electronic engineering, information engineering, 02 engineering and technology
Abstract

Resume Une consultation en telemedecine est une consultation realisee par un medecin a distance. C’est faisable en toute securite par rapport a une consultation presentielle. C’est le modele deja utilise pour les patients en detention. Ce n’est pas en contradiction avec le decret securite anesthesique de 1994. L’organisation en anesthesie n’est pas completement finalise : necessite d’un environnement securise incluant l’authentification du praticien et l’identification du patient, presence ou non d’un professionnel de Sante avec le patient, realisation d’un examen clinique en particuliers des voies aeriennes, gestion des resultats d’examens para-cliniques eventuels, delivrance d’une ordonnance, facturation… Demain la consultation d’anesthesie en telemedecine doit avoir pour but d’apporter une aide et une simplification a cet acte, en particulier pour le patient.

Published
2019
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18. Operation and organisation of ambulatory surgery in France. Results of a nationwide survey; The OPERA study

Author

Marc Beaussier, Pierre Albaladejo, Didier Sciard, Laurent Jouffroy, Dan Benhamou, Claude Ecoffey, Frederic Aubrun, Aline Albi, Sebastien Bloc, Marie-Paule Charriot, Vincent Compère, Christophe Dadure, Laurent Delaunay, Nicolas Dufeu, Michel Fiani, Elisabeth Gaertner, Thomas Lanz, Didier Sirieix, François Sztark, and Nathalie Vialles

Subjects
medicine.medical_specialty, Outpatient Clinics, Hospital, 020205 medical informatics, Nurses, 02 engineering and technology, Head nurse, Critical Care and Intensive Care Medicine, Nationwide survey, Patient pathway, Hospitals, Private, Hospitals, University, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Phone, Ambulatory Care, 0202 electrical engineering, electronic engineering, information engineering, Humans, Medicine, Anesthesia, Prospective Studies, General hospital, Hospitals, Public, business.industry, General Medicine, University hospital, Surgery, Anesthesiology and Pain Medicine, Ambulatory Surgical Procedures, Health Care Surveys, Ambulatory, Workforce, Observational study, France, business, Recovery Room
Abstract

Operation and organisation of ambulatory surgical activity in France remains largely undocumented. This nationwide observational prospective survey, carried out between December 2013 and December 2014, was undertaken to characterise the organisational processes of ambulatory surgery in France. Three hundred centres were randomly chosen from a list of 891 hospitals practicing ambulatory surgery, with stratification according to the type of facility (public general hospital, university hospital, private hospital) and region. An email was sent to the board of the randomly chosen facilities with an attached information letter explaining how the survey worked. Hospitals who did not reply to this email were contacted by phone. Among the 206 hospitals that answered the survey, 92 were private, 78 were public and 36 were university hospitals. Median accommodation capacities of ambulatory units were 8 beds, mostly distinct from conventional surgical ward. Patient pathways dedicated to ambulatory surgery appear as the current predominant practice. 77% of the French ambulatory units have a head nurse in charge of logistics and coordination. Several items still have to be improved, such as the adherence to modern fasting rules and the unnecessary use of stretcher to move the patient. Objective discharge score is used in 77% of ambulatory units. This survey highlights the implementation of some positive organisational parameters corresponding to common good practices recommendations. In contrast, several other recommendations are still insufficiently applied and may hamper the development of safe ambulatory surgery. This brings up new challenges for health regulatory boards, hospitals and ambulatory units managers.

Published
2017
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19. C omment maintenir la sécurité en anesthésie pédiatrique avec l’augmentation de la pression de production de soins ?

Author

Claude Ecoffey

Subjects
03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, 030212 general & internal medicine
Abstract

Resume La demographie des anesthesistes-reanimateurs et l’augmentation de la demande d’actes d’anesthesie ont cree une pression sur la production de soins anesthesiques. Les consequences sont le risque d’une modification de l’organisation anesthesique au bloc operatoire et/ou le risque de pratiques non securitaires de l’anesthesie. Il est important de mettre en place une culture globale de securite, cela ayant l’interet de minorer le risque pour les patients et aussi le stress du personnel anesthesique.

Published
2017
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20. The European society of regional anesthesia and pain therapy and the American society of regional anesthesia and pain medicine joint committee practice advisory on controversial topics in pediatric regional anesthesia I and II

Author

Adrian T. Bosenberg, Giorgio Ivani, Per-Arne Lönnqvist, Claude Ecoffey, and Santhanam Suresh

Subjects
medicine.medical_specialty, business.industry, Pain medicine, MEDLINE, Nerve Block, Anesthesia, General, Compartment Syndromes, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Anesthesia, Conduction, 030202 anesthesiology, Regional anesthesia, Practice Guidelines as Topic, Humans, Medicine, Anesthetics, Local, Child, business, Intensive care medicine, Societies, Medical, 030217 neurology & neurosurgery, Pain therapy
Abstract

To summarize the two recent sets of European and American Societies of Regional Anesthesia (ESRA-ASRA) Practice Advisory Guidelines for the performance of pediatric regional anesthesia (PRA).Owing to the still ongoing debate regarding crucial issues concerning the effective and safe conduct of PRA and because of the lack of any generally accepted guidelines regarding PRA the (ESRA-ASRA) have addressed these in two topical publications.Following an extensive literature search and an evidence-based approach the ESRA-ASRA task force have now provided a practice advisory on the following hot topics in PRA: the safety and appropriateness of placing block during general anesthesia or deep sedation, the use of test dosing, whether to use air or saline when performing loss-of-resistance, the risk of masking an acute compartment syndrome by use of PRA, dosing of local anesthetics for neuroaxial nerve blocks as well as peripheral nerve blocks, and finally the use of various drugs as adjuncts to local anesthetics.

Published
2017
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21. Evaluation of financial burden following complications after major surgery in France: Potential return after perioperative goal-directed therapy

Author

Claude Ecoffey, Alain Landais, Jerôme Loriau, Morgane Morel, Pascal Alfonsi, Corinne Chevalier, Gilles Rejasse, Annie Fresnel, and Jacques Goldstein

Subjects
Adult, Male, Waiting time, medicine.medical_specialty, Cost-Benefit Analysis, Psychological intervention, Goal directed therapy, Critical Care and Intensive Care Medicine, Perioperative Care, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Cost Savings, 030202 anesthesiology, Health care, medicine, Humans, Statistical analysis, Hospital Mortality, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Postoperative complication, 030208 emergency & critical care medicine, Health Care Costs, General Medicine, Perioperative, Length of Stay, Middle Aged, Surgery, Cost savings, Anesthesiology and Pain Medicine, Surgical Procedures, Operative, Female, France, business, Goals
Abstract

Perioperative goal-directed therapy (PGDT) has been demonstrated to improve postoperative outcomes and reduce the length of hospital stays. The objective of our analysis was to evaluate the cost of complications, derived from French hospital payments, and calculate the potential cost savings and length of hospital stay reductions.The billing of 2388 patients who underwent scheduled high-risk surgery (i.e. major abdominal, gynaecologic, urological, vascular, and orthopaedic interventions) over three years was retrospectively collected from three French hospitals (one public-teaching, one public, and one private hospital). A relationship between mortality, length of hospital stays, cost/patient, and severity scores, based mainly on postoperative complications but also on preoperative clinical status, were analysed. Statistical analysis was performed using Student's t-tests or Wilcoxon tests.Our analyses determined that a severity score of 3 or 4 was associated with complications in 90% of cases and this represented 36% of patients who, compared with those with a score of 1 or 2, were associated with significantly increased costs (€ 8205±3335 to € 22,081±16,090; P0.001, delta of € 13,876) and a prolonged length of hospital stay (mean of 10 to 27 days; P0.001, delta of 17 days). According to estimates for complications avoided by PGDT, there was a projected reduction in average healthcare costs of between € 854 and € 1458 per patient and a reduction in total hospital bed days from 1755 to 4423 over three years. Based on French National data (47,000 high risk surgeries per year), the potential financial savings ranged from € 40M to € 68M, not including the costs of PGDT and its implementation.Our analysis demonstrates that patients with complications are significantly more expensive to care for than those without complications. In our model, it was projected that implementing PGDT during high-risk surgery may significantly reduce healthcare costs and the length of hospital stays in France while probably improving patient access to care and reducing waiting times for procedures.

Published
2017
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22. Perioperative pain and postoperative nausea and vomiting (PONV) management after day-case surgery The SFAR-OPERA national study

Author

Pierre Albaladejo, Claude Ecoffey, Jean Luc Bosson, Kristina Skaare, Dan Benhamou, Laurent Jouffroy, Frédéric Aubrun, Pierre Diemunsch, Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Foie, métabolismes et cancer, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpital de Hautepierre [Strasbourg], CHU Grenoble, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
Male, nausea and vomiting. National study, [SDV]Life Sciences [q-bio], Pain, Procedural, Critical Care and Intensive Care Medicine, 0302 clinical medicine, Clinical Protocols, Anesthesia, Conduction, 030202 anesthesiology, Health care, pain, Prospective Studies, Tramadol, Pain Measurement, Pain, Postoperative, Morphine, General Medicine, Analgesics, Non-Narcotic, Middle Aged, 3. Good health, Analgesics, Opioid, Ambulatory, Vomiting, National study, Drug Therapy, Combination, Female, France, Day surgery, medicine.symptom, medicine.drug, Adult, medicine.medical_specialty, Nausea, Analgesic, 03 medical and health sciences, medicine, Humans, Pain Management, Acetaminophen, business.industry, General surgery, Perioperative, Anesthesiology and Pain Medicine, Ambulatory Surgical Procedures, Health Care Surveys, Postoperative Nausea and Vomiting, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Objectives - Since pain and post-operative nausea and vomiting (PONV) are the main reasons for failed discharge after day-case surgery, assessing pain and PONV is important. The aim was to describe the perioperative pain and PONV management within selected day-case surgical procedures in France. Methods - The OPERA trial was carried out on given days between December 2013 and December 2014. Each participating centre was required to fill out 3 separate questionnaires aiming at describing (1) protocols about pain and PONV, (2) patients' characteristics and procedures, (3) analgesic and PONV practice patterns for selected procedures. Results - Over the two days of investigation in each of the 221 randomly selected healthcare institutions, 7382 patients were included, of whom 2144 patients above 12 years underwent one of 10 selected procedures. Among responding institutions, 40% [33;47] had a dedicated pain management written protocol. Combination of tramadol and paracetamol was the most commonly prescribed (78% [71;83] of centres). Oral morphine was prescribed in 59/199 (30% [23; 37]) centres, for home treatment in 25/59 (42% [30; 56]) centres. However, there was no standardised take-home analgesic and PONV strategies for selected surgical procedures at risk of moderate to severe pain. PONV management guidance after discharge was included in only 12 % of centres. Conclusion - This survey demonstrates that practice patterns for pain treatment and PONV prophylaxis after ambulatory surgery vary among French centres and are not always in line with national guidelines. Strategies to improve practices and make them more homogeneous are necessary.

Published
2019
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24. Télémédecine et consultation d’anesthésie

Author

Claude Ecoffey, Service des urgences [Rennes] = Emergency [Rennes], and CHU Pontchaillou [Rennes]

Subjects
03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, [SDV]Life Sciences [q-bio], Emergency Medicine, 030212 general & internal medicine, Emergency Nursing, 030217 neurology & neurosurgery
Abstract

Resume Le developpement des moyens de communication permet d’organiser des consultations pre-anesthesie a distance. Sur des points specifiques tels que l’evaluation des difficultes d’intubation, les performances sont comparables a celles d’une consultation presentielle. La satisfaction des patients est bonne. L’interet de l’assistance d’un professionnel aupres du patient est debattu. La visite pre-anesthesie revet une importance particuliere comme premier acte presentiel aupres du patient. L’impact economique et sur la qualite des soins doit etre evalue avec precision.

Published
2019
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25. Post Ambulatory Discharge Follow-up Using Automated Text Messaging

Author

Claude Ecoffey, Hélène Beloeil, Thierry Dreano, David Leconte, CHU Pontchaillou [Rennes], Nutrition, Métabolismes et Cancer (NuMeCan), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA)-Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Adult, Male, medicine.medical_specialty, 020205 medical informatics, Adolescent, [SDV]Life Sciences [q-bio], Surgicenters, Outpatient surgery, Text messages, Medicine (miscellaneous), Aftercare, Health Informatics, 02 engineering and technology, Ambulatory Care Facilities, Teaching hospital, Young Adult, Health Information Management, Phone, 0202 electrical engineering, electronic engineering, information engineering, Clinical endpoint, Text messaging, Medicine, Humans, Prospective Studies, Prospective cohort study, Child, Aged, Response rate (survey), Aged, 80 and over, Text Messaging, business.industry, Automated follow-up, Ambulatory surgery, Infant, Middle Aged, Patient Discharge, 3. Good health, Child, Preschool, Ambulatory, Emergency medicine, Female, business, Information Systems
Abstract

International audience; Ambulatory surgery has grown to be the most common procedure in developed countries. Efficient quality of care and safety often require calling patient at day one after outpatient surgery to check patient's recovery and search for complications. This increasing flow in same day surgery centres motivates the use of automatic systems to contact patients. The overall objective of this study was to evaluate automated software sending text messages (TM) to patients at day 1 after ambulatory surgery compared to classical phone calls. This prospective study took place in Rennes Teaching Hospital, France, from June 1st, 2015 to December 15th, 2016. All patients owning a mobile phone were included, adults and children by means of their parents. The primary end point was the rate of successfully contacted patients, compared to usual phone calls in 2014. In cases of no response or an abnormal response, an automatic alert was sent to the ambulatory unit. Within the 7246 patients included, response rate to TM was significantly higher than response to phone calls in 2014 (87% vs 57%, respectively p

Published
2019
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26. Impact of Preoperative Iron Deficiency on Blood Transfusion in Elective Cardiac Surgery

Author

Marine Hubert, Sébastien Biedermann, Baptiste Gaudriot, Emmanuelle Sylvestre, Hervé Gouezec, Guillaume Bouzillé, Claude Ecoffey, Jean-Philippe Verhoye, Erwan Flecher, Jonchère, Laurent, CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, medicine.medical_specialty, Blood transfusion, Blood management, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, Anemia, medicine.medical_treatment, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030204 cardiovascular system & hematology, blood transfusion, law.invention, 03 medical and health sciences, 0302 clinical medicine, iron deficiency, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 030202 anesthesiology, law, medicine.artery, Preoperative Care, medicine, Cardiopulmonary bypass, Humans, Prospective Studies, Cardiac Surgical Procedures, ComputingMilieux_MISCELLANEOUS, Aged, Anemia, Iron-Deficiency, Transferrin saturation, business.industry, Iron deficiency, Middle Aged, medicine.disease, anemia, 3. Good health, Cardiac surgery, Surgery, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Anesthesiology and Pain Medicine, Elective Surgical Procedures, Descending aorta, Female, Cardiology and Cardiovascular Medicine, business, cardiopulmonary bypass, cardiac surgery
Abstract

Objective To evaluate the incidence and consequences of preoperative iron deficiency in elective cardiac surgery. Design A prospective observational study. Setting The cardiac surgery unit of a university hospital, from November 2016 to February 2017. Participants All patients presenting for elective cardiac surgery during the study period, with the exclusion of noncardiac thoracic surgeries, surgeries of the descending aorta, endovascular procedures, and patients affected by an iron-metabolism disease. Interventions Transferrin saturation and serum ferritin levels were systematically assessed before surgery, and the care of patients was maintained as usual. Measurements and Main Results Routine analyses, clinical data, and the number of blood transfusions were recorded during the hospital stay. Among the 272 patients included, 31% had preoperative iron deficiency and 13% were anemic. Patients with iron deficiency had significantly lower hemoglobin levels throughout the hospital stay and received blood transfusions more frequently during surgical procedures (31% v 19%, p = 0.0361). Detailed analysis showed that patients with iron deficiency received more red blood cell units. There were no differences in postoperative bleeding, morbidity, or mortality. Conclusions Iron deficiency appears to be related to lower hemoglobin levels and more frequent transfusions in elective cardiac surgery. Assessing iron status preoperatively and correcting any iron deficiencies should be one of the numerous actions involved in patient blood management for such surgeries, with the aim of reducing morbidity associated with both anemia and transfusion.

Published
2019
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27. Enhanced recovery in children: how could we go further?

Author

Gilles Orliaguet, Claude Ecoffey, Jean-Philippe Salaün, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Service d'Exploration Fonctionnelle [Pontchaillou - Rennes], Hôpital Pontchaillou, Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte (URP_7323), Université de Paris (UP), Service d'Exploration Fonctionnelle [CHU Rennes], and Université Paris Cité (UPCité)

Subjects
medicine.medical_specialty, RD1-811, medicine.medical_treatment, Early feeding, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Pediatrics, RJ1-570, 03 medical and health sciences, 0302 clinical medicine, Enhanced recovery, Multidisciplinary approach, Pediatric surgery, medicine, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, Rehabilitation, business.industry, General surgery, Multimodal therapy, Perioperative, Colorectal surgery, 3. Good health, 030220 oncology & carcinogenesis, Pediatrics, Perinatology and Child Health, Surgery, business
Abstract

The concept of enhanced recovery after surgery (ERAS) has been established in adult surgery since the 1990s, starting with Kehlet’s studies on colorectal surgery. ERAS is based on the premise that patient postoperative outcome can be improved through the modulation of the physiological response to surgical stress. This multimodal approach begins in the preoperative period and continues both intraoperatively and postoperatively in the form of an overall rehabilitation plan. Since then, the majority of adult surgical specialties have set up ERAS guidelines. Nevertheless, the scientific literature on pediatric ERAS has not followed the same dynamic. The question of how to go further in pediatric ERAS therefore should be considered. It is likely that part of the answer lies in the peculiarities of pediatrics. To enable the development of an ambitious pediatric ERAS, a collaborative and multidisciplinary effort involving clinicians, parents and their children must be implemented. ERAS is a multidisciplinary approach to patient management in the perioperative period aimed at the rapid recovery ad integrum of the patient’s functional condition. Initially described for colorectal surgery,1 the benefits of ERAS are now well demonstrated in several surgical specialties for adults.2 The application of ERAS guidelines is the key to reduce hospital length of stay and cost through early mobilization, early feeding and early discharge.3 The implementation of ERAS in adults is a success, but this is not yet the case in pediatric surgery. The existing literature on pediatric ERAS is limited. Only five studies were included in a recent literature review.4 Among those studies, only 5.6 rehabilitation elements against 23.8 in the adult papers were found in the rehabilitation protocols. Kehlet insisted on the fact that all patients should be included in ERAS pathway.5 However, most pediatric ERAS studies have focused on healthy patient populations.6 …

Published
2021
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29. Perioperative Use of Intravenous Lidocaine

Author

Alain Delbos, Axel Maurice-Szamburski, Claude Ecoffey, Marc Beaussier, and Luc Mercadal

Subjects
Lidocaine, Ileus, Analgesic, 03 medical and health sciences, 0302 clinical medicine, Pharmacotherapy, 030202 anesthesiology, Antithrombotic, medicine, Animals, Humans, Pharmacology (medical), General anaesthesia, Anesthetics, Local, Perioperative Period, Analgesics, Pain, Postoperative, business.industry, Perioperative, medicine.disease, Analgesics, Opioid, Treatment Outcome, Hyperalgesia, Anesthesia, Administration, Intravenous, business, 030217 neurology & neurosurgery, medicine.drug, Abdominal surgery
Abstract

Lidocaine is an amide local anaesthetic initially used intravenously as an antiarrhythmic agent. At some point it was proposed that intravenous lidocaine (IVL) had an analgesic effect that could be potentially beneficial in perioperative settings. Since these preliminary reports, a large body of evidence confirmed that IVL had anti-inflammatory and opiate-sparing effects, a combination of characteristics leading to an array of effects such as a decrease in postoperative pain and opiate consumption, and a reduction in the duration of digestive ileus. Additional studies demonstrated IVL to possess antithrombotic, antimicrobial and antitumoral effects. Beneficial effects of IVL have been characterized in abdominal surgery but remain controversial in other types of surgeries. Because the quality of evidence was limited, due to inconsistency, imprecision and study quality, recent conclusions from meta-analysis pooling together all types of surgery stated the uncertainty about IVL benefits. Additional indications such as the prevention of propofol-induced injection pain, prevention of hyperalgesia, protection against bronchial reactivity by bronchotracheal relaxation during surgery, and the increase in depth of general anaesthesia have since emerged. IVL is rapidly distributed in the body and metabolized by the liver. With the commonly recommended doses, lidocaine's therapeutic index remains very high and the plasma concentrations stay largely below the cardiotoxic and neurotoxic threshold levels, a notion that may be used by clinicians to draw conclusions on the benefit-risk profile of IVL in comparison to other analgesic strategies. The purpose of this review is to address the pharmacokinetic and pharmacodynamic properties of lidocaine in healthy and pathological conditions.

Published
2018

30. Ambulatory paediatric surgery in French non-paediatric surgical ambulatory units: Results of a nationwide survey: The OPERA study

Author

Claude Ecoffey, Jean Luc Bosson, Frédéric Aubrun, and Pierre Albaladejo

Subjects
medicine.medical_specialty, Adolescent, Opera, MEDLINE, Critical Care and Intensive Care Medicine, Nationwide survey, Pediatrics, Preanesthetic Medication, Surveys and Questionnaires, medicine, Humans, Anesthesia, Child, Paediatric anaesthesia, Pain Measurement, Pain, Postoperative, Paediatric surgery, business.industry, Infant, Newborn, Infant, General Medicine, Anesthesiology and Pain Medicine, Ambulatory Surgical Procedures, Child, Preschool, Emergency medicine, Ambulatory, Postoperative Nausea and Vomiting, France, business
Published
2018

31. Is intravenously administered, subdissociative-dose KETAmine non-inferior to MORPHine for prehospital analgesia (the KETAMORPH study): study protocol for a randomized controlled trial

Author

Marion Le Pottier, Emmanuel Montassier, Philippe Fradin, Said Lariby, Amine Kabbaj, Clément Le Cornec, Claude Ecoffey, François Javaudin, Hélène Broch, Vivien Brenckmann, Jean-Benoit Hardouin, Quentin Le Bastard, Yannick Auffret, Joël Jenvrin, Céline Longo, Florence Deciron, MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), and Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques

Subjects
Emergency Medical Services, Time Factors, [SDV]Life Sciences [q-bio], Analgesic, Pain, Medicine (miscellaneous), Context (language use), law.invention, Study Protocol, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Randomized controlled trial, 030202 anesthesiology, law, Multicenter trial, Humans, Multicenter Studies as Topic, Pain Management, Medicine, Single-Blind Method, Pharmacology (medical), Ketamine, Glutamate receptor antagonist, ComputingMilieux_MISCELLANEOUS, Pain Measurement, Randomized Controlled Trials as Topic, Anesthetics, Dissociative, lcsh:R5-920, Morphine, business.industry, 030208 emergency & critical care medicine, Traumatic and non-traumatic, Acute Pain, 3. Good health, Analgesics, Opioid, Treatment Outcome, Opioid, chemistry, Anesthesia, Administration, Intravenous, France, lcsh:Medicine (General), business, medicine.drug
Abstract

Background Acute pain is a common condition among prehospital patients and prompt management is pivotal. Opioids are the most frequently analgesics used in the prehospital setting. However, opioids are highly addictive, and some patients may develop opioid dependence, even when they are exposed to brief opioid treatments. Therefore, alternative non-opioid analgesia should be developed to manage pain in the prehospital setting. Used at subdissociative doses, ketamine, a noncompetitive N-methyl-D-aspartate and glutamate receptor antagonist, provides analgesic effects accompanied by preservation of protective airway reflexes. In this context, we will carry out a randomized controlled, open-label, multicenter trial to compare a subdissociative dose of ketamine to morphine to provide pain relief in the prehospital setting, in patients with traumatic and non-traumatic pain. Methods/design This will be a multicenter, single-blind, randomized controlled trial. Consecutive adults will be enrolled in the prehospital setting if they experience moderate to severe, acute, non-traumatic and traumatic pain, defined as a numeric rating scale score greater or equal to 5. Patients will be randomized to receive ketamine or morphine by intravenous push. The primary outcome will be the between-group difference in mean change in numeric rating scale pain scores measured from the time before administration of the study medication to 30 min later. Discussion This upcoming randomized clinical trial was design to assess the efficacy and safety of ketamine, an alternative non-opiate analgesia, to manage non-traumatic and traumatic pain in the prehospital setting. We aim to provide evidence to change prescribing practices to reduce exposition to opioids and the subsequent risk of addiction. Trial registration ClinicalTrials.gov, ID: NCT03236805. Registered on 2 August 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2634-3) contains supplementary material, which is available to authorized users.

Published
2018
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32. Application d’une stratégie transfusionnelle restrictive en chirurgie cardiaque

Author

Hervé Gouezec, Jean Philippe Verhoye, Baptiste Gaudriot, Claude Ecoffey, Etienne Delaval, and Sébastien Biedermann

Subjects
Biochemistry (medical), Clinical Biochemistry, Hematology
Abstract

Introduction La transfusion d’un culot globulaire (CGR) est un facteur de risque independant de morbi-mortalite, cumule a chaque CGR administre lors de la periode peri operatoire. La strategie transfusionnelle restrictive est bien documentee et non inferieure a la strategie liberale dans cette situation. Differentes actions ont ete menees dans le service entre 2014 et 2016 pour reduire le recours aux CGR. Materiels et methode Du 01/01/2014 au 31/12/2017, 4993 patients ont ete operes et inclus. Durant cette periode, les changements ont ete : (1) Monitorage de l’heparine et de la protamine par le systeme Hepcon® HMS Plus a partir d’octobre 2015. (2) discussion des seuils transfusionnels sur l’annee 2015 a partir des recommandations HAS, validation d’un protocole en decembre 2016 (3) Utilisation du ROTEM® a partir d’avril 2016. La base de donnees du service chirurgie a ete utilisee pour identifier les patients transfuses en fonction du type de chirurgie. Resultats Sur ces 4 annees, le nombre de patients transfuses a diminue de 43 % (53, 45, 31 et 30 % des patients ont recus des CGR respectivement en 2014, 2015, 2016 et 2017). Les donnees des PSL et des medicaments derives du sang par type de chirurgie et par annees et le nombre de CGR par patient sont resumees dans le Tableau 1 . Conclusion Les mesures per- et post-operatoires mises en place depuis trois ans sont efficaces et prolongees dans le temps en termes de reduction transfusionnelle.

Published
2019
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36. The European Society of Regional Anaesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine Joint Committee Practice Advisory on Controversial Topics in Pediatric Regional Anesthesia

Author

Elliot J. Krane, Per Anne Lonnqvist, Giorgio Ivani, David M. Polaner, Santhanam Suresh, Francis Veyckemans, Joseph M. Neal, Adrian T. Bosenberg, Marc Van de Velde, and Claude Ecoffey

Subjects
medicine.medical_specialty, Pediatrics, Pain medicine, Sedation, Advisory Committees, MEDLINE, Pain, Regional anaesthesia, Anesthesia, Conduction, medicine, Humans, Pain Management, Dosing, Societies, Medical, business.industry, General Medicine, United States, Test (assessment), Europe, Anesthesiology and Pain Medicine, Regional anesthesia, Family medicine, medicine.symptom, business, Pain therapy
Abstract

Background and Objectives Some topics in the clinical management of regional anesthesia in children remain controversial. To evaluate and come to a consensus regarding some of these topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a joint committee practice advisory on pediatric regional anesthesia (PRA). Methods Representatives from both ASRA and ESRA comprised the joint committee practice advisory on PRA. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Experts selected controversial topics in PRA. Results The performance of PRA under general anesthesia or deep sedation is associated with acceptable safety and should be viewed as the standard of care (Evidence B2 and Evidence B3). Because of the difficulty interpreting a negative test dose, the use of test dosing should remain discretionary (Evidence B4). The use of either air–loss of resistance or saline–loss of resistance techniques is supported by expert opinion, but the literature supporting one technique over the other is sparse and controversial; when used appropriately, each technique may be safely used in children. There are no current evidence-based data that the use of RA increases the risk for acute compartment syndrome or delays its diagnosis in children. Conclusions High-level evidence is not yet available for the topics evaluated, and most recommendations are based on Evidence B studies. The ESRA/ASRA recommendations intend to provide guidance for the safe practice of regional anesthesia in children.

Published
2015
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37. Recommandations pratiques sur des sujets controversés de l’anesthésie locorégionale pédiatrique

Author

Claude Ecoffey

Subjects
Anesthesiology and Pain Medicine
Abstract

Resume La Societe europeenne d’anesthesie regionale et traitement de la douleur (ESRA) et la Societe americaine d’anesthesie regionale et medecine de la douleur (ASRA) ont mis en place un comite consultatif mixte pour la pratique de l’anesthesie regionale pediatrique afin de rediger des recommandations sur 4 questions. (1) La realisation de l’anesthesie locoregionale pediatrique sous anesthesie generale ou sedation profonde est associee a une securite acceptable et doit etre consideree comme la norme de soins (niveau de preuve B2 et de niveau de preuve B3) ; (2) En raison de la difficulte d’interpretation d’une dose-test negative, l’utilisation de la dose-test doit rester optionnelle (niveau de preuve B4) ; (3) L’utilisation d’une perte de resistance avec de l’air ou une solution saline est validee par l’opinion d’experts, mais la litterature donnant la superiorite d’une technique sur l’autre est rare et controversee ; lorsqu’elle est utilisee de facon appropriee, chaque technique peut etre utilisee en toute securite chez les enfants ; (4) Il n’y a pas de donnees fondees sur des preuves actuelles que l’utilisation de l’anesthesie locoregionale pediatrique augmente le risque d’avoir un syndrome aigu de compression des loges ou retarde son diagnostic chez les enfants. Des preuves de haut niveau ne sont pas encore disponibles, et la plupart des recommandations sont basees sur des etudes de preuve B.

Published
2016
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38. A new national quality indicator reflecting pain relief in the PACU has been launched and initial results show the positive performance of French teams

Author

Frédéric Capuano, Arnaud Fouchard, Dan Benhamou, Marc Dahlet, Sophie Calmus, and Claude Ecoffey

Subjects
medicine.medical_specialty, media_common.quotation_subject, Pain relief, Audit, Critical Care and Intensive Care Medicine, Pacu, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Medicine, Humans, Pain Management, Quality (business), Quality of care, media_common, Pain score, biology, business.industry, General Medicine, biology.organism_classification, Acute Pain, Anesthesiology and Pain Medicine, Anesthesia Recovery Period, Physical therapy, business, 030217 neurology & neurosurgery
Published
2017

39. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Author

Walid Habre, Nicola Disma, Katalin Virag, Karin Becke, Tom G Hansen, Martin Jöhr, Brigitte Leva, Neil S Morton, Petronella M Vermeulen, Marzena Zielinska, Krisztina Boda, Francis Veyckemans, Walter Klimscha, Regina Konecny, Robert Luntzer, Ulrike Morawk-Wintersperger, Franz Neiger, Lydia Rustemeyer, Christian Breschan, Denise Frey, Manuela Platzer, Reinhard Germann, Joachim Oeding, Birgit Stoegermüller, Bernhard Ziegler, Philipp Brotatsch, Anton Gutmann, Gerlinde Mausser, Brigitte Messerer, Wolfgang Toller, Maria Vittinghoff, Gregor Zangl, Natascha Seidel-Ahyai, Christoph Hochhold, Ruth Kroess, Peter Paal, Steven Cnudde, Patricia Coucke, Birgit Loveniers, John Mitchell, David Kahn, Thierry Pirotte, Caroline Pregardien, Marc Coppens, Stefan De Hert, Björn Heyse, Martine Neckebroek, Aliaksandra Parashchanka, Jurgen Van Limmen, Nancy Van Den Eynde, Caroline Vanpeteghem, Piet Wyffels, Michaël Lalot, Jean-Paul Lechat, France Stevens, Sari Casaer, Françoise De Groote, Françoise De Pooter, Andrée De Villé, Marc Gerin, Natalia Magasich, Cristel Sanchez Torres, Denise Van Deenen, Johan Berghmans, Dirk Himpe, Eva Roofthooft, Ellen Joukes, Carine Smitz, Veronique Van Reeth, Christel Huygens, Julie Lauweryns, Karen De Smet, Nadia Najafi, Jan Poelaert, Anne Van de Velde, Veerle Van Mossevelde, Ivan Bekavac, Diana Butkovic, Dubravka Heli Litvic, Ivana Kerovec Soric, Hrvoje Maretic, Djurdjica Moscatello, Ljiljana Popovic, Slobodan Micici, Ivana Stuck Tus, Lada Kalagac Fabris, Tatjana Simurina, Nina Sulen, Gordana Kesic-Valpotic, Dajana Djapic, Jirí Žurek, Lucie Jureckova, Iveta Mackova, Monika Skacel, Stanislava Weinlichova, Jan Divák, Michal Frelich, René Urbanec, Vera Biskupova, Vladimir Mixa, Jana Pavlickova, Arash Afshari, Morten Bøttger, Marguerite B. Ellekvist, Mathias Johansen, Birgitte Ingeborg Madsen, Jens Christian Nilsson, Birgitte MB Schousboe, Nicola G. Clausen, Tom G. Hansen, Nick Phaff Steen, Mari-Liis Ilmoja, Virge Tonise, Juri Karjagin, Reet Kikas, Mika Isohanni, Anniina Lyly, Annika Takala, Johanna Happo, Kai Kiviluoma, Kati Martikainen, Riku Aantaa, Tuula Manner, Sanna Vilo, Catherine Amory, Hugues Ludot, Patricia Lambotte, René Busche, Olivier Jacqmarcq, Corinne Lejus, Julien Corouge, Christian Erb, Delphine Garrigue, Patricia Gillet, Anne Laffargue, Veronique Lambelin, Hélène Le Freche, Daliana Peresbota, Pierre Richart, Jerome Berton, Catherine Chapotte, Laurent Colbus, Thierry Lehousse, Jean Monrigal, Catherine Baujard, Philippe Roulleau, Giuseppe Staiti, Hélène Batoz, Maryline Bordes, Anne Didier, Yann Hamonic, Sylvaine Lagarde, Karine Nouette-Gaulain, François Semjen, Brigitte Zaghet, Jacky Dekens, Axelle Delcuze, Hervé Dupont, Aurélien Legrand, Celine Raffoflandreur, Noémie Audren, Blandine Camus, Marielle Cartal, Chantal Chazelet, Isabelle Davin, Marion Guillier, Luc Desjeux, Claire Larcher, Elodie Grein, Mickeal Leclercq, Roxana Levitchi, Lilica Rosu, Dominique Simon, Aurélien Zang, Anne Migeon, Anne-Charlotte Gagey, Nathalie Bourdaud, Anne-Charlotte Carre, Frédéric Duflo, Jean-Claude Riche, Philippe Robert, Emilie Druot, Olivier Maupain, Gilles Orliaguet, Lucie Sabau, Hanna Taright, Lynn Uhrig, Juliette Verchere-Montmayeur, Lise Debrabant, Clotaire Pilla, Alexandre Podvin, Benjamin Roth, Souhayl Dahmani, Florence Julien-Marsollier, Nada Sabourdin, Bogdan Alexandri, Gilles Brezac, Francois de la Brière, Catherine Hayem, Elizabeth Lhubat, Jean Paul Mission, Charlotte Rémond, Christophe Dadure, Maud Maniora, Anais Marie, Philippe Pirat, Anne-Charlotte Saour, Chrystelle Sola, Claude Ecoffey, Eric Wodey, Christian Adam, Thomas Standl, Ehrenfried Schindler, Tomohiro Yamamoto, Michael Brackhahn, Christoph Bernhard Eich, Holger Guericke, Petra Kindermann, Michael Laschat, Cornel Schink, Frank Wappler, Claudia Hoehne, Natalia Skordou, Johanna Ulrici, Martin Jetzek-Zader, Peter Kienbaum, Tanja Meyer-Treschan, Olaf Picker, Maximilian S. Schaefer, Golo Mielke, Sabine Baethge, Axel Ramminger, Martin Bauer, Matthias Bollinger, José Hinz, Michael Quintel, Sebastian G. Russo, Michael Bauer, Dfominik Geil, Andreas Kortgen, Niels-Peter Preussler, Ulrich Hofmann, Manfred Raber, Doris Reindl, Karin Oppenrieder, Bettina Schierlinger, Jens Roth, Wolfgang Funk, Thomas Fischer, Christian Gernoth, Christina Wiefelspütz, Hauke Volger, Nicole Zederer, Anja Diers, Matthias Huber, Clemens Schorer, Andreas Weyland, Konrad Schwarzkopf, Catharina Grau, Winfried Roth, Rolf Holy, Thomas Mader, Laura Peter, Hauke Supthut, Thomas Kuehhirt, Alexander Milde, Fritz Fiedler, Carsten Isselhorst, Ulrich Grundmann, Alexander Pattar, Jennifer Reinert, Birgit Ehm, Katrin Fritzsche, Ralf Gaebler, Patrick Meybohm, Maximilian Hein, Ines Guzman, Johanna Jokinen, Peter Kranke, Ulrich Goebel, Sarah Harris, Christoph Eisner, Miriam Ochsenreiter, Michael Schoeler, Elke Thil, Richard Ellerkmann, Andreas Hoeft, Claudia Neumann, Stefan Weber, Julia Keilhauer, Jan Kloessing, Michael Schramm, Uwe Trieschmann, Kristina Knauss, Barbara Sinner, Johannes Steinmann, Herbert Koessler, Evagelia Kalliardou, Anna Malisiova, Adelais Tsiotou, Pelagia Chloropoulou, Mpratzou Chrysi, Despoina Iordanidou, Merkourios Ntavlis, Krisztina B Boda, Christilynn Guerin, Janice Irwin, Claire Magner, Solmaz Nakhjavani, Brendan O'Hare, Deborah Galvin, Yosry Jamil, Carlos Lesmes, Yuri Barak, Haran Fisher, Ludmyla Kachko, Jacob Katz, Dmitry Kirilov, Michael Levinzon, Yair Manevich, Konstantin Nekrasov, Elia Peled, Elena Sanko, Dmitri Schmain, Olga Sheinkin, Eliahu Simhi, Alex Tarabikin, Evelina Trabkin, Irena Yagudaev, Yelena Zeitlin, Igor Zunser, Elisabetta Cerutti, Maria Maddalena Schellino, Silvia Valzan, Rosa Lucia Pinciroli, Luciano Bortone, Giorgia Cerati, Fabiana Salici, Leonardo Bussolin, Giuliana Rizzo, Francesca Rossetti, Laura Marchesini, Simonetta Tesoro, Brita De Lorenzo, Fabio Guarracino, Beate Kuppers, Marinella Astuto, Sofia Pitino, Rita Scalisi, Lucia Scordo, Sandra D'Alessandro, Luigi Dei Giudici, Ivano Farinelli, Giuseppe Lofino, Giuliano Marchetti, Sergio Giuseppe Picardo, Simone Reali, Alessandro Vittori, Francesco Antonio Idone, Maria Sammartino, Fabio Sbaraglia, Cinzia Barbera, Michela Bevilacqua, Valeria Cento, Svetlana Kotzeva, Leila Mameli, Giovanni Montobbio, Leandro Passariello, Cinzia Punzo, Rosanna Sileo, Rosanna Viacava, Claudia Volpe, Clelia Zanaboni, Edoardo Calderini, Daniele Genco, Simona Neri, Davide Ottolina, Anna Camporesi, Francesca Izzo, Ida Salvo, Andrea Wolfler, Andrea Sanna, Angela Sciascia, Paolo Stoia, Annamaria Guddo, Maria Lapi, Giorgio Ivani, Annalisa Longobardo, Valeria Mossetti, Dino Pedrotti, Maurizia Grazzini, Luisa Meneghini, Salvatore Metrangolo, Stefania Michelon, Carmelo Minardi, Costanza Tognon, Nicola Zadra, Ilaria Busi, Magda Khotcholava, Bruno Guido Locatelli, Valter Sonzogni, Giusi Starita, Nicole Almenrader, Caterina Aurilio, Pasquale Sansone, Raffaella Albarello, Paolo Bracci, Mariateresa Cecini, Maria Cristina Mondardini, Lorena Pasini, Milo Vason, Gianluca Zani, Roberto Zoppellari, Laura Pistidda, Andrea Cortegiani, Santi Maurizio Raineri, Antigona Hasani, Medita Hashimi, Agris Ancupans, Arta Barzdina, Zane Straume, Anda Zundane, Mikhail Chlopin, Dalia Gestautaite, Laura Lukosiene, Evelina Paliokaite, Ilona Razlevice, Inesa Armoniene, Aurelija Bernotiene, Vidunas Daugelavicius, Ilona Dockiene, Lina Gaidelyte, Nijole Saviciene, Jolita Krikstaponiene, Dominika Sidlovskaite-Baltake, Vladyslav Stasevski, Agne Vaitoskaite, David Gatt, Stephanie Mifsud, Simone Zammit, Celia Allison, Hamid Aslami, Susanne Eberl, Mireille F M van Stijn, Markus F Stevens, Kees Punt, Rob van Osch, Arthur Bauwman, Harm Scholten, Vesna Svircevic, Veronique Adriaens, Maaike Dirckx, Jaap Dogger, Ilse Dons-Sinke, Andreas Machotta, Xavier Moors, Mandana Rad, Lonneke Staals, Anouk van der Knijff - van Dortmont, Caroline van der Marel, Anne Sieben, Tim van der Zwan, Marianne Veldhuizen, David Alders, Wolfgang Buhre, Nicole Engel, Carine Vossen, Ravin Mahadewsing, Patrick Meijer, Volker Gerling, Roelof van der Schatte Olivier, Thea van Doorn, Kristy Vons Mark Hendriks, Sandra Lako, Gert jan Scheffer, Luc Tielens, Marieke Voet, Anthony Absalom, Margot Bergsma, Vera Spanjer, Rob Spanjersberg, Yvette van de Riet, Martin Volkers, Jurgen C. de Graaff, Geranne A.J. Hopman, Teus H. Kappen, J. Hannie, A.M. Megens, Sandra C. Numan, Anton N.J. Schouten, Nigel M. Turner, Désirée B.M. Van Der Werff, Renee T.M. Wensing, Erik Ephraim, Claire Nolte, Tore Reikvam, Ole Fredrik Lund, Lene Skaaden, Kari Marthe Ballovarre, Wenche Bakken Boerke, Guro Grindheim, Pal H H Lindenskov, Anne Beate Solas, Sjur Sponheim, Kyrre Ullensvang, Oddbjorn Viken, Inger Marie Drage, Kasper Gymoese Berthelsen, Bjørn Anders Kroken, Unni Bergland, Miroslaw Pryzmont, Mariola Talalaj, Malgorzata Wasiluk, Dorota Zalewska, Maria Damps, Jadzia Siemek-Mitela, Pawel Wieczorek, Magdalena Juzwa, Jowita Rosada-Kurasinska, Alicja Bartkowska-Sniatkowska, Maciej Cettler, Renata Kopycinska, Iwona Rudewicz, Jaek Sobczyk, Dariusz Wojciechowski, Artur Baranowski, Ewa Basiewicz, Magdalena Mierzewska-Schmidt, Wlodzimierz Retka, Piotr Sawicki, Magdalena Checinska, Magdalena Zurawska, Teresa Leal, Catia Mascarenhas, António Pedro Pina, Maria Joao Susano, Antonio Moniz, Maria Teresa Rocha, Carolina Calvao Santos, M Domingas Patuleia, Ricardo Pereira, Helena Roxo, Rosa Amaral, Isabel Guedes, Cristina Gomes, Marta Gonçalves, Helena Salgado, Maria Santos, Sara Rodrigues, Angela Sa, Elvira Machado, Sandra Pé d'Arca, Manuel Seabra, Ligia Mihaela Gheorghe, Constantin Ivascu, Lucia Moraru-Draghici, Mirela Suvejan, Remus Babici, Kovacs Eniko, Cristiana Hogea, Dubau Mihaela, Daraban Nicoleta, Danut Barbunc, Alina Maria Nistor, Violeta Stefan, Gabriela Catalina Ionescu, Irina Davidescu, Alina Teodora Nastase, Florin Dumitru Rusu, Victoria Badarau, Iulia Cindea, Melania Moscaliuc, Dana Olteanu, Luxita Petrescu, Daniela Ceuca, Irena Galinescu, Rodica Badeti, Alin Capusan, Cosmina Cucui-Cozma, Barbura Popescu, Luminita Cimpeanu, Mihaela-Petronela Birliba, Magdalena Miulescu, Stefania Balamat, Adriana Gurita, Luminita Ilie, Gabriel Mocioiu, Darina Pick, Rodica Sirghie, Radu Tabacaru, Irinel Trante, Lucian Horhota, Daniela Bandrabur, Tudor Ciobanu, Veaceslav Cuciuc, Valentin Munteanu, Valentin Olaru, Corneliu Paiu, Anca Savu, Oana Trifan, Anca Elena Malos, Anton Glazunov, Alexander Ivanov, Evgeny Poduskov, Alexander Popov, Igor 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M., Ephraim, Erik, Nolte, Claire, Reikvam, Tore, Fredrik Lund, Ole, Skaaden, Lene, Marthe Ballovarre, Kari, Bakken Boerke, Wenche, Grindheim, Guro, Lindenskov, Pal H. H, Beate Solas, Anne, Sponheim, Sjur, Ullensvang, Kyrre, Viken, Oddbjorn, Marie Drage, Inger, Gymoese Berthelsen, Kasper, Anders Kroken, Bjørn, Bergland, Unni, Pryzmont, Miroslaw, Talalaj, Mariola, Wasiluk, Malgorzata, Zalewska, Dorota, Damps, Maria, Siemek Mitela, Jadzia, Wieczorek, Pawel, Juzwa, Magdalena, Rosada Kurasinska, Jowita, Bartkowska Sniatkowska, Alicja, Cettler, Maciej, Kopycinska, Renata, Rudewicz, Iwona, Sobczyk, Jaek, Wojciechowski, Dariusz, Baranowski, Artur, Basiewicz, Ewa, Mierzewska Schmidt, Magdalena, Retka, Wlodzimierz, Sawicki, Piotr, Checinska, Magdalena, Zurawska, Magdalena, Leal, Teresa, Mascarenhas, Catia, Pedro Pina, António, Joao Susano, Maria, Moniz, Antonio, Teresa Rocha, Maria, Calvao Santos, Carolina, Domingas Patuleia, M., Pereira, Ricardo, Roxo, Helena, Amaral, Rosa, Guedes, Isabel, Gomes, Cristina, Gonçalves, Marta, Salgado, Helena, Santos, Maria, Rodrigues, Sara, Sa, Angela, Machado, Elvira, Pé d'Arca, Sandra, Seabra, Manuel, Mihaela Gheorghe, Ligia, Ivascu, Constantin, Moraru Draghici, Lucia, Suvejan, Mirela, Babici, Remu, Eniko, Kovac, Hogea, Cristiana, Mihaela, Dubau, Nicoleta, Daraban, Barbunc, Danut, Maria Nistor, Alina, Stefan, Violeta, Catalina Ionescu, Gabriela, Davidescu, Irina, Teodora Nastase, Alina, Dumitru Rusu, Florin, Badarau, Victoria, Cindea, Iulia, Moscaliuc, Melania, Olteanu, Dana, Petrescu, Luxita, Ceuca, Daniela, Galinescu, Irena, Badeti, Rodica, Capusan, Alin, Cucui Cozma, Cosmina, Popescu, Barbura, Cimpeanu, Luminita, Birliba, Mihaela Petronela, Miulescu, Magdalena, Balamat, Stefania, Gurita, Adriana, Ilie, Luminita, Mocioiu, Gabriel, Pick, Darina, Sirghie, Rodica, Tabacaru, Radu, Trante, Irinel, Horhota, Lucian, Bandrabur, Daniela, Ciobanu, Tudor, Cuciuc, Veaceslav, Munteanu, Valentin, Olaru, Valentin, Paiu, Corneliu, Savu, Anca, Trifan, Oana, Elena Malos, Anca, Glazunov, Anton, Ivanov, Alexander, Poduskov, Evgeny, Popov, Alexander, Guskov, Igor, Lugovoy, Alexander, Nechaev, Vladislav, Ovezov, Alexey, Basov, Mikhail, Kochkin, Vladimir, Lazarev, Vladimir, Chizhov, Dmitri, Ostreikov, Ivan, Tolasov, Konstantin, Budic, Ivana, Marjanovic, Vesna, Draskovic, Biljana, Pandurov, Marina, Simin, Jovana, Dolinaj, Vladimir, Janjevic, Dusanka, Mandras, Ana, Mircetic, Maja, Petrovic, Sladjana, Rebac, Vlatka, Slavkovic, Bojana, Stevanovic, Vesna, Velcev, Ana, Knezevic, Mirjana, Milojevic, Irina, Puric, Selena, Simic, Irena, Stevic, Marija, Stranjanac, Vladimir, Simic, Dusica, Cabanova, Barbora, Hanula, Miloslav, Grynyuk, Andry, Berger, Jelena, Cerne, Uro, Nastran, Andraz, Pirc, Dejan, Popic, Rok, Stupnik, Spela, Rubio, Paloma, del Río, Cristina, Benito, Pilar, Pino, Gema, Gutierrez, Ignacio, Gutierrez Valcarcel, Andrea, León Carsi, Irene, Perez Garcia, Anibal, López Galera, Sílvia, Marco Valls, Joan, Ricol Lainez, Laura, Vallejo Tarrat, Andrea, Artes, David, Banus, Ester, Chirichiello, Luca, De Abreu, Leidy, De Josemaria, Belen, Helena Gaitan, M., Garces, Antonio, Lazaro, Juan J, Manen Berga, Ferran, Molies, Dolor, Monclus, Enric, Navaro, Montserrat, Pamies, Carmen, Perelló, Marina, Prat, Mar, Ribo, Laura, Angeles Sanz, M., Serrano, Silvia, Sola Ruiz, Eva, Anuncia Escontrela Rodríguez, Blanca, Maria Gago Martinez, Andrea, Martínez Ruiz, Alberto, De La Cruz Benito, Fausto, Gabilondo Garcia, Gustavo, Martinez Maldonado, Ever, Noriega, Bryant, Oller Duque, Lara, Olmos Mendez, Alberto, Perez Ferrer, Antonio, Reinoso Barbero, Francisco, Acevedo Bambaren, Ismael, Domínguez, Fernando, Franco, Teresa, Jiménez, Anabel, Melero, Alicia, Feliu, Montserrat, García, Irene, Montferrer, Núria, Munar, Francisca, Muro, Cristina, Nuño, Rosario, Perera, Remel, Schmucker, Erika, Börjesson, Glenda, Gillberg, Lar, Castellheim, Albert, Sandström, Kerstin, Bauer, Annette, Roos, Torbjörn, Hedlund, Lar, Boegli, Yann, Dolci, Mirko, Marcucci, Carine, Spahr Schopfer, Isabelle, Pellegrini, Michel, Book, Malte, Errass, Loreen, Riggenbach, Christine, Casutt, Mattia, Hölzle, Martin, Hurni, Thoma, Mauch, Jacqueline, Anselmi, Luciano, Anselmi, Irene, Jacomet, Alfred, Oberhauser, Marku, Wossner, Stephanie, Zettl, Angelika, Erb, Thoma, Mackiewicz, Tomasz, Simitzes, Helena, Ozer, Yetkin, Takil, Arzu, Alanoglu, Zekeriyya, Bermede, Onat, Cakar Turhan, K. Sanem, Alkis, Neslihan, Yildirim Guclu, Cigdem, Ceyda Meco, Basak, Hatipoglu, Zehra, Ozcengiz, Dilek, Begec, Zekine, Ilksen Toprak, Huseyin, Kendigelen, Pinar, Cigdem Tütüncü, Ayse, Karadeniz, Meltem Savran, Seyhan Ozkan, Tulay, Sivrikoz, Nuket, Kemal Arslantas, Mustafa, Hizal, Ayse, Tore Altun, Gülbin, Umuroglu, Tumay, Baris, Sibel, Kazak Bengisun, Zuleyha, Goncharenko, Galyna, Khrapak, Maksym, Klymenko, Tetyana, Pavlenko, Vitaliy, Prysiazhniuk, Dmytro, Rudio, Olga, Varyvoda, Mykhailo, Vodianytskyi, Sergii, Boryshkevych, Ivanna, Kyselova, Iryna, Trikash, Nikolay, Albokrinov, Andrew, Perova Sharonova, Valentina, Sklyar, Vitaliy, Surkov, Deni, Abdelaal, Amr, Barber, Nicola, Checuti, Sarah, Godsiff, Leisha, Johanne, Lynch, Simpson, Joanna, Underhill, Helen, Diwan, Rishi, Kelgeri, Nivedita, Masip, Nuria, Ravi, Radha, Roberts, Steve, Cillis, Annagrazia, Marcus, Ritchie, Merella, Federica, Love, David, Baraggia, Paolo, Bird, Victoria, Hussey, Joseph, Alderson, Peter, Bartholomew, Karen, Moncreiff, Michael, Davidson, Sarah, Hare, Alison, Kotecha, Ami, Lee, Corina, Liyanage, Ganga, Patel, Shivali, Samani, Amee, Abou Samra, Mark, Boyd, Matthew, Hullatt, Laurence, Levy, David, Pauling, Mark, Sharman, Sarah Jane, Smith, Natalie, Rutherford, John, Cavalier, Alison, Locke, Christie, Sage, Frederic, Bapat, Smita, Hammerschlag, Jacinda, Ioannou, Ioanni, King, Stephanie, Pegg, Rachel, Salota, Vishal, Sketcher, Jonathan, Thadsad, Muthu, Zeitlin, Deborah, Jack, Ewan, Lang, Colin, Ahmed, Samira, Ayyash, Reema, Bari, Francoise, Bell, Sarah J, Elizabeth Biercamp, Claire, Briggs, Sandra, Gabriella Elena Clement, Maria, Dalton, Mark, Ali Eissa Eid, Mohamed, Gandhi, Monica, Harmen Herrema, Idse, Khaffaf, Ranj, Jeng Min Law, Savio, Mcclintock, Joanna, Ireland, Nichola, Majid Saleem, Mohammed, Smith, Fiona, Cohen, Marc, Lee, Clover Ann, O'Donahue, Lizanne, Powell, Alex, Rawlinson, Ellen, Snoek, Aarjan, Weiss, Katja, Wellesley, Hugo, Crawford, Michael, Abdel Hafiz, Mostafa, Day, Alexandra, Rajamani, Balaji, Saha, Rita, Wright, Dave, Chee, Lew Chin, Bew, Stephanie, Homer, Rachel, Malarkkan, Nalini, Wolfe Barry, Juliet, Angadi, Pradeep, Cagney, Brid, De Melo, Eric, Dekker, Elsa, Helm, Emma, Jones, Gareth, Peiris, Kawshala, Russell, William, Slater, Patricia, Sodhi, Puja, Browning, Mike, Phillips, Trudie, Van Hecke, Rachel, Muir, Vimty, Singh, Piyush, Soskova, Tereza, Cumming, Craig, Farquharson, Pamela, Pearson, Karen, Shaw, Neil, Whiteside, Jonathan, Whyte, Emma, Byers, Gordon, Davies, Kay, Engelhardt, Thoma, Faliszewski, Isabella, Johnston, Graham, Kaufmann, Nil, Kusnirikova, Zuzana, Wilson, Graham, Carachi, Peter, Makin, Andrew, Foster, Brian, Lipczynski, Dariusz, Mawer, Rebecca, Rutherford, William, Rogerson, David, Rushman, Sarah, Taylor, Christopher, Tomlinson, William, Dix, Philippa, Woodward, Tom, Bell, Graham, Boyle, David, Cloherty, Marianne, Cullen, Julia, Cullen, Pauline, Fairgrieve, Ro, Ghent, Robert, Glasgow, Russell, Gordeeva, Elena, Harden, Alison, Hivey, Sarah, Jerome, Kevin, Mckee, Lesley, Morton, Neil, Pribul, Vicky, Sinclair, John, Steiner, Maria, Steward, Heather, Sweeney, Lorraine, Thomson, Wendy, Whiteside, Jeanette, Dalton, Andrew, Ross, Mark, Smith, Carolyn, Allen, Claire, Anders, Nicola, Barlow, Victoria, Bassett, Mike, Darwin, Leanne, Davison, Rachel, Diacono, Jacque, Hobbs, Amy, Hutchinson, Adel, Lomas, Bernadette, Lonsdale, Hannah, Nasser, Leila, Oshan, Vimmi, Patel, Pradip, Raistrick, Christopher, Scott Warren, Victoria, Talbot, Laura, Wai, Carolynn, Childs, Sophie, Dickinson, Matthew, Bloomfield, Tom, Garrioch, Sweyn, Watson, Karen, Gaynor, Jame, Harrison, Richard, Lee, Juliette, Blythe, Elizabeth, Dorman, Teresa, Eissa, Ayman, Ellwood, Jame, Gooch, Ingrid, Hearn, Robert, Hodgetts, Vanessa, John, Robert, Kirton, Christine, Ladak, Nadia, Morgan, Judith, Plant, Nina, Shepherd, Elizabeth, Short, Judith, Stack, Charle, Steel, Simon, Taylor, Matthew, Thomas, Deborah, Wilson, Catharine, Wilson Smith, Elaine, Bradbury, Carol L., Hussain, Nageena, Mayell, Antonia, Mesbah, Ahmed, Qureshi, Arif, Vaidyanath, Chandra, Geary, Tim, Hawksworth, Chri, Parasuraman, Tamaraichelvi, Perry, Nicole, Banerjee, Indrani, Barr, Katharine, Butler, Patrick, Davies, Jack, Flewin, Lisa, Gande, Richard, Montague, Jame, Plumb, Jame, Pratt, Thoma, Sutherland, Paul, Vail, Hannah, Wilkins, Andrew, Hunter, Catherine, Russell, Susan, Thomas, Alun, Mifsud, Mark, Strachan, Dominic, Plichon, Benoit, Harlet, Pierre, Child and Adolescent Psychiatry / Psychology, Morawk-Wintersperger, Ulrike, Seidel-Ahyai, Natascha, Lechat, Jean-Paul, Kesic-Valpotic, Gordana, Ilmoja, Mari-Lii, Nouette-Gaulain, Karine, Gagey, Anne-Charlotte, Carre, Anne-Charlotte, Riche, Jean-Claude, Verchere-Montmayeur, Juliette, Julien-Marsollier, Florence, Saour, Anne-Charlotte, Jetzek-Zader, Martin, Meyer-Treschan, Tanja, Preussler, Niels-Peter, Sidlovskaite-Baltake, Dominika, van Stijn, Mireille F M, Dons-Sinke, Ilse, van der Knijff - van Dortmont, Anouk, Hopman, Geranne A.J., Megens, A.M., Schouten, Anton N.J., Van Der Werff, Désirée B.M., Wensing, Renee T.M., Lindenskov, Pal H H, Siemek-Mitela, Jadzia, Rosada-Kurasinska, Jowita, Bartkowska-Sniatkowska, Alicja, Mierzewska-Schmidt, Magdalena, Moraru-Draghici, Lucia, Cucui-Cozma, Cosmina, Birliba, Mihaela-Petronela, Perez- Ferrer, Antonio, Spahr-Schopfer, Isabelle, Cakar Turhan, K.Sanem, Perova-Sharonova, Valentina, Abou-Samra, Mark, Sharman, Sarah-Jane, McClintock, Joanna, Lee, Clover-Ann, Abdel-Hafiz, Mostafa, Chee, Lew-Chin, McKee, Lesley, Scott-Warren, Victoria, and Wilson-Smith, Elaine

Subjects
Male, Pediatrics, Health Status, OPERATING-ROOM, Respiratory Tract Diseases, CHILDREN, 0302 clinical medicine, REGIONAL ANESTHESIA, Postoperative Complications, 030202 anesthesiology, CARDIAC-ARREST, Medicine, General anaesthesia, Prospective Studies, Prospective cohort study, Child, Intraoperative Complications, COMPLICATIONS, ddc:617, Incidence (epidemiology), Mortality rate, musculoskeletal, neural, and ocular physiology, Incidence, Age Factors, Hospitals, Europe, Cardiovascular Diseases, Child, Preschool, RESPIRATORY ADVERSE EVENTS, Female, Clinical Competence, Cohort study, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Adolescent, macromolecular substances, Anesthesia, General, Drug Hypersensitivity, 03 medical and health sciences, MORBIDITY, Journal Article, Humans, business.industry, Infant, Newborn, Infant, 030208 emergency & critical care medicine, Perioperative, nervous system, PROSPECTIVE COHORT, Relative risk, RISK-FACTORS, Observational study, Human medicine, Nervous System Diseases, business, SYSTEM
Abstract

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0–5·5) with an incidence of respiratory critical events of 3·1% (2·9–3·3). Cardiovascular instability occurred in 1·9% (1·7–2·1), with an immediate poor outcome in 5·4% (3·7–7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86–0·90; p

Published
2017
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40. Score de sortie pédiatrique en chirurgie ambulatoire

Author

F. de la Brière, Eric Wodey, A. Pouvreau, S. Biedermann, and Claude Ecoffey

Subjects
Anesthesiology and Pain Medicine, General Medicine
Abstract

Resume Donnees Chez l’adulte, le « Post-Anesthetic Discharge Scoring System » (PADSS) a ete construit pour garantir le retour a domicile apres une chirurgie ambulatoire. L’objectif de ce travail etait d’evaluer une adaptation pediatrique de ce score : le Pediatric-PADSS (Ped-PADSS). Type d’etude Cohorte prospective. Methodes Il s’agissait d’une etude prospective, observationnelle, monocentrique pour des patients ambulatoires. Le Ped-PADSS est construit sur 5 items chacun cote 0, 1 ou 2 : hemodynamique, etat d’eveil, nausees/vomissements, douleur et saignement. Un resultat ≥ 9/10 validait la sortie si l’anesthesiste-reanimateur ne souhaitait pas revoir le patient, si les parents ne souhaitaient pas revoir l’anesthesiste-reanimateur ou s’il n’y avait ni dysphonie ni dyspnee. La sortie etait validee par l’anesthesiste-reanimateur et le chirurgien. Le Ped-PADSS etait realise a l’insu des equipes soignantes, une heure apres le retour dans le service et repete toutes les heures. Outre les donnees demographiques, le recueil comportait les heures d’autorisation de sortie de l’anesthesiste-reanimateur, du chirurgien et du Ped-PADSS, la duree d’hospitalisation postoperatoire. Resultats Sur 150 patients, 148 etaient autorises a sortir avec le Ped-PADSS et l’anesthesiste-reanimateur, un patient etait sorti malgre un Ped-PADSS Conclusion La majorite des enfants a rempli les criteres de sortie au bout de 2 heures de surveillance postoperatoire. L’utilisation de ce score permettrait de reduire le temps d’hospitalisation a l’unite ambulatoire.

Published
2014
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41. Les USC et la médecine périopératoire

Author

Marc Beaussier, Francis Bonnet, Claude Ecoffey, Xavier Capdevila, Laurent Heyer, Sébastien Kerever, Pierre-François Perrigault, and Marc Leone

Subjects
03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, business.industry, Medicine, 030208 emergency & critical care medicine, 030212 general & internal medicine, business
Published
2018
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42. Douleurs chroniques après césarienne : impact et facteurs de risque associés

Author

Nicolas Nardi, B. Campillo-Gimenez, P. Branchu, Claude Ecoffey, Eric Wodey, and S. Pong

Subjects
Gynecology, medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, Postoperative pain, Medicine, General Medicine, business
Abstract

Resume Donnees La douleur chronique post-chirurgicale (DCPC) est une complication bien connue apres amputation, thoracotomie, mastectomie et cure de hernie inguinale, mais a ete peu evaluee apres chirurgie obstetricale. Type d’etude. Cohorte retrospective. Objectif Determiner le taux de DCPC apres cesarienne, l’impact de ces DCPC sur la qualite de vie et les facteurs de risque (FDR) associes a cette complication. Methodes Un questionnaire etait envoye a 220 patientes, successivement cesarisees sur une periode de 6 mois, a distance de la chirurgie. Les questions portaient sur la duree des douleurs cicatricielles apres cesarienne, leur severite et leur repercussion sur les activites quotidiennes. Parallelement, un recueil retrospectif de donnees cliniques (antecedents, details de la chirurgie et de l’anesthesie) etait effectue. Apres une analyse descriptive de la population etudiee, une comparaison des patientes avec et sans DCPC etait effectuee afin de mettre en evidence d’eventuels facteurs de risque. Resultats Cent soixante-sept patientes (76 %) ont repondu au questionnaire avec un delai moyen de 10 mois (8–13) apres leur cesarienne. La douleur postoperatoire etait resolutive chez la plupart des patientes dans les trois mois, mais persistait chez 25 patientes (15 %). Sept patientes (4 %) presentaient une alteration de leur qualite de vie en raison de douleurs cicatricielles quotidiennes moderees a severes. Les FDR associes a ces DCPC etaient la presence de douleurs aigues en postoperatoire, l’existence de douleurs prealables (cephalees/migraines, dorsalgies), un âge jeune et la realisation d’une anesthesie generale sans locoregionale associee lors de la cesarienne. Conclusion La survenue de DCPC apres cesarienne pourrait etre frequente et peut etre responsable d’une alteration de la qualite de vie des patientes.

Published
2013
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43. Effectiveness and complications of ultrasound-guided subclavian vein cannulation in children and neonates

Author

François de la Brière, Claude Ecoffey, Anne Defontaine, Charlotte Engrand, Bruno Laviolle, Sabrina Dessard, Cécile Gauvrit, Nicolas Nardi, Severine Delahaye, Eric Wodey, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pharmacologie [Rennes], CHU Pontchaillou [Rennes], Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Brenner, Nelly, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
Male, medicine.medical_specialty, Endpoint Determination, [SDV]Life Sciences [q-bio], Subclavian, Anesthesia, General, Critical Care and Intensive Care Medicine, Subclavian Vein, Catheterization, Central venous, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Catheterization, Peripheral, medicine, Humans, General anaesthesia, Prospective Studies, Treatment Failure, Child, Children, Ultrasonography, Interventional, Ultrasonography, Catheter insertion, business.industry, Incidence (epidemiology), Infant, Newborn, Infant, 030208 emergency & critical care medicine, General Medicine, Arteries, medicine.disease, 3. Good health, Surgery, [SDV] Life Sciences [q-bio], Anesthesiology and Pain Medicine, Pneumothorax, Brachiocephalic, Anesthesia, Child, Preschool, Cohort, Observational study, Female, Complication, business, Subclavian vein
Abstract

International audience; Background The ultrasound (US)-guided supraclavicular approach to subclavian vein (Sup-SCV) catheterisation in children has recently been described and evaluated in a small cohort. The aim of this study was to assess this technique in a large paediatric cohort including neonates. Methods We conducted a prospective observational study between November 2010 and December 2013 which included 615 children divided into two groups according to their weight: Group 1 ≤ 5 kg (n = 124), Group 2 > 5 kg (n = 491). All procedures were performed under general anaesthesia by an anaesthesiologist or a supervised resident. The success rates of catheter insertion, the number of punctures required, the procedure time, and the complication rates were analysed. Results Sup-SCV catheterisation was successful in 98% of the cases and was higher in Group 2 than in Group 1 (99.4% versus 92.7%, P

Published
2016
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44. The structure, organisation and perioperative management of ambulatory surgery and anaesthesia in France: Methodology of the SFAR-OPERA study

Author

Marc Beaussier, Jean Luc Bosson, Pauline Romegoux, Dan Benhamou, Laurent Jouffroy, Kristina Skaare, Frédéric Aubrun, Claude Ecoffey, Pierre Albaladejo, and Charles-Marc Samama

Subjects
Adult, Male, medicine.medical_specialty, Breast surgery, medicine.medical_treatment, Outpatient surgery, 030232 urology & nephrology, Critical Care and Intensive Care Medicine, Perioperative Care, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Anesthesiology, Intensive care, Health care, medicine, Ambulatory Care, Humans, Anesthesia, Prospective Studies, Aged, business.industry, Hand surgery, General Medicine, Ambulatory Surgical Procedure, Middle Aged, medicine.disease, Surgery, Inguinal hernia, Anesthesiology and Pain Medicine, Ambulatory Surgical Procedures, Health Care Surveys, Ambulatory, Female, France, business
Abstract

The organization of health care establishments and perioperative care are essential for ensuring the quality of care and safety of patients undergoing outpatient surgery. In order to correctly inventory these organizations and practices, in 2013–2014, the French society of anaesthesia and intensive care organized an extensive practical survey in French ambulatory surgery units entitled the “OPERA” study ( Organisation perioperatoire de l’anesthesie en chirurgie ambulatoire ). From among all of the ambulatory surgery centres listed by the Agences regionales de sante (Regional health agencies, France), 206 public and private centres were randomly selected. A structural (typology, organization) survey and a medical-practice survey (focusing on the management of postoperative pain, nausea and vomiting as well as the prevention of venous thromboembolism) were collected and managed by a prospective audit of practices occurring on two randomly selected days. The latter was further accompanied by an additional audit specifically focussing on ten representative procedures: (1) stomatology surgery (third molar removal); (2) knee arthroscopy; (3) surgery of the abdominal wall (including inguinal hernia); (4) perianal surgery; (5) varicose vein surgery; (6) digestive laparoscopy–cholecystectomy; (7) breast surgery (tumourectomy); (8) uterine surgery; (9) hallux valgus and (10) hand surgery (excluding carpal tunnel). Over the 2 days of observation, 7382 patients were included comprising 2174 patients who underwent one of the procedures from the above list. The analysis of these data will provide an overview of the organization of health establishments, the modalities thus supported and compliance with standards.

Published
2016

45. Pratiques transfusionnelles en chirurgie cardiaque au CHU de Rennes en 2014

Author

Sébastien Biedermann, Erwan Flecher, Claude Ecoffey, Jean-Philippe Verhoye, Etienne Delaval, Baptiste Gaudriot, and Hervé Gouezec

Subjects
Biochemistry (medical), Clinical Biochemistry, Hematology
Abstract

Introduction Le recours a la transfusion est frequent en peri-operatoire de chirurgie cardiaque. Mais chaque culot globulaire (CG) transfuse augmente de facon independante la morbi-mortalite. Les pratiques transfusionnelles sont tres variables selon les centres. L’objectif de ce travail etait de faire une evaluation de nos pratiques transfusionnelles en chirurgie cardiaque au CHU de Rennes et de relever nos situations a risque transfusionnel en preambule a l’instauration d’un protocole d’epargne sanguine. Methodes Les donnees cliniques et transfusionnelles des patients operes de chirurgie cardiaque en 2014 a Rennes ont ete collectees retrospectivement a partir des dossiers d’hospitalisation et des donnees de l’EFS. Des analyses uni et multivariees ont ete effectuees pour determiner les facteurs de risque transfusionnel de notre population. Resultats Cinquante-trois pour cent des 1283 patients inclus ont ete transfuses durant leur hospitalisation. Cinquante-quatre pour cent d’entre eux ne recoivent que 1 ou 2 CG ( Figure 1 ). Le sexe feminin, l’âge, un index de masse corporelle bas, une anemie ou une fraction d’ejection alteree en preoperatoire etaient des facteurs de risque independants de transfusion de CG, tout comme les chirurgies complexes et l’association de la transfusion de CG a d’autres produits sanguins labiles (PSL) ( Tableau 1 ). Conclusion Le taux de transfusion en CG de nos patients est comparable aux centres de meme ampleur. Peu de facteurs de risque transfusionnels sont modulables par la prise en charge. Une strategie d’epargne sanguine, principalement axee sur l’anemie preoperatoire et les seuils transfusionnels peri operatoires, pourrait neanmoins permettre une diminution de la consommation de PSL.

Published
2017
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46. Pediatric Regional Anesthesia

Author

Claude Ecoffey

Subjects
medicine.medical_specialty, Ropivacaine, business.industry, medicine.medical_treatment, Surgery, Ultrasound guidance, Levobupivacaine, Regional anesthesia, Anesthesia, Medicine, Ultrasonography, business, Neurostimulation, medicine.drug
Published
2011
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47. Safety in pediatric regional anesthesia

Author

Claude Ecoffey

Subjects
Peripheral nerve blockade, medicine.medical_specialty, business.industry, Incidence (epidemiology), medicine.medical_treatment, MEDLINE, Patient safety, Anesthesiology and Pain Medicine, Regional anesthesia, Pediatrics, Perinatology and Child Health, medicine, Nerve block, Very low risk, Intensive care medicine, business, Adverse effect
Abstract

The use of regional anesthesia is increasingly common in pediatric practice. This review reports the complications and risks in pediatric regional anesthesia. Few large studies reported incidence of complications. However, the different studies have shown that regional anesthesia, when performed properly, carried a very low risk of morbidity in appropriately selected infants and children. In addition, the use of ultrasound-guided peripheral nerve blockade has shown some promise toward increasing the safety profile of these already safe techniques.

Published
2011
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48. Fast-tracking en anesthésie locorégionale périphérique : étude préliminaire de faisabilité

Author

B. Komly, P. Leclerc, B. Morel, Gilles Dhonneur, Claude Ecoffey, F. Renault, Sébastien Bloc, L. Mercadal, P. Cuny, T. Dessieux, and T. Garnier

Subjects
Anesthesiology and Pain Medicine, General Medicine
Abstract

Resume Objectif La surveillance en salle de surveillance postinterventionnelle (SSPI) a pour objectifs de garantir la securite, le confort et l’analgesie des patients. Certaines publications envisagent de court-circuiter la SSPI selon le principe du fast-tracking (FT). L’objectif de cette etude etait d’evaluer la faisabilite et la securite d’un FT simule apres une anesthesie locoregionale (ALR) peripherique. Patients et methodes Sept cents patients ont ete inclus prospectivement dans cette etude sur une periode de six mois. Methodes Les criteres de sortie etaient definis selon le score de White auquel nous avons ajoute un item concernant la surveillance du site chirurgical. Un score minimal de 14 etait necessaire a l’arrivee en SSPI pour envisager un FT. L’efficacite des blocs, le recours a une sedation ou a une anesthesie generale etaient precises. Les evenements indesirables etaient notes. Resultats L’efficacite globale de l’ALR etait de 93 %. Dans 98 % des cas, le score de sortie evalue a l’arrivee en SSPI etait superieur a 14, ce qui aurait autorise une sortie directe. Treize evenements indesirables ont ete rapportes avant l’acte chirurgical et au bloc operatoire. Aucun evenement indesirable n’a ete rapporte pendant la surveillance en SSPI. Conclusion L’ALR peripherique semble se preter parfaitement au principe du FT. Il pourrait apporter certains avantages tant en termes de reduction des depenses de sante, qu’en termes de reponse aux problemes d’engorgement des SSPI. Bien qu’en France, FT reste un concept marginal pour lequel il n’existe aucun support reglementaire, l’evolution vers une telle pratique pourrait etre envisagee.

Published
2010
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49. Comfort of the patient during axillary blocks placement: a randomized comparison of the neurostimulation and the ultrasound guidance techniques

Author

Bertrand Morel, Claude Ecoffey, Pascal Leclerc, Gilles Dhonneur, Thierry Garnier, Sébastien Bloc, Bernard Komly, and L. Mercadal

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Pain, Regional anaesthesia, law.invention, Patient satisfaction, Randomized controlled trial, law, medicine, Humans, Brachial Plexus, Prospective Studies, Neurostimulation, Ultrasonography, Interventional, Aged, Pain Measurement, Brachial plexus block, business.industry, Nerve Block, Middle Aged, Electric Stimulation, Surgery, body regions, Upper limb surgery, Ultrasound guidance, Anesthesiology and Pain Medicine, Elective Surgical Procedures, Patient Satisfaction, Axilla, Female, business, Elective Surgical Procedure
Abstract

Axillary brachial plexus block under neurostimulation is commonly used for upper limb surgery, but it is sometimes recognized as an uncomfortable technique, with most patients identifying electrical stimulation as an unpleasant moment. Ultrasound-guided regional anaesthesia, which becomes an increasingly popular technique, does not require electrical stimulation and then should theoretically improve axillary block placement comfort. The aim of this study was to compare the comfort of the patients during axillary block placement with neurostimulation and ultrasound guidance using either the out-of-plane or the in-plane approach.Consecutive patients were prospectively enrolled in three equal groups: neurostimulation, ultrasound out-of-plane and ultrasound in-plane approaches. A score was used to measure the comfort of the patients during axillary blocks placement. This score included three criteria: maximum pain intensity perceived during block placement measured using a visual analogue scale (0, no pain and 100, maximal or worse imaginable pain), the number of unpleasant events declared by the patients and the satisfaction of the patient (unsatisfied, acceptable, satisfied, very satisfied). The comfort score was calculated as the sum of each criterion, which was attributed a value of 0 or 1: visual analogue scale (or=30/100, 1;30/100, 0), number of unpleasant events (0, 1;or=1, 0) and satisfaction (satisfied or very satisfied, 1; acceptable or unsatisfied, 0). Procedures of axillary blocks placement resulting in a comfort score of 3 and 2 were arbitrary considered as very comfortable and comfortable, respectively. Success rate of axillary blocks, time to perform block and complications related to procedures were noted.One hundred and twenty patients were included. In the ultrasound out-of-plane group, 55% (22/40) and 25% (10/40) of the procedures were very comfortable and comfortable as compared with 32% (13/40, P0.05) and 20% (8/40, P0.01) in the ultrasound in-plane group and 25% (10/40, P0.01) and 8% (3/40, P0.01) in the neurostimulation group, respectively. Duration of axillary placement was significantly smaller in the ultrasound out-of-plane group as compared with that of in-plane approaches (P0.05) and neurostimulation (P0.01).The present study showed that the ultrasound approaches were less painful and more comfortable than neurostimulation to place axillary blocks. We also showed that, although pain intensity resulting from blocks placement was similar with the ultrasound approaches, very comfortable procedures were more frequent with the out-of-plane than with the in-plane approach.

Published
2010
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50. The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia

Author

Jose De Andres, Gildasio S. De Oliveira, Per Anne Lonnqvist, Claude Ecoffey, Santhanam Suresh, Oscar de Leon Casasola, Giorgio Ivani, and Adrian T. Bosenberg

Subjects
Consensus, Tetracaine, Pain medicine, MEDLINE, Regional anaesthesia, Pediatrics, 03 medical and health sciences, 0302 clinical medicine, Anesthesia, Conduction, 030202 anesthesiology, medicine, Humans, Pain Management, Drug Dosage Calculations, Anesthetics, Local, Dexmedetomidine, Child, Ultrasonography, Interventional, Bupivacaine, Ropivacaine, business.industry, Body Weight, Age Factors, Infant, Newborn, Infant, General Medicine, Treatment Outcome, Anesthesiology and Pain Medicine, Regional anesthesia, Child, Preschool, Anesthesia, business, 030217 neurology & neurosurgery, medicine.drug
Abstract

Background and Objectives Dosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Methods Representatives from both ASRA and ESRA composed the joint committee practice advisory. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Results Spinal anesthesia with bupivacaine can be performed with a dose of 1 mg/kg for newborn and/or infant and a dose of 0.5 mg/kg in older children (>1 year of age). Tetracaine 0.5% is recommended for spinal anesthesia (dose, 0.07–0.13 mL/kg). Ultrasound-guided upper-extremity peripheral nerve blocks (eg, axillary, infraclavicular, interscalene, supraclavicular) in children can be performed successfully and safely using a recommended LA dose of bupivacaine or ropivacaine of 0.5 to 1.5 mg/kg. Dexmedetomidine can be used as an adjunct to prolong the duration of peripheral nerve blocks in children. Conclusions High-level evidence is not yet available to guide dosage of LA used in regional blocks in children. The ASRA/ESRA recommendations intend to provide guidance in order to reduce the large variability of LA dosage currently observed in clinical practice.

Published
2018
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