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Introduction Postoperative ileus(POI) and anastomotic leakage(AL) are highly associated but the direction of this link is unknown. Indeed, it has traditionally been stated that AL leads to POI(secondary POI). The objective was to statistically determine the best model of link between POI and AL by comparing different Structural Equation Models(SEM). Methods This is a retrospective analysis of a prospective multicentric database from the Francophone Group for Enhanced Recovery after surgery(GRACE) including patients undergoing colorectal resection or Hartmann reversal between 2014 and 2017. The main outcome measure was the occurrence of postoperative ileus defined by the absence of Gastrointestinal (GI)-3 recovery in or after postoperative day 4 and the occurrence of AL. Results Among the 2227 patients included, 223 patients experienced POI (10 %) and 72 patients experienced anastomotic leakage (3.2 %). In all the models, POI was significantly increased in case of male gender, older age, opioids consumption, right colectomy, chronic obstructive bronchopneumopathy disease and performance of a stoma, and reduced by Enhanced Recovery Programs (ERP) compliance ≥ 70 % and intake of Non-Steroidal Anti-Inflammatory Drugs. Open surgery was not significantly associated with POI in all the models. In contrast, the male gender was the only factor increasing AL in the model drawn with ERP risk factors for AL. In all the models, POI was highly associated with AL and statistical analyses advocate for POI leading to AL. Conclusion The findings of the present large study suggest that the more statistically probable model is the one in which POI come first before AL.

Systemic sclerosis (SSc) is an auto-immune disease characterized by vasculopathy and the combination of microangiopathy and tissue collagen deposit leading to skin, digestive, pulmonary, myocardial and renal injuries. These repercussions could be challenging for anesthesiologists and associated with difficulties in airway management, and occurrence of congestive right heart failure or acute kidney crisis. The aim of this review is to review the physiopathology and the progression of the SSc, as well as to provide a strategy of perioperative management of these patients.

Resume Objectif La prehabilitation consiste a proposer un entrainement physique avant une chirurgie afin d’ameliorer la recuperation postoperatoire. Cette revue a pour objectif de presenter les modalites d’application et le benefice attendu de la prehabilitation sur la recuperation fonctionnelle et la morbi-mortalite postoperatoire. Sources des donnees Les recherches ont porte sur les articles de langue anglaise, dans la banque de donnees Medline, publies depuis 1989 jusqu’a 2013. Les mots cles, employes separement ou en combinaison, etaient : prehabilitation, functional capacity, postoperative morbidity, physical activity . Selection des travaux Articles originaux, cas cliniques, revues generales et meta-analyses. Extraction des donnees Donnees sur les modalites pratiques, les avantages et les limites des techniques de preparation physique preoperatoire. Synthese des donnees Un mauvais statut physique preoperatoire est associe a une morbidite postoperatoire accrue. Les personnes âgees sont particulierement exposees aux complications postoperatoires. L’amelioration du statut physique preoperatoire de ces patients est possible et permet de diminuer la morbidite et d’accelerer la recuperation apres chirurgie lourde. Afin d’etre le plus efficace possible, le programme d’entrainement doit proposer des exercices d’endurance et de renforcement musculaire dont l’intensite doit etre adaptee aux capacites physiques initiales du patient. Une moyenne de trois seances par semaine sur une duree de six a huit semaines parait un bon compromis entre faisabilite et efficacite. Conclusion L’efficacite de la prehabilitation a ete demontree en chirurgie cardiovasculaire et probablement en chirurgie abdominale lourde. Elle doit s’integrer dans une prise en charge complete du patient, et doit s’associer a une renutrition preoperatoire et a des protocoles de rehabilitation postoperatoire. C’est en optimisant toutes les etapes de la prise en charge chirurgicale, du diagnostic a la guerison, que le pronostic des patients les plus fragiles pourra etre ameliore.

Resume Objectifs Les recommandations incitent chaque bloc operatoire a disposer d’un fibroscope pour l’intubation tracheale difficile. Le materiel reutilisable pose le probleme de sa disponibilite, de sa maintenance, du risque infectieux et de son cout d’acquisition. Des fibroscopes a usage unique sont desormais disponibles (Ambu ® aScope™). Cette etude a pour objectif d’evaluer le cout de la fibroscopie utilisant un materiel reutilisable et de le comparer a celui de l’usage unique. Type d’etude Etude de type minimisation de cout. Materiel etudie Fibroscope reutilisable Pentax ® FB 15P (Pentax France, Argenteuil) et fibroscope a usage unique Ambu ® aScope™ (Ambu A/S, Ballerup, Danemark). Methode Evaluation du cout amorti par utilisation de deux fibroscopes reutilisables incluant le prix d’achat, les depenses de maintenance et de desinfection sur une periode de six annees. Le cout d’utilisation du fibroscope Ambu ® aScope™ correspond a son prix d’achat. Resultats Le cout des fibroscopes reutilisables a ete de 55 874 € pour 270 intubations, soit un cout unitaire de 206 € par fibroscopie. Durant cette periode, 780 procedures de nettoyage-desinfection ont ete realisees pour un cout de 32 611 €. Les depenses d’investissement et de maintenance ont ete respectivement de 18 382 € et de 4880 €. Ce cout est a rapporter a celui du fibroscope a usage unique, de 200 € par fibroscopie. Conclusion Sur une periode de six ans, les couts lies a l’utilisation des fibroscopes reutilisables et a usages uniques sont proches. Les avantages de l’usage unique conduisent a discuter l’interet de ce materiel pour l’intubation difficile prevue dans les blocs operatoires.

All the files of complications of regional anaesthesias requiring an expertise for a Regional Commission for Conciliation and Compensation for medical accidents (CRCI) between 2003 and 2008 were analyzed. The objective was to estimate the homogeneity of the appointed experts, their opinions and the opinions of the CRCI. Querying the database, shared by the National Office for Compensation for Medical Accidents (ONIAM) and the CRCI, and identified 40 files corresponding to the selection criteria. The expertise carried out involved an anaesthetist in 27 cases, always registered, either on the national list of the experts in medical accidents, or on one list of court-appointed experts. Conversely, in 13 cases, no specialist performing himself the technique in question was involved in the expertise, and sometimes the expert was registered on any list. Mostly, the non-specialists do not conclude to medical malpractice. This was not the case in a single file, where the anaesthetist sought and obtained the addition of an anaesthetist in a new expertise, which concluded differently. Damages assessed were highly variable, but the given evidence provided to understand why. The CRCI have generally followed the opinions of the experts, except in a few cases where the evidence allowed a different opinion without requiring a new expertise. In conclusion, the abnormalities in the appointment of experts do not seem to have had consequences in terms of damage assessment, but may alter the balance between causes faulty and not faulty, in favour of the latter.

Resume Objectifs Le Transversus Abdominis Plane block (TAP bloc) est une technique d’analgesie efficace qui peut etre realise apres reperage anatomique du triangle de J.-L. Petit, par la technique de perception de ressauts. L’objectif de cette etude a ete d’evaluer par echographie la localisation de l’injection de l’anesthesique local (AL) dans le TAP bloc realise par reperage anatomique et perceptions de ressauts. Type d’etude Etude prospective observationnelle. Patients et methode Cinquante-deux patients consecutifs operes d’une fermeture d’ileostomie unilaterale sous AG ont beneficie d’un TAP bloc consistant apres reperage du triangle de Petit et perception de deux ressauts a la ponction, en l’injection de 20 mL de ropivacaine 7,5 mg/mL. Une echographie etait realisee immediatement apres l’injection afin de visualiser la localisation de l’injection de l’AL. Le TAP bloc etait considere efficace si le patient ne necessitait pas de titration de morphine en SSPI pour une douleur au site operatoire. Resultats L’AL etait injecte entre le muscle oblique interne et le muscle transverse dans 14 cas (27 %) et se revelait efficace 13 fois. Dans 38 cas (73 %), l’AL etait administre dans les structures adjacentes et efficaces dans seulement 14 cas. Une injection intraperitoneale a ete observee dans deux cas. Discussion La localisation de l’AL au cours d’un TAP bloc realise par un reperage anatomique avec perception de ressauts est aleatoire, donnant lieu a une incidence elevee d’echecs. Cela plaide pour l’utilisation systematique du reperage echographique.

This paper aims to analysis the behavior of DC corona discharge in wire-to-plate electrostatic precipitators (ESP). Currentvoltage curves are particularly analyzed. Experimental results show that discharge current is strongly affected by the applied voltage. The proposed method of current identification is to use the method of least squares. Least squares problems that of into two categories: linear or ordinary least squares and non-linear least squares, depending on whether or not the residuals are linear in all unknowns. The linear least-squares problem occurs in statistical regression analysis; it has a closed-form solution. A closed-form solution (or closed form expression) is any formula that can be evaluated in a finite number of standard operations. The non-linear problem has no closed-form solution and is usually solved by iterative., {"references":["A. Mizuno, Electrostatic precipitation, IEEE Trans. Dielectr. Electr.\nInsul. 7, pp. 615-624, 2000.","J. S. Chang, Next generation integrated electrostatic gas cleaning\nsystems, J. Electrostat. 57, pp. 273-291, 2003.","T. Yamamoto and H. R. Velkoff, Electrohydrodynamics in an\nelectrostatic precipitator, J. Fluid Mech. 108, pp. 1–18, 1981","P. Atten, F. M. J. Mccluskey and A. C. Lahjomri, The\nelectrohydrodynamic origin of turbulence in electrostatic precipitators,\nIEEE Trans. Ind. Appl, 23, pp. 705–711, 1987.","J. Podliński, J. Dekowski, J. Mizeraczyk, D. Brocilo and J. S. Chang,\nElectrohydrodynamic gas flow in a positive polarity wire-plate\nelectrostatic precipitator and the related dust particle collection\nefficiency, J. Electrostatic. 64, pp.259-262, 2006.","N. Zouzou, B. Dramane, P. Braud, E. Moreau and G. Touchard, EHD\nflow in DBD precipitator, IJPEST, 3, pp.142-145, 2009.","H. Nouri, N. Zouzou, E. Moreau, L. Dascalescu, Y. Zebboudj, Effect of\nrelative humidity on the collection efficiency of a wire-to-plane\nelectrostatic precipitator, The IEEE Industry Applications Society\nAnnual Meeting, Houston, Tx, ISSN: 0197-2618, Print ISBN: 978-1-\n4244-6393-0 3-7 October, 2010.","K. R. Parker, Applied Electrostatic Precipitation, Edition Kluwer\nAcademic Publishers, London, 1997.","H. Nouri, N. Zouzou, E. Mreau, L. Dascalescu, Y. Zebboudj, Effect of\nRelative Humidity on Current-Voltage Characteristics of an Electrostatic\nPrecipitator, Journal of Electrostatics, 2012, Vol 70 N° 1, pp. 20-24,\n2012.\n[10] H. Nouri and Y. Zebboudj, Analysis of Positive Corona in Wire-to-Plate\nElectrostatic Precipitator, Eur. Phys. J. Appl. Phys., Vol. 49,p 11001,\n2010.\n[11] A. Bologa, H. R. Paur, H. Seifert, Th. Wäscher and K. Woletz, Novel\nwet electrostatic precipitator for collection of fine aerosol, J.\nElectrostatics. 67, pp.150–153, 2009.\n[12] P. Joaquim, S. Marques, Applied Statistics Using SPSS, STATISTICA,\nMATLAB and R. Springer-Verlag Berlin Heidelberg, Second Edition,\npp. 271- 327, 2007.\n[13] D. Alexander, Z. Poularikas, M. Ramadan, Adaptive filtering primer\nwith matlab. CRC Press Taylor & Francis Group, pp. 101 - 197, 2006.\n[14] F. van der Heijden, R .P. W. Duin, D. de Ridder, D. M. J. Tax,\nClassification, Parameter Estimation and State Estimation An\nEngineering Approach using MATLAB, John Wiley & Sons Ltd, The\nAtrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England,\npp. 13 -138, 2004.\n[15] M. Boumahrat, A.Gourdin, Méthodes numériques appliquée, OPU, pp.\n293 – 364, 1993.\n[16] P. Borne, Modélisation et identification des processus, Tome 2, Editions\nTechnip, Paris, France, 1992.\n[17] M. Abdel– Salam, Z. Al– Hamouz, Analysis of monopolar ionized field\nas influenced by ion diffusion, IEEE Trans., Ind. App, vol.31, pp.484-\n493, 1995.\n[18] S. Pasare, calcul de champ magnétique d'une ligne aérienne a haute\ntension, Electrical engineering series, N°:32, 2008.\n[19] M. Nicolas, Ondes et électromagnétisme, Dunod, Paris, ISBN 978-2-10-\n054276-5, pp.133- 159, 2009."]}

Abdominal surgery induces postoperative ventilatory dysfunction related to a combination of reflex diaphragmatic inhibition, respiratory muscle injury and pain. The role of pain is difficult to isolate from other components. Thoracic epidural analgesia using local anesthetics is able to partially reverse the diaphragmatic dysfunction. However, this effect seems not directly related to analgesia. Regardless of the mechanisms, epidural analgesia has been shown to improve the postoperative ventilation and to prevent the occurrence of pulmonary complications. Pain relief, either by parenteral administration of opiate, and/or parietal blockade has been shown to improve the diaphragm motion and the overall respiratory status. All analgesic strategies may facilitate the implementation of postoperative physiotherapy which has a significant interest in preventing postoperative pulmonary complications.

Prehabilitation consists in providing a repetitive physical exercise before surgery to improve the postoperative recovery course. This review aims to evaluate the feasibility and the expected benefits of prehabilitation on the postoperative recovery course and the reduction of the postoperative morbidity.Data research has focused on English-language articles in the Medline database, published from 1989 to 2013. Keywords, used separately or in combination, were: prehabilitation, functional capacity, postoperative morbidity, physical activity.Selected articles were original articles, clinical cases, review articles and meta-analysis.Articles were analyzed for feasibility, benefits and limitations of preoperative physical preparation techniques.Poor preoperative functional status is associated with increased postoperative morbidity. Elderly are more prone to postoperative complications. The improvement of preoperative physical status of these patients is possible and may reduce morbidity and allow faster recovery after major surgery. In order to improve efficiency, the training program must provide endurance and muscle reinforcement exercises, whose intensity must be adapted to the patient's baseline physical abilities. An average of three sessions per week over a period of six to eight weeks before surgery seemed a good compromise between feasibility and effectiveness.The effectiveness of prehabilitation has been demonstrated in cardiovascular surgery and probably in abdominal surgery. Prehabilitation must be integrated into the overall patient medical management, and must be associated with preoperative refeeding and postoperative rehabilitation protocols. By optimizing all stages of the surgical patient management, from diagnosis to recovery, prognosis of high-risk surgical patients could be improved.

TAP is a regional anaesthetic technique where local anaesthesic (LA) is injected between the internal oblique and the transversus abdominis muscles in order to block intercostal nerves. The technique originally described, is based on the identification of the lumbar triangle of Petit as the area where to insert the needle before the LA injection. We performed a study to determine, using ultrasonography, the actual location of the LA when TAP block was performed using landmark-based technique.Prospective and observational study.Fifty-two patients scheduled for ileostomy closure surgery under general anaesthesia received a TAP block (20 mL 0.75% ropivacaine) based on standard anatomical landmarks technique. Ultrasonography was used immediately after the block to determine the LA placement. Failed blocks were considered when the patient required intravenous morphine in the immediate postoperative period for pain localised at the operative site.LA solution was injected in the right place in 14 cases out of 52. Only one of these patient received morphine in the postoperative period. In the remaining 38 blocks, the LA was administered in adjacent anatomical structures and 25 failed. Two injections in the peritoneum were observed.The localization of LA after the TAP block being performed by landmark-based techniques is highly variable. In the majority of patients, the LA was injected in adjacent anatomical structures with unpredictable block results. This may promote the use of ultrasound-guided technique to perform the TAP block.

Nach grosen Oberbaucheingriffen ist ein adaquates postoperatives Schmerzmanagement essenziell fur die Genesung und Lebenszufriedenheit des Patienten. Tilleul et al. haben Kosten und Nutzen verschiedener etablierter pharmakotherapeutischer Analgesieverfahren verglichen.