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Background Changes in the epidemiology of traumatic brain injury (TBI) in older patients have received attention, but limited data are available on the outcome of these patients after admission to intensive care units (ICUs). The aim of this study was to evaluate the outcomes of patients over 65 years of age who were admitted to an ICU for TBI. Methods This was a multicentre, retrospective, observational study conducted from January 2013 to February 2019 in the surgical ICUs of 5 level 1 trauma centres in France. Patients aged ≥ 65 years who were hospitalized in the ICU for TBI with or without extracranial injuries were included. The main objective was to determine the risk factors for unfavourable neurological outcome at 3 months defined as an Extended Glasgow Outcome Scale (GOSE) score Results Among the 349 intensive care patients analysed, the GOSE score at 3 months was ≤ 4 and ≥ 5 in 233 (67%) and 116 (33%) patients, respectively. The mortality rate at 3 months was 157/233 (67%), and only 7 patients (2%) fully recovered or had minor symptoms. Withdrawal or withholding of life-sustaining therapies in the ICU was identified in 140 patients (40.1%). Multivariate analysis showed that age (OR 1.09, CI 95% 1.04–1.14), male sex (OR 2.94, CI95% 1.70–5.11), baseline Glasgow Coma Scale score (OR 1.20, CI95% 1.13–1.29), injury severity score (ISS; OR 1.04, CI95% 1.02–1.06) and use of osmotherapy (OR 2.42, CI95% 1.26–4.65) were associated with unfavourable outcomes (AUC = 0.79, CI 95% [0.74–0.84]). According to multivariate analysis, the variables providing the best sensitivity and specificity were age ≥ 77 years, Glasgow Coma Scale score ≤ 9 and ISS ≥ 25 (AUC = 0.79, CI 95% [0.74–0.84]). Conclusions Among intensive care patients aged ≥ 65 years suffering from TBI, age (≥ 77 years), male sex, baseline Glasgow coma scale score (≤ 9), ISS (≥ 25) and use of osmotherapy were predictors of unfavourable neurological outcome. Trial registration ClinicalTrials.gov Identifier: NCT04651803. Registered 03/12/2020. Retrospectively registered.

ABSTRACT: EPOS Thematic Core Service ANTHROPOGENIC HAZARDS (TCS AH) integrates, within the framework of the European Plate Observing System (EPOS) (www.epos-eu.org), research infrastructures freely open for scientists, engineers, and all others interested in hazards posed by the seismicity induced by geo-resource exploration and exploitation. The integrated infrastructures consist of three components: •Data gathered in "episodes." An episode is a set of time-correlated geophysical and technological data and other relevant geo-data that comprehensively report anthropogenic seismicity cases and the industrial and geological conditions of these processes. •Applications, i.e., problem-oriented, bespoke, and standard software tools to process and analyze the data. They help relate seismicity and technological factors for hazard assessment and other scientific targets. •The episodes and applications are accessible on the EPISODES e-platform (https://tcs.ah-epos.eu), an IT environment for data modeling and analysis. The platform provides the user’s workspace, adequate hardware resources, including HPC systems and other facilities that grant quick and efficient execution of commissioned tasks. Here we present and describe the structure and details of this open-access facility. On an example of the pilot "Time-Dependent Anthropogenic Seismic Hazard Assessment," we demonstrate the potential of the integrated infrastructures for developing innovative practice solutions, ready-for-implementation in geo-resource exploitation. 1. INTRODUCTION Exploitation of geo-resources alters the stress and strength conditions in the engaged rock mass. In favorable conditions such alterations result in rock fracturing and violent emission of seismic waves. This process known as anthropogenic seismicity is an unwanted response of the rock mass to the technological processes. With rising demands for energy and minerals, anthropogenic seismicity has been appearing in association with diverse technological processes, and often also in previously aseismic regions. The induced or triggered earthquakes can accompany underground and open-pit mining, conventional and unconventional hydrocarbon extraction, geothermal energy production, underground liquid and gas storage including carbon sequestration, impoundment of surface reservoirs of liquids (like artificial lakes of dammed water for hydroelectric plants and ore-floatation waste repositories) and many other technological processes that perturb the boundary conditions in the affected rock (Lasocki and Orlecka-Sikora, 2020).

International audience; Delayed defecation is common in patients on intensive care. We aimed to determine factors associated with time to defecation after admission to intensive care and in turn its association with length of stay and mortality. We studied 396 adults admitted to one of five intensive care units in whom at least 2 days' invasive ventilation was anticipated during an expected stay of at least 3 days. The median (IQR [range]) time to defecate by the 336 out of 396 (84%) patients who did so before intensive care discharge was 6 (4-8 [1-18]) days. Defecation was independently associated with five factors, hazard ratio (95%CI), higher values indicating more rapid defecation: alcoholism, 1.32 (1.05-1.66), p = 0.02; laxatives before admission, 2.35 (1.79-3.07), p < 0.001; non-invasive ventilation, 0.54 (0.36-0.82), p = 0.004; duration of ventilation, 0.78 (0.74-0.82), p < 0.001; laxatives after admission, 1.67 (1.23-2.26), p < 0.001; and enteral nutrition within 48 h of admission, 1.43 (1.07-1.90), p = 0.01. Delayed defecation was associated with prolonged intensive care stay but not mortality.

The conversion of neuraxial anesthesia (NA) to general anesthesia (GA) during a cesarean section (CS) may be associated with a higher risk of neonatal morbidity by adding the undesirable effects of both these anesthesia techniques. We aimed to compare the neonatal morbidity of non-elective CS performed after conversion from NA to GA (secondary GA) vs. that after GA from the outset (primary GA).We performed a monocentric retrospective study at the Angers University Hospital (France). All non-elective CSs performed under GA between January 2015 and December 2019 were included. The CSs were classified using a three-color coding system (green for non-urgent delivery, orange for urgent CS, and red for very urgent CS). The primary neonatal outcome was a composite of umbilical artery pH7.10 or 5-min Apgar score7. The crude and adjusted odds ratios (OR) for the risk of neonatal morbidity associated with secondary GA were estimated.We included 247 patients, of whom 101 (41.3%) had a secondary GA and 146 (58.7%) had primary GA. In the secondary GA group, 86.1% (87/101) had epidural anesthesia and 13.9% (14/101) had spinal anesthesia. Multivariate analysis showed no difference in neonatal morbidity between the two groups (adjusted odds ratio 1.18, 95% CI 0.56 to 2.51).Our study found insufficient evidence to identify a difference in neonatal outcomes between secondary compared with primary GA for CS, regardless of the level of emergency. However, our study is underpowered and additional studies are needed to confirm these data.

Additional file 1: Table S1. Conversion table for FiO2 determination. Table S2. Comparison between patients intubated early and not intubated early in the group of patients with standard criteria for early endotracheal intubation.

Shale oil and gas exploitation by hydraulic fracturing experienced a strong development worldwide over the last years, accompanied by a substantial increase of related induced seismicity, either consequence of fracturing or wastewater injection. In Europe, unconventional hydrocarbon resources remain underdeveloped and their exploitation controversial. In UK, fracturing operations were stopped after the M

L’anemie est tres frequente chez les patients hospitalises dans les services de reanimation et la mise en place d’une politique transfusionnelle restrictive aboutit a la presence d’une anemie chez 80 a 90 % des patients au sortir de la reanimation. Les consequences sur la survie ou la recuperation peuvent etre tres nefastes. L’anemie de ces patients est multifactorielle, resultant, d’une part, d’un etat inflammatoire et, d’autre part, de pertes et/ou de prelevements de sang importants evalues a 128 mL/j representant une perte en fer-element de 64 mg/j. Plusieurs mecanismes contribuent a l’anemie des etats inflammatoires, en particulier une alteration de la proliferation des precurseurs erythroides, une diminution de la synthese d’erythropoietine (EPO) par le rein, une activation des macrophages, conduisant a une augmentation de l’erythrophagocytose et a une diminution de la duree de vie des globules rouges, et enfin des perturbations de l’homeostasie du fer. En particulier, l’IL6 stimule fortement l’expression de l’hepcidine qui reprime le recyclage du fer heminique au niveau des macrophages et induit une diminution du fer serique. La plupart de ces mecanismes ont ete mis en evidence chez les patients de reanimation a l’exception de l’augmentation de l’hepcidine qui n’a jamais ete exploree dans ce contexte. Par ailleurs, les pertes sanguines repetees sont susceptibles d’entrainer une carence en fer vraie, alors que l’inflammation entraine une diminution de la disponibilite du fer pour l’erythropoiese par sequestration dans les macrophages. La stimulation de l’erythropoiese reprime la synthese d’hepcidine, et des travaux recents obtenus sur un modele murin de l’anemie de reanimation suggerent que l’EPO ou les prelevements sanguins iteratifs peuvent reprimer l’hepcidine, meme en presence de taux eleves d’IL6. Ces resultats incitent a developper des etudes cliniques pour evaluer le benefice d’un traitement de l’anemie de reanimation par des injections d’EPO, avec ou non une supplementation en fer, dans l’idee, non plus de limiter les transfusions, mais plutot de corriger l’anemie a long terme et d’ameliorer l’avenir des patients.

Resume Objectifs Evaluation des pratiques de la prescription du fer en reanimation. Type d’etude Enquete d’opinion par questionnaire des participants a un congres national de reanimation. Methodes Les medecins interroges ont ete separes en deux groupes (prescripteur [P] de fer une fois ou plus par semaine ou non prescripteur [NP] une prescription ou moins par mois). L’efficacite et la tolerance des traitements martiaux ont ete evaluees sur une echelle de 1 a 10. Resultats Les 128 reanimateurs interroges (73 % d’hommes ; âge moyen 36 ± 8 ans) estimaient tous avoir des patients anemiques et 94 % des patients avec carence martiale. Pour 72 % des reanimateurs, la carence martiale etait jugee frequente (> 10 % de leurs patients), tandis qu’un quart se declarait prescripteur de fer. Le fer injectable, oral ou l’association des deux etait choisi dans, respectivement, 20, 35 et 44 % des cas. Le fer injectable etait percu comme plus efficace que le fer oral (7 ± 2 versus 6 ± 2 sur 10 ; p p p = 0,04). En revanche, ils n’utilisaient pas plus souvent le diagnostic biologique et ne jugeaient pas l’efficacite ni la tolerance des traitements martiaux meilleures que les NP. Conclusion La carence martiale est jugee frequente et les traitements martiaux ont une efficacite et une tolerance jugees acceptables, mais seuls 25 % des reanimateurs interroges les prescrivent regulierement. Ces resultats demontrent que la prescription du fer en reanimation semble seulement basee sur une impression clinique.

interaction correlated with a positive change in their impact factor from their first adoption of Twitter to date. Recognizing that correlation does not imply causation, we examined this perceived relationship. Seven of 25 (28%) indexed anaesthesia journals have a Twitter account. We correlated Twitter presence, user/content interaction and validated metrics of social-media influence (Klout and BirdSong scores) with the journal’s current impact factor. We also looked at the change in impact factor since Twitter adoption by each journal and the number of article citations (Fig. 1). Comparison was made with the change in impact factor of anaesthesia journals without Twitter accounts over the same period. An active Twitter account with a high Klout score directlycorrelated with higher journal impact factor (P=0.034) and with a greater number of article citations (P=0.016) than journals not embracing social media. A highly-performing Twitter account was also associated with an increase in impact factor in the period after Twitter adoption (P=0.01), while journals without a social media presence, on average, saw a net stasis or decline in their impact factor. Twitter offers a unique platform for fast dissemination and discussion of the latest publications in anaesthesia. With smartphones and tablet devices allowing constant access to social media, anaesthetists communicate via social media to discuss journal publications and respond to journal editors. To encourage further adoption by our academic journals, we share our observations of a positive correlation between journal editorial interaction on Twitter and a subsequent increase in journal impact factor. Journals which did not actively embrace Twitter as a 21st-century Letter to (and from) the Editor saw a net stasis or even decline in impact factor.

During the past 10 years, the knowledge of iron metabolism has been revolutionized by the discovery of the main regulatory hormone of body iron: hepcidin. Meanwhile, new formulations of intravenous iron have been developed and are already or readily available. In this article, we review the recent pathophysiological mechanisms underlying anemia of chronic disease or due to iron deficiency. We describe the various treatment modalities of iron deficiency anemia using oral or intravenous route and the emerging indications of treatment with iron. Finally, we discuss the situations in which iron supplementation may be harmful.

We reported the case of a 61-year-old woman, who has been hospitalized in ICU because of an extensive mesenteric ischaemia, involving the small bowel, secondary to a naratriptan overuse. This mesenteric ischaemia was complicated by multiple organ failure and was responsible for extensive small bowel resection and left colectomy. A concomitant abundant absorption of grapefruit juice, a well-known P450 inhibitor, may have enhanced this naratriptan toxicity. This case underscore that an abdominal pain occurring in the context of headache treatment may be related to a mesenteric ischaemia.

Anemia in critically ill patients is frequent and consists of chronic disease associated with blood losses. These two mechanisms have opposite effects on iron homeostasis, especially on the expression of the iron regulatory hormone hepcidin. We developed a mouse model mimicking the intensive care anemia to explore iron homeostasis.Experimental study.University-based research laboratory.C57BL/6 mice.Mice received either a single intraperitoneal injection of lipopolysaccharide followed 1 week later by zymosan, or were subjected to repeated phlebotomies by retro-orbital punctures, or both. Several subsets of mice were analyzed over a 14-day period to describe the mouse model of intensive care anemia. Additional mice received erythropoietin injections with or without the zymosan treatment and were killed at day 5, to perform a more detailed analysis.We observed anemia as soon as 5 days after zymosan injection, together with increased messenger RNA (mRNA) levels for interleukin-6 and hepcidin. Phlebotomies alone fully suppressed hepcidin mRNA expression. Interestingly, in mice treated with zymosan and phlebotomies, hepcidin expression was suppressed, despite the persistent increase in interleukin-6. Stimulation of erythropoiesis by erythropoietin injections also led to a decrease in hepcidin mRNA in zymosan-treated mice. In these situations combining inflammation and erythropoiesis stimulation, there was no change in ferroportin, the membrane iron exporter, at the mRNA level, whereas ferroportin protein increased. Macrophage iron stores (assessed by histology using diaminobenzidine staining, or by quantification of nonheme iron and ferritin concentrations) were depleted in the spleen.These results suggest that the erythroid factor dominates over inflammation for hepcidin regulation, and that iron could be mobilized in these situations combining inflammation and erythropoiesis stimulation.

To evaluate the practice concerning the iron prescription by French intensivists.Survey during an intensive care-national congress.Interviewed practitioners were separated in two groups (prescribing [P] iron once time or more per week; or not [NP] less than one time per month). Iron-treatments (iv or oral) efficacy and tolerance were quoted from 1 to 10.All the 128 interviewed intensivists (73% male; mean age 36+/-8 years) considered having anaemic patients and 94% considered having patients with iron deficiency. For 72% of them, the iron deficiency was judged frequent (concerning10% of their patients) and 25% were P. Intravenous iron, oral iron or both were used by, respectively, 20, 35 and 44% of the interviewed intensivists. Intravenous iron was considered more efficient (7+/-2 versus 6+/-2; p0.001) and better tolerated (7+/-2 versus 6+/-2; p0.001) than oral iron. There was no demographic difference between P and NP. P answered more often having patients with iron deficiency (p=0.04), but they did not perform biological tests for diagnosis of iron deficiency more often and did not consider iron-treatment efficacy or tolerance higher than NP.Intensive-care anaemia and iron deficiency were considered to be frequent and iron treatments to be efficient and quite well tolerated. But only 25% of the interviewed intensivists were frequent-iron prescribers. This survey underscore that iron prescription in ICU seems to rely more on clinical feeling than on strong evidence: it's time to investigate!

A large number of immunomodulatory therapies has been evaluated in patients with severe sepsis and septic shock. Until recently, none of these treatments has ever demonstrated any benefit in terms of decreased mortality. Many biases could interfere with the results of these clinical trials linked to poor comprehension of immune response, pharmacological errors, selection bias, and mistakes in the evaluation of the patients and in the interpretation of the results. Based on these methodological flaws, the authors try to define directions for future clinical trials.

Many examples have shown that the activity accompanying underground mining works can be hazardous both to underground staff and mining installations, as well as to ground structures. Magnitude of the strongest seismic events in copper mines of Legnica-Glogow Copper District (LGCD) in Poland exceeds 4.0. Furthermore, due to shallow focal depth, events of this size can give rise to peak ground acceleration of more than 2 m/s2. An accurate assessment of seismic hazard posed by mining-induced events is thus a problem of primary importance. Monitoring mining seismicity in LGCD is carried on both underground as well as from the surface. The underground seismic network is supposed to provide information about seismic sources. Yearly several thousands events are recorded and parameterized. The surface accelerometric ground motion monitoring aims at assessing seismic impacts to buildings and other man-made structures in this considerably urbanized area. The mining seismic events are weak earthquakes but the seismicity in mines significantly differs from the earthquake process. Firstly, mining event occurrence is predominantly controlled by time-varying mining works, therefore the active zones in mines are, by their nature, transient. Moreover, even during their lifetime, the activity of these zones changes considerably. In our approach to seismic hazard assessment in mines, locations and times of activity of the zones that will be active in the future are deduced from programs of mining operations. Characteristics of fracturing process in these zones are inferred from characteristics of the zones that were active in the past and can be considered as models for the future activity. The model zones are selected by expert judgment based on anticipated similarity between mining and geologic conditions of the past and future zones. The epistemic uncertainty of such selections is considered within the logic tree scheme. Secondly, due to the heterogeneity of the rockmass fracturing process, the magnitude distribution of seismic events induced by exploitation is often non-Gutenberg-Richter's, complex and multimodal. As a remedy the model-free approach with the non-parametric kernel estimator of magnitude density is applied. This approach ensures reliable estimates of probability functions of event size regardless the actual complexity of the underlying distribution of magnitude. The mentioned ways of analyzing the seismic hazard posed by mining-induced seismicity are illustrated by a practical example in which we predict future seismic activity and estimate limiting values for ground motion in the 20 years horizon.

Empirical broad spectrum antimicrobial therapy prescribed in life-threatening situations should be de-escalated to mitigate the risk of resistance emergence. Definitions of de-escalation (DE) vary among studies, thereby biasing their results. The aim of this study was to provide a consensus definition of DE and to establish a ranking of β-lactam according to both their spectra and their ecological consequences. Twenty-eight experts from intensive care, infectious disease and clinical microbiology were consulted using the Delphi method (four successive questionnaires) from July to November 2013. More than 70% of similar answers to a question were necessary to reach a consensus. According to our consensus definition, DE purpose was to reduce both the spectrum of antimicrobial therapy and the selective pressure on microbiota. DE included switching from combination to monotherapy. A six-rank consensual classification of β-lactams allowing gradation of DE was established. The group was unable to differentiate ecological consequences of molecules included in group 4, i.e. piperacillin/tazobactam, ticarcillin/clavulanic acid, fourth-generation cephalosporin and antipseudomonal third-generation cephalosporin. Furthermore, no consensus was reached on the delay within which DE should be performed and on whether or not the shortening of antibiotic therapy duration should be included in DE definition. This study provides a consensual ranking of β-lactams according to their global ecological consequences that may be helpful in future studies on DE. However, this work also underlines the difficulties of reaching a consensus on the relative ecological impact of each individual drug and on the timing of DE.

Fournier's gangrene is a necrotizing infection of skin and soft tissue of the perineum. Several sources of contamination have been described: cutaneous, urological or anorectal. Anatomy of the perineum helps in the prediction of the extension of the infection. The bacterial flora (usually mixed aero-anaerobic flora) depends on the source of infection: gram-positive cocci (skin source) combined with gram-negative bacilli and anaerobes (urological or anorectal source). CT scan and echography are useful tools for the diagnosis without delaying surgery. In the diagnostic procedure and the management, proctological examination, retrograde uretrography, bowel and urine derivation should be discussed.

Measurement of cardiac troponin I or T in serum (highly specific for the myocardium) have replaced classical markers, such as creatine kinase MB. Cardiac troponins are preferred markers because of their high specificity and sensitivity. This had led to modifications of the original World Health Organization criteria for acute myocardial infarction. Furthermore, the place of the troponins as superior markers of subsequent cardiac risk in acute coronary syndrome has now become firmly established, for both diagnostic and risk stratification purposes. The use of C-reactive protein and/or other inflammatory biomarkers may add independent information in this context. After non cardiac surgery, the total cardiospecificity of cardiac troponins explains why other biomarkers of necrosis should no longer be used. Recent studies suggest that any elevation of troponin in the postoperative period is indicative of increased risk of long-term cardiac complications. This prognostic value has been previously demonstrated in other clinical settings such as invasive coronary intervention (surgical myocardial revascularization and percutaneous coronary intervention) and after heart valve surgery. Increases of troponin indicate cardiac damage, whatever the mechanism (ischemic or not). Other causes of cardiac injury include: pulmonary embolism, myocarditis, pericarditis, congestive heart failure, septic shock, myocardial contusion. In most cases, elevation of troponins has been shown to be associated with a bad outcome.

Introduction Les recommandations pour le traitement antibiotique empirique des pneumonies acquises sous ventilation mecaniques (PAVM) ont ete preconisees par l’American Thoracic Society en 2005 [1] . Des questions relatives a la fiabilite de ces recommandations ont emerge. Nous avons developpe et valide un score predictif de la presence de bacteries resistantes chez les patients cerebroleses presentant une PAVM. Materiel et methodes Dans une etude observationnelle prospective realisee dans 3 reanimations de CHU, les donnees de 379 patients atteints de lesions cerebrales aigues (score de Glasgow ≤ 12) et presentant une PAVM ont ete utilisees pour developper un score predictif de bacterie resistance a une antibiotherapie a spectre limitee. Ce score a ete valide dans une cohorte independante de 252 patients. Le diagnostic de PAVM etait retenu sur l’association de signes cliniques, d’un foyer radiologique et d’un prelevement bacteriologique pulmonaire quantitatif positif. La resistance a une antibiotherapie a spectre limite etait definie par la presence d’au moins une bacterie resistante a l’ampicilline/sulbactam, la ceftriaxone ou la levofloxacine. Un patient etait correctement classe par le score si : (1) il ne presentait aucun facteur de risque du score et qu’il n’avait a posteriori pas de bacterie resistante, ou (2) il presentait au moins un des facteurs de risque et qu’il avait a posteriori une bacterie resistante. Resultats En analyse multivariee, les trois facteurs predictifs de resistance a un traitement antibiotique a spectre limite (incidence = 16,4 %) etaient un antecedent d’insuffisance respiratoire chronique (OR 4,88, IC95 % 1,40–17,02), une duree du traitement antibiotique ≥ 48 heures (OR 12,73 ; IC95 % 6,60–24,63) et une duree d’hospitalisation ≥ 10 jours. (OR 2,33, IC95 % 1,15–4,72). L’aire sous la courbe (ASC) pour ce score etait de 0,835 (Intervalle de Confiance a 95 % (IC95 %), 0,784–0,890) versus 0,735 (IC95 % 0,697–0,786) lorsque l’on utilisait les criteres de l’ATS. Dans la cohorte de validation, l’ASC du score a trois–item etait 0,808 (IC95 %, 0,737 a 0,877) et de 0,762 (95 % CI, 0,713–0,825) avec le score de l’ATS. A posteriori, le pourcentage de patients correctement classes etait de 77 % avec le score a trois items, et de 33 % avec le score de l’ATS ( p Discussion Nous rapportons la haute performance d’un score permettant de predire la presence de bacteries resistantes a une antibiotherapie a spectre etroit, comprenant un antecedent d’insuffisance respiratoire, une antibiotherapie prealable > 48 heures ou un delai de survenue > 10 jours, chez les patients cerebroleses avec PAVM. L’utilisation de ce score pourrait etre crucial pour le choix de l’antibiotherapie probabiliste chez les patients hospitalises en reanimation et developpant une PAVM.

Introduction Notre equipe anesthesique a integre l’hypnose depuis 3 ans au bloc operatoire pediatrique. Le but de ce travail est d’evaluer l’apport de l’hypnose chez les enfants de plus de 3 ans des leur accueil au bloc jusqu’a l’induction anesthesique. Materiel et methodes Etude observationnelle, prospective sur 2 mois (avril-mai 2013), realisee apres accord du comite d’ethique du CHU d’Angers. Criteres d’inclusion : enfants de plus de 3 ans en chirurgie ambulatoire, pris en charge par un des 4 medecins anesthesistes ou des 3 IADE formes a l’hypnose. En consultation d’anesthesie, une information est faite aux parents et a l’enfant (lettre explicative et consentement), ainsi qu’un questionnaire precisant les gouts, activites preferees, dessin, histoire, recuperes le jour de l’intervention. La premedication est laissee au libre choix du medecin. Les niveaux de confort (Evendol, echelle verbale de confort), d’anxiete (m-YPAS), d’agitation au reveil (EPAD) de l’enfant sont evalues a chaque etape (arrivee au bloc, transfert, acceptation du masque, inhalation sevoflurane, SSPI). L’accueil au bloc jusqu’a l’endormissement est filme, relu a posteriori avec analyse du comportement et observation de la prise en charge. Resultats Soixante enfants inclus (refus de protocole 12 %) ; âge median 6,5 ans, sexe ratio M/F 65 %. Questionnaires remplis (92 %). Premedication (midazolam) : 50 % des cas. Cinquante-deux pour cent des enfants dont 33 % premediques sont anxieux (m-YPAS > 24) des l’arrivee au bloc. Cinquante-huit pour cent sont transferes en salle d’intervention allonges, 23 % assis, 10 % dans les bras, 10 % en marchant. Quatre-vingt-trois pour cent acceptent le masque d’emblee. Le questionnaire est un point de depart dans 75 % des cas pour le choix de la technique de distraction chez les moins de 6 ans (livre, doudou, DVD…) ou du theme de la transe pour les plus grands (souvenir agreable, lieu de securite,…). La communication utilise le mirroring, le choix illusoire, le saupoudrage des mots de confort. La focalisation sur les 5 sens (VAKOG) sert tout au long du parcours, renforcee lors de la pose du masque et l’inhalation du sevoflurane. L’agitation au reveil (EPAD > 10) est decrite chez 6 enfants premediques et 1 non premedique. Discussion L’hypnose est adoptee sans reticence par les differents acteurs du bloc. L’information participe a la preparation psychologique. Le questionnaire implique l’enfant activement, favorise l’alliance therapeutique le jour de l’intervention, permet une prise en charge individualisee. L’hypnose peut representer une alternative a la premedication permettant une meilleure interaction de l’enfant avec son environnement (plus autonome et actif, moins somnolent). Pour les plus anxieux, la prescription pourrait s’orienter vers un medicament moins sedatif. Les techniques hypnotiques sont nombreuses, permissives et facilitent l’accompagnement de l’enfant par la distraction pour les plus petits, l’induction hypnotique type transe formelle pour les plus grands. Elles semblent pour la plupart suffisamment puissantes pour faire disparaitre la transe negative presente a l’entree du bloc. Le refus du masque est minoritaire mais peut conduire a une impasse. Dans ce cas, la pose d’une voie avec hypnose peut etre une alternative a l’induction par inhalation pour permettre un meilleur vecu de l’enfant. Une etude comparative pourrait approfondir ces premiers resultats.

Explosives are extensively used in underground and open-cast mining, in civil engineering and hydrotechnics, and also in geophysical (seismic) prospecting. Detonation of explosives is a source of ground vibrations which can be hazardous for surrounding buildings and structures.