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Sepsis-associated encephalopathy (SAE) remains a challenge for intensivists that is exacerbated by lack of an effective diagnostic tool and an unambiguous definition to properly identify SAE patients. Risk factors for SAE development include age, genetic factors as well as pre-existing neuropsychiatric conditions. Sepsis due to certain infection sites/origins might be more prone to encephalopathy development than other cases. Currently, ICU management of SAE is mainly based on non-pharmacological support. Pre-clinical studies have described the role of the alarmin high mobility group box 1 (HMGB1) in the complex pathogenesis of SAE. Although there are limited data available about the role of HMGB1 in neuroinflammation following sepsis, it has been implicated in other neurologic disorders, where its translocation from the nucleus to the extracellular space has been found to trigger neuroinflammatory reactions and disrupt the blood–brain barrier. Negating the inflammatory cascade, by targeting HMGB1, may be a strategy to complement non-pharmacologic interventions directed against encephalopathy. This review describes inflammatory cascades implicating HMGB1 and strategies for its use to mitigate sepsis-induced encephalopathy., SCOPUS: re.j, info:eu-repo/semantics/published

Les troubles neurocognitifs représentent une complication post-opératoire majeure dontl’étiologie est restée longtemps spéculative. Ce n’est que récemment qu'une cascadeinflammatoire, menant à l’activation des microglies, a été identifiée et proposée. Dans cetravail, nous avons voulu éclaircir les mécanismes responsables des troubles cognitifs postopératoires à travers deux axes, l’un clinique, l’autre pré-clinique sur des modèles murins.Dans l’étude clinique, l’influence des habitudes de vie sur la prévalence des troublesneurocognitifs péri-opératoires ainsi que sur les marqueurs inflammatoires périphériques (IL6; HMGB1) classiquement associés aux troubles neurocognitifs péri-opératoires a été évaluée.Cette étude suggère que la sédentarité pré-opératoire n’est pas un facteur de risque alors que lemultilinguisme et l’absence de tendance dépressive seraient des facteurs protecteurs. De plus,cette étude révèle que le taux d’IL-6 sérique, contrairement à celui de l’HMGB1, varie enfonction du type de chirurgie et de l’âge du patient. Cette étude a aussi permis de dégager unerelation préliminaire basée sur les taux d’IL-6 et d’HMGB1 sanguins du premier jouropératoire et prédictive de l’incidence d’un déclin cognitif six semaines après l’interventionchirurgicale. Dans l’étude pré-clinique sur des modèles murins, il a été pris en considérationque plusieurs canaux K+(KCa3.1; Kv1.3; Kvir) identifiés à la surface cellulaire étaientessentiels à l’activation microgliale et l’acquisition d’un phénotype neuroinflammatoire.Atténuer l'activation microgliale via l’inhibition de ces canaux s’avère une approche rationnellepour prévenir le développement de la neuro-inflammation et du déclin cognitif aprèsintervention chirurgicale (ici résolution d’une fracture tibiale expérimentale). Nous avons ainsimontré que l’inhibition pharmacologique et génétique du canal Kv1.3 réduit laneuroinflammation et le déclin cognitif post-opératoires dans un modèle murin de fracture detibia. D’autre part, Doctorat en Sciences, info:eu-repo/semantics/nonPublished

INTRODUCTION: The demographics of aging of the surgical population has increased the risk for perioperative neurocognitive disorders in which trauma-induced neuroinflammation plays a pivotal role. SOURCES OF DATA: After determining the scope of the review, the authors used PubMed with select phrases encompassing the words in the scope. Both preclinical and clinical reports were considered. AREAS OF AGREEMENT: Neuroinflammation is a sine qua non for development of perioperative neurocognitive disorders. AREAS OF CONTROVERSY: What is the best method for ameliorating trauma-induced neuroinflammation while preserving inflammation-based wound healing. GROWING POINTS: This review considers how to prepare for and manage the vulnerable elderly surgical patient through the entire spectrum, from preoperative assessment to postoperative period. AREAS TIMELY FOR DEVELOPING RESEARCH: What are the most effective and safest interventions for preventing and/or reversing Perioperative Neurocognitive Disorders., SCOPUS: ar.j, DecretOANoAutActif, info:eu-repo/semantics/published

BACKGROUND: Currently, there is no gold standard for monitored anaesthesia care during oocyte retrieval. OBJECTIVE: In our institution, the standard is a conscious sedation technique using a target-controlled infusion (TCI) of remifentanil, titrated to maintain a visual analogue pain score less than 30 mm. This protocol is well accepted by patients but is associated with frequent episodes of respiratory depression. The main objective of this study was to evaluate whether the addition of a continuous intravenous infusion of ketamine could reduce these episodes. DESIGN: Controlled, randomised, prospective, double-blinded study. SETTING: The current study was conducted in a tertiary-level hospital in Brussels (Belgium) from December 2013 to June 2014. PATIENTS: Of the 132 women undergoing oocyte retrieval included, 121 completed the study. INTERVENTION: After randomisation, patients received either a ketamine infusion (40 μg kg min over 5 min followed by 2.5 μg kg min) or a 0.9% saline infusion in addition to the variable remifentanil TCI. MAIN OUTCOME MEASURES: The primary outcome was the number of respiratory depression episodes. Effect site target remifentanil concentrations, side effects, pain score, patient satisfaction and incidence of pregnancy were also recorded. RESULTS: No significant difference in the incidence of respiratory events was noted (pulse oximetry oxygen saturation < 95% was 49% in the ketamine group and 63% in the control group; P = 0.121). No patient required ventilatory support. In the ketamine group, visual analogue pain score and remifentanil concentrations were significantly reduced, but the latter remained above 2 ng ml. Postoperative nausea was less frequent in the ketamine group, 4 versus 15% (P = 0.038). The addition of ketamine did not influence length of stay nor patient satisfaction. CONCLUSION: The addition of low plasma levels of ketamine to a TCI remifentanil conscious sedation technique did not decrease the incidence nor the sever, SCOPUS: ar.j, info:eu-repo/semantics/published

Background: Cardiac output (CO) is a physiological variable that should be monitored during cardiac surgery. The purpose of this study was to assess the trending ability of two CO monitors, esCCO (Nihon Kohden™, Tokyo, Japan) and Volume View (VV) (Edwards Lifesciences, Irvine, USA). Methods: A total of 19 patients were included in the study. Before cardiopulmonary bypass (CPB), CO was measured simultaneously using both esCCO and VV devices before and after three CO-modifying manoeuvres (passive leg raise [PLR], the end expiratory occlusion test [EEOT] and positive end expiratory pressure [PEEP] at 10 cm H2O). Five CO values for esCCO and three for VV were averaged and compared during a one-minute period of time before and after each manoeuvre. Results: A total of 114 paired readings were collected. Median CO values were 4.3 L min-1 (IQR: 3.8; 5.2) and 3.8 L min-1 (IQR: 3.5; 4.5) for esCCO and VV, respectively. The precision error was 1.4% (95% CI:1.0-1.7) for esCCO and 2.2% (95% CI: 1.8-2.7) for VV. The bias between esCCO and VV values was normally distributed (P = 0.0596). Between esCCO and VV, the mean bias was +0.6 L min-1 with a Limit of Agreement (LOA) of -1.8 L min-1 and +3.0 L min-1. The concordance rate was 43% (95% CI: 29-58) between esCCO and VV. Conclusion: Both single and trended measurements of CO using esCCO and VV were not in agreement. This large discrepancy leads one to the conclusion that any outcome study conducted with one of these devices cannot be applied to the other., SCOPUS: ar.j, info:eu-repo/semantics/published

Background: We investigated the effect of a peri-operative opioid-free approach on postoperative patient comfort in patients undergoing breast cancer surgery. Subjects and Methods: From September 2014 to July 2015, 66 female patients of the Belgian Oncology Institut Jules Bordet were recruited. They were randomized into two groups: the first group received anesthesia with opioids for their breast cancer surgery, and the second group received opioid-free anesthesia. Patient comfort was evaluated 24 hours postoperatively through the QoR-40 score, with a difference of 15 points considered as being clinically relevant. Postoperative analgesia was provided through a piritramide patient-controlled analgesia device, during the first 24 hours. The hypothesis of this study was that opioid-free anesthesia would improve quality of recovery after anesthesia. Results: A statistically significant difference in postoperative QoR-40 score was observed between groups [Mean (SD) QoR-40 of 182.1/200 (13.9) in the opioid-free group, and 175.6/200 (14.80) in the opioid group; P = 0.04]. The clinical relevance of this finding is questionable, insofar as the difference of 15 points was not met. A statistically significant difference in postoperative piritramide usage was observed (8.1 (6.6) in the opioid-free group, and 13.1 (9.4) in the opioid group; P = 0.03). Conclusions: This randomized controlled trial shows, for the first time, equal comfort during the immediate postoperative period in patients having received opioid-free and conventional anesthesia for their breast cancer surgery. Opioid-free anesthesia in this indication appears safe, and may be associated with slightly reduced pain during the first 24 postoperative hours., SCOPUS: re.j, info:eu-repo/semantics/published