Anesthésie-réanimation de la chirurgie de l'épilepsie de l'enfant de moins de cinq ans (étude rétrospective sur 70 dossiers)

25% des enfants épileptiques présentent une épilepsie résistante au traitement médical. La chirurgie de l'épilepsie s'adresse donc aux épilepsies pharmacorésistantes. Les traitements chirugicaux les plus fréquemment proposés, chez l'enfant, sont les résections corticales focales et les hémisphérotomies. Cette étude identifie les éléments pertinents pour la prise en charge médicale ánesthésique pré- per- et postopératoire au cours de la chirurgie de l'épilepsie de l'enfant de moins de 5 ans. Les dossiers de 70 enfants de moins de 5 ans ayant bénéficié d'une chirurgie de l'épilepsie dans notre établissement ont été analysés de manière rétrospective. 103 interventions chirurgicales ont été recensées : 26 hémisphérotomies, 36 résections focales, 36 poses d'électrodes intracrâniennes et 5 poses de stimulateurs vagaux. Les enfants [moy. (ET), 31 (18) mois, 14 (5) kg] présentaient un déficit moteur et un retard psychomoteur préopératoires dans respectivement 57% et 79% des cas. Leur traitement médicamenteux habituel comportait en moyenne 3 antiépileptiques et 66% des enfants présentaient entre 2 et 20 crises par jour. En moyenne, 3 anesthésies générales étaient pratiquées en rapport avec la maladie épileptique. 92% des enfants étaient extubés en salle d'opération. Les complications principales étaient : anémie nécessitant une transfusion (15%), crise convulsive (25%) et état de mal convulsif, vomissement postopératoire (61%), fièvre postopératoire (40%), diabète insipide (8% des hémisphérotomies). Aucun décès n'est survenu.PARIS7-Villemin (751102101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Etude cas-témoin sur la mortalité des hémorragies intra abdominales sous anticoagulants et antiagrégants en réanimation

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Pharmacologie des curares sur différents groupes musculaires chez l'homme anesthésié

CHATENAY M.-PARIS 11-BU Pharma. (920192101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Evaluation des pratiques de la curarisation en chirurgie viscérale au CHU de Caen comparées à celles de l'HUG de Genève

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

'Chronomics' in ICU: circadian aspects of immune response and therapeutic perspectives in the critically ill

International audienceComplex interrelations exist between the master central clock, located in the suprachiasmatic nuclei of the hypothalamus, and several peripheral clocks, such as those found in different immune cells of the body. Moreover, external factors that are called 'timekeepers', such as light/dark and sleep/wake cycles, interact with internal clocks by synchronizing their different oscillation phases. Chronobiology is the science that studies biologic rhythms exhibiting recurrent cyclic behavior. Circadian rhythms have a duration of approximately 24 h and can be assessed through chronobiologic analysis of time series of melatonin, cortisol, and temperature. Critically ill patients experience severe circadian deregulation due to not only the lack of effective timekeepers in the intensive care unit (ICU) environment but also systemic inflammation. The latter has been found in both animal and human studies to disrupt circadian rhythmicity of all measured biomarkers. The aims of this article are to describe circadian physiology during acute stress and to discuss the effects of ICU milieu upon circadian rhythms, in order to emphasize the value of considering circadian-immune disturbance as a potential tool for personalized treatment. Thus, besides neoplastic processes, critical illness could be linked to what has been referred as 'chronomics': timing and rhythm. In addition, different therapeutic perspectives will be presented in association with environmental approaches that could restore circadian connection and hasten physical recovery

'Chronomics' in ICU: circadian aspects of immune response and therapeutic perspectives in the critically ill.

Complex interrelations exist between the master central clock, located in the suprachiasmatic nuclei of the hypothalamus, and several peripheral clocks, such as those found in different immune cells of the body. Moreover, external factors that are called 'timekeepers', such as light/dark and sleep/wake cycles, interact with internal clocks by synchronizing their different oscillation phases. Chronobiology is the science that studies biologic rhythms exhibiting recurrent cyclic behavior. Circadian rhythms have a duration of approximately 24 h and can be assessed through chronobiologic analysis of time series of melatonin, cortisol, and temperature. Critically ill patients experience severe circadian deregulation due to not only the lack of effective timekeepers in the intensive care unit (ICU) environment but also systemic inflammation. The latter has been found in both animal and human studies to disrupt circadian rhythmicity of all measured biomarkers. The aims of this article are to describe circadian physiology during acute stress and to discuss the effects of ICU milieu upon circadian rhythms, in order to emphasize the value of considering circadian-immune disturbance as a potential tool for personalized treatment. Thus, besides neoplastic processes, critical illness could be linked to what has been referred as 'chronomics': timing and rhythm. In addition, different therapeutic perspectives will be presented in association with environmental approaches that could restore circadian connection and hasten physical recovery

Residual Paralysis after Emergence from Anesthesia

International audienc