Preoxygenation by high-flow nasal oxygen in the non-hypoxemic patient: the early stages.

peer reviewe

Anesthesiologists and their monitoring: benefits, limits and confusing factors.

peer reviewe

Comparaison of two levels of laryngeal mask inflation on the occurrence of pharyngeal pain

peer reviewedAfter the insertion of a laryngeal mask (LM), some patients experience pharyngeal pain. To the best of our knowledge, no studies have investigated a possible correlation between ML inflation pressure and postoperative pharyngeal pain. This study aimed to compare postoperative pharyngeal pain, analgesic requirement, and patients’ satisfaction between two groups of ML inflation pressure

Pleth variability index and fluid management practices : a multicenter service evaluation

Funding Information: NonePeer reviewedPublisher PD

Influence of level of training on patient's satisfaction and quality of analgesia when performing axillary blockade

peer reviewedRegional anesthesia requires adequate training. In the early phase of regional anesthesia training, it is expected that the time required for performing a block would be longer and the failure rate would be higher. To the best of our knowledge, this relationship has never been studied before. The purpose of this study was to assess whether the level of training of the anesthesiology resident performing the block impacts the patient’s satisfaction and the success rate of axillary brachial plexus blockade for outpatient hand surgery

Influence of premedication with alprazolam on the occurrence of obstructive apneas

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Pleth variability index and fluid management practices: a multicenter service evaluation.

peer reviewed[en] OBJECTIVES: The introduction of a new technology has the potential to modify clinical practices, especially if easy to use, reliable and non-invasive. This observational before/after multicenter service evaluation compares fluid management practices during surgery (with fluids volumes as primary outcome), and clinical outcomes (secondary outcomes) before and after the introduction of the Pleth Variability Index (PVI), a non-invasive fluid responsiveness monitoring. RESULTS: In five centers, 23 anesthesiologists participated during a 2-years period. Eighty-eight procedures were included. Median fluid volumes infused during surgery were similar before and after PVI introduction (respectively, 1000 ml [interquartile range 25-75 [750-1700] and 1000 ml [750-2000]). The follow-up was complete for 60 from these and outcomes were similar. No detectable change in the fluid management was observed after the introduction of a new technology in low to moderate risk surgery. These results suggest that the introduction of a new technology should be associated with an implementation strategy if it is intended to be associated with changes in clinical practice

Correlation and agreement between bispectral index and state entropy of the electroencephalogram during propofol anaesthesia

Background. Bispectral index (BIS) and state entropy (SE) monitor hypnosis. We evaluated the correlation and the agreement between those parameters during propofol anaesthesia and laryngoscopy with and without muscle relaxation. Methods. A total of 25 patients were anaesthetized with propofol. At steady state (SS: BIS 40-50), they randomly received rocuronium (R) or saline (S); 3 min thereafter, a 20 s laryngoscopy was performed. Correlation (regression analysis) and agreement (Bland-Altman analysis) were evaluated before induction (baseline), at loss of eyelash reflex (LER), at SS and during the first 3 min after laryngoscopy (L). Results. The correlation coefficient r (95% CI), the mean difference (MD) (95% CI), and the limits of agreement [lower-upper limits of 95% CI of MD (sd 1.96)] between BIS and SE were as follows. Overall recordings: 0.87 (0.83 to 0.90), 2.5 (1.2 to 3.0), and [-19.5 to 24.6]; Baseline: 0.45 (0.06 to 0.72), 7.6 (6.0 to 9.2), and [-2.7 to 17.9]; LER: 0.74 (0.47 to 0.88), 8.3 (3.5 to 13.2), and [-22.6 to 39.3]; SS, all patients: 0.41 (0.14 to 0.63), 2.0 (-0.5 to 4.6), and [-19.0 to 23.3]; SS, Group S: 0.36 (-0.07 to 0.68), 1.9 (-2.5 to 6.3), and [-25.0 to 28.8]; SS, Group R: 0.63 (0.32 to 0.82), 0.2 (-2.0 to 2.3), and [-14.0 to 14.4]; L, all patients: 0.49 (0.32 to 0.63), 0.7 (-1.6 to 3.0), and [-25.6 to 27.1]; L, Group S: 0.41 (0.13 to 0.63), 2.3 (-2.4 to 7.1), and [-36.7 to 41.3]; L, Group R: 0.72 (0.56 to 0.83), -0.6 (-2.2 to 1.0), and [-14.3 to 13.1]. The correlation was good except for SS in Group S. The MD was significantly different from 0 for overall recordings, during baseline and LER, but not for the other conditions. The agreement was poor except for baseline, and SS and L in Group R. Conclusions. BIS and SE are globally well correlated. In contrast, agreement is poor as differences of more than 20 units are frequently observed, except for awake and paralysed patients

Contribution à l’amélioration du dépistage et de la prise en charge périopératoire du Syndrome d’Apnées et d’Hypopnées Obstructives du Sommeil (SAHOS)

RésuméLes recherches développées dans le cadre de cette Thèse ont eu pour but d'améliorer la prise en charge périopératoire des patients atteints d'un SAHOS (Syndrome d'Apnées et d'Hypopnées Obstructives du Sommeil). Les travaux ont principalement consisté en une amélioration de la détection préopératoire des patients apnéiques. Nous avons développé et validé un score prédictif de SAHOS, clinique et original (le score DES-OSA). Il est basé uniquement sur des critères morphologiques. Nous l'avons par la suite comparé aux scores cliniques existant et avons démontré sa supériorité pour dépister les patients apnéiques sévères. Nous avons également étudié spécifiquement les patients apnéiques sévères et hypoxémiques. De plus, nous nous sommes intéressés à la physiopathologie, à la prémédication, au traitement et aux complications postopératoires des patients apnéiques.AbstractThis Doctoral Thesis aimed at improving perioperative care of OSA (Obstructive Sleep Apnea) patients. Mainly, we have developed and validated a clinical score to detect severe OSA. This score (the DES-OSA score) uses only morphological parameters. We compared our score to others clinical scores for their ability to predict severe OSA patients. The DES-OSA score is more efficient at detecting these patients. We also investigated patients combining severe OSA and nocturnal hypoxemia who are probably at higher risk of developing postoperative complications. Furthermore, we studied premedication, treatment and postoperative complications in OSA patients

Remplissage vasculaire peropératoire durant la chirurgie abdominale: remplir ou ne pas remplir?

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