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

peer reviewe

The penetration syndrome : from symptomatology to airway management !

editorial reviewedPenetration syndrome is common and dangerous. In front of any suspicion of inhalation of foreign bodies, an endoscopy is necessary and the anesthesia that accompanies this gesture is a real challenge given the complexity of the management and exposure of the airways. The anaesthesiologist is confronted with unsafe, partially obstructed airways and will have to share his workspace with surgeon colleagues while ensuring efficient ventilation and oxygenation. This is a real teamwork requiring close and permanent collaboration with the surgical team. Jet ventilation is a technique that is particularly useful and adapted to this type of operation. It offers undeniable advantages, such as continuity of the gesture, better visualization of the laryngeal structures and a clear operating field. Its use is constantly increasing. It is nevertheless a technique that requires regular training and is reserved for experienced anaesthesiologists in this field. This article covers the main principles of anaesthetic management of the penetration syndrome, highlighting the advantages of jet ventilation.Le syndrome de pénétration est fréquent et dangereux. Devant toute suspicion d’inhalation de corps étranger, la réalisation d’une endoscopie est nécessaire et l’anesthésie qui accompagne ce geste est un véritable challenge vu la complexité de la gestion et de l’exposition des voies aériennes. L’anesthésiste est confronté à des voies respiratoires non sécurisées, partiellement obstruées, et il devra partager son espace de travail avec ses collègues chirurgiens ORL, tout en garantissant une ventilation et une oxygénation efficace. Il s’agit d’un véritable travail d’équipe nécessitant une collaboration étroite et permanente avec l’équipe chirurgicale. La «jet ventilation» est une technique particulièrement utile et adaptée à ce type d’intervention. Elle offre des avantages indiscutables, tels que la continuité du geste, une meilleure visualisation des structures laryngées et un champ opératoire dégagé. Son utilisation est d’ailleurs en constante augmentation. Il s’agit, néanmoins, d’une technique qui nécessite un entraînement régulier et est réservée à des anesthésistes expérimentés dans ce domaine. Cet article reprend les grands principes de la prise en charge anesthésique du syndrome de pénétration, en mettant en lumière la «jet ventilation» et l’aide précieuse qu’elle apporte

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

peer reviewe

Preoxygenation by high-flow nasal cannula in a patient with difficult ventilation and intubation criteria.

editorial reviewedThe different protocols and algorithms for difficult intubation highlight the need for early detection of patients at risk of ventilation and difficult intubation. These protocols allow an adaptation of the management and all conclude that an emergency trans-tracheal approach is necessary in case of impossible intubation. In this context, the prevention of hypoxemia must be a major concern of any anaesthetic management. Indeed, in case of an impossible orotracheal intubation, the occurrence of hypoxemia is directly correlated to the duration of apnea. Classically, preoxygenation maneuvers can significantly increase the duration of apnea without hypoxemia. Furthermore, apneic oxygenation maneuvers may be added in case of impossible ventilation but permeable laryngeal passage. This article reports on a patient with difficult intubation and ventilation criteria who benefitted from preoxygenation associated with apneic oxygenation via high flow nasal cannula.Les différents protocoles et algorithmes d’intubation difficile mettent en avant la nécessité d’un dépistage précoce des patients à risque de ventilation et d’intubation difficiles. Ces protocoles permettent une adaptation de la prise en charge en concluant, tous, à la nécessité d’un abord trans-trachéal en urgence en cas d’intubation impossible. Dans ce contexte, la prévention des hypoxémies se doit d’être une préoccupation majeure de toute prise en charge anesthésique. En effet, en cas d’intubation orotrachéale impossible, la survenue d’une hypoxémie est directement corrélée à la durée de l’apnée. Classiquement, les manœuvres de pré-oxygénation permettent d’augmenter significativement la durée d’apnée sans hypoxémie. à celles-ci peuvent s’ajouter les manœuvres d’oxygénation apnéique en cas de ventilation impossible, mais avec une filière laryngée perméable. Cet article rapporte et discute le cas d’un patient présentant des critères d’intubation et de ventilation difficile qui a pu bénéficier d’une pré-oxygénation associée à une oxygénation apnéique par l’intermédiaire de lunettes nasales à haut débit

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

Continuous Posterior Transversus Abdominis Plane (TAP) block in the management of chronic postsurgical pain of the abdominal wall

peer reviewedWe present the case of a 30-year-old man who developed chronic postsurgical pain (CPSP) after coloproctectomy with terminal ileostomy for severe inflammatory bowel disease refractory to medical treatments. CPSP was severe with negative impact on his quality of life and resistant to high doses of tramadol combined with antidepressants and benzodiazepine. Referred to our pain clinic he was first treated with repeated transversus abdominis plane (TAP) blocks which provided short-lasting pain relief. Because of the temporary effect of the infiltrations a catheter was then indwelled in the TAP under ultrasound guidance and local anesthetic was continuously infused for 10-days. Complete analgesia was reported during the infusion and persisted after removal of the catheter. Twelve months later, pain has markedly decreased, is reported as bearable and amenable with low doses of analgesics. A continuous TAP infusion was repeated twice separated by approximately one year. Thereafter no further infiltration was necessary

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