Characteristics of mepivacaine axillary brachial plexus block performed at 2800 m of altitude

Objective

We evaluated the feasibility and pharmacodynamic profile of axillary brachial plexus nerve blocks performed in high altitude.

Study design

A prospective study was performed in healthy volunteers.

Patients and methods

Ten male volunteers received 20 ml of 1.5% mepivacaine on radial and median nerves (total 40 ml), first at altitude of 150 then at 2877 m. Onset and offset times for sensory, motor and sympathetic blocks were recorded. Blood was sampled up to 60 min after injection to measure plasma concentrations of mepivacaine.

Results

At 150 and 2877 m of altitude, onset times for blocks were similar. Duration of sensory and motor blocks was not different at low and high altitude (193 ± 35 min and 180 ± 47 min; and 237 ± 32 min and 217 ± 44 min, respectively). Plasma mepivacaine concentrations were significantly lower at 20 minutes in high altitude (p < 0.05). At higher altitude, one patient showed clinical signs of neurological toxicity, with plasma concentrations of mepivacaine ranging from 0.94 to 1.21 μg/ml.

Conclusion

At altitude of 2877 m, axillary brachial plexus block with 1.5% mepivacaine is feasible, with onset and offset times for sensory and motor effects similar to those performed at 150 m.     

Dopexamine Test in septic shock with hyperlactatemia

Objective

To evaluate the 6 hours haemodynamic effects of dopexamine (DPX) infusion in septic shock patients with persistent hyperlactatemia treated with high dose of norepinephrine (NE).

Study design

Preliminary, prospective, uncontrolled study.

Patients

Twenty-one septic shock with NE > 0.5 μg/kg/min, venous mixed oxygen saturation (ScvO₂/SvO₂) > 70%, cardiac index (CI) > 3.5 l/min/m² and lactate > 3 mmol/l.

Interventions

Infusion of DPX at 0.5 μg/kg/min. After 6 hours, patients were classified as DPX-responders or DPX-non-responders according to the presence or not of a decrease ≥ 20% in lactatemia.

Measurement

DPX-responders and DPX-non-responders were compared with MAP, CI, central venous pressure (CVP), heart rate (HR) before infusion of DPX (h0), 30 minutes (h0.5) and 6 hours later (h6); and with NE infusion rate at h0 and h6.

Results

Eleven (52%) patients were DPX-responders and 10 (48%) DPX-non-responders. At H0.5, DPX-responders increased MAP more than DPX-non-responders (+21% versus +7%, P = 0.01) with no change in CI, CVP and HR in both groups. At h0.5, an increase in MAP higher than 14%, compared to h0, could predict lactate clearance at h6 (sensitivity 91%, specificity 90%). From h0 to h6, increase in MAP (80 ± 7 versus 70 ± 8 mmHg, P < 0.01) in DPX-responders allowed reduction in NE infusion (from 1.6 ± 0.3 to 0.4 ± 0.3 μg/kg/min, P < 0.01); 28-day mortality was lower in DPX-responders than in DPX-non-responders (7 versus 90%, P < 0.01).

Conclusion

This study suggests that DPX did induce a decrease in lactatemia in 52% of septic shock, that could be predict by an increase in MAP (> 14% within 30 minutes). Controlled studies are needed to confirm those preliminary results.     

Influence of the analgesic strategy on the respiratory function after thoracic surgery for lobectomy

Objective

To compare the influence of thoracic epidural analgesia (TEA) with intravenous patient-controlled analgesia with morphine (PCA) on the early postoperative respiratory function after lobectomy.

Study design

Prospective and comparative observational study.

Patients and methods

Fourty-four patients scheduled for lobectomy (n = 22 per group) were studied on the evolution of the postoperative respiratory function assessed by the forced vital capacity (FVC) and the forced expired volume (FEV₁) during the first two postoperative days and the analysis of noctural arterial desaturation during the three first postoperative nights.

Results

The use of TEA resulted in fewer decrease both in FEV₁ (1.01 ± 0.34 versus 1.31 ± 0.51 l/s for Day 1, P = 0.03; 1.13 ± 0.37 versus 1.53 ± 0.59 l/s for Day 2, P = 0.01) and in FVC (1.23 [1.05-1.51] versus 1.57 [1.38–2.53] l for day 1, P = 0.008; 1.33 ± 0.43 versus 2.24 ± 0.87 l for day 2, P < 0.001). Moreover, the duration of arterial desaturation < 90% were longer in the PCA group during the first (8.6 [0.8–28.2] versus 1.3 [0–2.6] min, P = 0.02) and the second postoperative night (13.5 [3.5–54] versus 0.4 [0–2.6] min, P = 0.025).

Conclusion

The results of this study suggest that the use of TEA is associated with a better preservation of respiratory function assessed by spirometric data and noctural arterial desaturation recording after thoracic surgery for lobectomy.     

Daily interruption of sedation in intensive care unit patients with renal impairment: remifentanil-midazolam compared to fentanyl-midazolam

Objective

We compared extubation time following daily interruption of sedation in intensive care unit patients with renal impairment with two sedation regimes remifentanil–midazolam and fentanyl–midazolam.

Study design

Prospective, randomized double-blind trial.

Patients and methods

Patients with renal impairment needing mechanical ventilation for more than 48 hours. Two groups: remifentanil (R) and fentanyl (F), Infusion rates were titrated to achieve the desired Ramsay score. The two groups received midazolam (2.5 mg then 0.1 mg/kg/h).

Results

Nineteen patients were included. Patient's characteristics, mean sedation time and sedation quality were comparable. Extubation time was significantly shorter in R group (1480 ± 980 versus 2880 ± 1280 min, P = 0.04). Weaning time was also shorter in R group (220 ± 164 versus 720 ± 480 min). Agitation on weaning was comparable in the two groups. Group R received significantly more morphine than group F after interruption of sedation.

Conclusion

Daily interruption of sedation with remifentanil is associated with shorter weaning and extubation time in patients with renal impairment. However further studies are necessary to determine if this issue is associated with lower rate of ventilation induced complications.     

Interest of entropy monitoring during low-grade cerebral aneurysm embolisation

Objective

Evaluate the supply of entropy monitoring on anaesthetic drugs consumption, haemodynamic stability, and recovery time in patients undergoing embolisation of cerebral artery aneurysm (asymptomatic or low Hunt and Hess grades).

Methods

Two groups, G1 without entropy monitoring (Datex-Ohmeda S/5™), G2 with entropy monitoring (16 patients in each group). Each group had similar anaesthetic protocol (propofol target control infusion and continuous intravenous infusion remifentanil). For G2, the state entropy (SE) values were kept between 35 and 45. We studied anaesthetic drug consumption, arterial pressure parameters, extubation delay and feasibility. Statistical analysis used Mann and Whitney test, Fisher test. Significativity was p < 0.05.

Results

No intraoperative incident. Propofol consumption was lower in G2 (7.49 ± 2.28 mg/kg per hour versus 9.46 ± 2.50 mg/kg per hour; p < 0.05). A tendency to reduction was observed for remifentanil consumption (6.65 ± 2.04 μg/kg per hour versus 7.94 ± 2.92 μg/kg per hour; p = 0.056), and extubation delay (14.1 ± 8.6 min versus 26.5 ± 22.0 min; p = 0.056), in G2. The entropy monitoring had no repercussion on haemodynamic stability, but the arterial pressure values were significantly higher in G2 (73.60 ± 8.49 mmHg versus 67.10 ± 5.58 mmHg). Entropy captor does not disrupt embolisation procedure. Coils liberation alter temporarily RE and SE values.     

Electrical nerve localization: non-linear relationship between intensity and pulse duration to stimulate a nerve

Objective

When performing a peripheral nerve block, the current allowing local anaesthetic injection is between 0.3 and 0.5 mA. It has never been assessed if such a threshold remains the same whatever be the pulse duration. The aim of this study was to determine the minimal current required to stimulate a nerve while different pulse durations were applied, and to evaluate the importance of the placement of the cutaneous electrode.

Study design

Prospective study.

Patients and methods

One hundred and twenty posterior popliteal sciatic (S), femoral (F), or median (M) nerve blocks performed with a nerve stimulator were included. The minimal current for a clearly visible motor response of the corresponding muscle was recorded with a pulse duration set at 50, 150 and 300 μs. The same procedure was repeated with the electrode sited on the controlateral side, before injection of local anaesthetic.

Results

The mean lowest charge of current required to stimulate a nerve was 24 ± 8 nC at 50 μs. At 150 and 300 μs, it has to be increased by 175 % (42 ± 14 nC) and 280 % (67 ± 23 nC), respectively. No significant difference in the charge required was noted either among S, F, or M, or by changing the cutaneous electrode position. Adequate anaesthesia was noted in all cases.

Conclusion

The relationship between intensity and pulse duration is not linear. Moreover, a low charge of current does not seem to be appropriate with pulse duration equal or superior to 300 μs. The location of the cutaneous electrode does not seem to be important.     

Analgesia after hip fracture repair in elderly patients: the effect of a continuous femoral nerve block: a prospective and randomised study

Introduction

The usefulness of peripheral femoral nerve block for pain management after hip fracture has been established. This prospective and randomised study compared the analgesia effect of a continuous femoral nerve block (CF) versus two conventional analgesia procedures after hip fracture.

Patients and methods

Patients. (n = 62) scheduled for surgery under spinal anaesthesia were prospectively included. After surgery, analgesia (48 hours) was randomised: group FC (femoral catheter, anterior paravascular approach, initial bolus followed by continuous infusion of ropivacaine 0.2%), group P (iv 2 g propacetamol/6 hours), group M (sc morphine, 0.05 mg/kg per 4 hour). Intravenous morphine titration was performed, followed by subcutaneous (sc) morphine every 4 hours according to the VAS score. The primary end-point was the morphine requirements. Secondary end-points were VAS score, side effects, and mortality.

Results

Demographic data and surgical procedures were similar between groups. After morphine titration, the VAS pain score did not differ between groups. All patients in-group M received additional morphine. Morphine mean consumption was increased in CF group: 26 mg (5–42) versus P: 8 mg (3–12) (p = 0.0001) or M: 19 mg (8-33) (p < 0.006) while constipation was decreased in P group vs CF. Percentage of patients requiring no morphine was similar between P (n = 6 ; 28%) and CF (n = 6 ; 28%) and greater than M (n = 0 ; 0%). Hospital discharge, cardiovascular or pulmonary complications and mortality after 6 months showed no statistical difference.

Conclusion

Continuous femoral nerve block provided limited pain relief after hip fracture did not reduced side effects and induced an expensive cost.     

Timing of tracheostomy and outcome of patients requiring mechanical ventilation

Objectives

To assess the impact of tracheostomy timing on outcome of critically ill patients requiring mechanical ventilation (MV).

Study design

Retrospective clinical study in a twelve beds intensive care unit (ICU).

Patients and methods

From January 2001 to June 2005, patients under MV who received tracheostomy were divided into 2 groups: early tracheostomy group when tracheostomy was performed before or on day 7 and late tracheostomy group when it was performed thereafter. We compared prevalence of nosocomial pneumonia, length of sedation, lengths of MV, length of stay in ICU, weaning from MV and mortality rates between the 2 groups.

Results

During this period of 4 years and half, 112 patients underwent tracheostomy, 62 of whom had early tracheostomy and 50 had late tracheostomy. Early tracheostomy was associated with significant reduction of length of sedation (10 ± 3 vs 17 ± 5 days, P < 0.001), length of MV (21 ± 19 vs 29 ± 17 days, P = 0.02) and length of stay in ICU (33 ± 22 vs 42 ± 18 days, P = 0.042). There were no differences in prevalence of pneumonia (21% for early tracheostomy group vs 31% for late tracheostomy group, P = 0, 13), weaning from MV (50 vs 36%, P = 0.19), and mortality rates between the 2 groups (38 vs 54%, P = 0.15).

Conclusion

This study demonstrated that early tracheostomy (≤ 7 days), was associated with shorter length of sedation, shorter duration of MV and shorter ICU length of stay, without affecting weaning from MV, prevalence of nosocomial pneumonia or survival.     

A randomised comparison of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour

Background

The μ-opioid agonist remifentanil has a rapid onset and offset and a short half-life making it an attractive option for intravenous patient-controlled labour analgesia. We aimed to compare the efficacy of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour.

Methods

Parturients were randomly assigned to receive intravenous patient-controlled analgesia with remifentanil (n = 10) or epidural analgesia (n = 10). Pain and satisfaction scores were assessed every hour by means of visual analogue scale, together with an observer sedation score. Side effects and neonatal outcome were noted.

Results

After one hour, visual analogue pain scores had decreased significantly in both groups (remifentanil: −3.8 ± 2.6, P < 0.01; epidural −6.7 ± 2.0, P < 0.01). The decrease in pain scores in the epidural group was significantly greater than the remifentanil group at all time intervals. The decrease in pain scores was sustained in the epidural group whereas in the remifentanil group pain scores increased over time. Oxygen saturation was significantly lower in the remifentanil group after one hour of treatment compared to the epidural group (95.2 ± 2.4% vs. 99.0 ± 1.1%, P < 0.01). Patient satisfaction scores during and after delivery were similar in both groups. No differences were found in neonatal outcome.

Conclusions

In the 20 patients recruited to this study, pain relief in labour with epidural ropivacaine/sufentanil was more effective than with intravenous remifentanil patient-controlled analgesia.     

Epidural analgesia in obstetrics: anaesthesiologists practice in Auvergne

Objective

To evaluate the practice of labour epidural analgesia in Auvergne.

Study design

Cross-sectional study by a mail survey.

Methods

An anonymous postal questionnaire was sent to all anaesthetists working in public or private hospital having a maternity unit.

Results

The response rate was 82%. Eighty-eight percent of the respondents practise epidural analgesia in obstetrics (EAO) for labour pain relief, but 49% of them did so only on call. Fifty percent of the respondents ask for platelets and fibrinogen beforehand and 41% accept a one month validity for these tests. One third uses a full aseptic method (surgical hand washing, cap and face mask, sterile gloves and gown, double disinfection of patient's back). Nearly all respondents practice skin anaesthesia, 67% use saline solution for identification of the epidural space, 58% insert the catheter 4 cm into the epidural space and 25% use a lidocaine–epinephrine epidural test dose. The analgesic solution is mostly based on ropivacaine (83%) associated with sufentanil (96%); patient controlled epidural analgesia rate is used by 58% of anaesthetists whereas 37% of them never use epidural clonidine and 52% never practice combined spinal epidural (CSE) analgesia during labour.

Conclusion

EAO is mainly practiced on call. There are too many laboratory tests ordered before EAO. Technique used to insert epidural catheter is partly uniform and ropivacaine with sufentanil is the analgesic solution most often used. CSE for labour analgesia is still not often used.     

Effects of music therapy in intensive care unit without sedation in weaning patients versus non-ventilated patients

Objectives

Music has been found to be an effective nonpharmacologic adjunct for managing anxiety and promoting relaxation in limited trials of critically ill patients. However, its effects have not been compared in intubated patients during weaning from mechanical ventilation with non-intubated patients spontaneously breathing.

Study design

A cross-over randomized experimental design.

Patients and Methods

Thirty patients were studied (intubated group n?=?15, non-intubated group n?=?15). Patients were randomized to receive either 20 minutes of uninterrupted rest or then 20 minutes of music therapy or the music therapy first and then the uninterrupted rest period. Patients selected a relaxing music of their choice from a selection including different types of music. Heart rate (HR), systolic blood pressure (SAP), respiratory rate (RR) and bispectral index (BIS score) were recorded each 5-min intervals throughout both periods (rest and music). Agitation/sedation state and pain were evaluated by the Richmond-Agitation-Sedation-Scale (RASS) and the Numerical-Rating-Scale (NRS) respectively, before and after each studied periods. Music have not been performed in five patients (5/35?=?14%).

Results

Music significantly decreased HR (88 ± 15 vs 82 ± 15, P < 0.05), SAP (137 ± 17 vs 128 ± 14, P < 0.05), RR (25 ± 3 vs 22 ± 4, P < 0.05), BIS (94 ± 5 vs 81 ± 10, P < 0.01), RASS (+0.1 ± 0.7 vs –0.7 ± 0.9, P < 0.05) and NRS (4.4 ± 1.7 vs 1.9 ± 1.3, P < 0.01) in both intubated and non-intubated groups whereas no significant change was observed during the rest period. The variations level studied parameters induced by music were comparable for the two groups.

Conclusion

A single music therapy session was found to be effective for decreasing anxiety and promoting relaxation, as indicated by decreases in heart rate, blood pressure, BIS and respiratory rate over the intervention period in intubated patients during weaning phase.     

Minimal effective dose of dysport and botox in a rat model of neurogenic detrusor overactivity

Background

Two botulinum toxins A have been evaluated for the treatment of refractory neurogenic detrusor overactivity (NDO) in humans: Dysport (abobotulinumtoxinA) and Botox (onabotulinumtoxinA). However, these two distinct commercialized products have different potency units and are not interchangeable.

Objective

Assessment of the dose response and determination of minimal effective dose (MED) for Dysport and Botox in spinal cord–injured (SCI) rats with NDO.

Design, setting, and participants

Female, adult, Sprague-Dawley rats (n = 98) underwent T8-T9 spinal cord transection. Nineteen days after spinal cord injury, rats received intradetrusor injections (25 μl injected, eight sites) of vehicle (V); Dysport 2, 5, 7.5, 10, and 12.5 U; and Botox 0.8, 2, 5, 7.5, and 10 U. Two days after injection, continuous cystometry was performed in conscious rats.

Measurements

Voiding contractions (VC) were assessed by duration of VC, intercontraction interval, voided volume, maximal pressure, pressure threshold change, and intravesical baseline pressure (BP), while nonvoiding contractions (NVC) were evaluated by amplitude, frequency, and volume threshold to elicit NVC. MEDs for Dysport and Botox were determined by analysis of variance step-down trend test.

Results and limitations

MEDs for Dysport and Botox were 10 U and 7.5 U, respectively. Regarding VC, only BP significantly decreased after 10 U Dysport and 7.5 U Botox compared to V (from 3.7 ± 0.6 to 1.5 ± 0.1 and 1.4 ± 0.3 mm Hg, respectively; p < 0.01 and p < 0.001, respectively). Dysport (10 U) and Botox (7.5 U) significantly inhibited NVC by decreasing their amplitude (from 7.4 ± 1.1 to 5.8 ± 0.5 and 5.4 ± 0.6 mm Hg, respectively; p < 0.05); frequency (from 2.2 ± 0.4 to 1.5 ± 0.2 and 1.3 ± 0.3 NVC per minute, respectively; p < 0.01); and increasing volume threshold to elicit NVC (from 29.8 ± 3.7 to 47.6 ± 6.9 and 47.7 ± 6.3%, respectively; p < 0.05 and p < 0.001, respectively).

Conclusions

This is the first preclinical dose-ranging study with Dysport and Botox under standardized conditions showing similar inhibiting effects on NDO, albeit at different MEDs. It highlights the importance of distinguishing each preparation for predicted outcomes and doses to be used. Further studies in patients with NDO are warranted to confirm these experimental results.     

Endoluminal isoproterenol irrigation decreases renal pelvic pressure during flexible ureterorenoscopy: a clinical randomized, controlled study

Objectives

Irrigation during ureterorenoscopic procedures causes increased pelvic pressure (PP), which may lead to intrarenal backflow with potential harmful consequences. This study aims to investigate PP response to intraluminal administration of isoproterenol (β-agonist; ISO) during flexible ureterorenoscopy.

Methods

Twelve patients admitted for retrograde intrarenal stone surgery (RIRS) were included. Patients were randomized to (1) irrigation with saline (n = 6) or (2) irrigation with ISO 0.1 μg/mL (n = 6). Irrigation rate was standardized to 8 mL/min. A ureteral catheter was retrogradely placed in the renal pelvis for PP measurements. PP, heart rate (HR), and mean arterial pressure (MAP) were also measured.

Results

Baseline PP was 12.1 ± 4 mm Hg in the saline group and 10.3 ± 4 mm Hg in the ISO group (p = 0.44).In the saline group, PP increased to a mean 33 ± 12 mm Hg during ureterorenoscopy. In the ISO group, PP was a mean 19 ± 3 mm Hg (p = 0.029).During endoscopy, PP peaks as high as 328 mm Hg were noted during saline irrigation. The number of pressure peaks above 50 mm Hg was minimized dramatically during ISO irrigation (p = 0.035). No systemic side effects to ISO irrigation were observed.

Conclusion

For the first time, a randomized, controlled human study demonstrates that pharmacologic modulation of the ureter is possible during upper urinary tract endoscopy. The ability to relax ureteral tone during endoscopy may have clinical advantages.     

Laparoscopic adrenalectomy using needlescopic instruments for adrenal tumors less than 5cm in 112 cases

Objective

To examine the safety and efficacy of laparoscopic adrenalectomy with needlescopic instruments for most adrenal tumors less than 5 cm.

Methods

Transperitoneal laparoscopic adrenalectomy with needlescopic instruments for 112 patients with presumptively benign adrenal tumors < 5 cm were enrolled from July 2000 to February 2005. Operative time, blood loss, conversion and complication rates, and postoperative data were analyzed by appropriate statistical methods.

Results

All 112 operations were completed without any mortality or reoperation. Mean operative time was 151 min and mean blood loss was 30 ml. Only one patient required a blood transfusion and application of a hand-assisted device. Conversion to conventional laparoscopic instruments was necessary in another five patients (4.5%). The operative time of the latter 100 cases (147 ± 5.1 min, mean ± standard error of mean) was significantly shorter than that of the initial 12 cases (183 ± 8.8 min, p = 0.001). Larger tumors, previous abdominal surgery, and pheochromocytoma group were independent risk factors of a longer operative time. Except for one leiomyosarcoma, all other tumors were benign adrenal pathologies (57 aldosterone-producing adenomas, 23 Cushing's adenomas, 12 pheochromocytomas, and 20 incidentalomas).

Conclusion

The safety and effectiveness of laparoscopic adrenalectomy employing needlescopic instruments for most adrenal tumors less than 5 cm was feasible with acceptable operative time. Pheochromocytomas can also be managed with a longer operative time. Patients with previous upper midline or ipsilateral upper quadrant open surgery might not be suitable candidates for such a technique.     

Vardenafil decreases bladder afferent nerve activity in unanesthetized, decerebrate, spinal cord-injured rats

Background

Phosphodiesterase type 5 inhibitors (PDE5-Is) improve storage symptoms in benign prostatic hyperplasia patients, despite a lack of effect on peak urinary flow rate. Moreover, vardenafil improves urodynamic parameters in spinal cord-injured (SCI) patients with neurogenic detrusor overactivity (NDO). SCI rats also display NDO characterized by nonvoiding contractions (NVCs) during bladder filling, resulting in an increased bladder afferent nerve firing (BANF).

Objective

We postulated that vardenafil could improve urodynamic parameters by reducing BANF. The effect of vardenafil has been investigated on intravesical pressure by cystometry experiments while recording BANF in response to bladder filling.

Design, setting, and participants

Complete T7–T8 spinalization was performed in 15 female adult Sprague-Dawley rats (250–275 g).

Measurements

At 21–29 d postspinalization, fine filaments were dissected from the L6 dorsal roots and placed across a bipolar electrode. Bladder afferent nerve fibers were identified by electrical stimulation of the pelvic nerve and bladder distension. SCI rats were decerebrated before cystometry experiments. Bladders were filled to determine the maximal bladder filling volume (BFV) for each rat. Then, after bladder stabilization at 75% of maximal BFV, saline (n = 7) or vardenafil 1 mg/kg (n = 8) was delivered intravenously. NVCs and BANF were recorded for 45 min.

Results and limitations

In all SCI rats, BANF was already present and regular at resting conditions (26.2 ± 4.1 spikes per second). During bladder filling, intravesical pressure (IVP) slowly increased with transient NVCs superimposed. Concomitantly, BANF progressively increased up to 2.4-fold at maximal BFV (2.08 ± 0.24 ml). After stabilization at submaximal BFV, BANF was increased by 186 ± 37%. Vardenafil injection induced an immediate decrease in NVCs compared to saline (p < 0.001) and BANF (52% decrease vs 28% in saline after 45 min; p < 0.001).

Conclusions

Systemic vardenafil reduced both NVCs and BANF in unanesthetized, decerebrate, SCI rats. These findings provide new insights into the mechanism of action by which PDE5-Is improve storage symptoms in SCI patients.     

Effect of whole body vibration on leg muscle strength after healed burns: A randomized controlled trial

Objective

To investigate the effects of eight weeks whole body vibration training program on leg muscle strength (force-producing capacity) in adults after healed burns.

Design

Randomized controlled trial.

Setting

Faculty of Physical Therapy, Cairo University.

Subjects

Thirty-one burned patients participated in the study and were randomized into whole body vibration group and control group. Non-burned healthy adults were assessed similarly to burned subjects and served as matched healthy controls.

Methods

The whole body vibration group performed an eight weeks vibration program three times a week on a vibration platform; the control group received home based physical therapy program without vibration training.

Main measures

Assessment of knee extensors and ankle planter flexor strength by isokinetic dynamometer at 150°/s were performed at the beginning of the study and at the end of the training period for both groups.

Results

Subjects with burns more than 36% TBSA produced significantly less torque in the quadriceps and calf muscle than non-burned healthy subjects. Patients in whole body vibration group showed a significant improvement in knee extensor and ankle planter flexor strength as compared with those in the control group. Knee extensor strength and percent improvement was 233.40 ± 5.74 (64.93 ± 3.03 change score) and 38.54% for the vibration group and 190.07 ± 3.99 (21.66 ± 4.41 change score) and 12.86% for the control group, ankle plantar flexor strength and percent improvement was 156.27 ± 5.95 (54.53 ± 6.16 change score) and 53.70% for the vibration group and 116.13 ± 3.24 (14.66 ± 2.71 change score) and 14.52% for the control group.

Conclusions

Participation in whole body vibration program resulted in a greater improvement in quadriceps and calf muscle strength in adults with healed thermal burn compared to base line values; a WBV program is an effective for strength gain in rehabilitation of burned patients.     

Analgésie péridurale pour le traitement chirurgical des carcinoses péritonéales : une pratique à risque ?

Background

To study the risks of haemodynamic instability, and the possible occurrence of spinal haematoma, meningitis and epidural abscess when epidural analgesia is performed for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods

We retrospectively analyzed the data of 35 patients treated by HIPEC with oxaliplatin or cisplatin. An epidural catheter was inserted before induction of general anaesthesia. Postoperatively, a continuous epidural infusion of ropivacain, then a patient-controlled epidural analgesia were started.

Results

The epidural catheter was used peroperatively before HIPEC in 12 subjects (34%), and after HIPEC in 23 subjects (66%). The median dose of ropivacain given peroperatively in the epidural catheter was 40 mg (30–75). Norepinephrin was used in two subjects (6%) peroperatively (median infusion rate 0.325 μg/kg per minute [0.32–0.33]), and in four subjects (11%) in the postoperative 24 hours. No spinal haematoma, meningitis or epidural abscess were noted. Five subjects (14%) had a thrombopenia or a prothrombin time less than 60% before catheter removal. Two subjects (6%) had a leukopenia before catheter removal. No thrombopenia or blood coagulation disorders were recorded the day of catheter removal.

Conclusion

In this series of 35 patients, the use of epidural analgesia for HIPEC does not seem to be associated with a worse risk of haemodynamic instability, spinal haematoma, meningitis or epidural abscess. HIPEC with platinum salt is not incompatible with the safety of epidural analgesia, with an optimized fluid management peroperatively and the following of perimedullary anesthesia practice guidelines.     

Cerebral salt wasting syndrome: experimental study in rats

Introduction

The cerebral salt wasting syndrome (CSWS) is characterized by hyponatraemia secondary to excessive natriuesis with osmotic duiresis. This syndrome, frequently, occurs after subarachnoid haemorrhage (SAH), but may occur after any acute cerebral aggression.

Objectives

The aim of the study was to assess the frequency of the CSWS in animal models with, SAH, cerebral ischemia (CI), and cranial trauma (CT), and its correlation with the secretion of brain natriuretic peptide (BNP).

Method

Four groups of rats were selected: group SAH (n = 7) consisted of SAH induced by perforation of the carotid artery in its intracerebral part; group CI (n = 7) consisted of CI induced by ligature of the carotid artery; group CT (n = 7) consisted of induced CT; and a control group Sham (n = 7). Weight, serum sodium, BNP, and urinary sodium, were measured at baseline and 24 hours after.

Results

Rats with SAH had significant natriuresis and diuresis with negative sodium balance (–95.9 ± 447.4 μmol) with a significant difference (P < 0.05) compared to the rats of the CI and the Sham groups. There was no difference in the 24 hours level of BNP between the four different groups.

Conclusion

We conclude that SAH, in animal models, induced high diuresis with negative sodium balance in the first 24 hours. These findings were absents in the others groups. This was independent of the BNP secretion and may correspond to the early occurrence of a CSWS.