Dysfonctions cognitives postopératoires : stratégie de prévention, de dépistage et de prise en charge

The femoral neck fracture is a major cause of morbidity and mortality in the elderly. The etiology of cognitive impairment observed in this population of aged patient seems to be multifactorial. In the strategy of prevention, elderly patient must have the clearer information dealing with the postoperative cognitive dysfunction. This would reduce the incidence of POCD and some cognitive complaints, which often reflect the anxiety of the elderly patient facing the possibility of cognitive impairment. During the anaesthesia consultation, it seems important to assess the cognitive function of this elderly patient (like using neuropsycholgical scale as the MMSE) and to identify associated risk factors of cognitive dysfunction. The management of cognitive disorders should be multidisciplinary, the anesthesiologist being the main referent, in collaboration with the geriatrician and the surgeon. In the clinical setting of femoral neck fracture in the elderly, this multimodal management (pain, nutrition, functional rehabilitation to make these patients autonomous as quickly as possible), seems to improve the functional prognosis and to have the observed POCD decreased.     

Anesthésie locorégionale périphérique sous échographie : efficacité de stratégie de décontamination de la sonde

Objectives

The objective of this study was to determine if the ultrasound probe can act as a vector for cross-infection and to compare two cleaning methods for ultrasound probes in order to limit or control the transmission risk.

Study design

Prospective study.

Patients and methods

The first part of the study (P1) was conducted to evaluate the possibility of the ultrasound probe to serve as a source of cross-contamination. Thirty blocks were placed under ultrasound guidance in elective outpatients. After each procedure (Proc), the ultrasound probe was decontaminated/cleaned using either an antiseptic solution spray (AS: n = 15) or just wiped with two dry paper sheets (DP: n = 15), in a randomly assigned order. Bacteriological samples were collected before and after each decontamination/cleaning methods and inoculated on a chocolate agar plates. The second part of the study (P2) was conducted to compare the effectiveness of two cleaning methods for ultrasound probes. The ultrasound probes were exposed to a large inoculum of three bacteria (Inoc). They were then cleaned/decontaminated using either DP (n = 10) or AS (n = 10), in a randomly assigned order. Bacteriological samples were collected before and after each cleaning/decontamination methods and inoculated on a chocolate agar plates.

Results

During P1, after Pro, all probes were found to be sterile before and after both AS and DP. During P2, after Inoc, all probes were found infected (CFU > 150) but were considered sterile (CFU < 10) after both DP and AS.

Conclusion

The results of this study suggest that the risk of cross-infection during ultrasound guidance in locoregional anaesthesia is really low. Our data suggest that wiping ultrasound probe with two dry paper sheets is an adequate cleaning method to prevent cross-contamination risk.     

Épiglottite aiguë obstructive en réanimation : stratégie pour une intubation à haut risque

Acute epiglottitis is an infection of supraglottic structures, with a high risk of life-threatening respiratory obstruction. We report a case of a 52-year-old patient who presented with a prehospital hypoxic respiratory arrest caused by obstructive oedema with a successful resuscitation. Laryngoscopy after a sudden unplanned extubation permits diagnosis of acute obstructive epiglottitis. The growing threat of laryngeal dyspnea prompts emergency tracheal airway protection, by means of the combined preparation of transtracheal oxygenation access and the use of fiber-optic laryngoscopy. This case report emphasises the airway management strategy successfully used in this patient.     

Dissection de l''aorte ascendante au cours de la grossesse: césarienne et réparation chirurgicale de l''aorte simultanées

The authors report a case of an ascending aorta dissection, occurring at 35 weeks of pregnancy. Emergency Caesarean section, and surgical aortique dissection repair under cardio-pulrnonary bypass, were undertaken. The aetiology, diagnosis and anaesthetic management are discussed.     

Évaluation des régulateurs de débit passifs utilisés pour la perfusion intraveineuse

Objective

The aim of our study is to evaluate seven flow rate regulators (FRR) to assess the reliability of these devices compared to standard perfuser with roller clamp.

Study design

Each FRR was tested with 5% dextrose and 0.9% sodium chloride combined with three different theoretical flow rates (30, 80 and 250 ml/h). Accuracy was compared with the theoretical value. Repeatability of flow rate was assessed thanks to variance break-up.

Results

Each FFR exhibits at least one combination “flow rate–solution” significantly different of the theoretical flow rate. Exadrop^® was the least successful of the FFR according to the accuracy. This FFR had for each combination a flow rate different of the theoretical (mean error: −24.0 ml/h). Tutodrop^® was the most successful of the FFR according to the accuracy with five combinations comparable to the theoretical value (mean error: −1.2 ml/h). The standard perfuser with roller clamp, used without FRR, reported two combinations comparable to the theoretical value and showed lowest rates for repeatability.

Conclusion

Our study exhibits the poor performances of the FRR studied: according to expected flow regulation, the reported results demonstrate the lack of accuracy. Their only one value added compare to the roller clamp is to improve the repeatability of the flow rate.