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1.
M. Trifa S. Ben KhalifaF. Gargouri N. KaouechM. Friaa 《Annales fran?aises d'anesthèsie et de rèanimation》2010
Objective
To evaluate the effectiveness of hydroxyzine as a premedication agent for the acceptance of facial mask during induction of general anaesthesia in children.Study design
Prospective randomized single-blind study including ASA 1 and 2 children, aged between 1 and 9 years and undergoing outpatient surgery.Patients and methods
Patients were randomly allocated to receive orally either 1 mg/kg hydroxyzine (G1) or water 0.1 ml/kg (G2) one hour before induction of standardized inhalational anaesthesia. Tolerance of facial mask was assessed with a 3-points scale (good, moderate or poor). Chi-square and Student's t-test were used in statistical analysis; p values less than 0.05 were considered statistically significant.Results
One hundred patients were included (G1 = 49, G2 = 51). Demographic data were similar in both groups. Acceptance of facial mask was significantly better in G1 than in G2 (p = 0,002).Conclusion
Hydroxyzine provided better acceptance of facial mask than placebo during induction of general anaesthesia in children. 相似文献2.
A. Faucher D. Savary J. Jund F. Carpentier J.-F. Payen V. Danel 《Annales fran?aises d'anesthèsie et de rèanimation》2009
Objectives
Describe the epidemiology and the survival of patients with traumatic cardiac arrest (CA), and compare them to those with nontraumatic CA. Highlight the weaknesses in their care and consider ways to improve their survival.Method
Traumatic and nontraumatic CA are described using the Utstein style in the “réseau nord-alpin des urgences” registry. Regarding the traumatic CA, we focus on circumstances, types of injuries and specific resuscitation techniques used.Results
From 1st January 2004 to 31st December 2005, prehospital medical teams provided care to 1552 victims of CA, 129 of whom were trauma patients (8.3%). Average age was 47.1 years; 74.4% were males. Blunt trauma occurred in 94.6%. None of the patients had chest tube insertion or thoracotomy on the scene. A return of spontaneous circulation was observed in 24.8%, the survival after 24 h was of 3.9%, and 0.8% of patients remained alive 1 year following the accident. The topography of lesions responsible for the CA as well as the fact that these lesions are limited or multiorgan influence the survival.Conclusion
The survival of patients with prehospital traumatic CA is catastrophic and it is worse than that of patients with nontraumatic CA. However, a specific earlier and more adapted prehospital resuscitation could help improve this survival. 相似文献3.
R. Simon O. Desebbe R. Hénaine O. Bastien J.-J. Lehot M. Cannesson 《Annales fran?aises d'anesthèsie et de rèanimation》2009
Objective
Thoracic bioimpedance has been proposed for cardiac output (CO) determination and monitoring without calibration or thermodilution (ICG Monitor 862146, Philips Medical System, Philips, Suresnes, France). The accuracy and clinical applicability of this technology has not been fully evaluated in the cardiac surgery setting. We designed this prospective study to compare the accuracy of the ICG Monitor (COICG) versus pulmonary artery catheter standard bolus thermodilution (COPAC) in patients after cardiac surgery or having benefited from cardiac surgery.Study design
Prospective, monocentric.Material and methods
We studied 13 patients in the postoperative period. COICG and COPAC were determined at the arrival in the intensive care unit and every four hours. Bland-Altman and Critchley and Critchley's analysis were used to assess the agreement between COICG and COPAC.Results
COPAC ranged from 2.6 to 11.0 l/min and COICG ranged from 1.8 to 11.7 l/min. There was a significant relationship between COPAC and COICG (r = 0.61 ; p < 0.001). Agreement between COPAC and COICG was −0.5 ± 1.3 l/min (Bland-Altman analysis). Percentage error between the two methods was 49% (Critchley and Critchley's analysis).Conclusion
We found clinically unacceptable agreement between COICG and COPAC in this setting. Despite its non invasiveness, this device cannot be recommended for CO monitoring in the postoperative period following cardiac surgery. 相似文献4.
N.-S. Goddet N. Lode A. Descatha F. Dolveck P. Pès J.-L. Chabernaud M. Baer D. Fletcher 《Annales fran?aises d'anesthèsie et de rèanimation》2009
Introduction
After the publication of new recommendations for cardiopulmonary resuscitation (2005 guidelines and 2006 French recommendations), we conducted a study amongst EMS teams concerning their approach with children and infants, nationwide. The objective was to measure the level of knowledge of guidelines and practice.Methods
The online questionnaire was offered to emergency physicians belonging to the French emergency database, between November 1st and December 15th 2007. Incomplete questionnaires were excluded from the study. We recorded: profile of personnel, knowledge of guidelines, basic CPR and advanced CPR parameters.Results
Four hundred and thirty-nine questionnaires were analyzed. Personnel was aged under 40 in 50.2 %, with 2–5 years experience in prehospital emergency care (57.6 %); 51,3 % declared having had training in pediatric CPR. A minority of subjects declared knowing the 2005 Guidelines (35 %), more the French 2006 recommendations (62.5 %). Basic CPR: transition age child/adult known in 30.3 %. Compression/ventilation ratio: 30/2 for one rescuer in 50.2 % (child), 46.5 % (infant); 15/2 for two or more rescuers in 57.6 % (child), 48 % (infant). AED age for use (1 year old) known in 59.8 %. Advanced CPR: epinephrine dose known in 89.3 % (intravenous) and 34.3 % (tracheal). External shock known in 57.2 %.Conclusion
This study emphasizes the lack of knowledge, especially with regard to first aid. Formations will be developed. 相似文献5.
P.-S. Abback T. Ben Sallah J. Hilly A. Skhiri V. Silins C. Brasher M. François T. Van Den Abeele C. Wood Y. Nivoche S. Dahmani 《Annales fran?aises d'anesthèsie et de rèanimation》2013
Introduction
In the adult population, Ketamine is currently used as an antihyperalgesic and opioid-sparing agent during the perioperative period. However, for doses of ketamine up to 0.5 mg/kg, these effects have not been found in pediatric population. The aim of the present study was to evaluate the efficacy of a preoperative bolus of 1 mg/kg of ketamine on postoperative pain intensity and morphine consumption in children undergoing tonsillectomy.Methods
We have undertaken a retrospective comparison of 60 consecutive children operated for tonsillectomy in our institution before (first 30 patients) and after (last 30 patients) the introduction of a preoperative bolus of 1 mg/kg of ketamine. Data collected were: age, ASA score, dose of intraoperative sufentanil, OPS score during PACU stay and the first postoperative day, morphine consumption during PACU stay and the first postoperative day, psychodysleptic manifestations, pain at first solid oral intake and postoperative respiratory complications or haemorrhage.Results
No difference was found between the two groups in terms of demographic characteristics. Perioperative doses of sufentanil, postoperative opioid consumption or pain score in PACU or during 24 hours were similar between the two groups. The two groups did not differ in terms of pain at first oral intake, or other adverse effects.Conclusion
These results suggest that 1 mg/kg of ketamine administered right after anaesthesia induction in children undergoing tonsillectomy did not result in an opioid sparing effect. 相似文献6.
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8.
J. Fusciardi F. Remérand A. Landais J. Brodeur D. Journois M. Laffon 《Annales fran?aises d'anesthèsie et de rèanimation》2010
Objective
To know: (1) how French public services of anaesthesia and critical care (ACC) have applied the new principles of hospital management and (2) whether or not it has impacted the different components of ACC.Study design
National questionnaire at the end of 2008, i.e., after 2 years of new hospital management.Material
Heads of ACC services in general (GH) and university hospitals (UH).Methods
Eighteen closed questions and open opinions analyzed. Comparisons of percentages (Chi2 – Yates): linear correlation.Results
Percentages of responses were 70% (n = 51) for UH and 37% (n = 146) for GH. The new management principles were mainly applied. The different clinical and academic components of the ACC specialty (ACC, emergency medicine, pain management) mainly remained associated in UH. In GH, the new management induced constant and various changes. They were mainly judged as defeating the object of the ACC speciality in GH, especially in those of lower and mild sizes.Conclusion
The general tendency is that the ACC specialty was able to maintain the family ties of its different components in the UH. However, this principle was not a cornerstone of the new management in the GH. 相似文献9.
S. Nebout M. Wagner J.-P. Saint-Maurice E. Houdart C. Madadaki A. Borsali R. Pirracchio 《Annales fran?aises d'anesthèsie et de rèanimation》2013
Objectives
The goal of the study was to assess whether clinically significant cerebral hypoperfusion in awake patients would be associated with some alterations in the values of the bispectral index (BIS) monitoring.Study design
Observational study.Population and methods
We monitored the BIS during endovascular carotid artery occlusion testing in awake patients.Results
Twenty-eight patients were included. Twenty-one adequately tolerated the procedure. Their BIS value remained stable throughout the procedure. Four patients had poor angiographic tolerance, but no clinical symptoms. Their BIS value slightly decreased during the test (minimal BIS: 83 [79–87]). Three patients had poor clinical and angiographic tolerance of the occlusion. They all experienced an immediate and dramatic decrease in their BIS value (minimal BIS: ipsilateral to clamping: 50 [45–60]; contralateral to clamping: 48 [45–52]). In all patients, the clinical symptoms and the BIS normalized after deflating the occlusion balloon.Conclusion
In awake patients, the observed values of the BIS monitoring seem to be associated with clinically relevant cerebral hypoperfusion. 相似文献10.
11.
J. Jeanneteau O. Braud F. Pinaud S. Faraj S. Gillet C. Cottineau J.-L. de Brux C. Baufreton 《Annales fran?aises d'anesthèsie et de rèanimation》2009
Objectives
Insertion of Swan-Ganz catheter for a few days may be necessary in cardiac surgery. This study was aimed at determining the incidence and the evolution of thrombotic images within the internal jugular vein as well as assessing their association with the presence of a prolonged fever at postoperative day 7 in the lack of any documented infection.Material and methods
All the patients undergoing cardiac surgery had a two-dimensional ultrasonography of internal jugular veins preoperatively, at discharge (day 7) and at postoperative day 90 if thrombotic images were seen at day 7.Results
Sleeve-like and compact thrombotic images have been observed in site of venipuncture in 52 patients (70.3%). None had any residual thrombotic image 90 days after the operation. No clinical thromboembolic migration has been observed. There was no statistical association between the presence of a thrombotic image at the ultrasonography and the duration of catheterization. Moreover, there was no association between the anticoagulation before, during and after the surgery and the presence of a thrombotic image. We found a non-significant association between fever at day 7 and the presence of a thrombotic image within the internal jugular vein.Conclusion
Thrombotic images in the internal jugular vein after catheterization are frequent and disappear at day 90. The limited sample size of this study does not provide strong evidence of the role of jugular thrombi in the prolongation of fever after cardiac surgery. 相似文献12.
A. Tshibangu-N F. Motte-Neuville E. Gepts A. Bailly T. Nguyen L. Hirsoux 《Annales fran?aises d'anesthèsie et de rèanimation》2010
Introduction
Early feeding is well tolerated in patients undergoing caesarean section under general or regional anaesthesia. Intrathecal morphine is effective for postoperative analgesia but can induce nausea and vomiting which may hamper feeding. This study assessed prospectively the effects of intrathecal morphine on early feeding in patients undergoing caesarean section.Methodology
After ethical committee approval, 66 consenting women scheduled for caesarean section were randomized to receive intrathecal morphine 0.1 mg (group M, n = 32) or not (“control group”, group C, n = 34) at the time of intrathecal anaesthesia performed with a 3 ml mixture containing 8.6 mg bupivacaine, 64 μg clonidine and 4.3 μg sufentanil. Standard antiemetic prophylaxis (5 mg dexamethasone + 2 mg tropisetron) was administered intravenously in all patients after umbilical cord clamping. Standardized multimodal analgesia was initiated postoperatively with 1 g of paracetamol and 30 mg of ketorolac given every 6 hours. Analgesia was evaluated by a numeric rating scale (NRS) at 4 hours intervals and 10 mg of oral morphine was administered if the NRS score exceeded 3. All patients received a protein enriched solution, 8 hours after caesarean section and were allowed to eat solid food on postoperative day 1. Nausea and vomiting episodes, gas and/or stools emission, itching, NRS score and morphine consumption were recorded on the first, second and fourth postoperative hour and then every 4 hours during 48 hours.Results
Nausea was significantly more frequent and persisted longer in group M. Vomiting occurred equally in both groups and stopped after feeding. Gas and/or stools emission appeared within 48 hours postoperatively in 72 and 77 % of patients in group M and group C respectively. Oral morphine consumption was significantly lower in group M (1.9 ± 4 vs 6.5 ± 7.3 mg, p = 0.006). When compared to group C, NRS were also lower in group M from the second to the 20th postoperative hour. Itching was observed more frequently and persisted longer in group M.Discussion and conclusion
A small dose of intrathecal morphine provided adequate and prolonged pain relief after caesarean section but increased the incidence of nausea and vomiting despite anti-emetic prophylaxis. Oral food intake was not hampered by intrathecal morphine. 相似文献13.
N. Mongardon A. Bouglé G. Geri F. Daviaud T. Morichau-Beauchant R. Tissier F. Dumas A. Cariou 《Annales fran?aises d'anesthèsie et de rèanimation》2013
Objective
This review aims at providing an update on post-cardiac arrest syndrome, from pathophysiology to treatment.Data sources
Medline database.Data extraction
All data on pathophysiology, clinical manifestations and therapeutic management, with focus on the publications of the 5 last years.Data synthesis
Care of the patients after cardiac arrest is a medical challenge, in face of “post-cardiac arrest syndrome”, which culminates into multi-organ failure. This syndrome mimics sepsis-related dysfunctions, with all clinical and biological manifestations related to the phenomenon of global ischemia-reperfusion. Acute cardiocirculatory dysfunction is usually controlled through pharmacological and mechanical support. Meanwhile, as a majority of cardiac arrest is related to myocardial infarction, early angiographic exploration should then be discussed when there is no obvious extracardiac cause, percutaneous coronary revascularization being associated with improved short and long-term prognosis. Therapeutic hypothermia is the cornerstone of neuroprotective armamentarium, beyond hemodynamic stabilization and metabolic maintenance.Conclusion
If ongoing evaluations should shed light on potential efficiency of new therapeutic drugs, a multidisciplinary approach of the post-cardiac arrest syndrome in expertise centre is essential. 相似文献14.
O. Delhaye E. Robin J.-E. Bazin J. Ripart G. Lebuffe B. Vallet 《Annales fran?aises d'anesthèsie et de rèanimation》2010
Objective
To analyze the current knowledge related to xenon anaesthesia.Data sources
References were obtained from computerized bibliographic research (Medline®), recent review articles, the library of the service and personal files.Study selection
All categories of articles on this topic have been selected.Data extraction
Articles have been analyzed for biophysics, pharmacology, toxicity and environmental effects, clinical effects and using prospect.Data synthesis
The noble gas xenon has anaesthetic properties that have been recognized 50 years ago. Xenon is receiving renewed interest because it has many characteristics of an ideal anaesthetic. In addition to its lack of effects on cardiovascular system, xenon has a low solubility enabling faster induction of and emergence from anaesthesia than with other inhalational agents. Nevertheless, at present, the cost and rarity of xenon limits widespread use in clinical practice. The development of closed rebreathing system that allowed recycling of xenon and therefore reducing its waste has led to a recent interest in this gas.Conclusion
Reducing its cost will help xenon to find its place among anaesthetic agents and extend its use to severe patients with specific pathologies. 相似文献15.
16.
K. Mounir M. Bensghir A. Elmoqaddem S. Massou L. Belyamani M. Atmani H. Azendour N. Drissi Kamili 《Annales fran?aises d'anesthèsie et de rèanimation》2010
Introduction
The reduction of postoperative pain after surgery of inguinal hernia is an objective of lot of studies. The subfasciale infiltration of the wound may be an efficient technique.Methods
This study was designed as a randomized, double blind, prospective study, comparing two treatment groups: a group infiltrated by bupivacaine (Gr B), and second one infiltrated by a placebo (Gr P). A part of demographic parameters and ASA class, the postoperative pain intensity at rest and at coughing, the morphine consumption and the secondary effects were compared. Patient's satisfaction and postoperative chronic pain at 3 and 6 months were also analyzed.Results
Concerning demographic parameters, ASA class and secondary effects, we didn’t find any meaningful difference between the two groups. However, there was a significant reduction of postoperative pain in the bupivacaine group as well at rest as coughing. Gr P patients have more morphine consumption and they were unsatisfied and accused more chronic pain.Discussion
Wound infiltration is still a simple and efficient technique in postoperative pain reduction. With this technique, hernia surgery may become ambulatory. 相似文献17.
18.
D. Roger J.-M. Dudouit D. Résière H. Mehdaoui D. Courcier L. Villain C. Léonard F. Roques G. Lebreton 《Annales fran?aises d'anesthèsie et de rèanimation》2013
Objective
The transportation of critically ill patients in the French West Indies represents a real challenge; in order to ensure territorial continuity of health care provision, the cardiac surgical department of the Fort-de-France Hospital created a mobile ECMO/ECLS unit. The aim of our work is to describe the logistical, technical and financial aspects of the interhospital transfer of ECMO/ECLS-assisted patients in the French Caribbean.Patients and methods
All ECMO/ECLS-assisted patients in the French Antilles-Guyane area subsequently repatriated towards the Fort-de-France Hospital were included from December 29th, 2009 to September 30th, 2011. Indication and type of the extracorporeal assistance used, location of departure, type of transport vehicle, complications during transfer, survival after hospital discharge and direct costs were collected.Results
Nineteen patients were supported by our mobile unit far away from our centre (sex-ratio 0.63, median age 34 years old [16–64]). Twelve were assisted by ECMO for a refractory ARDS, and seven were assisted by ECLS for a refractory cardiogenic shock. Four patients were transferred by ambulance (7–29 km), seven by helicopter (190–440 km), and eight by plane (440–1430 km). No patient died during transfer. No major adverse event occurred during these transfers. Fifteen patients survived. An economic assessment was conducted.Conclusion
Interhospital transfer of ECMO/ECLS-assisted patients by land or air is technically feasible under perfectly secure conditions in our area. Prior coordination of this activity has helped to make it affordable. 相似文献19.
G. Gayraud O. Bastien H. Taheri P. Schoeffler C. Dualé 《Annales fran?aises d'anesthèsie et de rèanimation》2013
Objective
To assess the current practice of analgesia after thoracotomy and thoracoscopy in France.Study design
Cross-sectional practice survey.Material
Anaesthetist physicians, each referent for one of the French centres practicing thoracic surgery, during year 2012.Methods
Electronic questionnaire about the activity of the centre in thoracic surgery, and modalities and estimated frequencies of different analgesic techniques. Primary assessment was the estimated percentage of acts, after imputation from original data.Results
Eighty-four centres out of 103 (82 %) answered the questionnaire. Coupling locoregional to general anaesthesia involved 74 % of thoracotomies and 35 % of thoracoscopies. A practice (i.e. for more than 5 % of patients) of epidural analgesia was declared by 68 centres (81 %), and by 27 centres (32 %) for paravertebral block. The most current practices for epidural analgesia were: thoracic puncture, intraoperative initiation, ropivacaïne 0.2 % plus sufentanil, patient-controlled administration with infusion plus bolus, application more than 48 hrs post surgery. The practice rates for technique of paravertebral block were: Eason & Wyatt 34 %, ultrasound-guided 24 %, internal 42 %. The most frequent systemic analgesia was patient-controlled intravenous morphine. Ketamine was used in 60 % of the cases.Conclusions
French practice of analgesia after thoracic surgery improved quality during the last decade, but more than one patient on four (compared to 8 % in UK) may have neither epidural nor paravertebral block, while such techniques are nowadays considered as standard. 相似文献20.