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1.
Background
Deceased donor organ procurement provides unparalleled opportunity for surgical residents with extensive surgical exposure. We hypothesize that surgical residents regard organ donation positively and organ procurement enhances their education.Methods
We conducted an institutional review board approved anonymous national survey to evaluate organ procurement experiences and attitudes of general surgical residents.Results
Three hundred ninety-seven residents representing all postgraduate years responded, with 97% completion rate. Organ procurement increased with training level (92% seniors vs 53% interns). Over 85% agree organ procurement is a good educational and operative experience, and 73% believe that it will benefit their future surgical career. About 68% agree that organ procurement provided knowledge of anatomy and exposures; under 10% felt organ procurement could be duplicated with simulation. Presence of transplant program did not affect attitudes or experience. Eighty-eight percent women versus77% men plan to donate their own organs.Conclusion
Results indicate that surgical residents value organ procurement, and it remains an essential encounter that applies to general surgery. 相似文献2.
A. Wyniecki M. Raucoules-Aimé J. de Montblanc D. Benhamou 《Annales fran?aises d'anesthèsie et de rèanimation》2013
Aims
Although most components of an enhanced recovery programme (ERP) can be applied to caesarean delivery, it is unknown if their implementation is large in France.Type of study
Structured interview by telephone or e-mailing of an anaesthetist to describe usual perioperative practice in two French regions (Provence - Alpes - Côte d’Azur [PACA] and Île-de-France [IDF]).Methods
Questionnaire related to scheduled caesarean delivery.Results
Response rate 74% (111/149 maternity units). Multimodal analgesia was almost universally applied and intrathecal/epidural morphine used by 86% of respondents. Oral administration of analgesic drugs was started before h24 in 50% of responding units and immediately after delivery in 7% of them. The urinary catheter was withdrawn after h24 in 71% of responding centres. Women were allowed to drink between h4 and h6 (60%), in an unlimited amount (79%). The first meal was authorised after h6 (89%) but before h24 (65%) or after recovery of bowel function (13%). Oxytocin was used in 69% of respondents and maintained postoperatively for 12 to 24 hours (70% of oxytocin users). Carbetocin was used in the remaining 31%, usually without any maintenance oxytocic drug. Attributing one point to each major component of the ERP protocol (0–6), the median value was 3 (2–4). An ERP protocol was available in 14% of responding units and was associated with a shorter duration of intravenous and urinary catheters use.Conclusion
The study shows that the components of an ERP are insufficiently implemented in France after caesarean delivery. Moreover, significant heterogeneity exists between maternity units and among regions. 相似文献3.
A.-S. Ducloy-Bouthors C. Prunet J. Tourrès D. Chassard D. Benhamou B. Blondel 《Annales fran?aises d'anesthèsie et de rèanimation》2013
Objective
The equipment and practices in obstetric analgesia, anaesthesia and intensive care, as well as their evolution between 2003 and 2010 in metropolitan France, were described.Population and methods
Data were derived from two representative samples of births in 2003 and 2010, based on all births in France during one week. The sample included 534 maternity units and 14,903 births in 2010 and 618 maternity units and 14,737 births in 2003.Results
The caesarean operating room was adjacent or inside the labour ward in 66% of maternity units in 2010 vs 56% in 2003. An anaesthetist was appointed permanently to the labour ward in 38.9% of maternity units in 2010 vs 21.5% in 2003. Locoregional analgesia or anaesthesia rate increased significantly: 81.5% in 2010 compared to 74.9% in 2003. Almost all operative vaginal deliveries were performed under epidural anesthesia in 2010. Patient controlled epidural analgesia (PCEA) was available in 58% of the units in 2010 but only 34.2% of women had PCEA. Newborn's resuscitations were performed mainly by paediatricians in 2010, but 11.4% of children were resuscitated by an anaesthetist in level 1 maternity units.Conclusion
The conditions required to ensure anaesthetic care safety in maternity units has improved since 2003. Improvements in quality of care are still possible. 相似文献4.
S. Boet M. Jaffrelot V.N. Naik S. Brien J.-C. Granry 《Annales fran?aises d'anesthèsie et de rèanimation》2014
Objective
Update on simulation-based education and its evolution in North America.Data sources
Main articles including those published within the last five years and indexed in Medline, and unpublished data from the Royal College of Physicians and Surgeons of Canada have been analyzed.Data synthesis
After a review of historical development of simulation in North America, this article draw the place of simulation in healthcare, for medical education, research and assessment. Funding and accreditation of simulation centres are also discussed.Conclusion
Simulation is fully integrated in healthcare in North America and represents one of the main elements for healthcare professional education. Simulation is also a symbol of excellence for health and teaching institutions. The evolution of simulation in North America is likely to inform the future of simulation in France. 相似文献5.
Y. Puymirat M. Hachouf G. Doassans-Cazaban F. Poullenot L. Lefévre S. Winnock A. Ouattara 《Annales fran?aises d'anesthèsie et de rèanimation》2013
Introduction
Gastrointestinal hemorrhage is an emergency requiring usually an admission in intensive care unit (ICU), which may prove abusive secondarily. The aim of this study was to identify predictive risk factors of organ failure in patients admitted for GH in our ICU.Design
Retrospective and observationalMethods and measurements
Between January 2008 and December 2011, all patients admitted in our ICU for gastrointestinal hemorrhage were consecutively included. The primary endpoint was the occurrence of at least an organ failure. We realized an univariate analysis then a backward regression to identify independent risk factors associated with the occurrence of at least one organ failure during the ICU hospitalization.Results
During this period study, 441 consecutive patients with a mean age of 67 ± 15 years were included. The median ICU length of stay was of 4 (3–7) days and 116 (26% [IC95%: 22–30]) patients presented at least one organ failure. The multivariate analysis identified predictive risk factors of organ failure: history of cirrhosis (OR = 3.5 [IC95%: 1.9–6.7], P < 0.001) and an increase in troponin at the admission above the 99th percentile (OR = 3.1 [IC95%: 1.8–5.5], P < 0.001).Conclusion
Our results confirmed that a large proportion of patients admitted in ICU for the primary diagnosis of gastrointestinal hemorrhage developed any organ failure. The history of cirrhosis and the systemic consequences of the hemorrhagic syndrome as myocardial damage represents important risk factors of morbidity and mortality and thus should be considered during the management. 相似文献6.
Objective
To detail specificity of regional anaesthesia techniques in the obese patient.Data sources
Articles were selected from Medline database using the combination of the following keywords: obesity, peripheral nerve block, spinal anaesthesia, epidural, morbidity, mortality.Study selection
Most recent original articles or review have mainly been selected. Some case reports that highlighted specific points were added.Data extraction
Articles were analyzed for advantages and drawbacks, and risks of different techniques in obese patient.Data synthesis
Techniques avoiding obese patient's mobilization are recommended. The use of skin landmarks may be challenging for both central and peripheral blocks. Ultrasound techniques should improve block performance, even though deep fat layers seem limit sound diffusion. Success rate and incidence of complications are usually increased after regional anaesthesia technique in obese patient. The reduction of intrathecal local anesthetic dose remains controversial in this population.Conclusion
Regional anaesthesia techniques could represent an alternative to general anaesthesia (less cardiorespiratory complications). However, many specific considerations have to be taken into account. 相似文献7.
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8.
Objective
This review discusses variability among patients in anesthesia, due to genetic polymorphisms.Data sources
Articles in French and English languages were retrieved from PubMed database. The initial request was “anesth* and (genotyp* or polymorphism* or genetic*)”.Study selection
Original articles, general reviews and one case report. Letters were excluded.Data extraction
Rare genetic diseases were excluded from the scope of this review. We stressed on frequent genetic polymorphisms that may have a daily impact in anesthesiology.Data synthesis
Most results were related to pain studies. We selected various examples to describe how genetic polymorphisms impacts the pharmacology of a given drug, and what are the clinical consequences.Conclusion
There is a growing field of pharmacogenetic related evidences in anesthesiology. The results from various animal and human studies underline the genetic origin of variability among individuals. How anaesthesists have to integrate these parameters for their daily practice is still unclear, but pharmacogenetic will obviously be a leading field of anesthesia research in the future. 相似文献9.
F. Fischer O. Collange G. Mahoudeau M. Simon H. Moussa A. Thibaud A. Steib T. Pottecher M. Mertes 《Annales fran?aises d'anesthèsie et de rèanimation》2014
Introduction
Mechanical ventilation can initiate ventilator-associated lung injury and postoperative pulmonary complications. The aim of this study was to evaluate (1) how mechanical ventilation was comprehended by anaesthetists (physician and nurses) and (2) the need for educational programs.Methods
A computing questionnary was sent by electronic-mail to the entire anaesthetist from Alsace region in France (297 physicians), and to a pool of 99 nurse anaesthetists. Mechanical ventilation during anaesthesia was considered as optimized when low tidal volume (6–8 mL) of ideal body weight was associated with positive end expiratory pressure, FiO2 less than 50%, I/E adjustment and recruitment maneuvers.Results
The participation rate was 50.5% (172 professionals). Only 2.3% of professionals used the five parameters for optimized ventilation. Majority of professionals considered that mechanical ventilation adjustment influenced the patients’ postoperative outcome. Majority of the professionals asked for a specific educational program in the field of mechanical ventilation.Discussion
Only 2.3% of professionals optimized mechanical ventilation during anaesthesia. Guidelines and specific educational programs in the field of mechanical ventilation are widely expected. 相似文献10.
11.
S. Bloc L. Mercadal P. Cuny F. Renault T. Dessieux T. Garnier B. Komly P. Leclerc B. Morel G. Dhonneur C. Ecoffey 《Annales fran?aises d'anesthèsie et de rèanimation》2010
Objective
The monitoring in the postanaesthesia care unit (PACU) improves the safety, the comfort and the analgesia of patients. At present, studies suggest the possibility to bypass the PACU according to the principle of fast-tracking (FT). The aim of this study was to evaluate the feasibility and the safety of a simulated protocol of FT after a regional anaesthesia.Patients and methods
Seven hundred patients were prospectively included in this study over a period of 6 months.Methods
The Withes’ scoring system was used for determining when patients could be safely discharged from PACU. We added a variable concerning the monitoring of surgical site. A minimum score of 14 was required on arrival to the PACU to consider a FT. The success rate of blocks, the use of sedation or general anaesthesia were noted. Adverse events were recorded.Results
The success rate of blocks was 93 %. The score was higher than 14 in 98 % of case on arrival to the PACU. Thirteen adverse events were reported before surgery and/or operating room. No adverse events were reported during the stay in the PACU.Conclusion
Regional anaesthesia seems to be an appropriate principle to fast-track the PACU. It could be a way to reduce health care costs, and can offer solution for the PACU congestion problem. In France, the fast-tracking is a marginal concept without any support regulatory. An evolution to such a practice could be considered. 相似文献12.
M. Aïssou M. Coroir C. Debes T. Camus N. Hadri C. Gutton M. Beaussier 《Annales fran?aises d'anesthèsie et de rèanimation》2013
Objective
Recommendations on difficult tracheal intubation constrain each surgical block to have a fiberscope available. Reusable fiberscope presents the problem of availability, the risk of non-conventional infections transmission and the cost. Single-use fiberscopes are presently available (Ambu® aScope™). This medico-economic study aims to assess the cost of using a reusable fiberscope as compared to the single use fiberscope.Study design
Cost minimization analysis.Material
Reusable fiberscope Pentax® FB 15P (Pentax France, Argenteuil) and single-use fiberscope Ambu® aScope™ (Ambu A/S, Ballerup, Denmark).Method
Minimization-cost analysis conducted between 2006 and 2012. The amortization cost per utilization for two reusable fiberscopes took into account the acquisition and maintenance costs, as well as the costs related to disinfection. The cost of the single use fiberscope was calculated according to its acquisition cost.Results
The total cost of the reusable material was 55,874 € over 6 years, corresponding to a unitary cost of 206 € per fiberscopy. During this period, 780 sterilizations were carried out for a total cost of 32,611 €. Acquisition and maintenance costs were respectively 18,382 € and 4880 €. The cost of the single use fiberscope is of 200 € per fiberscopy.Conclusion
This medico-economic evaluation shows that the utilization cost of single use and reusable fiberscopes are very close. This should be analyzed at the light of some benefits of using single use devices for the difficult tracheal intubation. 相似文献13.
Introduction
Neurenteric cysts defined as a cyst lined by endodermal-type epithelium are extremely rare. We report a rare case of an orbital neurenteric cyst.Case report
A 19-year-old female presented with an orbital cyst tumor that had cosmetic consequences. The signal of the cyst was not enhanced after administration of gadolinium on MRI examination. The patient underwent surgery due to the increase in size of the tumor. A complete cyst removal including the cyst wall through the inferior palpebral fold was performed. The histological examination confirmed the diagnostic of neurenteric cyst. The patient was discharged home in excellent condition.Conclusion
This report discusses the clinical presentation, neuroradiological aspect, pathological findings and therapeutic consideration of the neurenteric cyst. We described a rare case of orbital neurenteric cyst. Due to the local recurrence rate observed after partial resection, the goal of the surgery should be a total resection of the cyst with the cyst wall. 相似文献14.
B. Bourret V. Compère S. Torre K. Azhougagh D. Provost B. Rachet R. Gillet M. Rieu L. Marpeau B. Dureuil 《Annales fran?aises d'anesthèsie et de rèanimation》2012
Introduction
The use of magnesium sulfate (MgSO4) has been advocated since 2000 in France in the management of eclampsia. The aim of this study was to determine the frequency of use of this treatment for eclampsia in a French department.Patients and methods
All patients obstetrical patients admitted to Critical Care Units of Seine-Maritime for eclampsia over a period of 7 years (2002–2008) were included. Obstetric data, the treatment used for eclampsia and pre-eclampsia and maternofetal complications were collected. The primary outcome parameter was the use of MgSO4 in the secondary prevention of eclampsia.Results
Thirty-nine patients were included. Nineteen patients (48%) had eclampsia in prepartum, three (8%) in per-partum and 17 (44%) in post-partum periods. The use of MgSO4 in the secondary prevention of eclampsia was observed in 92% of cases (36/39). Primary prevention was seen in 8% of cases. The duration of treatment was 2 days (1–7 days). The maternal and perinatal mortality was respectively 2.5 and 11%.Conclusion
In this study, the use of MgSO4 in the secondary prevention is frequent. This result emphasizes the importance of the recommendations of learned societies in the homogenization of the management of rare but serious conditions such as eclampsia. 相似文献15.
M. Fekih Hassen S. AyedH. Ben Sik Ali R. GharbiS. Marghli S. Elatrous 《Annales fran?aises d'anesthèsie et de rèanimation》2009
Objective
To compare the efficiency of a 7-day antibiotics regimen with a 10-day regimen for ventilator-associated pneumonia (VAP).Study design
Prospective randomized study.Patients and methods
Adults patients ventilated for more than 48 hours in the intensive care unit (ICU) with a clinical diagnosis of VAP documented by positive quantitative cultures of tracheal aspiration were included in this study. All included patients were randomized in two groups. Ten-day group: 10 days antibiotic therapy, and 7-day group: 7 days antibiotic therapy. Primary judgment criteria were 14- and 28-day mortality, the number of days without antibiotics. Secondary judgments criteria were rate of recurrent pulmonary infection, the evolution of the clinical pulmonary infection scores (CPIS), the length of ICU stay and the length of mechanical ventilation.Results
Thirty patients were included in this study (16 in the 10-day group and 14 in the 7-day group). The demographic and clinical characteristics of the groups assigned to receive antibiotic therapy for 7 or 10 days were generally similar. The 14-day and 28-day mortality rate following VAP onset were 31.2 and 37.5% in the 10-day group and 7.1 and 35.7% in the 7-day group. The difference was not significant. The number of day without antibiotics and without mechanical ventilation turned out: 1.75 and 2.06 days versus 4.14 and 3.43 days in the 10-day group and 7-day group respectively, the recurrent rate of pulmonary infection (12.5% versus 14.3%, p = 0.6), the length of stay in the ICU (27.7 days versus 26.0 days, p = 0.8) and the evolution of the CPIS were no different in the two groups.Conclusion
In patients with microbiologically confirmed VAP who received appropriate empirical antibiotic therapy, a 7-day antibiotic regimen was as efficient clinically and microbiologically as a 10-day antibiotic regimen with a reduction of antibiotic use. 相似文献16.
L. Zieleskiewicz J.-P. BellefleurF. Antonini D. OrtegaM. Leone C. Martin 《Annales fran?aises d'anesthèsie et de rèanimation》2009
Objective
To describe the airway management during general anaesthesia performed at the end of labour.Study design
Observational retrospective study in a French university obstetrical unit.Patients and methods
All parturients who underwent general anaesthesia for manual removal of the placenta or instrumental delivery were included. Demographic data, anaesthesia management, indication and duration of anaesthesia were recorded. Incidents as vomiting, a drop in oxygen saturation of five points or more, aspiration and difficult endotracheal intubation were investigated.Results
Among 111 parturients with inclusion criteria, the rate of tracheal intubation was 5%. The duration of anaesthesia ranged from five to 60 minutes (mean duration: 16 min). No incident was recorded within the methodological limits of this retrospective study.Conclusion
There is a major discrepancy between guidelines and clinical practice in our unit concerning systematic tracheal intubation during general anaesthesia performed at the end of labour. A national survey is in process to confirm these results. 相似文献17.
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18.
G. Lacroix E. Meaudre B. Prunet T. Guerin M. Allary E. Kaiser 《Annales fran?aises d'anesthèsie et de rèanimation》2010
Objective
Defining the place of regional anaesthesia (RA) for facial wounds in an emergency department.Study Design
Prospective observational study conducted in the emergency department of a regional hospital.Patients and methods
Two hundred and forty-six successive patients with one or more facial wounds were included from 1st august 2004 to 31st december 2004. Data on patient, operator, wound (measured by the number of stitches), anaesthetic method (RA, local anaesthesia [LA], or no anaesthesia), method of repairing skin, duration of intervention, operator comfort (verbal numeric scale [VNS] from 0 to 10) and pain feeled by the patient (visual analogic scale [VAS] from 0 to 10) in the different stages of care were collected.Results
Compared to the LA, the RA of the face decreased the number of punctures (1.36 vs 4.38 punctures, p < 0.001) and the quantity of local anaesthetic injected (2.8 ml vs 5.3 ml, p < 0.01) for wounds requiring more than 10 stitches. It has improved operator comfort (VNS = 10 [8–10] vs 8 [6.75–10] (p < 0.01)). Its effectiveness during skin repair was equivalent to that of the LA by infiltration (VAS 0 [0–1] vs 0 [0–1]).Conclusion
When practicable, the RA of the face is a better technique than the LA for facial wounds treatment. 相似文献19.
20.
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