Appréciation de la place de l’anesthésie locorégionale pour la prise en charge des plaies de la face aux urgences

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.     

Variation de kaliémie après une induction en séquence rapide avec la succinylcholine chez les patients de réanimation

Objective

Evaluate the changes in potassium following rapid sequence induction with succinylcholine in critically ill-patients and determine whether hospital length of stay could influence the succinylcholine-induced hyperkaliemia.

Study design

Prospective and observational study.

Patients and methods

After approval by our local ethical committee, we prospectively included 36 patients admitted from more than 24 hours in ICU and who required succinylcholine for rapid tracheal intubation (1 mg/kg). Serum potassium was measured before, 5 and 30 min after succinylcholine. The incidence of life-threatening hyperkaliemia (≥ 6.5 mmol/L) was noted.

Results

We could observe significant and transient increase in serum potassium (median increase of 0.45 [0.20–0.80] mmol/L at five minutes). A significant relationship was observed between the ICU length of stay and arterial potassium increase (r = 0.37, P < 0.05). From the ROC curve, a threshold of 12 days had an 86% sensitivity and 69% specificity in discriminating patients in whom the potassium increase was more than 1.5 mmol/L.

Conclusion

Induction with succinylcholine is followed by significant but transient hyperkaliema. The ICU length of stay before giving succinylcholine could influence significantly the amplitude of potassium increase.     

Facteurs prédictifs de défaillance d’organes chez les patients admis en réanimation pour hémorragie digestive aiguë

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 observational

Methods 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.     

The incidence and outcomes of acute kidney injury amongst patients admitted to a level I trauma unit

Purpose

This study aimed to identify the incidence and outcomes of patients with trauma related acute kidney injury (AKI), as defined by RIFLE criteria, at a single level I trauma centre and trauma ICU.

Methods

We performed a retrospective observational study of 666 patients admitted to a trauma ICU from a level I trauma unit from March 2008 to March 2011. We conducted multivariable logistic regression to identify independent predictors for AKI and mortality.

Results

The overall incidence of AKI was 15% (n = 102). Median injury severity score (ISS) was 25 (inter quartile range [IQR] 16–34) and mean age was 39 (SD 16.3) in the AKI group. Thirteen patients (13%) were referred with rhabdomyolysis associated renal Failure. Overall mortality in the AKI group was 57% (n = 58) but was significantly lower in the rhabdomyolysis Failure group (23% versus 64%; p = 0.012). AKI was independently associated with older age, base excess (BE) < −12 (odd ratio [OR] 22.9, 95% confidence interval [CI] 1.89–276.16), IV contrast administration (OR 2.7 95% CI 1.39–5.11) and blunt trauma (OR 2.2 95% CI 1.04–4.71). AKI was an independent predictor of mortality (OR 8.5, 95% CI 4.51–15.95). Thirty-nine (38%) patients required renal replacement therapy.

Conclusions

AKI in critically ill trauma patients is an independent risk factor for mortality and is independently associated with increasing age and low BE. Renal replacement therapy utilisation is high in this group and represents a significant health care cost burden.     

Comparaison prospective et randomisée de la morphine nébulisée versus la péridurale thoracique dans la prise en charge de la douleur des traumatisés thoraciques

Introduction

Successful management of pain reduces morbidity and improves patient satisfaction of patient after a chest trauma. The purpose of the study was to evaluate the efficacy of the respiratory administration of nebulized morphine in such patients.

Patients and methods

Patients were included in this prospective and randomized study patients to receive either nebulized morphine in group M or a mixture of bupivacaine-fentanyl by epidural route. In group M, patients received nebulized morphine every 30 minutes until the second hour then every 4 hours during 48 hours. In the thoracic epidural analgesia group (group P) they received a mixture of 0.125% bupivacaine and 0.115% of fentanyl continuously infused at the rate of 7 ml/h during 48 hours. The main criterion of judgment was the analgesic effects of analgesic regimen with EVA < 4. Sedation, haemodynamic and respiratory parameters were continuously recorded, as adverse side effects were they occurred. Statistical comparisons were performed with Chi², Fisher or Student t-test when appropriate (p < 0.05).

Results

Forty patients were randomized in two groups. Groups were not different regarding the demographic parameters. Analgesia was effective in both groups (NS). Sedation, hemodynamic and respiratory parameters were not different between groups. No side effect was noted in groups.

Conclusion

Nebulized morphine was an analgesic technique as effective as epidural bupivacaine-fentanyl in our series. This non-invasive route of administration of morphine appears to be useful to treat pain after a chest trauma.     

Enquête nationale sur l’assistance circulatoire et respiratoire de courte durée en 2009

Objective

Indications for short-term circulatory and/or respiratory support (STCRS) increased during the last years. The goal of this survey was to characterize this activity in France in 2009.

Study design

Observational retrospective pluricentral.

Materiel and methods

Each center of cardiothoracic surgery received a questionnaire validated by the Société française de perfusion about the activity, materials and organization used for STCRS. Data were expressed as percentages or median (25–75 percentiles).

Results

Forty-one centers on 61 (67%) answered. STCRS was performed respectively by 33 (80.5 %), 36 (87.8 %) and 39 (95.1 %) of centers in 2007, 2008 and 2009 including 10 [4–26], 18 [6–29] and 18 [5–33] cases/center per year. In 2009, types of STCRS installed were veno-arterial in 39 centres (95.1 %), veno-venous in 27 (65.9 %) and Novalung^® in four (9.8 %), including 18 [5–32], five [2–7] and 15 [1–17] cases respectively. Twenty-nine centers (70.7%) installed STCRS outside the operating theater, and 24 (58.5%) in non-cardiothoracic surgery. A mobile circulatory support unit was created in eight centers (19.5%), however 21 (51.2%) have installed STCRS externally, at distances between 10 [5–55] to 100 [15–200] km, using emergency vehicles in most of the cases (90.5%), but helicopter seldom (19%).

Conclusion

STCRS has increased over the last few years in France. Externalized activity outside the operating theater was important, time-consuming and used hospital resources therefore modifying the professional activity of perfusionists.     

Gestion de la glycémie : un audit dans 66 réanimations

Introduction

The interest of tight glucose control in ICU is still debated. In France, no data are available regarding this therapy and the implementation of its guidelines.

Study design

Sub-study of a one-day audit performed between January and May 2009.

Patients and methods

During a one-day audit performed in 66 ICUs, trained residents collected data regarding the presence of a formal glucose control protocol and its practical application.

Results

A formalized glucose control protocol was found in 88% of patients. During the day before the audit, 3645 glycemia measurements were performed accounting for six measurements [4–9] per patient with a median higher value of 1.6 [1.4–2.1]. Hypoglycemia (< 0.8 g/L) and hyperglycemia (> 1.4 g/L in non-diabetic and > 1.8 g/L in diabetic patients) were found in 81 (15%) and 326 (58%) patients respectively. Two episodes (0.36%) of severe hypoglycemia (< 0.4 g/L) were reported. Factors associated with glucose control protocol application were: a high SOFA score, cardioversion, mechanical ventilation, intracranial pressure monitoring, steroid use and nurse to patient ratio less than 1/2.5. Hepatic failure was the only factor associated with hypoglycemia.

Discussion

Glucose control protocols are available in more than 80% ICUs but their implementation is still imperfect. However, the median glycemia meets international current recommendations. Severe hypoglycemia is a very rare event in ICU.     

Efficacité d’une manœuvre de recrutement alvéolaire associée à une pression expiratoire positive sur la mécanique respiratoire en cœliochirurgie bariatrique

Objective

To evaluate recruitment manoeuvre (RM) efficiency associated with a 10 cmH₂O positive end expiratory pressure (PEEP) on respiratory mechanic estimated by lung compliance (Ctp) and PEEP to ZEEP expiratory volume delta (Δ VTE) during laparoscopic bariatric surgery in patients with morbid obesity.

Study design

Prospective randomized study.

Methods

Twenty-six obese patients (BMI > 40 kg/m²) undergoing laparoscopic bariatric surgery. The recruitment group received an RM followed by a 10 cmH₂O PEP versus only 10 cmH₂O PEP in the control group. Ctp was measured during the intervention and functional residual capacity (FRC) was estimated measuring Δ VTE during a PEP to ZEP manoeuvre. Mann and Whitney tests as well as a t-test were used (significance p < 0.05).

Results

In the RM group, a significant improvement of 52 ± 14 ml/cmH₂O was noted versus a 36 ± 10 ml/cmH₂O in the PEP group (p = 0,004). This improvement was transitory and no statistically significant Δ VTE difference was noted between the groups at the end of the intervention (360 [90–770] ml [MRA] and 310 [190–450] ml [PEP]).

Conclusion

In patients with morbid obesity undergoing laparoscopic bariatric surgery, an RM conducted prior the pneumoperitoneum temporarily improves lung mechanics but without any change of the end expiratory lung volume at the end of the surgery in comparison with PEP alone. The RM was well tolerated.     

Formation à la gestion des situations violentes en contexte hospitalier

Objective

Evaluate the typology of violence in hospital setting, study the psychophysiological state of care givers dealing with the aggression and provide appropriate training.

Study design

Single centre, observational.

Patients and methods

A first anonymous questionnaire was given to a sample of emergency and intensive care providers in Narbonne Hospital. The parameters studied included: demographics data, the Trait Anxiety Inventory test, the typology of aggressions, and the psycho-physiological state of subjects dealing with the aggression. Robert Paturel, an instructor of French Special Forces (Recherche–Assistance–Intervention–Dissuasion [RAID]), has provided training for the management of violence. A second questionnaire assessed satisfaction for proposed formation.

Results

Forty-one questionnaires were returned. The rates of verbal and physical violence touching care givers were respectively 97 % and 41 % (median of 7 years [1–36] experience on the job). Eighty-five percent of care givers wanted training in psychology of conflict and 93 % wanted a formation with a self-defense aspect. The first reason of violence was drugs and alcohol abuse. The “tunnel effect” during stress was identified in 34 % of care givers, and 20 % were unaware of its nature. Twenty-one percent of care givers spontaneously adopting a safe distance of more than 1 m during a conflict had been physically assaulted versus 63 % for those staying less than 1 m (P = 0.03). The proposed formation, including psychology of conflict and self-defense, was satisfactory to all care givers who participated (median score 9/10 [7–10]).

Conclusion

The verbal and physical violence affecting emergency departments is a common phenomenon warranting appropriate training. The proposed formation included the comprehension of the conflict causality, self-defense and self-control.     

Enquête sur les pratiques françaises d’analgésie en chirurgie thoracique (réalisée avec le concours de l’ARCOTHOVA)

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.     

Effet d’une dose unique intramusculaire de déxaméthasone sur la douleur après circoncision. Étude randomisée contrôlée

Objective

To assess the effect of a preoperative single dose of dexamethasone associated with penile block on pain after circumcision.

Study design

Prospective randomized controlled study.

Patients and methods

Forty male children aged 2 to 5 years, scheduled for circumcision under general anaesthesia, combined with penile block, were randomized into two groups. The dexamethasone group received dexamethasone 0.4 mg/kg preoperatively. The control group received the same volume of normal saline. Data compared between two groups were: postoperative pain assessed by the Objective Pain Scale collected in the recovery room, at 8 and 24 hours postoperatively (h0, h8 and h24), time to first analgesic request and the quality of sleep on the first postoperative night.

Results

Pain scores at h0 were similar between the two groups. The dexamethasone group showed significantly lower pain scores at h8 [0 (0–1) vs. 2 (0–3); P = 0.04] and h24 [0 (0–0) vs. 0 (0–1); P = 0.02]. The time to first analgesic administration was also significantly delayed in the dexamethasone group compared to the control group (240 vs 180 min; P = 0.035). The quality of sleep was also better in children in the dexamethasone group (P = 0.018).

Conclusion

This study showed that the combination of a preoperative single dose of dexamethasone 0.4 mg/kg with penile block significantly improves the quality of analgesia after circumcision.     

A trauma quality improvement programme associated with improved patient outcomes: 21 years of experience at an Australian Major Trauma Centre

Introduction

Quality improvement programmes are an important part of care delivery in trauma centres. The objective was to describe the effect of a comprehensive quality improvement programme on long term patient outcome trends at a low volume major trauma centre in Australia.

Methods

All patients aged 15 years and over with major trauma (Injury Severity Score > 15) admitted to a single inner city major trauma centre between 1992 and 2012 were studied. The outcomes of interest were in-hospital mortality and transfer to rehabilitation. Time series analysis using integer valued autoregressive Poisson models was used to determine the reduction in adjusted monthly count data associated with the intervention period (2007–2012). Risk adjusted odds ratios for mortality over three yearly intervals was also obtained using multivariable logistic regression. Crude and risk adjusted mortality was compared before and after the implementation period.

Results

3856 patients were analysed. Crude in-hospital mortality fell from 16% to 10% after implementation (p < 0.001). The intervention period was associated with a 25% decrease in monthly mortality counts. Risk adjusted mortality remained stable from 1992 to 2006 and did not fall until the intervention period. Crude and risk adjusted transfer to in-patient rehabilitation after major trauma also declined during the intervention period.

Conclusion

In this low volume major trauma centre, the implementation of a comprehensive quality improvement programme was associated with a reduction in crude and risk adjusted mortality and risk adjusted discharge to rehabilitation in severely injured patients.     

Prise en charge anesthésique des transplantations hépatiques : évolution des pratiques périopératoires en France entre 2004 et 2008

Objectives

To determine the evolution of French perioperative anaesthetic practices in liver transplantation between 2004 and 2008.

Study design

Phone survey.

Methods

In 2004 and 2008, a similar questionnaire has been administered by phone to a senior anaesthesiologist from each French centre performing adult liver transplantation (n = 21). Results were compared using Fisher test and p < 0.05 was considered significant.

Results

Between 2004 and 2008, there was a trend towards an increase of centres performing transplantation for more than 40% of Child C patients (p = 0.1). Simultaneously, work force dedicated to liver transplantation cases has been reduced since in 2008, one anaesthesiologist was in charge in 90% of the centres (p = 0.06 vs 2004). Perioperative practices remained largely heterogeneous between centres with regard to hemodynamic monitoring, fluid and blood products management, antifibrinolytics use or postoperative analgesia.

Conclusions

This French survey has shown a reduction of work force dedicated to a liver transplantation from 2004 to 2008 simultaneously with a trend towards a greater severity of liver recipients. Practices heterogeneity reflect at least in part, unresolved questions about the best perioperative management for liver transplantation and the need for guidelines. Working for standardization of our practices and multicentric trials could allow gaining a better understanding of what should be the good practices in perioperative management of liver transplantation.     

Problématique de la prise en charge des traumatismes graves du rachis cervical en pays sous-développé

Background and purpose

The management of cervical spine injuries requires a multidisciplinary approach based on emergency management and rehabilitation. In our context this chain fails, especially on the post-hospital care. Our goal is to explain the difficulties we had in the management of these patients in Dakar.

Methods

This retrospective cohort study (2005–2009) included 99 patients admitted for severe cervical spinal cord injury in two hospitals in Dakar. The clinical signs, treatment and outcome were studied. The follow up was between 3 and 54 months.

Results

The average age of patients was 36.1 years and the traffic accidents were the main etiology (73.7%). Medical transport of patients was done in 65.7% with an admission average time of 64.86 hours. On admission, 57.6% of patients had Frankel score A or B. Dislocations (59.6%) and Tear drop fractures (16.2%) were the main lesions. The surgery was performed in 83.8% with a mean interval of 128.84 hours after the trauma. Outpatient rehabilitation was offered whatever the patient's neurological status. Recovery was complete in 20.2% and partial in 31.3% with a mortality rate of 37.4%. Most deaths occurred between 1 and 6 months (59.5%) mainly due to decubitus complications (56.8%).

Conclusion

The efficacy of the management of severe spinal cord injuries is based on reducing the preoperative time and rehabilitation.     

Cinétique du saignement en chirurgie orthopédique majeure : implications pour la prise en charge périopératoire

Introduction

Management of the perioperative hemorrhagic risk is of major interest in patients undergoing total arthroplasty of the lower limb. Anemia in the postoperative period of that increasingly performed surgery carries its own morbidity and mortality. Better anticipation of its occurrence could be done with a refined knowledge of bleeding kinetics.

Patients and methods

We conducted a retrospective study in a single centre on 451 consecutive patients undergoing elective unilateral primary total hip or knee arthroplasty for osteoarthritis. Volume of total blood loss according to Mercuriali's formula and variations of haemoglobin levels were calculated between day 0 (D0) and postoperative day 8 (D8), and during subdivided periods between D0–D1, D1–D3 and D3–D8. Frequency and volume of autologous and homologous blood transfusions were also analyzed. Comparisons were done taking into account the use of intraoperative tranexemic acid (TA).

Results

Seventy to 75% of blood loss occurred between D0 and D1. Bleeding occurred mostly between the end of surgery and morning of D1, and tended to stop at D3. TA significantly reduced blood loss in the first 3 days, mostly after knee prosthesis surgery. However, the bleeding kinetics were the same with or without TA.

Conclusion

Loss of haemoglobin occurred mostly in the early postoperative period. To avoid transfusion delays, haemoglobin levels should be monitored regularly until the third postoperative day after total arthroplasty, especially when D1 haemoglobin is close to the transfusion threshold. Furthermore, our results support the routine use of TA.     

Évaluation des pratiques professionnelles de la prise en charge de la douleur postopératoire à court,moyen et long terme

Objectives

To evaluate the short medium and long-term impact of a quality-improvement program (QIP) in a university hospital using a validated reference tool.

Methods

Seven surgical departments were audited before and after implementation of a QIP in postoperative pain management. Audits were conducted in 2005, 2007, 2009 and 2012. In each audit, 10 medical charts from each surgical department were analyzed for 9 quality criteria. A surgical department score (SDS) was calculated for each department (maximum score = 90). The surgical departments with a SDS < 45 received targeted training sessions.

Results

In 2005, three surgical departments had a SDS < 45. After the first audit, a targeted training sessions was conducted in the three surgical departments, all seven departments improved their scores with a SDS > 45 in 2007. Between 2007 and 2009, all seven departments improved their scores. Conversely, between 2009 and 2012, the SDS diminished in six of the seven surgical departments and four of the nine evaluated quality criteria decreased significantly: right detailed order for postoperative pain analgesia (prescriber identifier, agent used, unit doses, mode of administration; 100% versus 53; P = 0.027), appropriate dosing of steps I and II analgesics (96% versus 80%; P = 0.041), morphine (90% versus 76%; P = 0.039), based on corresponding physician orders and monitor morphine side effects (87% versus 29; P = 0.027).

Conclusion

Audits should be performed regularly (at least every two years) for detecting postoperative pain management degradation. Lack of targeted training sessions can explain partially this degradation.     

Étude de faisabilité pour la mise en place d’une filière de chirurgie ambulatoire en urgence

Introduction

Development of outpatient care is one of the major goals of public health policy in our country. For the purpose of this study, we set up an emergency outpatient surgery unit 24 hours a day in our hospital. We assessed the feasibility of such a unit with a length of stay less than 12 hours and no patient readmission.

Patients and methods

A prospective observational and monocentric study was conducted in our hospital by systematically including patients eligible for emergency surgery outpatient care. We built a database compiling patient characteristics, lengths of stay, surgical and anesthesic procedures, complications and readmission rate. Satisfaction was then assessed by the « EVAN-G » questionnaire.

Results

From May 2011 to October 2012, 147 patients were included in our research. They were 31 years old [25–43]. Hundred and twenty-six of them (86%) remained in the outpatient procedure without any readmission. Twenty-one (14%) were excluded, essentially for surgical contraindications or due to the absence of an accompanying person. Length of stay was of 10.5 hours [8.5–13]. The satisfaction survey showed an average score of 83/100.

Conclusion

The setting up of an ambulatory emergency surgery unit is possible after proper training of emergency care specialists, anesthesiologists, and surgeons. This activity is compatible with safe care and a high level of patient satisfaction. It must be considered as part of the emergency procedures available and should not be systematically ruled out.     

Facteurs de risque de pose de sonde gastrique en chirurgie colorectale programmée,dans le cadre d’un programme de réhabilitation postopératoire : une analyse multivariée

Objective

Nasogastric tube placement (NTP) is no more systematically recommended in patients scheduled for elective colorectal surgery but could be necessary in case of postoperative vomiting. The aim of this study was to determine independent risk factors for NTP after colorectal surgery.

Patients and methods

We performed an observational study including 290 patients scheduled for elective colorectal surgery included in an enhanced recovery programme: immunonutrition, thoracic epidural analgesia, antiemetic prophylaxis, respiratory physiotherapy, absence of NT and drainage, forced mobilization and oral nutrition. The main outcome was the occurrence of vomiting requiring NTP. Univariate analysis included: age, sex, BMI, American Society of Anesthesiologist Physical Status Classification System (ASA), duration of surgery, epidural analgesia, and mobilization, intraoperative fluid, temperature, laparotomy, use of droperidol, parenteral nutrition, stoma, diabetes, hypertension or coronary disease, COPD, type of surgery. A logistic regression was performed to determine independent risk factors of NTP.

Results

Among the 290 patients included, 277 were analyzed. The incidence of NTP was 10.5% (95%CI [7.4–14.6%]). Univariate analysis documented BMI, low temperature in PACU (< 35 °C), ASA scores, duration of surgery and epidural analgesia, rectal and sigmoid resections, diabetes, transfusion, no use of droperidol, duration of mobilization, conversion to laparotomy. Three independent risk factors were associated with NTP: temperature in SSPI < 35.5 °C (OR: 14.49; IC95% [4.52–45.45], P < 0.0001), BMI < 21 kg/m² (8.40; [1.99–35.71], P = 0.0038) and lack of postoperative droperidol administration (3.37 [1.02–11.39], P = 0.04).

Conclusions

After colorectal surgery tolerance to rapid oral feeding is impaired by denutrition and postoperative hypothermia. The combined used of postoperative droperidol should also be considered to avoid postoperative NTP.