Chirurgie mini-invasive du rachis. État de l’art,indications et techniques

Minimally invasive spinal surgery is a set of techniques whose primary goal is to minimize the trauma induced surgically approaching the spine. This technological advance can be ascribed mainly to recent progress in visualization and optical lighting techniques and to the development of instrumentations specifically designed for insertion via minimally invasive approaches. No published scientific studies have proved that minimally invasive techniques are superior over standard techniques. However, patients benefit from the decreased postoperative pain, shorter hospital stay, and expedited return to normal activities. Finally, minimally invasive surgery of the spine is evolving at a fast pace. Progress is being made in defining the indications, and assessable results have been obtained for a number of disorders. This article describes the main techniques used in minimally invasive spinal surgery and highlights the beneficial effects on patient comfort.     

Comparaison de sérum salé, d’air et d’un mélange oxygène–protoxyde d’azote pour le remplissage des ballonnets de sondes d’intubation chez l’enfant ? Étude prospective randomisée

Objective

The purpose of the present study was to compare how many inflate and deflate are necessary to maintain the endotracheal tube cuff pressure between 15 and 35 cm H₂O by using air, O₂–N₂O mix or saline solution.

Study design

Randomized and prospective study.

Patients and methods

Ninety children from 1 month to 15 years of age were included in the study. All patients were ventilated with O₂50%–N₂O50%. Subsequently, the patients were divided in three groups: (1) Group 1: patients with air inflated cuffs; (2) Group 2: patients with O₂–N₂O mix inflated cuffs; (3) Group 3: patients with saline solution inflated cuffs. In all groups cuffs were inflated to reach an intracuff pressure of 20 cmH₂O. The cuff pressure was then monitored every 10 minutes and adjusted to be between 15 and 35 cmH₂O. Laryngeal and tracheal symptoms were noted in the recovery room.

Results

The three groups of patients were similar for age, weight, and sex. The length of surgery was significantly longer in Group 3. The deflate rate was higher in Group 1 (60%) than in Group 2 (10%) or 3 (3.3%) (p < 0.0001). The inflate rate was higher in Group 2 (76.6%) than in Group 1 or 3 (both 3.3%) (p < 0.0001). Side effects were comparable in the three groups of patients.

Conclusion

Using air or O₂–N₂O mix to inflate cuffs is not reliable. SSI helps to maintain a more stable cuff pressure but monitoring is difficult and sometimes contraindicated by tracheal tubes producers. Inflating cuffs with air and regularly monitoring pressure is the most reliable and easiest technique.     

Cartographie du risque d’être transfusé en chirurgie au CHU de Lyon : un outil de rationalisation de la prescription des examens immunohématologiques (Hospices civils de Lyon – HCL)

Introduction

Immunohaematology examinations are usually prescribed preoperatively according to more or less standardized protocols. We wanted to assess the relevance of these protocols on the basis of factual data: an overview of the rate of transfusions carried out as part of surgery within the HCL in 2009.

Study design

The list of patients operated in 2009 in the HCL (IPOP by Cristalnet) has been combined with the list of patients transfused in the same time period (CTS server, Inlog). The percentage of patients transfused during the stay, and the percentage of patients transfused on the day of the intervention itself were determined for each type of surgery. The study focused on 13 571 patients affected by 44 surgeries.

Patients and methods

Six hundred and thirty-three patients were transfused, 45% of them the day of the intervention. The risk of needing to carry out a transfusion depends on the risk to the patient and surgery. For example, the total hip arthroplasty transfusion risk is 11.9% when it's programmed against 37.8% in emergency surgery. The transfusion risk of knee arthroscopies, osteosynthesis of wrist fracture, carpal canal surgeries and of appendectomies, thyroidectomies, herna repair surgeries are below 0.5%. The transfusion risk of colectomy is 18.1%. Thus, new recommendations for good clinical practices on the relevance of settled surgery-preoperative immunohematologic exams can be established.

Conclusion

The emergency degree of the transfusion must be taken into account for such recommendation. Each hospital should perform its own cartography to justify its own protocols.     

Prise en charge transfusionnelle du choc hémorragique d’origine traumatique à la phase aiguë : quoi de neuf en 2009 ?

In spite of continuous progress in surgery and in interventional radiology, massive haemorrhage remains a leading cause of death in traumatology. The transfusionnal strategy appears a key step in the treatment of haemorrhagic shock. In the light of new insights into the pathophysiology of coagulopathies associated with traumatic shock it seems reasonable to transfuse patients with haemorrhagic shock earlier than previously recommended.     

XXXX<Superscript>ème</Superscript> Anniversaire de la Société Française de Médecine et Chirurgie du Pied (SFMCP)

Reportages Photographiques / Photographs from Recent Meetings

XXXX^ème Anniversaire de la Société Fran?aise de Médecine et Chirurgie du Pied (SFMCP) XXX^èmes Journées Montpelliéraines de Médecine et Chirurgie du Pied