Enquête sur la formation initiale des internes français en anesthésie locorégionale

Objective

To assess both level and type of the initial training on regional anesthesia for French residents after the publication of formalized recommendations of experts on training and practice in regional anesthesia in 2006.

Study design

Practical statement enquiry.

Material and methods

A multiple choice questionnaire was sent to all the French residents in anesthesiology. Questions are focused on demographic data (year of training, university hospital origin, theoretical training, type and length of practical courses) and regional anesthesia practice, particularly about the essentials of regional anesthesia techniques for initial training, level of practice and degree of autonomy, especially for the 5th and the 3rd years students. After sending, two follow-ups were done, responses were obtained by mail or post.

Results

The global answer rate was 29.1% (25.3% and 23.4% for the 5th and the 3rd years respectively). Concerning theoretical training, 29% of responders had anatomy course, 33% dissection and 38% a supplemental training. At the end of initial training, the official goal (30 acts for a specific technique) was achieved in 98% of cases for epidural anesthesia, 95% for spinal anesthesia, 82% for both axillary and humeral block and 72% for femoral block, with a declared 100% autonomy at this level.

Conclusion

The main goal of the formalized recommendations on training and practice in regional anesthesia is partially reached. This apparent failure can be due to both a lack of regional anesthesia exposure, inadequate faculty training, usual slavery to routine, or technical evolution of medical practice.     

Erreurs médicamenteuses en anesthésie : enquête prospective au niveau des CHU Marocains

Introduction

Medication errors are a major public health problem because of their morbidity and financial costs. In anesthesia, few articles publications, mostly retrospective, have assessed its incidence and outcomes. By our prospective study, we intend to identify and describe the drug errors in anesthesia in four university hospitals in Morocco.

Material and methods

After approval of our ethics committee, a prospective study was conducted in nine hospitals affiliated to four university hospitals (Rabat, Casablanca, Fes and Marrakech) from October 2009 to June 2010. Data collection was carried out by an anesthesiologist at each hospital who was designated by the investigator. Informations were based on practitioner's statements. Medication errors were divided into distinct categories: substitution errors, omission errors, errors of the way of administration, dosage and dilution errors. The consequences were classified into four levels according to their severity.

Results

During the study period, 9199 anesthetic procedures were reported (mean response of 36%). General anesthesia was performed in 75% of patients. Sixteen cases of drug errors were reported (an incidence of 1/575 with 1/405 in a pediatric setting). The drugs involved were dominated by hypnotics (six cases/16) and morphine (four cases/16). Medication errors were mainly due to labeling mistakes (seven cases/16) and to attention deficit due to fatigue and stress (seven other cases) leading to substitution error in most of cases (10 cases/16. Errors were mainly made by the less experienced practitioners (14 cases/16). They occurred during the induction phase (seven cases/16) as well as during the interview process (nine cases/16), and also during emergent surgeries (seven errors/16) as well as during elective ones (nine errors/16). No errors caused death. Pulmonary edema (recognized as a grade III severity incident) was secondary to inappropriate administration of adrenaline.

Conclusion

Our study helped us to set recommendations, which are approved by the Moroccan pharmacovigilance center, and in accordance with the international committees to prevent the occurrence of medication errors in our daily anesthetic practice.     

Fibrillation atriale en anesthésie–réanimation : de la cardiologie médicale à la période périopératoire

Atrial fibrillation (AF) is the most frequent arythmia. During the perioperative period and in intensive care units, management of patients with AF is frequent and difficult. As in cardiology, two main issues are present: the risk of acute hemodynamically instability and the risk of thromboembolic complication. Cardiological guidelines recently published must guide the management of patients in this context. Two main factors must be kept in mind: acute AF in these situations are often of short duration; the risk of anticoagulation can be superior to the risk of thrombotic complication in this situation. An individualized benefit–risk analysis must be done in each patient. New treatments, antiarrhythmic or mainly antithrombotic drugs, are under evaluation and will be soon available.     

Conchal flap with a superior pedicle to reconstruct the middle or upper third of the auricle

The middle or upper third of the auricle can be reconstructed with a composite chondro-cutaneous peninsular flap of the conchal part of the auricle. This peninsular flap is based on the anastomotic network between the posterior auricular and the superficial temporal artery. The authors report their experience about 24 clinical cases. Most of the cases were partial auricular amputations for squamous cell carcinoma. The surgical procedure allows a hidden cartilaginous donor site, the concha, allowing in a single operation a color- and texture-matched reconstruction. This flap represents an alternative to more complex surgical procedures, and can easily be realised under local anaesthesia.     

实时超声弹性成像技术在宫颈癌的应用研究

目的 探讨助力式及声力式弹性成像技术在宫颈癌诊断的应用价值.方法 应用助力式弹性成像技术(ETE)及声触诊组织量化技术(VTQ)检测44例宫颈癌患者病灶及50例正常宫颈,记录图像及测量相关数值进行分析统计.结果 ETE诊断宫颈癌的敏感度88.6％,特异度94％;宫颈癌VTQ均值(2.68±0.49) m/s,明显大于正常宫颈VTQ均值(1.53±0.47) m/s (P＜0.05).结论 ETE及VTQ检查均显示宫颈癌病变的硬度明显增加,且随着宫颈癌分期越高硬度越硬,说明弹性超声成像技术在协助宫颈癌的诊断上有应用价值.     

Retrait impossible d’un cathéter de péridural

The knotting of an epidural catheter is a rare complication preventing catheter withdrawal. We report two cases of catheter knotting and subsequent impossible withdrawal with moderate repeated traction. Imaging by CT scan allowed visualisation in the epidural space of a loop and a real knot for the first and the second patient respectively. The common risk factor found was an excess in catheter length inserted. A surgical procedure was necessary for both patients.