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Auroy Y, Benhamou D, Péquignot F, Jougla E, Lienhart A. Enquête mortalité Sfar–Inserm : analyse secondaire des décès par inhalation de liquide gastrique. ACTA ACUST UNITED AC 2009; 28:200-5. [DOI: 10.1016/j.annfar.2008.12.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 12/22/2008] [Indexed: 11/24/2022]
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Auroy Y, Benhamou D, Péquignot F, Jougla E, Lienhart A. Hyponatraemia-related death after paediatric surgery still exists in France. Br J Anaesth 2008; 101:741. [PMID: 18854387 DOI: 10.1093/bja/aen282] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Dargaud Y, Bordet JC, Lienhart A, Negrier C. Use of the Thrombin Generation Test to Evaluate Response to Treatment With Recombinant Activated Factor VII. Semin Hematol 2008; 45:S72-3. [DOI: 10.1053/j.seminhematol.2008.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lienhart A. [Changes in transfusion practice for surgery]. Transfus Clin Biol 2008; 14:533-7. [PMID: 18359655 DOI: 10.1016/j.tracli.2008.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 01/18/2008] [Indexed: 11/16/2022]
Abstract
The context of transfusion has changed in recent years. Some data could lead to an increased demand: the risk of viral transmission has significantly decreased; a national survey has revealed that the mortality related to an insufficient or delayed transfusion was higher to the side effects of the transfusion itself. Some other data could decrease the demand: the preoperative use of EPO is now easier; the intraoperative use of antifibrinolytic has been shown to be efficient. The number of allogenic red blood cells units (RBCs) transfused each year in France regularly increases, while the transfusion of predeposited autologous blood is in sharp decline. However, in hospitals still using but reducing this technique, the consumption of allogenic RBCs does not increase and the transfusion of any blood (allogenic and/or autologous) decreases. The strategy is based on preoperative evaluation of usual blood loss and tolerable blood loss by accepting a reasonable risk of allogenic blood transfusion. Advances in public health seem to be found above all in the analysis of system failures.
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Hequet O, Lienhart A, Jaeger S, Meunier S, Sobas F, Rigal D, Negrier C. Adaptability of protein A-immunoadsorption allows temporary reduction of anti-VIII antibodies and realisation of high-risk haemorrhagic surgery. Transfus Apher Sci 2007; 36:255-8. [PMID: 17569589 DOI: 10.1016/j.transci.2007.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report the successful treatment by protein A-immunoadsorption (IA) of an hemophilic man with anti-F VIII antibodies (Abs) who needed high-risk bleeding surgery. This patient had developed high levels of anti-F VIII Abs preventing substitution by clotting factor and preventing high-risk bleeding surgery. Because of rebound in Abs levels or complications, IA procedures were modified several times leading to appropriate decrease of anti-F VIII inhibitor Abs allowing bilateral knees surgery. IA procedure is enough adaptable to be modified to prevent complications. Collaboration between clinical, biological, apheresis and surgical teams implied has permitted surgery and prevented life-threatening bleeding complications.
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Fusciardi J, Lienhart A, Clergue F, Fletcher D, Martin C. [Information before anaesthesia: a proposal for a new document]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2007; 26:488-9. [PMID: 17521854 DOI: 10.1016/j.annfar.2007.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Tilleul P, Weickmans H, Sean PT, Lienhart A, Beaussier M. Cost analysis applied to postoperative analgesia regimens: a comparison between parecoxib and propacetamol. ACTA ACUST UNITED AC 2007; 29:374-9. [PMID: 17310303 DOI: 10.1007/s11096-006-9083-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Accepted: 12/21/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postoperative pain management represents a significant part of perioperative costs. Non-opioid analgesics are often used in combination with opiates to improve pain relief and reduce opioid-related side effects. OBJECTIVE To assess the costs and cost efficacy of intravenous (i.v.) parecoxib versus i.v. propacetamol in postoperative pain. METHODS A prospective, randomised, double-blind, clinical evaluation was performed to compare the efficacy of a single bolus injection of 40 mg parecoxib and 2 g propacetamol, administered twice within 12 h following surgical repair of inguinal hernia. Resources for each arm of treatment were collected, and total costs were determined, including costs of drug acquisition, devices and labour for preparation of the two analgesic drugs. Cost-efficacy analysis was performed as the cost to achieve complete satisfaction with analgesia. Incremental cost efficacy was determined as the ratio between the differential costs and the differential patient satisfaction. The analysis was performed from an institutional perspective over a 12 h time frame. RESULTS A total of 182 patients was evaluated. Pain at rest and morphine consumption were observed to be reduced in the parecoxib group. The percentages of patients totally satisfied with their pain management 12 h after surgery were 87% in the parecoxib-treated group and 70% in the propacetamol-treated group (P < 0.01). The average cost per patient was higher in the parecoxib group, 6.65 euros vs 5.28 euros in the propacetamol group). Cost per patient satisfied was calculated at a mean value of 7.64 euros for parecoxib and 7.54 euros for propacetamol. Incremental cost per additional patient satisfied was 8.02 euros in the parecoxib-treated group when preparation costs were included. Sensitivity analysis (+/-15%), including a bootstrap method applied to costs and efficacy, did not modify these conclusions. CONCLUSION Parecoxib exhibits higher cost and greater patient satisfaction than does propacetamol. From a cost-efficacy approach, incremental cost per additional patient satisfied for parecoxib treatment must be analysed in light of overall perioperative pharmaceutical cost.
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Lienhart A, Puybasset L, Beloucif S, Boulard G. Recommandations de bonnes pratiques cliniques concernant l'application de la loi no 2005-370 du 22 avril 2005 relative aux droits des malades et à la fin de vie. ACTA ACUST UNITED AC 2006; 25:e4-8. [PMID: 17118620 DOI: 10.1016/j.annfar.2006.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 08/02/2006] [Indexed: 11/25/2022]
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Martin C, Lienhart A, Dureuil B, Eledjam JJ. Endoscopie digestive : quelle sédation, faite par qui ? ACTA ACUST UNITED AC 2006; 25:921-3. [PMID: 16934954 DOI: 10.1016/j.annfar.2006.07.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Beaussier M, Boughaba A, Schiffer E, Debaene B, Lienhart A, d'Hollander A. Acute desflurane or sevoflurane exposure on a previously stabilized atracurium-induced neuromuscular block. Eur J Anaesthesiol 2006; 23:755-9. [PMID: 16723050 DOI: 10.1017/s0265021506000706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2006] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this prospective study was to compare the effect of the administration of desflurane or sevoflurane to a fixed neuromuscular block. METHODS After written consent, 12 patients were anaesthetized with propofol and sufentanil. Atracurium was administered via a continuous infusion in order to obtain 85% twitch depression of the control value assessed by repeated accelerometric stimulation at the adductor pollicis. Once stabilized over the course of 30 min, propofol was discontinued and either desflurane (n = 6) or sevoflurane (n = 6) was delivered at 1 MAC in a mixture of 50% O(2) in air. Study parameters were the magnitude and the time of twitch height variations. Results are presented in mean +/- SD. RESULT Exposure to halogenated agents led to a significant reduction in twitch height with similar magnitude between the two agents. However, interaction with desflurane showed an initial and transient rise (35 +/- 22%) in twitch height before subsequent depression occurred. The time to reach 50% of the signal depression in the desflurane group was significantly delayed (25 +/- 7 vs. 11 +/- 4 min in the sevoflurane group; P < 0.01). CONCLUSIONS On a stable neuromuscular block elicited by continuous infusion of atracurium, the abrupt administration of desflurane or sevoflurane reduces the accelerometric responses of the adductor pollicis in a similar way. This potentiating effect is produced faster after sevoflurane than after desflurane. With desflurane, a biphasic effect (of a transient and moderate increase followed by depression of the signal) was recorded.
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Lienhart A, Puybasset L, Beloucif S, Boulard G, Alazia M, Balagny E, Bazin JE, Cohen C, de La Dorie-Leroy A, Eon B, Ferrand E, Gauzit R, Jacob A, Pourriat JL, Quiviger PY, Tarot JP, Martin C. [Recommendations for good clinical practice concerning law number 2005-370 of April 22, 2005 relative to the treatment of disease at the end of life]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2006; 25:912-7. [PMID: 17044142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Lienhart A, Puybasset L, Beloucif S, Boulard G. [Implementation of the French law related to the patients' rights and the end of life]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2006; 25:491-2. [PMID: 16600562 DOI: 10.1016/j.annfar.2006.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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d'Oiron R, Volot F, Reynaud J, Peerlinck K, Goudemand J, Guérois C, Rothschild C, Chambost H, Borel-Derlon A, Roussel-Robert V, Marquès-Verdier A, Lienhart A, Berthier AM, Moreau P, Lambert T. Impact of Choice of Treatment for Bleeding Episodes on Inhibitor Outcome in Patients With Mild/Moderate Hemophilia A and Inhibitors. Semin Hematol 2006; 43:S3-9. [PMID: 16427382 DOI: 10.1053/j.seminhematol.2005.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with mild/moderate hemophilia A (MHA) may develop inhibitors to factor VIII (FVIII). In this condition, FVIII clotting activity (FVIII:C) baseline levels may remain stable for some patients, but may be reduced to less than 0.01 U/mL for others. Several risk factors for the development of inhibitors in MHA have been proposed. Genetic factors, such as mutations in the FVIII gene, may play a central role; however, other influences, such as intensive treatment with FVIII products, may also be important. Optimal treatment regimens have yet to be determined, not only for the eradication of inhibitors, but also for the management or surgical prophylaxis of hemorrhages associated with this condition. Several treatment options for the control of bleeding in patients with MHA and inhibitors (MHAI) are currently available, and the choice of therapeutic strategy should be given careful consideration; some treatments may produce an anamnestic response, thus delaying the return to FVIII:C baseline levels and adversely affecting the duration of the severe bleeding phenotype. To increase our knowledge of MHAI, a retrospective collection of data is currently being performed among hemophilia centers in France and Belgium. Based on five examples of patients with MHAI collated from preliminary study data, we illustrate the impact on inhibitor outcome of the therapeutic choices used to treat bleeding episodes in these patients.
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Dargaud Y, Lienhart A, Meunier S, Hequet O, Chavanne H, Chamouard V, Marin S, Negrier C. Major surgery in a severe haemophilia A patient with high titre inhibitor: use of the thrombin generation test in the therapeutic decision. Haemophilia 2005; 11:552-8. [PMID: 16128902 DOI: 10.1111/j.1365-2516.2005.01141.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Summary. In haemophilia patients with inhibitor, elective orthopaedic surgery is usually performed under recombinant activated factor VII (rFVIIa). We report here the case of a severe haemophilia A patient with a high inhibitor who needed a bilateral total knee arthroplasty. Recombinant FVIIa was previously shown to be ineffective for the treatment of muscle and joint bleedings, and he had a history of excessive postoperative bleeding under activated prothrombin complex concentrate (APCC). Thrombin generation test (TGT) was used to assess the efficacy of Factor Eight Inhibitor Bypassing Activity (FEIBA). Insufficient correction of thrombin-generating capacity was observed after administration of 75 U kg(-1) FEIBA. In a multidisciplinary environment, a bilateral total knee arthroplasty was performed using a protocol combining immunoadsorption of inhibitors preoperatively associated with FVIII replacement during a first phase followed by FEIBA when the inhibitor reappeared. To our knowledge this is the first direct application of TGT in the management of haemophilia patients with inhibitor, which indicated that a sequential use of immunoadsorption, FVIII and FEIBA was the most appropriate treatment to perform this major elective surgery. This case demonstrates that this combined protocol can be safely used to cover major surgery in inhibitor patients. In addition, it also suggests that TGT may have a major contribution in the decision-making process of the most adapted therapy for the treatment of such high-risk patients.
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Beaussier M, Weickmans H, Paugam C, Lavazais S, Baechle JP, Goater P, Buffin A, Loriferne JF, Perier JF, Didelot JP, Mosbah A, Said R, Lienhart A. A Randomized, Double-Blind Comparison Between Parecoxib Sodium and Propacetamol for Parenteral Postoperative Analgesia After Inguinal Hernia Repair in Adult Patients. Anesth Analg 2005; 100:1309-1315. [PMID: 15845675 DOI: 10.1213/01.ane.0000150972.88708.13] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The newly injectable cyclooxygenase-2 selective nonsteroidal antiinflammatory drug, parecoxib, has never been compared with propacetamol, a parenteral formulation of acetaminophen. In this prospective, randomized, double-blind, double-dummy study, we randomly assigned 182 patients scheduled for initial inguinal hernia repair under general anesthesia to receive a single injection of 40 mg parecoxib or 2 injections of 2 g propacetamol within the first 12 h after surgery. The study variables were morphine consumption, pain at rest and while coughing, and patient satisfaction throughout the first 12 h postoperatively. For statistical analysis, we used the Student's t-test, chi(2), and covariance analysis. Total morphine consumption did not differ between the two groups. Pain was less intense in the parecoxib group at rest (P = 0.035) but did not differ for pain while coughing. The incidence of side effects was similar. Significantly more patients in the parecoxib group rated their pain management as good or excellent (87% versus 70% in the propacetamol group, P = 0.001). Within the first 12 h after inguinal hernia repair in adult patients, a single injection of parecoxib 40 mg compares favorably with 2 injections of propacetamol 2 g.
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Mertes PM, Laxenaire MC, Lienhart A, Aberer W, Ring J, Pichler WJ, Demoly P. Reducing the risk of anaphylaxis during anaesthesia: guidelines for clinical practice. J Investig Allergol Clin Immunol 2005; 15:91-101. [PMID: 16047708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
These guidelines represent a consensus of experts in the field of immediate hypersensitivity reactions occurring during anaesthesia. They were based on international science, and implemented in France under the auspices of the French Society for Anaesthesia and Intensive Care (SFAR: Société Française d'Anesthésie et de Reanimation). Their aim was to provide the most valid, widely accepted, effective and easily teachable guidelines that current knowledge, research and experience can provide. This paper presents the main extracts of these recommendations with the most relevant clinical implications.
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Lienhart A, Auroy Y. [The anaphylactic shock exists: we have met it]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2004; 23:1127-8. [PMID: 15589349 DOI: 10.1016/j.annfar.2004.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Lienhart A, Auroy Y, Benhamou D, Pequignot F, Jougla E. P8-10 Les décès en rapport avec l’anesthésie en France : méthode d’analyse de l’imputabilité. Rev Epidemiol Sante Publique 2004. [DOI: 10.1016/s0398-7620(04)99306-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Pequignot F, Jougla E, Bovet M, Auroy Y, Benhamou D, Lienhart A. E2-3 Enquête épidémiologique nationale sur la mortalité liée à l’anesthésie. Rev Epidemiol Sante Publique 2004. [DOI: 10.1016/s0398-7620(04)99200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Benhamou D, Péquignot F, Auroy Y, Jougla E, Clergue F, Laxenaire MC, Lienhart A. Factors associated with use of regional anaesthesia: a multivariate analysis in seven surgical procedures in France. Eur J Anaesthesiol 2004; 21:576-8. [PMID: 15318474 DOI: 10.1017/s026502150425712x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Rosencher N, Lienhart A. La transfusion autologue programmée (TAP) : faut-il jeter le bébé avec l'eau du bain ? ACTA ACUST UNITED AC 2004; 23:457-8. [PMID: 15158234 DOI: 10.1016/j.annfar.2004.02.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lienhart A, Péquignot F, Auroy Y, Benhamou D, Clergue F, Laxenaire MC, Jougla E. [Factors associated with laparoscopic approach for cholecystectomy, appendicectomy and inguinal herniorraphy in France]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2003; 22:778-86. [PMID: 14612165 DOI: 10.1016/s0750-7658(03)00328-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To determine on a national level the factors associated with the use of laparoscopy for digestive surgery. STUDY DESIGN Nation wide study using a large representative sample (3 days of anaesthesia in France). METHODS Univariate followed by multivariate analyses of data gathered in 1996 during the survey led by the French Society of Anaesthesia and Intensive care ("SFAR") including 2847 surgical procedures for cholecystectomy, appendicectomy or inguinal herniorraphy. RESULTS Independent factors associated with the use of laparoscopy were: for cholecystectomy: age (less frequent when > or =71 years: adjusted Odds ratio [AOR] 0.4), sex (more frequent in female: AOR 1.7), ASA physical status (less frequent when > or =3: AOR 0.5), private hospital (AOR 2.0), procedure scheduled at least the night before (AOR 2.1), and use of closed circuit general anaesthesia (AOR 1.6); for appendectomy: age >15 years (AOR 1.9-2.2), female (AOR 2.1), private hospital (AOR 2.7), scheduled procedure (AOR 2.1), prolonged procedure (AOR 8.4), endotracheal intubation (AOR 16.7), and closed circuit (AOR 2.7); for inguinal herniorraphy: ASA physical status (less frequent when > or =3: AOR 0.4), private hospital (AOR 3.4), prolonged procedure (AOR 5.6), and endotracheal intubation (AOR 21.6). Association with a closed circuit was confirmed for general anaesthesia using a volatile agent (AOR 1.5). Overall, ambulatory surgery was rarely performed and used only for open procedures. Regional anaesthesia was used only for inguinal open herniorraphy. CONCLUSION These data obtained from a large national survey confirmed the higher frequency of laparoscopy in middle aged patients, female (except for inguinal herniorraphy), without important comorbidity, in private hospitals. Laparoscopy was associated with prolonged procedures and with a change in the anaesthetic technique for appendicectomy and inguinal herniorraphy: tracheal intubation was almost constantly used. Whatever the procedure, closed circuit anaesthesia was more frequently used when surgery was performed under laparoscopy, reflecting newer equipment of the hospital, private or public.
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