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Simon L, Finoco M, Julien-Marsollier F, Happiette A, Simon AL, Ilharreborde B. Does the addition of convex uniplanar screws in hybrid constructs improve 3D surgical correction in thoracic adolescent idiopathic scoliosis posterior fusion? J Child Orthop 2024; 18:124-133. [PMID: 38567048 PMCID: PMC10984149 DOI: 10.1177/18632521231220388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/22/2023] [Indexed: 04/04/2024] Open
Abstract
Purpose Hybrid techniques using thoracic sublaminar bands have proved their efficacy in adolescent idiopathic scoliosis posterior fusion, but clinical axial correction sometimes remained disappointing. One solution found was "the frame technique" and the second alternative was the replacement of the convex sublaminar bands by periapical uniplanar screws. The goal of this study was to compare clinical and radiological outcomes of both techniques in a consecutive cohort of adolescent idiopathic scoliosis patients. Methods All patients undergoing primary posterior fusion for thoracic adolescent idiopathic scoliosis between January 2017 and March 2020 were included. Two groups were compared: Group 1 with thoracic sublaminar bands only and Group 2 with periapical uniplanar screws. All patients underwent standing stereoradiographs. The main frontal, sagittal, and axial (apical vertebra rotation) radiological parameters of interest were analyzed. Functional outcomes were assessed using the Scoliosis Research Society 30 score. Results A total of 147 adolescents were included (Group 1, n = 73 and Group 2, n = 74 patients). In the frontal plane, a greater reduction index was observed in Group 2 (68% versus 62%, p < 0.001) as well as a better apical axial correction (67.8% versus 46.6%, p = 0.03). The number of thoracoplasty performed was reduced (6.7% versus 20.5%, p = 0.02) in Group 2, with a significant decrease in the rate of mechanical complication. No significant loss of correction was observed during follow-up in any of the group. Conclusion The adjunction of convex uniplanar screws at the periapical levels improved the three-dimensional surgical correction of thoracic adolescent idiopathic scoliosis treated with hybrid constructs. Level of evidence level III, retrospective comparative study.
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Affiliation(s)
- Laurie Simon
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Paris Cité University, Paris, France
| | - Mikael Finoco
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Paris Cité University, Paris, France
| | - Florence Julien-Marsollier
- Paris Cité University, Paris, France
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Adèle Happiette
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne-Laure Simon
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Paris Cité University, Paris, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Paris Cité University, Paris, France
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Pardessus P, Tournié E, Bezia D, Julien-Marsollier F, Dahmani S. Cardiac Output Monitoring Using Electrical Cardiometry Can Predict Changes in Cerebral Saturation in Infants. J Cardiothorac Vasc Anesth 2024; 38:1060-1061. [PMID: 38360422 DOI: 10.1053/j.jvca.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Pierre Pardessus
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care. Robert Debré Hospital, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Elise Tournié
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care. Robert Debré Hospital, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Delphine Bezia
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care. Robert Debré Hospital, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Florence Julien-Marsollier
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care. Robert Debré Hospital, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Souhayl Dahmani
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care. Robert Debré Hospital, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France.
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Pio L, Tulelli B, Ali L, Carvalho L, Chalhoub M, Julien-Marsollier F, Bonnard A. Enhanced Recovery after Surgery Applied to Pediatric Laparoscopic Cholecystectomy for Simple Cholelithiasis: Feasibility and Teaching Insights. Children (Basel) 2023; 10:1881. [PMID: 38136083 PMCID: PMC10742299 DOI: 10.3390/children10121881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Same-day discharge after a cholecystectomy is a common practice in the adult population and has been demonstrated as safe and viable for children as well. However, there is a lack of comprehensive teaching models for pediatric cholecystectomy. Drawing inspiration from standardized outpatient procedures, this study aimed to assess the clinical outcomes and feasibility of teaching programs and an Enhanced Recovery After Surgery (ERAS) protocol following ambulatory laparoscopic cholecystectomy in pediatric patients. METHODS In 2015, an ERAS pathway for laparoscopic cholecystectomy (LC) was implemented, focusing on admission procedures, surgery timing, anesthetic choices, analgesia, postoperative feeding, mobilization, and pain assessment. Day-case surgery was not applicable for acute cholecystitis, choledochal lithiasis, sickle cell disease, and hereditary spherocytosis cases. The protocol was employed for a group of attending surgeons and fellows, as well as a group of residents under the supervision of experienced surgeons. A retrospective analysis was conducted to evaluate the feasibility and effectiveness of ambulatory cholecystectomy in children and its utilization in training pediatric surgical trainees. RESULTS Between 2015 and 2020, a total of 33 patients were included from a cohort of 162 children who underwent LC, with 15 children operated on by senior surgeons and 18 by young surgeons. The primary diagnoses were symptomatic gallbladder lithiasis (n = 32) and biliary dyskinesia (n = 1). The median age at the time of surgery was 11.3 years (interquartile range (IQR) 4.9-18), and the median duration of surgery was 54 min (IQR 13-145). One intraoperative complication occurred, involving gallbladder rupture and the dissemination of lithiasis into the peritoneal cavity. Three patients (9%) required an overnight stay, while no postoperative complications or readmissions within 30 days were observed. ERAS was successfully implemented in 30 patients (91%). No significant differences in surgical outcomes were noted between senior and young surgeons. At an average follow-up of 55 months, no long-term sequelae were identified. CONCLUSIONS These findings align with the current trend of increasing use of outpatient laparoscopic cholecystectomy and underscore its feasibility in the pediatric population. The application of a structured ERAS protocol appears viable and practical for training the next generation of pediatric surgeons. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Luca Pio
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
- Paediatric Surgery Department, University Sorbonne Paris-Cité, 75006 Paris, France
| | - Berenice Tulelli
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
| | - Liza Ali
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
| | - Lucas Carvalho
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
| | - Marc Chalhoub
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
| | - Florence Julien-Marsollier
- Department of Anesthesia, Intensive Care and Pain Management, Robert Debré Children University Hospital, APHP, 75019 Paris, France;
| | - Arnaud Bonnard
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
- Paediatric Surgery Department, University Sorbonne Paris-Cité, 75006 Paris, France
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Pardessus P, Loiselle M, Silins V, Horlin AL, Brouns K, Marsac L, Fait C, Ilharreborde B, Julien-Marsollier F, Dahmani S. The association between intraoperative fluid management and perioperative allogenic blood transfusion during adolescent idiopathic scoliosis surgery. Paediatr Anaesth 2023; 33:829-836. [PMID: 37386846 DOI: 10.1111/pan.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Bleeding and transfusion remain important concerns during surgical correction of scoliosis even when multiple conservative strategies, such as preoperative recombinant erythropoietin and/or antifibrinolytic agents, are used. The current work aimed to determine the impact of other potential risk factors, especially the volume of intraoperative fluid intake, on the perioperative risk of allogenic transfusion during surgical correction of adolescent idiopathic scoliosis. METHODS This prospective study included all cases of adolescent idiopathic scoliosis operated in a single center during 2 years (2018-2020). Predictors analyzed were as follows: body mass index, preoperative hemoglobin concentration, thoracoplasty, preoperative halo-gravity, volume of intraoperative crystalloid administration, use of esophageal Doppler (for goal-directed fluid therapy), and duration of surgery. Statistical analyses were performed using a multivariable logistic regression model. RESULTS Two hundred patients were included in the analysis. Multivariable analysis found: an increased volume of intraoperative crystalloid administration as a significant predictor of allogenic blood transfusion. Receiving operator characteristics analysis found the model exhibiting an area under the curve of 0.85 (95% confidence interval: 0.75-0.95). Optimizing stroke volume using esophageal Doppler was associated with a decrease in intraoperative crystalloid intake. CONCLUSION These results indicate a statistical association between the increase in crystalloid intake and the risk of allogenic blood transfusion during surgical correction of adolescent idiopathic scoliosis. Controlled studies are needed to address the causative relation between intraoperative fluid intake and the risk of allogenic transfusion.
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Affiliation(s)
- Pierre Pardessus
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Maud Loiselle
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Vilnis Silins
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Anne-Laure Horlin
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Kelly Brouns
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Lucile Marsac
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Charlotte Fait
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
| | - Brice Ilharreborde
- Université de Paris-Cité, Paris, France
- FHU I2D2. Robert Debré Hospital, Paris, France
- Department of orthopedic surgery, Robert Debré Hospital, Paris, France
| | - Florence Julien-Marsollier
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
- FHU I2D2. Robert Debré Hospital, Paris, France
| | - Souhayl Dahmani
- Université de Paris-Cité, Paris, France
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France
- FHU I2D2. Robert Debré Hospital, Paris, France
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Pio L, Jafar Y, Carvalho L, Ali L, Delcaux C, Julien-Marsollier F, Bonnard A. Thoracoscopic lobectomy for congenital pulmonary airway malformations before or after 5 months of age: evaluation of pulmonary function. Minerva Pediatr (Torino) 2023:S2724-5276.23.07124-0. [PMID: 37212683 DOI: 10.23736/s2724-5276.23.07124-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Congenital pulmonary airway malformation (CPAM) is the most common pulmonary malformation. It can be managed via thoracoscopic lobectomy, which is safe and advantageous over thoracotomy. Some authors advocate the need for early resection to get an advantage over lung growth. Our study aimed to evaluate and compare the pulmonary function in patients who underwent thoracoscopic lobectomy for CPAM before and after 5 months of age. METHODS This retrospective study was conducted between 2007 and 2014. Patients younger than 5 months were assigned to group 1 and those over 5 months of age were assigned to group 2. Pulmonary function tests (PFT) were requested for all the included patients. For patients who could not undergo full PFT, the function residual capacity (FRC) was evaluated by the helium dilution technique. The parameters evaluated in full PFT were forced expiratory volume in one second (FEV1), forced vital capacity (FVC), total lung capacity (TLC), and FEV1 to FVC ratio (FEV1/FVC). The Mann Whitney U test was used to compare both groups of patients. RESULTS Seventy patients underwent thoracoscopic lobectomy during this period, 40 of which had CPAM. Twenty-seven patients tolerated and underwent PFT (group 1: 12 patients; group 2: 15 patients). Among them, 16 patients underwent full PFT and 11 patients had FRC measurement. FRC was similar in both groups (91% vs. 88.2%). FEV1 (83.9% vs. 86.4%), FVC (86.8% vs. 92.6%) and TLC (86.5% vs. 87.8%) were also similar between both groups. FEV1/FVC was slightly higher in group 1 (97.9% vs. 89.4%) but the difference was not statistically significant. CONCLUSIONS PFT for patients who underwent thoracoscopic lobectomy for CPAM before or after 5 months of age is normal and comparable between both groups. Surgical resection of CPAM can be performed safely early in life without any consequences for pulmonary function or more complications when older children undergo surgery.
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Affiliation(s)
- Luca Pio
- Department of Pediatric Surgery and Urology, Public Assistance, Hospitals of Paris, Paris, Robert-Debré University Hospital, Paris, France -
- Paris Diderot University, University of Paris, Paris, France -
| | - Yaqoub Jafar
- Department of Pediatric Surgery and Urology, Public Assistance, Hospitals of Paris, Paris, Robert-Debré University Hospital, Paris, France
| | - Lucas Carvalho
- Department of Pediatric Surgery and Urology, Public Assistance, Hospitals of Paris, Paris, Robert-Debré University Hospital, Paris, France
| | - Liza Ali
- Department of Pediatric Surgery and Urology, Public Assistance, Hospitals of Paris, Paris, Robert-Debré University Hospital, Paris, France
| | - Christrophe Delcaux
- Unit of Physiology, Public Assistance, Hospitals of Paris, Paris, Robert-Debré University Hospital, Paris, France
| | - Florence Julien-Marsollier
- Department of Anesthesia, Intensive Care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Arnaud Bonnard
- Department of Pediatric Surgery and Urology, Public Assistance, Hospitals of Paris, Paris, Robert-Debré University Hospital, Paris, France
- Paris Diderot University, University of Paris, Paris, France
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Julien-Marsollier F, Penisson L, Happiette A, Ilharreborde B. Can hydroxyapatite charged collagen sponge help reduce perioperative blood loss in adolescent idiopathic scoliosis surgery? Preliminary results in 68 patients. Eur Spine J 2023; 32:883-888. [PMID: 36653577 DOI: 10.1007/s00586-022-07512-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/10/2022] [Accepted: 12/17/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Patient blood management has been recently emphasized to avoid perioperative blood transfusion in AIS surgery. Hydroxyapatite charged collagen sponge (HCS) is a bone substitute material made of collagen and ceramized hydroxyapatite, with associated haemostatic properties. The goal of this study was to assess the impact of HCS in the perioperative blood loss in AIS surgery. METHODS After IRB approval, all AIS patients undergoing primary correction were prospectively included over a 15-month period. Patients receiving HCS at the end of the procedure were compared to a control group (matched for age, gender, and fusion levels) without any haemostatic agent or bone substitute. The same perioperative blood saving strategies were used in both groups. Two subfascial drains were used for 48 h in all patients. Perioperative blood loss and transfusion rates were analysed. RESULTS A total of 34 patients were included in each group. No difference in drainage volume was observed at day 1, but the reduction was statistically different at day 3 (1135 mL [800-1640] versus 930 [480-1510], p = 0.028, 0.63 ml/Kg/h [0.4-0.92] versus 0.46 [0.29-0.7], p = 0.042). Multivariate analysis found that the use of HCS was associated with a decrease in the postoperative blood loss (OR = 1.17 [1.10-1.25]). The transfusion rate was lower in the HCS group [0 (0% vs. 3(8.8%), p = 0.076)]. No infection occurred, and no complication was reported. CONCLUSION With 27% reduction in drain volume, hydroxyapatite charged collagen sponge can be considered as a blood salving strategy in AIS surgery. The role of the biomaterial in fusion rate still needs to be further assessed.
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Affiliation(s)
- Florence Julien-Marsollier
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, 48 boulevard Sérurier, 75019, Paris, France. .,Université de Paris, Paris, France.
| | - Leo Penisson
- UFR Sciences Pharmaceutiques, Université de Bordeaux, Bordeaux, France
| | - Adele Happiette
- Université de Paris, Paris, France.,Department of Orthopedic Surgery, Robert Debré Hospital, 48 boulevard Sérurier, 75019, Paris, France
| | - Brice Ilharreborde
- Université de Paris, Paris, France.,Department of Orthopedic Surgery, Robert Debré Hospital, 48 boulevard Sérurier, 75019, Paris, France
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Simon AL, Kassab Hassan S, Julien-Marsollier F, Happiette A, Jehanno P, Delvaque JG, Ilharreborde B. Descriptive analysis of pediatric orthopedic surgical emergencies during the COVID-19 lockdown: Single-center observational study in a pandemic red-zone area in France. Orthop Traumatol Surg Res 2023; 109:103088. [PMID: 34597824 PMCID: PMC9761103 DOI: 10.1016/j.otsr.2021.103088] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/17/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Lockdown involved strict confinement of children at home, radically affecting their way of life, with increased risk of domestic accidents and the temptation to step outside of the legal framework. The aim of the present study was to analyze the impact of lockdown on pediatric emergency turnover in a university reference center situated in a high-risk "red zone" and to describe specific management measures. HYPOTHESIS Pediatric emergency turnover and the corresponding lesion mechanisms were altered by lockdown. MATERIALS AND METHODS All children undergoing emergency orthopedic surgery during lockdown (group 1) were prospectively included, then retrospectively compared to series operated on during the same period in the previous 3 years. Demographic and surgical data were analyzed, and the pathway changes that were developed were detailed. RESULTS Turnover fell by a mean 33.5%, without change in indications. The most frequent lesions were wounds (54.3%), followed by fractures (34.3%) and infections (11.4%); the upper limbs were involved in 84.6% of cases. Lockdown had been infringed in 9.7% of traumas, mainly concerning fractures (55%). Postoperative management was modulated during lockdown in 34% of cases, without complications at the time of writing. DISCUSSION Pediatric emergency turnover decreased, without major change in lesion mechanisms. Accidents associated with lockdown infringement were rare (<10%), demonstrating good adaptation on the part of these children living in an urban area. The adapted care pathway was beneficial, and will no doubt continue to optimize management in future, with accelerated circuits and use of telemedicine. LEVEL OF EVIDENCE IV, comparative retro-prospective study.
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Affiliation(s)
- Anne-Laure Simon
- Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France,Corresponding author
| | - Sammy Kassab Hassan
- Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - Florence Julien-Marsollier
- Service d’Anesthésie-Réanimation Pédiatrique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - Adèle Happiette
- Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - Pascal Jehanno
- Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - Jean-Gabriel Delvaque
- Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - Brice Ilharreborde
- Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
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Simon AL, Kassab Hassan S, Julien-Marsollier F, Happiette A, Jehanno P, Delvaque JG, Ilharreborde B. [Descriptive analysis of pediatric orthopedic surgical emergencies during the COVID-19 lockdown: Single-center observational study in a pandemic red-zone area in France]. Revue de chirurgie orthopedique et traumatologique 2023; 109:30-35. [PMID: 34630763 PMCID: PMC8486638 DOI: 10.1016/j.rcot.2021.09.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/23/2020] [Indexed: 02/08/2023]
Abstract
Introduction Le confinement a imposé un maintien strict des enfants à domicile, modifiant considérablement leur mode de vie avec un risque accru d’accidents domestiques et la tentation de désobéir au cadre légal. L’objectif était d’analyser l’impact du confinement sur l’activité d’urgence pédiatrique dans un centre universitaire de référence situé en zone rouge, et de décrire les modes de prise en charge spécifiques. Hypothèse L’activité chirurgicale d’urgence ainsi que les mécanismes lésionnels en orthopédie pédiatrique ont été modifiés par le confinement. Matériels et méthodes Tous les enfants pris en charge au bloc opératoire pour une urgence orthopédique pendant le confinement (groupe 1) ont été inclus de façon prospective, puis comparés de manière rétrospective aux patients opérés lors des mêmes périodes les 3 années précédentes. Les données démographiques et chirurgicales ont été analysées, et les circuits spécifiques instaurés ont été décrits. Résultats Une diminution moyenne de 33,5 % de l’activité a été constatée, sans modification des motifs de prise en charge. Les lésions les plus fréquentes étaient les plaies (54,3 %), suivies des fractures (34,3 %) et des infections (11,4 %) et concernaient le membre supérieur dans 84,6 % des cas. Le cadre légal était non respecté dans 9,7 % des traumatismes et occasionnant principalement des fractures (55 %). La prise en charge postopératoire a été modifiée durant le confinement dans 34 % des cas, sans complication à ce jour. Discussion Nos résultats ont retrouvé une diminution de l’activité d’urgence pédiatrique sans modification majeure des mécanismes lésionnels. Les accidents survenant en dehors du cadre légal sont demeurés rares (<10 %), témoignant de la bonne adaptation des enfants vivant en zone urbaine. L’adaptation du parcours patient qui a été utile pendant le confinement, a été efficace, et va sans doute permettre de continuer à optimiser la prise en charge dans le futur, avec des circuits raccourcis et la télémédecine. Niveau de preuve IV ; Étude comparative rétroprospective.
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Affiliation(s)
- Anne-Laure Simon
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France,Auteur correspondant
| | - Sammy Kassab Hassan
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Florence Julien-Marsollier
- Service d’anesthésie-réanimation pédiatrique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Adèle Happiette
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Pascal Jehanno
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Jean-Gabriel Delvaque
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Brice Ilharreborde
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France
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Duray C, Ilharreborde B, Khalifé M, Julien-Marsollier F, Simon AL, Ferrero E. Benefit - risks analysis of thoracoplasty in adolescent idiopathic scoliosis treated by sublaminar bands. Orthop Traumatol Surg Res 2022:103484. [PMID: 36435372 DOI: 10.1016/j.otsr.2022.103484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cosmetic concerns are one of the main complaints of patients with adolescent idiopathic scoliosis (AIS). Several studies have shown a significant improvement in self-image scores after thoracoplasty. However, the effects of thoracoplasty on pulmonary function and clinical outcomes remain debated. The objective was to analyze the benefits and risks of thoracoplasty during AIS surgery using a hybrid construct with sublaminar bands. MATERIAL AND METHODS In this monocentric prospective cohort study, 68 patients with thoracic AIS were consecutively included between 2016 and 2017. All patients had low-dose 3D radiographs. Surgical correction was performed via the posterior approach, using the posteromedial translation technique with a hybrid construct (thoracic sublaminar band and lumbar pedicle screws). A thoracoplasty was proposed in cases of severe rib hump (more than 3 cm). Pulmonary function was assessed by pulmonary function tests (PFT) with forced vital capacity, forced expiratory volume in 1 second and total lung capacity). Radiographic parameters and PFT were compared between patients who had or had not had a thoracoplasty preoperatively and 2 years postoperatively. The SRS-22 score was collected at follow-up. RESULTS The average age was 15 ± 3 years. Nineteen patients (27%) had a thoracoplasty. The demographic, radiographic and respiratory data of the 2 groups were comparable preoperatively. The correction was similar between the groups on sagittal and coronal views. At 2 years, the PFTs were comparable to those performed preoperatively and no difference was found between the groups. None of the 12 patients who had a pleural effusion had it drained. The total SRS-22 score and the cosmetic subscore were higher in the thoracoplasty group (p<0.03). DISCUSSION The association of a thoracoplasty with AIS surgery improves the self-image of patients without altering the PFTs at 2 years postoperatively. Given the low morbidity of thoracoplasty, it seems reasonable to offer it to patients with severe rib hump and high cosmetic demands. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Cédric Duray
- Service de chirurgie orthopédique et du rachis, HEGP, Université de Paris, France.
| | - Brice Ilharreborde
- Service de chirurgie orthopédique infantile, Hôpital Robert Debré, Université de Paris, France
| | - Marc Khalifé
- Service de chirurgie orthopédique et du rachis, HEGP, Université de Paris, France
| | | | - Anne-Laure Simon
- Service de chirurgie orthopédique infantile, Hôpital Robert Debré, Université de Paris, France
| | - Emmanuelle Ferrero
- Service de chirurgie orthopédique et du rachis, HEGP, Université de Paris, France
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10
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Ould-Slimane M, Hossein Nabian M, Simon AL, Happiette A, Julien-Marsollier F, Ilharreborde B. Posterior vertebral column resection for pediatric rigid spinal deformity. Orthop Traumatol Surg Res 2022; 108:102797. [PMID: 33333284 DOI: 10.1016/j.otsr.2020.102797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Surgery for pediatric spinal deformity may involve vertebral osteotomies in complex cases. Vertebral column resection (VCR) is the most technically demanding procedure, with the severest morbidity. It can use a double anterior and posterior approach (APVCR), though a single posterior approach (PVCR) is gaining in popularity. HYPOTHESIS PVCR provides effective correction with acceptable morbidity in children. METHOD A single-center retrospective series included spinal deformities treated by PVCR. Surgical data and global pelvic-spinal balance parameters were analyzed. RESULTS Sixteen PVCRs were performed in 13 patients, with a mean age of 14.1±2.8 years. Mean operative time was 411±54minutes. Mean preoperative rigid principal Cobb angle was 74.3°. Mean correction was 64.3% postoperatively, without significant correction loss at last follow-up. Mean blood loss was 941±221ml. The cell-saver enabled 92.3% autologous transfusions, with 53.4% homologous transfusions. Transient monoplegia and permanent psoas deficit were observed during the postoperative period. Radiologic follow-up found 4 non-unions requiring revision. CONCLUSION PVCR provided major correction of rigid spinal deformity in children. Complications mainly comprised mechanical or neurological incidents. LEVEL OF EVIDENCE IV, non-comparative cohort study.
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Affiliation(s)
- Mourad Ould-Slimane
- Department of Orthopedic Surgery, Spine Unit, Rouen University Hospital, institut Rouennais du Rachis, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
| | - Mohammad Hossein Nabian
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University, Tehran, Iran
| | - Anne-Laure Simon
- Service de chirurgie orthopédique infantile, CHU de Robert-Debré, Paris, France
| | - Adèle Happiette
- Service de chirurgie orthopédique infantile, CHU de Robert-Debré, Paris, France
| | | | - Brice Ilharreborde
- Service de chirurgie orthopédique infantile, CHU de Robert-Debré, Paris, France
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11
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Kassab Hassan S, Simon L, Campana M, Julien-Marsollier F, Simon AL, Ilharreborde B. S2-Alar-iliac screw fixation for paediatric neuromuscular scoliosis: Preliminary results after two years. Orthop Traumatol Surg Res 2022; 108:103234. [PMID: 35144011 DOI: 10.1016/j.otsr.2022.103234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Correcting pelvic obliquity is among the main goals of surgery for neuromuscular scoliosis. Spino-pelvic fixation must be stable and capable of withstanding the considerable mechanical forces applied at the lumbo-sacral junction. Selection of the best anchoring option is therefore crucial. S2-alar-iliac (S2AI) screws, which are used in adults, are less often chosen in the French paediatric spinal-surgery community. The objective of this study was to report our preliminary experience with S2AI screws used in the treatment of paediatric patients with neuromuscular scoliosis. HYPOTHESIS Pelvic anchoring by means of S2AI screws is reliable and technically feasible in non-ambulatory children with neuromuscular scoliosis. MATERIALS AND METHODS Consecutive non-ambulatory patients who underwent scoliosis surgery with S2AI screw fixation to the pelvis between 2016 and 2018 were retrospectively included. The surgical procedure consisted in either posterior spinal fusion (PSF) or magnetic growing rod (MGR) implantation. In all patients, radiographs were obtained before surgery, within 3 months after surgery, and at last follow-up; and low-dose computed tomography (CT) was performed before and after surgery. RESULTS We included 25 patients with a mean age of 13.8±4.0 years, 18 managed by PSF and 7 by MGRs. Screw diameters ranged from 7.5 to 9.5mm and all screws were at least 60mm in length. The diameters and lengths were the same on both sides in 16 (89%) patients in the PSF group and in all patients in the MGR group. At last follow-up after a mean of 35.5±3.0 months, pelvic obliquity was corrected in all 23 patients with this abnormality before surgery. Complications consisted of lateral cortical screw breakthrough in 8 (32% of screws) patients and screw malposition in 2 (8% of screws) patients. No clinically significant complications related to the fixation material were recorded. DISCUSSION The results of our study demonstrate the feasibility of S2AI screw fixation in paediatric patients with neuromuscular scoliosis. Pelvic asymmetry and dysmorphism do not contra-indicate the procedure but must be evaluated before surgery. Further work is needed to assess the potential long-term consequences on pain and growth of screw passage through the sacro-iliac joints. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Sammy Kassab Hassan
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Laurie Simon
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Matthieu Campana
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Florence Julien-Marsollier
- Service d'anesthésie - réanimation pédiatrique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Anne-Laure Simon
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France.
| | - Brice Ilharreborde
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
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12
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Julien-Marsollier F, Loiselle M, Brouns K, Brasher C, Dahmani S. Perioperative management of surgical correction of ureteropelvic junction obstruction in children: A comparison of robotic-assisted versus conventional minimally invasive techniques. Paediatr Anaesth 2022; 32:973-975. [PMID: 35476877 DOI: 10.1111/pan.14473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/30/2022] [Accepted: 04/10/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Florence Julien-Marsollier
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2. INSERM U1141. Robert Debré University Hospital, Paris, France
| | - Maud Loiselle
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2. INSERM U1141. Robert Debré University Hospital, Paris, France
| | - Kelly Brouns
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2. INSERM U1141. Robert Debré University Hospital, Paris, France
| | - Christopher Brasher
- Department of Anaesthesia & Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia.,Anaesthesia and Pain Management Research Group, Murdoch Children 's Research Institute, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Souhayl Dahmani
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2. INSERM U1141. Robert Debré University Hospital, Paris, France
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13
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Julien-Marsollier F, Cholet C, Coeffic A, Dupont T, Gauthier T, Loiselle M, Brouns K, Bonnard A, Biran V, Brasher C, Dahmani S. Intraoperative cerebral oxygen saturation and neurological outcomes following surgical management of necrotizing enterocolitis: Predictive factors of neurological complications following neonatal necrotizing enterocolitis: Predictive factors of neurological complications following neonatal necrotizing enterocolitis. Paediatr Anaesth 2022; 32:421-428. [PMID: 34984774 DOI: 10.1111/pan.14392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 12/19/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The goal of the present study was to investigate intraoperative factors associated with major neurological complications at 1 year following surgery for necrotizing enterocolitis. MATERIAL AND METHODS The study consisted of a retrospective review of medical charts of patients operated for over one calendar year in one institution. Data collected included demographic data, cardiac resuscitation at birth, Bell classification, antibiotics usage, time of day of surgery, surgical technique, surgical duration, type of ventilation, intraoperative vasoactive agents, and albumin use, nadir cerebral saturation, the decrease in cerebral saturation from baseline, the time period when cerebral saturation was at least 20% below baseline, and the mean arterial pressure at nadir cerebral saturation. Reported follow-up complications were assessed during formal neonatologist consultation and additional imaging exploration as needed. Analyses included descriptive statistics, and univariable and multivariable statistics. RESULTS The study included 32 patients with no prior clinical neurological complications, of which 25 had normal cerebral imaging. Severe neurological complications occurred in nine patients at 1 year: Intraventricular hemorrhage (N = 2) and Periventricular leukomalacia (N = 7). However, preoperative cerebral imaging was lacking in seven patients. Consequently, the observed neurological complications at 1 year might be present before the surgery. Multivariable analysis found the decrease in cerebral saturation ≥36% from baseline as the only factor associated with the occurrence of those complications. CONCLUSION Intraoperative decrease of cerebral oxygen saturation below ≥36% from baseline is associated with severe neurological complications in neonates undergoing surgery for necrotizing enterocolitis.
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Affiliation(s)
- Florence Julien-Marsollier
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Clementine Cholet
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Adrien Coeffic
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Thibault Dupont
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Thibault Gauthier
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Maud Loiselle
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Kelly Brouns
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Arnaud Bonnard
- Department of general and urological surgery, Robert Debré University Hospital, Paris, France
| | - Valerie Biran
- Université de Paris, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France.,Department of Neonatology, Robert Debré University Hospital, Paris, France
| | - Christopher Brasher
- Department of Anesthesia & Pain Management, Royal Children's Hospital, Melbourne, Australia.,Anesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Centre for Integrated Critical Care, University of Melbourne, Australia
| | - Souhayl Dahmani
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
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14
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Dahmani S, Laffargue A, Dadure C, De Queiroz M, Julien-Marsollier F, Michelet D, Veyckemans F, Amory C, Ludot H, Bert D, Godart J, Laffargue A, Dupont H, Urbina B, Baujard C, Roulleau P, Staiti G, Bordes M, Nouette Gaulain K, Hamonic Y, Semjen F, Jacqmarcq O, Lejus-Bourdeau C, Magne C, Petry L, Ros L, Zang A, Bennis M, Coustets B, Fesseau R, Constant I, Khalil E, Sabourdin N, Audren N, Descarpentries T, Fabre F, Legrand A, Druot E, Orliaguet G, Sabau L, Uhrig L, De La Briere F, Jonckheer K, Mission JP, Scordo L, Couchepin C, Dadure C, De La Arena P, Hertz L, Pirat P, Sola C, Bellon M, Depret-Donatien V, Lesage A. Epidemiology and complications of anaesthesia in the French centres that participated to NECTARINE: A secondary analysis. Anaesth Crit Care Pain Med 2022; 41:101036. [PMID: 35181529 DOI: 10.1016/j.accpm.2022.101036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/08/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Neonatal and infant anaesthesia are associated with a high risk of perioperative complications. The aim of the current study was to describe those risks in France using the French data from the NECTARINE study. MATERIAL AND METHODS Data from the French centres that participated to the NECTARINE study were analysed. The primary goal of the study was the description of patients' characteristics, procedures and perioperative management and their comparison with the results of the European NECTARINE study. Secondary outcomes were the description of major perioperative complications and death. RESULTS Overall, 926 procedures collected in 15 centres (all teaching hospitals) were analysed. Comparison between the French and European NECTARINE cohorts found few differences related to patients' characteristics and procedures. The rate of interventions for critical events (respiratory, haemodynamic, and metabolic) was similar between the two cohorts. Near-infrared spectroscopy monitoring was used in 12% of procedures. Nearly none of the thresholds for these interventions met the published standards. By day 30, complications (respiratory, haemodynamic, metabolic, renal, and liver failure) and death were observed in 14.4% [95% CI 11.6 - 16.4] % and 1.8% [95 % CI 1.1 - 2.9] of cases, respectively. DISCUSSION Although the health status of the patients in the French cohort was less severe, procedures, management and postoperative complications and mortality rates were similar to the European cohort. However, thresholds for interventions were often inadequate in both cohorts. Efforts should be undertaken to improve the knowledge and use of new monitoring devices in this population.
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Affiliation(s)
- Souhayl Dahmani
- French NECTARINE Trial Group, France; Paris Diderot University (Paris VII), Paris, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; FHU I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France.
| | - Anne Laffargue
- Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Christophe Dadure
- Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France; Institut de Neurosciences de Montpellier, Unité INSERM U1051, Montpellier, France
| | - Mathilde De Queiroz
- Department of Anaesthesia and Intensive Care, University Hospital of Lyon, Lyon, France
| | - Florence Julien-Marsollier
- French NECTARINE Trial Group, France; Paris Diderot University (Paris VII), Paris, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; FHU I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Daphné Michelet
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Department of Anaesthesia and Intensive Care, University Hospital of Reims, Reims, France
| | - Francis Veyckemans
- Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Catherine Amory
- French NECTARINE Trial Group, France; American Memorial Hospital CHU Reims, Reims, France
| | - Hugues Ludot
- French NECTARINE Trial Group, France; American Memorial Hospital CHU Reims, Reims, France
| | - Dina Bert
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Juliette Godart
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Anne Laffargue
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Hervé Dupont
- French NECTARINE Trial Group, France; CHU Amiens Picardie, Amiens, France
| | - Benjamin Urbina
- French NECTARINE Trial Group, France; CHU Amiens Picardie, Amiens, France
| | - Catherine Baujard
- French NECTARINE Trial Group, France; CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Philippe Roulleau
- French NECTARINE Trial Group, France; CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Giuseppe Staiti
- French NECTARINE Trial Group, France; CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Maryline Bordes
- French NECTARINE Trial Group, France; CHU de Bordeaux, Bordeaux, France
| | | | - Yann Hamonic
- French NECTARINE Trial Group, France; CHU de Bordeaux, Bordeaux, France
| | - François Semjen
- French NECTARINE Trial Group, France; CHU de Bordeaux, Bordeaux, France
| | | | | | - Cécile Magne
- French NECTARINE Trial Group, France; CHU de Nantes, Nantes, France
| | - Léa Petry
- French NECTARINE Trial Group, France; CHU Nancy, Nancy, France
| | - Lilica Ros
- French NECTARINE Trial Group, France; CHU Nancy, Nancy, France
| | - Aurélien Zang
- French NECTARINE Trial Group, France; CHU Nancy, Nancy, France
| | - Mehdi Bennis
- French NECTARINE Trial Group, France; CHU Toulouse, Toulouse, France
| | - Bernard Coustets
- French NECTARINE Trial Group, France; CHU Toulouse, Toulouse, France
| | - Rose Fesseau
- French NECTARINE Trial Group, France; CHU Toulouse, Toulouse, France
| | - Isabelle Constant
- French NECTARINE Trial Group, France; Hôpital Armand-Trousseau AP-HP, Paris, France
| | - Eliane Khalil
- French NECTARINE Trial Group, France; Hôpital Armand-Trousseau AP-HP, Paris, France
| | - Nada Sabourdin
- French NECTARINE Trial Group, France; Hôpital Armand-Trousseau AP-HP, Paris, France
| | - Noémie Audren
- French NECTARINE Trial Group, France; Hôpital couple enfant, CHU Grenoble Alpes, Grenoble, France
| | - Thomas Descarpentries
- French NECTARINE Trial Group, France; Hôpital couple enfant, CHU Grenoble Alpes, Grenoble, France
| | - Fanny Fabre
- French NECTARINE Trial Group, France; Hôpital couple enfant, CHU Grenoble Alpes, Grenoble, France
| | - Aurélien Legrand
- French NECTARINE Trial Group, France; Hôpital couple enfant, CHU Grenoble Alpes, Grenoble, France
| | - Emilie Druot
- French NECTARINE Trial Group, France; Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Gilles Orliaguet
- French NECTARINE Trial Group, France; Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Lucie Sabau
- French NECTARINE Trial Group, France; Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Lynn Uhrig
- French NECTARINE Trial Group, France; Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - François De La Briere
- French NECTARINE Trial Group, France; Fondation Lenval - Hôpital pour enfants, Nice, France
| | - Karin Jonckheer
- French NECTARINE Trial Group, France; Fondation Lenval - Hôpital pour enfants, Nice, France
| | - Jean-Paul Mission
- French NECTARINE Trial Group, France; Fondation Lenval - Hôpital pour enfants, Nice, France
| | - Lucia Scordo
- French NECTARINE Trial Group, France; Fondation Lenval - Hôpital pour enfants, Nice, France
| | - Caroline Couchepin
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Christophe Dadure
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Pablo De La Arena
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Laurent Hertz
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Philippe Pirat
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Chrystelle Sola
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Myriam Bellon
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Anne Lesage
- French NECTARINE Trial Group, France; Teaching Hospital of Caen, Caen, France
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15
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Simon AL, Angelliaume A, Happiette A, Huneidi M, Julien-Marsollier F, Ilharreborde B. Halo-gravity traction followed by definitive fusion in severe early onset scoliosis: results of a trunk analysis based on biplanar 3D reconstructions. Eur Spine J 2021; 30:3540-3549. [PMID: 34490588 DOI: 10.1007/s00586-021-06986-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/23/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Definitive fusion can be considered in early onset scoliosis (EOS) around triradiate cartilage closure. Halo-gravity traction (HGT) is an old strategy that can help lengthen and balance the spine before fusion. The postoperative changes of the trunk have never been investigated to date with modern imaging. The goal of this study was to analyze the 3D radiological outcomes, and the associated pulmonary function, of a cohort of severe EOS patients treated by definitive posterior fusion prepared by HGT. METHODS All consecutive EOS patients with severe (> 85°) and stiff (flexibility < 25%) curves, treated by HGT followed by posterior fusion, were followed. 3D radiological measurements and pulmonary function were assessed. RESULTS Forty-nine EOS patients underwent fusion, with a mean follow-up of 4 years (± 1). Age at surgery averaged 13.5 years old. HGT protocol reached on average 41% of body weight. Mean preoperative 3D Cobb angle was 95° (± 10) and final correction averaged 68.4% after surgery. 3D T4T12 kyphosis was reduced after surgery (11°, p < 0.01), while the apical vertebral rotation was improved by 27.8% (p = 0.06). 3D thoracic volume increased after surgery (p = 0.02), with a 3D T1T12 height gain averaging 3.7 cm (± 2). Both parameters were significantly correlated with total lung capacity improvement. Seven complications (14.2%) were reported, and 5 patients (10.6%) underwent unplanned revision. CONCLUSION HGT is a safe and efficient strategy to prepare posterior fusion in severe EOS patients. The 3D trunk analysis demonstrated significant postoperative gains in thoracic and spinal lengths, as well as in thoracic volume. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Anne-Laure Simon
- Department of Paediatric Orthopaedics, Robert Debré hospital, AP-HP, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
| | - Audrey Angelliaume
- Department of Paediatric Orthopaedics, Robert Debré hospital, AP-HP, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
| | - Adèle Happiette
- Department of Paediatric Orthopaedics, Robert Debré hospital, AP-HP, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
| | - Maxime Huneidi
- Department of Paediatric Orthopaedics, Robert Debré hospital, AP-HP, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
| | | | - Brice Ilharreborde
- Department of Paediatric Orthopaedics, Robert Debré hospital, AP-HP, Paris University, 48 Boulevard Sérurier, 75019, Paris, France.
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16
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Julien-Marsollier F, Assaker R, Michelet D, Camby M, Galland A, Marsac L, Vacher T, Simon AL, Ilharreborde B, Dahmani S. Effects of opioid-reduced anesthesia during scoliosis surgery in children: a prospective observational study. Pain Manag 2021; 11:679-687. [PMID: 34102877 DOI: 10.2217/pmt-2020-0100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims: Opioid-reduced anesthesia (ORA) was suggested to decrease morphine consumption after adolescent idiopathic scoliosis (AIS) surgery and incidence of chronic pain. Materials & methods: A prospective analysis using the ORA in AIS surgery was performed. Two cohorts were compared: a control group (opioid-based anesthesia) and the ORA group. The main outcome was morphine consumption at day 1. Results: 33 patients operated for AIS using ORA were compared with 36 with opioid-based anesthesia. Morphine consumption was decreased in the ORA group (1.1 mg.kg-1 [0.2-2] vs 0.8 mg.kg-1 [0.3-2]; p = 0.02) at day 1. Persistent neuropathic pain at 1 year was decreased in the ORA group (p = 0.02). Conclusion: The ORA protocol is efficient to reduce postoperative morphine consumption in AIS surgery and preventing neuropathic pain.
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Affiliation(s)
- Florence Julien-Marsollier
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Rita Assaker
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Daphné Michelet
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Matthieu Camby
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Anne Galland
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Lucile Marsac
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Thomas Vacher
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Anne-Laure Simon
- Université de Paris, Paris, France.,Department of Orthopedic Surgery, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Brice Ilharreborde
- Université de Paris, Paris, France.,Department of Orthopedic Surgery, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Souhayl Dahmani
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
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17
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Ayanmanesh F, Abdat R, Jurine A, Azale M, Rousseaux G, Coulons S, Samain E, Brasher C, Julien-Marsollier F, Dahmani S. Transnasal humidified rapid-insufflation ventilatory exchange during rapid sequence induction in children. Anaesth Crit Care Pain Med 2021; 40:100817. [PMID: 33677095 DOI: 10.1016/j.accpm.2021.100817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/13/2020] [Accepted: 10/31/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The objective of this study was to measure the incidence of arterial oxygen desaturation during rapid sequence induction intubation in children following apnoeic oxygenation via transnasal humidified rapid-insufflation ventilatory exchange (THRIVE). METHODS In this prospective observational study, arterial desaturation < 95% SaO2 before intubation was recorded following apnoeic RSI combining an intravenous hypnotic agent, suxamethonium and THRIVE (used during the apnoeic period). The incidence of desaturation was calculated in the whole cohort and according to patients' age (older or younger than 1 year). RESULTS Complete data were collected for 79 patients, 1 day to 15 years of age. Nine patients (11.4%) exhibited arterial desaturation before tracheal intubation and received active facemask ventilation. Patients exhibiting desaturation were more likely to be less than 1 year of age (9/9, (100%) versus 37/70, (52.9%); P = 0.005), to be reported as difficult intubations (5/9, (55.6%) versus 1/70, (1.4%), p < 0.001), and to have regurgitation at induction (2/9, (22.2%) versus 0/70, (0%), p = 0.01). CONCLUSIONS Results of the current study indicated that almost 91% of RSI can be performed without desaturation when THRIVE is used. A comparative controlled study is required to confirm these findings. Specific situations and conditions limiting the efficacy of THRIVE during RSI should also be investigated.
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Affiliation(s)
- Fanny Ayanmanesh
- Department of Anaesthesia and Intensive Care, Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France; Université de Paris, Paris, France; DHU PROTECT. Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France
| | - Rachida Abdat
- Department of Anaesthesia and Intensive Care, Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France; Université de Paris, Paris, France; DHU PROTECT. Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France
| | - Amélie Jurine
- Department of Anaesthesia and Intensive Care, Jean Minjoz Hospital, 3, Bd Alexandre Flemming, 25000 Besançon, France
| | - Mehdi Azale
- Department of Anaesthesia and Intensive Care, Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France; Université de Paris, Paris, France; DHU PROTECT. Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France
| | - Guillaume Rousseaux
- Department of Anaesthesia and Intensive Care, Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France; Université de Paris, Paris, France; DHU PROTECT. Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France
| | - Sarah Coulons
- Department of Anaesthesia and Intensive Care, Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France; Université de Paris, Paris, France; DHU PROTECT. Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France
| | - Emmanuel Samain
- Department of Anaesthesia and Intensive Care, Jean Minjoz Hospital, 3, Bd Alexandre Flemming, 25000 Besançon, France
| | - Christopher Brasher
- Department of Anaesthesia & Pain Management, Royal Children's Hospital, Melbourne, Australia; Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Centre for Integrated Critical Care, University of Melbourne, Melbourne, Australia
| | - Florence Julien-Marsollier
- Department of Anaesthesia and Intensive Care, Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France; Université de Paris, Paris, France; DHU PROTECT. Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France
| | - Souhayl Dahmani
- Department of Anaesthesia and Intensive Care, Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France; Université de Paris, Paris, France; DHU PROTECT. Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France.
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18
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Julien-Marsollier F, Michelet D, Assaker R, Doval A, Louisy S, Madre C, Simon AL, Ilharreborde B, Brasher C, Dahmani S. Enhanced recovery after surgery: Many ways for the same destination. Paediatr Anaesth 2021; 31:375-376. [PMID: 33631036 DOI: 10.1111/pan.14115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Florence Julien-Marsollier
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Daphné Michelet
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Rita Assaker
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Antoine Doval
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Simon Louisy
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | | | - Anne-Laure Simon
- Department of orthopaedic surgery. Robert Debré Hospital, Paris, France
| | | | - Christopher Brasher
- Department of Anaesthesia & Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia.,Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Souhayl Dahmani
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
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19
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Assaker R, Loiselle M, Julien-Marsollier F, Dahmani S. 'Nudge' as a rescue technique for implementing changes in peri-operative care. Eur J Anaesthesiol 2021; 38 Suppl 1:S69-S70. [PMID: 33645935 DOI: 10.1097/eja.0000000000001377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rita Assaker
- From the Department of Anaesthesia and Intensive care, Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris Sorbonne Cité (RA, ML, FJM, SD), Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité (RA, ML, FJM, SD) and DHU PROTECT. INSERM U1141, Robert Debré University Hospital, Paris, France (RA, ML, FJM, SD)
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20
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Colas AE, Azale M, Ayanmanesh F, Tran C, Papapanayotou L, Assaker R, Bruneau B, Julien-Marsollier F, Brasher C, Dahmani S. Mandatory preoperative SARS-CoV-2 infection screening policies for paediatric surgery. Br J Anaesth 2021; 126:e182-e184. [PMID: 33558053 PMCID: PMC7813489 DOI: 10.1016/j.bja.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/27/2020] [Accepted: 01/09/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Anne-Emmanuelle Colas
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Mehdi Azale
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Fanny Ayanmanesh
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Celine Tran
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Loannis Papapanayotou
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Rita Assaker
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Beatrice Bruneau
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Florence Julien-Marsollier
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Christopher Brasher
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Australia; Anesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Centre for Integrated Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Souhayl Dahmani
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France.
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21
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Montalva L, Haffreingue A, Ali L, Clariot S, Julien-Marsollier F, Ghoneimi AE, Peycelon M, Bonnard A. The role of a pediatric tertiary care center in avoiding collateral damage for children with acute appendicitis during the COVID-19 outbreak. Pediatr Surg Int 2020; 36:1397-1405. [PMID: 33070203 PMCID: PMC7568762 DOI: 10.1007/s00383-020-04759-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the impact of the COVID-19 pandemic-related lockdown on management and outcomes of children with acute appendicitis. METHODS A retrospective cohort study was conducted, including children treated for acute appendicitis (January 20th-May 11th, 2020). The data regarding the severity of appendicitis and outcome were collected and compared for two time periods, before and after the nationwide lockdown (March 17th, 2020). RESULTS The number of cases of acute appendicitis increased by 77% during the lockdown (n = 39 vs. n = 69, p = 0.03). During the lockdown, children treated for appendicitis were older (11.1 vs. 8.9 years, p = 0.003), and were more likely to live more than 5 km away from our institution (77% vs. 52%, p = 0.017). Less children had previously consulted a general practitioner (15% vs. 33%, p = 0.028), whereas more children were transferred from other hospitals (52% vs. 31%, p = 0.043). There was no difference in terms of length of hospital stay, rate of postoperative intra-abdominal abscess, ER visits, and readmissions between both periods. Three children (4%) were diagnosed with COVID-19 and appendicitis. CONCLUSIONS Despite an increase in the number of children with appendicitis managed at our hospital during the COVID-19-related lockdown, management, and outcome remained similar. Although our pediatric center was strongly affected by this pandemic, maintaining our prior practice strategies for acute appendicitis avoided the occurrence of collateral damage for those children.
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Affiliation(s)
- Louise Montalva
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France
| | - Aurore Haffreingue
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France
| | - Liza Ali
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France
| | - Simon Clariot
- Department of Anesthesia and Intensive Care, Henri-Mondor University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
| | - Florence Julien-Marsollier
- Department of Anesthesia and Intensive Care, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alaa El Ghoneimi
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France ,University of Paris, Paris, France
| | - Matthieu Peycelon
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France ,University of Paris, Paris, France
| | - Arnaud Bonnard
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France ,University of Paris, Paris, France
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22
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Dagorno C, Pio L, Capri Y, Ali L, Giurgea I, Qoshe L, Morcrette G, Julien-Marsollier F, Sommet J, Chomton M, Berrebi D, Bonnard A. Mowat Wilson syndrome and Hirschsprung disease: a retrospective study on functional outcomes. Pediatr Surg Int 2020; 36:1309-1315. [PMID: 32980962 DOI: 10.1007/s00383-020-04751-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 01/05/2023]
Abstract
AIM OF THE STUDY Mowat Wilson syndrome (MWS) is a complex genetic disorder due to mutation or deletion of the ZEB2 gene (ZFHX1B), including multiple clinical features. Hirschsprung disease is associated with this syndrome with a prevalence between 43 and 57%. The aim of this study was to demonstrate the severe outcomes and the high complication rates in children with MWS, focusing on their complicated follow-up. METHODS A retrospective comparative study was conducted on patients referred to Robert-Debré Children's Hospital for MWS from 2003 to 2018. Multidisciplinary follow-up was carried out by surgeons, geneticists, gastroenterologists, and neurologists. Data regarding patient characteristics, surgical management, postoperative complications, and functional outcomes were collected. RESULTS Over this period of 15 years, 23 patients were diagnosed with MWS. Hirschsprung disease was associated with 10 of them (43%). Of these cases, two patients had recto-sigmoïd aganglionosis (20%), three had aganglionic segment extension to the left colic angle (30%), two to the right colic angle (20%), and three to the whole colon (30%). The median follow-up was 8.5 years (2 months-15 years). All patients had seizures and intellectual disability. Six children (60%) presented with cardiac defects. At the last follow-up, three patients still had a stoma diversion and 7 (70%) were fed orally. One patient died during the first months. Eight (80%) of these children required a second surgery due to complications. At the last follow-up, three patients reported episodes of abdominal bloating (42%), one recurrent treated constipation (14.3%), and one soiling (14.3%). Genetic analysis identified three patients with heterozygous deletions, three with codon mutations, and three with frameshift mutations. CONCLUSIONS MWS associated with Hirschsprung disease has a high rate of immediate surgical complications but some patients may achieve bowel function comparable with non-syndromic HD patients. A multidisciplinary follow-up is required for these patients. LEVEL OF EVIDENCE Retrospective observational single cohort study, Level 3.
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Affiliation(s)
- Claire Dagorno
- Department of Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France
| | - Luca Pio
- Department of Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France. .,Paris University, Paris, France.
| | - Yline Capri
- Department of Genetics, Robert-Debré Children University Hospital, APHP, Paris, France
| | - Liza Ali
- Department of Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France
| | - Irina Giurgea
- Department of Genetics, Trousseau Hospital, APHP, Paris, France
| | - Livia Qoshe
- Princeton Internships in Civic Service, Princeton University, Princeton, NJ, 08542, USA
| | - Guillaume Morcrette
- Department of Pediatric Pathology, Robert-Debré Children University Hospital, APHP, Paris, France
| | - Florence Julien-Marsollier
- Department of Pediatric Anesthesiology, Intensive care and Pain Management, Robert Debré Children University Hospital, APHP, Paris, France.,PRES Paris Sorbonne Cité, Paris University, Paris, France
| | - Julie Sommet
- Pediatric Intensive Care Unit, Robert-Debré Children University Hospital, APHP, Paris, France
| | - Maryline Chomton
- Pediatric Intensive Care Unit, Robert-Debré Children University Hospital, APHP, Paris, France
| | - Dominique Berrebi
- Paris University, Paris, France.,Department of Pediatric Pathology, Robert-Debré Children University Hospital, APHP, Paris, France
| | - Arnaud Bonnard
- Department of Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France.,Paris University, Paris, France
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23
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Julien-Marsollier F, Michelet D, Assaker R, Doval A, Louisy S, Madre C, Simon AL, Ilharreborde B, Brasher C, Dahmani S. Enhanced recovery after surgical correction of adolescent idiopathic scoliosis. Paediatr Anaesth 2020; 30:1068-1076. [PMID: 32750176 DOI: 10.1111/pan.13988] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/08/2020] [Accepted: 07/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few publications in the literature examine enhanced recovery after scoliosis surgery (ERAS) in children, despite significant scientific interest in adults. The objective of the current study was to describe an ERAS protocol for surgical correction of adolescent idiopathic scoliosis (AIS) and its results. METHODS ERAS outcomes were measured in two patient cohorts. Historical controls and ERAS groups were selected from patients managed for scoliosis surgery in 2015 and 2018, respectively. The ERAS protocol included fasting minimization, carbohydrate loading, the avoidance of background morphine infusions, perioperative opioid-sparing protocols, the use of a cooling brace, early physiotherapy, feeding and oral medications, and the early removal of urinary catheters and surgical drains. The main outcome of the study was hospital length of stay. RESULTS Overall, 82 controls and 81 ERAS patients were recruited. ERAS protocols were observed in over 80% of patients for almost items. Median length of hospital stay was significantly lower in the ERAS group (- 3 [95% confidence interval: -2; -4] days). Median morphine consumption was reduced by 25% and 35% on days 2 and 3, respectively. The incidence of PONV did not differ between the two groups, and the incidence of constipation decreased slightly but significantly in the ERAS group on day 2. Pain intensity at rest and movement were lower in the ERAS group at day 2 and 3. CONCLUSIONS The current study suggests an ERAS protocol after adolescent idiopathic scoliosis surgery is associated with reduced hospital length of stay and improved postoperative care.
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Affiliation(s)
- Florence Julien-Marsollier
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Daphné Michelet
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Rita Assaker
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Antoine Doval
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Simon Louisy
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | | | - Anne-Laure Simon
- Department of Orthopaedic Surgery, Robert Debré Hospital, Paris, France
| | | | - Christopher Brasher
- Department of Anaesthesia & Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia.,Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Centre for Integrated Critical Care, University of Melbourne, Melbourne, Vic., Australia
| | - Souhayl Dahmani
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
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Michelet D, Truchot J, Du Fayet De La Tour C, Benichou C, Berdji A, Delivet H, Ceccaldi PF, Plaisance P, Julien-Marsollier F, Dahmani S. The impact of psychological factors on the management of intraoperative haemodynamic events in children. Anaesth Crit Care Pain Med 2020; 39:785-791. [PMID: 33010488 DOI: 10.1016/j.accpm.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Paediatric anaesthesia requires specific theoretical knowledge and practical training. Non-technical skills and psychological factors might influence learning and practice. The aim of this study was to assess personality type and decision-making styles of paediatric anaesthesiology residents during the management of simulated intraoperative life-threatening cases. METHOD Residents in anaesthesiology (between 4 and 5 years of training) participated in a simulated hypoxic cardiac arrest in the operating theatre. Their performance was evaluated using a score derived from international recommended management algorithm. They were asked to answer self-assessment questionnaires regarding both their personality (the five personality factors) and their decision-making style. Correlations between performance and personality were investigated. RESULTS Thirty-eight residents participated in the simulation session and 36 accepted to answer the questionnaires. Good management scoring was positively correlated with agreeableness and conscientiousness personality traits but was negatively correlated with avoidance and spontaneous decision-making styles. DISCUSSION The current study identified personality traits and decision-making styles that might influence the management of critical situations during paediatric anaesthesia. The proper identification of these factors might allow targeted personalised training to improve knowledge mobilisation and translation in the clinical context.
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Affiliation(s)
- Daphné Michelet
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France; Gynaecology and Obstetrics Department, Beaujon Hospital, 92110 Clichy, France
| | - Jennifer Truchot
- Emergency Department, Lariboisière University Hospital, 75010 Paris, France; Gynaecology and Obstetrics Department, Beaujon Hospital, 92110 Clichy, France
| | - Charlotte Du Fayet De La Tour
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France
| | - Candy Benichou
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France
| | - Abdellouahabe Berdji
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France
| | - Honorine Delivet
- Emergency Department, Robert Debré Hospital, 75019 Paris, France
| | - Pierre-Francois Ceccaldi
- Gynaecology and Obstetrics Department, Beaujon Hospital, 92110 Clichy, France; Ilumens Department of Simulation in Healthcare, Paris Diderot University (Paris 7), Université de Paris, Paris, France
| | - Patrick Plaisance
- Emergency Department, Lariboisière University Hospital, 75010 Paris, France; Ilumens Department of Simulation in Healthcare, Paris Diderot University (Paris 7), Université de Paris, Paris, France
| | - Florence Julien-Marsollier
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France
| | - Souhayl Dahmani
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France; UMR INSERM U 676.Robert Debré University Hospital, 75019 Paris, France.
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Assaker R, Colas AE, Julien-Marsollier F, Bruneau B, Marsac L, Greff B, Tri N, Fait C, Brasher C, Dahmani S. Presenting symptoms of COVID-19 in children: a meta-analysis of published studies. Br J Anaesth 2020; 125:e330-e332. [PMID: 32534738 PMCID: PMC7261471 DOI: 10.1016/j.bja.2020.05.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 01/26/2023] Open
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Michelet D, Julien-Marsollier F, Bahaji M, Dahmani S. Potential beneficial effect of pre-operative nebulisation of corticosteroids in children with upper respiratory tract infection. Eur J Anaesthesiol 2019; 36:796-797. [PMID: 31483344 DOI: 10.1097/eja.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Daphné Michelet
- From the Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris Sorbonne Cité (DM, FJ-M, MB, SD), Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité (DM, FJ-M, MB, SD) and DHU PROTECT, Inserm U1141, Robert Debré University Hospital, Paris, France (DM, FJ-M, SD)
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Marsac L, Michelet D, Sola C, Didier-Vidal A, Combet S, Blanc F, Orliaguet G, Aubineau JV, Julien-Marsollier F, Brasher C, Dahmani S. A survey of the anesthetic management of pediatric kidney transplantation in France. Pediatr Transplant 2019; 23:e13509. [PMID: 31168909 DOI: 10.1111/petr.13509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Renal transplantation is the best available therapeutic option for end-stage renal failure in both children and adults. However, little is known about anesthetic practice during pediatric renal transplantation. MATERIAL AND METHODS The study consisted of a national survey about anesthetic practice during pediatric renal transplantation in France. French tertiary pediatric centers performing renal transplants were targeted, and one physician from each team was asked to complete the survey. The survey included patient data, preoperative assessment and optimization data, and intraoperative anesthesia data (drugs, ventilation, and hemodynamic interventions). RESULTS Twenty centers performing kidney transplantation were identified and contacted to complete the survey, and eight responded. Surveyed centers performed 96 of the 122 pediatric kidney transplantations performed in France in 2017 (79%). Centers consistently performed echocardiography and ultrasound examinations of the great veins preoperatively and consistently employed esophageal Doppler cardiac output estimation and vasopressors intraoperatively. All other practices were found to be heterogeneous. Central venous pressure was monitored in six centers, and dopamine was administered perioperatively in two centers. CONCLUSIONS The current study provides a snapshot of the perioperative management of pediatric kidney transplantation in France. Results emphasize the need for both standardization of practice and awareness of recent evidence against the use of CVP monitoring and dopamine infusions.
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Affiliation(s)
- Lucile Marsac
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris, France.,PRES Paris Sorbonne Cité, Paris Diderot University (Paris VII), Paris, France
| | - Daphné Michelet
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris, France.,PRES Paris Sorbonne Cité, Paris Diderot University (Paris VII), Paris, France
| | - Chrystelle Sola
- Pediatric Anesthesia Unit, Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier University, Montpellier, France.,IGF, Montpellier University, CNRS, INSERM, Montpellier, France
| | - Anne Didier-Vidal
- Department of Anesthesia and Intensive Care, Hôpital des Enfants, Groupe Hospitalier Pellegrin, Bordeaux Cedex, France
| | - Sylvie Combet
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Hopital Femme Mere Enfant, Bron, France
| | - Frederic Blanc
- Department of Anesthesia and Intensive Care, Assistance Publique Hôpitaux de Marseille, Timone Enfants Hospital, Aix-Marseille University, Marseille, France
| | - Gilles Orliaguet
- Department of Anesthesia and Intensive Care, Necker-Enfant Malades Hospital, Paris, France.,EA08, Pharmacologie et Évaluation des Thérapeutiques Chez L'enfant et la Femme Enceinte, Paris-Descartes and Paris Descartes University (Paris V), PRES Paris Sorbonne Cité, Paris, France
| | | | - Florence Julien-Marsollier
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris, France.,PRES Paris Sorbonne Cité, Paris Diderot University (Paris VII), Paris, France
| | - Christopher Brasher
- Department of Anesthesia & Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia.,Anaesthesia and Pain Management Research Group, Murdoch Childrens' Research Institute, Parkville, Victoria, Australia
| | - Souhayl Dahmani
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris, France.,PRES Paris Sorbonne Cité, Paris Diderot University (Paris VII), Paris, France.,DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France
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Bruneau B, Julien-Marsollier F, Bevilacqua V, Michelet D, Dahmani S. Postoperative tramadol administration at home after ambulatory surgery in children. Paediatr Anaesth 2019; 29:663-665. [PMID: 30908784 DOI: 10.1111/pan.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Béatrice Bruneau
- Department of Anesthesia, Intensive care and Pain Management, AP-HP, Robert Debré University Hospital, Paris, France.,Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, Paris, France.,DHU PROTECT, RobertDebré University Hospital, Paris, France
| | - Florence Julien-Marsollier
- Department of Anesthesia, Intensive care and Pain Management, AP-HP, Robert Debré University Hospital, Paris, France.,Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, Paris, France.,DHU PROTECT, RobertDebré University Hospital, Paris, France
| | - Vincent Bevilacqua
- Department of Anesthesia, Intensive care and Pain Management, AP-HP, Robert Debré University Hospital, Paris, France.,Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, Paris, France.,DHU PROTECT, RobertDebré University Hospital, Paris, France
| | - Daphné Michelet
- Department of Anesthesia, Intensive care and Pain Management, AP-HP, Robert Debré University Hospital, Paris, France.,Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, Paris, France.,DHU PROTECT, RobertDebré University Hospital, Paris, France
| | - Souhayl Dahmani
- Department of Anesthesia, Intensive care and Pain Management, AP-HP, Robert Debré University Hospital, Paris, France.,Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, Paris, France.,DHU PROTECT, RobertDebré University Hospital, Paris, France
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Michelet D, Julien-Marsollier F, Vacher T, Bellon M, Skhiri A, Bruneau B, Fournier J, Diallo T, Luce V, Brasher C, Dahmani S. Accuracy of the sleep-related breathing disorder scale to diagnose obstructive sleep apnea in children: a meta-analysis. Sleep Med 2019; 54:78-85. [DOI: 10.1016/j.sleep.2018.09.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/13/2018] [Accepted: 09/20/2018] [Indexed: 12/11/2022]
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Bellon M, Skhiri A, Julien-Marsollier F, Malbezin S, Thierno D, Hilly J, ElGhoneimi A, Bonnard A, Michelet D, Dahmani S. Paediatric minimally invasive abdominal and urological surgeries: Current trends and perioperative management. Anaesth Crit Care Pain Med 2018; 37:453-457. [DOI: 10.1016/j.accpm.2017.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/14/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022]
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Julien-Marsollier F, Rachdi K, Caballero MJ, Ayanmanesh F, Vacher T, Horlin AL, Skhiri A, Brasher C, Michelet D, Dahmani S. Evaluation of the analgesia nociception index for monitoring intraoperative analgesia in children. Br J Anaesth 2018; 121:462-468. [PMID: 30032886 DOI: 10.1016/j.bja.2018.03.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/27/2018] [Accepted: 04/26/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Intraoperative analgesia is still administered without guidance. Anaesthetists decide upon dosing on the basis of mean population opioid pharmacological studies and in response to variations in haemodynamic status. However, those techniques have been shown to be imprecise. We assessed the diagnostic value of monitoring the analgesia nociception index (ANI) to detect surgical stimulation in children. METHODS This was an observational study of 2- to 12-yr-old patients 5 min before and after surgical incision. Hypnosis was maintained with sevoflurane and guided by bispectral index. Intraoperative analgesia was administered as a remifentanil infusion titrated to variations in haemodynamic parameters, and ANI monitor values were recorded. ANI parameters assessed included instantaneous ANI (ANIi), mean ANI (ANIm), and the relative change of ANIi to ANIm (DeltaANI=ANIi-ANIm/ANIm). Statistical analyses were performed using receiver-operating-characteristic analysis with determination of the area under the receiver operating characteristic (AUROC) curve and the grey zone. RESULTS Overall, 49 subjects were included in this study. The AUROC was 0.755 (0.738-0.772), 0.771 (0.755-0.787), and 0.756 (0.738-0.774) for ANIi, ANIm, and DeltaANI, respectively. The threshold of ANI parameters indicating the presence of noxious surgical stimuli was ≤53%, ≤56%, and ≤-13.3% for ANIi, ANIm, and DeltaANI, respectively. The percentage of subjects in the inconclusive zone was 41%, 51%, and 33% for ANIi, ANIm, and DeltaANI, respectively. CONCLUSIONS ANI has diagnostic value for detecting surgical stimuli in children.
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Affiliation(s)
- F Julien-Marsollier
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France
| | - K Rachdi
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France
| | - M-J Caballero
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France
| | - F Ayanmanesh
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France
| | - T Vacher
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France
| | - A-L Horlin
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France
| | - A Skhiri
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France
| | - C Brasher
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Australia; Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - D Michelet
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Paris Descartes University, Paris, France
| | - S Dahmani
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France.
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Michelet D, Brasher C, Horlin AL, Bellon M, Julien-Marsollier F, Vacher T, Pontone S, Dahmani S. Ketamine for chronic non-cancer pain: A meta-analysis and trial sequential analysis of randomized controlled trials. Eur J Pain 2017; 22:632-646. [DOI: 10.1002/ejp.1153] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2017] [Indexed: 01/17/2023]
Affiliation(s)
- D. Michelet
- Department of Anaesthesia and Intensive Care; Robert Debre University Hospital; Paris France
- Paris Diderot University; France
| | - C. Brasher
- Department of Anaesthesia and Pain Management; Royal Children's Hospital; Melbourne Australia
| | - A.-L. Horlin
- Department of Anaesthesia and Intensive Care; Robert Debre University Hospital; Paris France
- Paris Diderot University; France
| | - M. Bellon
- Department of Anaesthesia and Intensive Care; Robert Debre University Hospital; Paris France
- Paris Diderot University; France
| | - F. Julien-Marsollier
- Department of Anaesthesia and Intensive Care; Robert Debre University Hospital; Paris France
- Paris Diderot University; France
| | - T. Vacher
- Department of Anaesthesia and Intensive Care; Robert Debre University Hospital; Paris France
- Paris Diderot University; France
| | - S. Pontone
- Paris Diderot University; France
- Department of Palliative Care and Pain Management; Robert Debre University Hospital; Paris France
| | - S. Dahmani
- Department of Anaesthesia and Intensive Care; Robert Debre University Hospital; Paris France
- Paris Diderot University; France
- DHU PROTECT; INSERM U1141; Robert Debre University Hospital; Paris France
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Julien-Marsollier F, Salis P, Abdat R, Diallo T, Van Den Abbelle T, Dahmani S. Predictive factors of early postoperative respiratory complications after tonsillectomy in children with unidentified risks for this complication. Anaesth Crit Care Pain Med 2017; 37:439-445. [PMID: 29033358 DOI: 10.1016/j.accpm.2017.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 06/15/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Tonsillectomy is considered as a therapeutic option in obstructive sleep apnoea syndrome (OSAS). Postoperative respiratory failure is a complication that can require respiratory support. The main objective of our study is to determine risk factors of postoperative respiratory complications in children undergoing tonsillectomy. MATERIAL AND METHODS This is a retrospective single centre observational study including patients with unanticipated postoperative respiratory failure. Patients with a planned preoperative intensive care admission were excluded (age is lower than 2 years, overweight (>95% percentile of BMI), moderate or severe asthma, major medical conditions). Those patients were compared with randomly selected control patients. Factors studied were: age, weight, indication of surgery, ASA status, preoperative illness conditions, durations of surgery and anaesthesia and administered medications. Statistics used a univariate analysis and a multivariate logistic regression. RESULTS Eight hundred and five patients underwent adenotonsillectomy during the study period and 25 developed postoperative respiratory failure. These patients were compared to 103 non-complicated control patients. Age (<4 years), weight (<18kg), indication of surgery (as SOAS), laryngomalacia, stable and minor congenital cardiac malformation and duration of anaesthesia were found statistically associated. Multivariate analysis found that weight <18kg is a risk factor associated with the occurrence of postoperative respiratory failure. Overall the model shows a strong accuracy with an area under the curve of ROC analysis of 0.9 [95% confidence interval: 0.85-0.95]. DISCUSSION Our study found that weight <18kg is a major risk factor for predicting a postoperative respiratory complication.
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Affiliation(s)
- Florence Julien-Marsollier
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France
| | - Pierre Salis
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France
| | - Rachida Abdat
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France
| | - Thierno Diallo
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France
| | - Thierry Van Den Abbelle
- Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France; Department of Ent-Nose and Throat Surgery, Robert Debré University Hospital, AP-HP, 75019 Paris, France; UMR Inserm U 676, Robert Debré University Hospital, 75019 Paris, France
| | - Souhayl Dahmani
- Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France; Department of Ent-Nose and Throat Surgery, Robert Debré University Hospital, AP-HP, 75019 Paris, France.
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Michelet D, Julien-Marsollier F, Hilly J, Diallo T, Vidal C, Dahmani S. Predictive factors of intraoperative cell salvage during pediatric scoliosis surgery. Cell saver during scoliosis surgery in children. Anaesth Crit Care Pain Med 2017; 37:141-146. [PMID: 28546128 DOI: 10.1016/j.accpm.2017.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/17/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Blood-saving strategy during spinal surgery in children often includes recombinant erythropoietin (rEPO) and antifibrinolytic therapapy (AFT). The aim of this study was to investigate the efficacy of intraoperative blood salvage in decreasing homologous blood transfusion. MATERIAL AND METHODS Using the prospective data from patients operated during a one year period for scoliosis correction, we calculate the predictable hematocrit at day postoperative 1 without the use of blood salvage and compare it to the target hematocrit transfusion according to patient's status. Predictors analyzed were: age, weight, surgical indication, Cobb's angle, ASA status, preoperative hemoglobin, number of level fused, sacral fusion and thoracoplasty. Statistical analyses were performed using a classification tree analysis. RESULTS This study included 147 patients. Blood salvage was estimated avoiding homologous blood transfusion in 17 patients. Predictors of the efficacy of blood salvage were: neuromuscular indications, number of level fused and BMI. Blood salvage was found totally ineffective in: patients with no neuromuscular diseases with either: surgeries interesting<13 levels fused or surgeries interesting>13 levels with a preoperative BMI ≥ 21. In all other cases, blood salvage can decrease homologous transfusion. The model exhibited 97% of accurate for the prediction if the inefficacy of blood salvage. The AUCROC of the model was 0.93 [95% confidence interval 0.9 to 0.99] and the overall validation was 60.1% of explained variability. CONCLUSION The present study indicates that blood salvage is ineffective under certain circumstances. More studies are mandatory to confirm these results.
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Affiliation(s)
- Daphné Michelet
- Department of anaesthesia and Intensive care, Robert-Debré University Hospital, 75019 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75019 Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Florence Julien-Marsollier
- Department of anaesthesia and Intensive care, Robert-Debré University Hospital, 75019 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75019 Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Julie Hilly
- Department of anaesthesia and Intensive care, Robert-Debré University Hospital, 75019 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75019 Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Thierno Diallo
- Department of anaesthesia and Intensive care, Robert-Debré University Hospital, 75019 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75019 Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Christophe Vidal
- Department of pediatric orthopedic surgery, Robert-Debré University Hospital, 75000 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75019 Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Souhayl Dahmani
- Department of anaesthesia and Intensive care, Robert-Debré University Hospital, 75019 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75019 Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France.
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Habre W, Disma N, Virag K, Becke K, Hansen TG, Jöhr M, Leva B, Morton NS, Vermeulen PM, Zielinska M, Boda K, Veyckemans F, Klimscha W, Konecny R, Luntzer R, Morawk-Wintersperger U, Neiger F, Rustemeyer L, Breschan C, Frey D, Platzer M, Germann R, Oeding J, Stoegermüller B, Ziegler B, Brotatsch P, Gutmann A, Mausser G, Messerer B, Toller W, Vittinghoff M, Zangl G, Seidel-Ahyai N, Hochhold C, Kroess R, Paal P, Cnudde S, Coucke P, Loveniers B, Mitchell J, Kahn D, Pirotte T, Pregardien C, Veyckemans F, Coppens M, De Hert S, Heyse B, Neckebroek M, Parashchanka A, Van Limmen J, Van Den Eynde N, Vanpeteghem C, Wyffels P, Lalot M, Lechat JP, Stevens F, Casaer S, De Groote F, De Pooter F, De Villé A, Gerin M, Magasich N, Sanchez Torres C, Van Deenen D, Berghmans J, Himpe D, Roofthooft E, Joukes E, Smitz C, Van Reeth V, Huygens C, Lauweryns J, De Smet K, Najafi N, Poelaert J, Van de Velde A, Van Mossevelde V, Bekavac I, Butkovic D, Heli Litvic D, Kerovec Soric I, Maretic H, Moscatello D, Popovic 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Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. The Lancet Respiratory Medicine 2017; 5:412-425. [DOI: 10.1016/s2213-2600(17)30116-9] [Citation(s) in RCA: 355] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 11/24/2022]
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