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Schaefer A, Grousson S, Bessede T, Benhamou D, Ruscio L. Subcostal TAP block: one or two sequential injections? A cadaveric study. Reg Anesth Pain Med 2024:rapm-2023-105079. [PMID: 38395463 DOI: 10.1136/rapm-2023-105079] [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] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND AND OBJECTIVES The subcostal transversus abdominis plane block (scTAPB) provides analgesia to the anterior abdominal wall but analgesic spread following a single injection remains modest and variable. The oblique scTAPB, which is performed with a continuous injection during needle progression into the TAP along the oblique subcostal line, may extend the block to the whole anterior abdominal wall but needle progression by hydrodissection may be difficult, explaining why this block is not widely used. This study investigated if two sequential scTAPB injections (2scTAPI) may reach more nerves than a single scTAPB (1scTAPI). METHODS After institutional approval and under ultrasound guidance, a single injection of 20 mL of blue dye was performed in 16 cadaveric subjects into the TAP along the costal margin and lateral to the semilunaris line (1scTAPI). On the opposite side, a 20 mL of green solution was split into two injections (2scTAPI), using one injection medial and one lateral to the semilunaris line. Dye spread was assessed via gross anatomical dissection using an indirect method to quantify the involvement of the anterior cutaneous branches of the intercostal nerves with each technique. A nerve was considered stained if the dye was observed in the TAP, reaching the costal margin aligned with the bony extremity of its corresponding rib. RESULTS According to the spread to the costal margin, the estimated median number of consecutive nerves reached by dye after 2scTAPI was 5 (IQR 5-6) vs 3 (IQR 3-4) for 1scTAPI (p=0.00001). Spread after 2scTAPI suggested coverage of nerves originating from T8 to T12 in 85% of the subjects, and from T7 to T12 in 5 out of 17 cases. Spread following the 1scTAPI suggested coverage of nerves from T9 to T11 in most cases. CONCLUSIONS In a cadaveric model, a larger spread at the costal margin was obtained after 2scTAPI, suggesting a greater coverage of anterior branches of abdominal wall nerves compared with 1scTAPI. Clinical studies are needed to confirm these results.
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Affiliation(s)
- Augustin Schaefer
- Anesthesia and Intensive Care Medecine, Hôpital Bicêtre, Le Kremlin-Bicetre, France
- INSERM 1195, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Sébastien Grousson
- Anesthesia and Intensive Care Medecine, Hôpital Bicêtre, Le Kremlin-Bicetre, France
| | - Thomas Bessede
- INSERM 1195, Université Paris-Saclay, Le Kremlin Bicêtre, France
- INSERM U 1195, Universite Paris-Saclay, Saint-Aubin, France
| | - Dan Benhamou
- Anesthesia and Intensive Care Medecine, Hôpital Bicêtre, Le Kremlin-Bicetre, France
- INSERM 1195, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Laura Ruscio
- Anesthesia and Intensive Care Medecine, Hôpital Bicêtre, Le Kremlin-Bicetre, France
- INSERM 1195, Université Paris-Saclay, Le Kremlin Bicêtre, France
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Benhamou D, Tant S, Gille B, Bornemann Y, Ruscio L, Kamel K, Dunyach C, Jeannin B, Bouilliant-Linet M, Blanié A. An observer tool to enhance learning of incoming anesthesia residents' skills during simulation training of central venous catheter insertion: a randomized controlled trial. BMC Med Educ 2023; 23:942. [PMID: 38082446 PMCID: PMC10714635 DOI: 10.1186/s12909-023-04915-9] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Central venous catheter (CVC) insertion using simulation is an essential skill for anesthesiologists. Simulation training is an effective mean to master this skill. Given the large number of residents and the limited duration of training sessions, the active practice time is limited and residents remain observers of their colleagues for much of the session. To improve learning during observation periods, the use of an observer tool (OT) has been advocated but its educational effectiveness is not well defined. METHODS Incoming anesthesia residents were randomized to use an OT (i.e. procedural skill-based checklist) (OT+) or not (OT-) when observing other residents during a simulation bootcamp. The primary outcome was a composite score (total 60 points) evaluating CVC procedural skills rated immediately after the training. This score covers theoretical knowledge explored by multiple choice questions (MCQs) (/20), perceived improvement in knowledge and skills (/20), perceived impact on future professional life (/10) and satisfaction (/10). Measurements were repeated 1 month later. Residents in each group recorded the number of CVCs placed and their clinical outcomes (attempts, complications) during the first month of their clinical rotation using a logbook. RESULTS Immediately after training, the composite score was similar between the two groups: 45.3 ± 4.2 (OT+, n = 49) and 44.4 ± 4.8 (OT-, n = 42) (p = 0.323). Analysis of sub-items also showed no difference. Results at 1 month were not different between groups. Analysis of the logbook showed no difference between groups. No serious complications were reported. CONCLUSIONS The use of a procedural task-based OT by incoming anesthesia residents and used during CVC insertion simulation training was not associated with better learning outcomes, neither immediately after the session nor when re-evaluated 1 month later. The training at least once on simulator of all residents could limit the impact of OT. Further studies are necessary to define the place of OT in simulation training.
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Affiliation(s)
- Dan Benhamou
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
- CIAMS, Univ. Paris-Saclay, Université Paris-Saclay, Orsay Cedex, 91405, France
- CIAMS, Université d'Orléans, Orléans, 45067, France
| | - Sarah Tant
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Benoit Gille
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Yannis Bornemann
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Laura Ruscio
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Karl Kamel
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Chloé Dunyach
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Bénédicte Jeannin
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Maxime Bouilliant-Linet
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Antonia Blanié
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France.
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France.
- CIAMS, Univ. Paris-Saclay, Université Paris-Saclay, Orsay Cedex, 91405, France.
- CIAMS, Université d'Orléans, Orléans, 45067, France.
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Bloc S, Alfonsi P, Belbachir A, Beaussier M, Bouvet L, Campard S, Campion S, Cazenave L, Diemunsch P, Di Maria S, Dufour G, Fabri S, Fletcher D, Garnier M, Godier A, Grillo P, Huet O, Joosten A, Lasocki S, Le Guen M, Le Saché F, Macquer I, Marquis C, de Montblanc J, Maurice-Szamburski A, Nguyen YL, Ruscio L, Zieleskiewicz L, Caillard A, Weiss E. Guidelines on perioperative optimization protocol for the adult patient 2023. Anaesth Crit Care Pain Med 2023; 42:101264. [PMID: 37295649 DOI: 10.1016/j.accpm.2023.101264] [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] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The French Society of Anesthesiology and Intensive Care Medicine [Société Française d'Anesthésie et de Réanimation (SFAR)] aimed at providing guidelines for the implementation of perioperative optimization programs. DESIGN A consensus committee of 29 experts from the SFAR was convened. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Four fields were defined: 1) Generalities on perioperative optimization programs; 2) Preoperative measures; 3) Intraoperative measures and; 4) Postoperative measures. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. The recommendations were formulated according to the GRADE® methodology and then voted on by all the experts according to the GRADE grid method. As the GRADE® methodology could have been fully applied for the vast majority of questions, the recommendations were formulated using a "formalized expert recommendations" format. RESULTS The experts' work on synthesis and application of the GRADE® method resulted in 30 recommendations. Among the formalized recommendations, 19 were found to have a high level of evidence (GRADE 1±) and ten a low level of evidence (GRADE 2±). For one recommendation, the GRADE methodology could not be fully applied, resulting in an expert opinion. Two questions did not find any response in the literature. After two rounds of rating and several amendments, strong agreement was reached for all the recommendations. CONCLUSIONS Strong agreement among the experts was obtained to provide 30 recommendations for the elaboration and/or implementation of perioperative optimization programs in the highest number of surgical fields.
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Affiliation(s)
- Sébastien Bloc
- Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, France; Department of Anesthesiology, Clinique Drouot Sport, Paris, France.
| | - Pascal Alfonsi
- Department of Anesthesia, University of Paris Descartes, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, F-75674 Paris Cedex 14, France
| | - Anissa Belbachir
- Service d'Anesthésie Réanimation, UF Douleur, Assistance Publique Hôpitaux de Paris, APHP.Centre, Site Cochin, Paris, France
| | - Marc Beaussier
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | | | - Sébastien Campion
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie-Réanimation, F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
| | - Laure Cazenave
- Department of Anaesthesia and Critical Care, Hospices Civils de Lyon, Lyon, France; Groupe Jeunes, French Society of Anaesthesia and Intensive Care Medicine (SFAR), 75016 Paris, France
| | - Pierre Diemunsch
- Unité de Réanimation Chirurgicale, Service d'Anesthésie-réanimation Chirurgicale, Pôle Anesthésie-Réanimations Chirurgicales, Samu-Smur, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, Avenue Molière, 67098 Strasbourg Cedex, France
| | - Sophie Di Maria
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Dufour
- Service d'Anesthésie-Réanimation, CHU de Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75013 Paris, France
| | - Stéphanie Fabri
- Faculty of Economics, Management & Accountancy, University of Malta, Malta
| | - Dominique Fletcher
- Université de Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise-Paré, Service d'Anesthésie, 9, Avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Marc Garnier
- Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire Rive Droite, Paris, France
| | - Anne Godier
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, France
| | | | - Olivier Huet
- CHU de Brest, Anesthesia and Intensive Care Unit, Brest, France
| | - Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Villejuif, France
| | | | - Morgan Le Guen
- Paris Saclay University, Department of Anaesthesia and Pain Medicine, Foch Hospital, 92150 Suresnes, France
| | - Frédéric Le Saché
- Department of Anesthesiology, Clinique Drouot Sport, Paris, France; DMU DREAM Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Isabelle Macquer
- Bordeaux University Hospitals, Bordeaux, Anaesthesia and Intensive Care Medicine Department, Bordeaux, France
| | - Constance Marquis
- Clinique du Sport, Département d'Anesthésie et Réanimation, Médipole Garonne, 45 rue de Gironis - CS 13 624, 31036 Toulouse Cedex 1, France
| | - Jacques de Montblanc
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Yên-Lan Nguyen
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France
| | - Laura Ruscio
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France; INSERM U 1195, Université Paris-Saclay, Saint-Aubin, Île-de-France, France
| | - Laurent Zieleskiewicz
- Service d'Anesthésie Réanimation, Hôpital Nord, AP-HM, Marseille, Aix Marseille Université, C2VN, France
| | - Anaîs Caillard
- Centre Hospitalier Universitaire La Cavale Blanche Université de Bretagne Ouest, Anaesthesiology, Critical Care and Perioperative Medicine Department, Brest, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP, Nord, Clichy, France; University of Paris, Paris, France; Inserm UMR_S1149, Centre for Research on Inflammation, Paris, France
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Ruscio L, Mortazavi A, de Montblanc J, Zetlaoui P, Bessede T, Benhamou D. Effect of catheter type on dye spread in the thoracic paravertebral space: a cadaveric study in 16 subjects. Reg Anesth Pain Med 2020; 46:282-283. [PMID: 33122423 DOI: 10.1136/rapm-2020-101637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Laura Ruscio
- INSERM U 1195, Université Paris-Saclay, Saint-Aubin, Île-de-France, France .,Anesthésie Réanimation, Hopital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
| | - Antoine Mortazavi
- Anesthésie Réanimation, Hopital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
| | - Jacques de Montblanc
- Anesthésie Réanimation, Hopital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
| | - Paul Zetlaoui
- Anesthésie Réanimation, Hopital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
| | - Thomas Bessede
- INSERM U 1195, Université Paris-Saclay, Saint-Aubin, Île-de-France, France.,Service d'Urologie, Hopital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
| | - Dan Benhamou
- INSERM U 1195, Université Paris-Saclay, Saint-Aubin, Île-de-France, France.,Anesthésie Réanimation, Hopital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
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Ruscio L, Planche O, Zetlaoui P, Benhamou D. Percutaneous Radiofrequency Ablation of Pulmonary Metastasis and Thoracic Paravertebral Block Under Computed Tomographic Scan Guidance: A Case Report. A A Pract 2019; 11:213-215. [PMID: 29702487 DOI: 10.1213/xaa.0000000000000784] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pain during and after pulmonary percutaneous radiofrequency ablation (RFA) may be severe enough to require opioids. Thoracic paravertebral block (TPVB) is a regional anesthetic technique that can relieve pain during and after abdominal or thoracic painful procedures. We report the use of TPVB to relieve postprocedural pain in a 50-year-old woman after RFA of lung metastasis. The TPVB was performed under computed tomographic guidance by the anesthesiologist. The patient was pain free (rest and mobilization) during the first postoperative 36 hours. TPVB may represent an easy, safe, and effective strategy to prevent or treat postoperative pain after pulmonary RFA.
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Affiliation(s)
- Laura Ruscio
- From the Service d'Anesthésie-Réanimation, Hôpital de Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | - Olivier Planche
- Service de Radiologie, Hôpitaux Paris-Sud, Hôpital de Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | - Paul Zetlaoui
- From the Service d'Anesthésie-Réanimation, Hôpital de Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | - Dan Benhamou
- From the Service d'Anesthésie-Réanimation, Hôpital de Bicêtre, AP-HP, Le Kremlin Bicêtre, France
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Fessenmeyer C, Ruscio L, Blanié A, De Montblanc J, Benhamou D. Epidural Analgesia after Colorectal Surgery Within an Enhanced Recovery Program. J Am Coll Surg 2018; 226:337-338. [PMID: 29478475 DOI: 10.1016/j.jamcollsurg.2018.01.001] [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] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/08/2018] [Indexed: 11/28/2022]
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Legrand G, Ruscio L, Benhamou D, Pelletier-Fleury N. Goal-Directed Fluid Therapy Guided by Cardiac Monitoring During High-Risk Abdominal Surgery in Adult Patients: Cost-Effectiveness Analysis of Esophageal Doppler and Arterial Pulse Pressure Waveform Analysis. Value Health 2015; 18:605-613. [PMID: 26297088 DOI: 10.1016/j.jval.2015.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 02/08/2015] [Accepted: 04/12/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Several minimally invasive techniques for cardiac output monitoring such as the esophageal Doppler (ED) and arterial pulse pressure waveform analysis (APPWA) have been shown to improve surgical outcomes compared with conventional clinical assessment (CCA). OBJECTIVE To evaluate the cost-effectiveness of these techniques in high-risk abdominal surgery from the perspective of the French public health insurance fund. METHODS An analytical decision model was constructed to compare the cost-effectiveness of ED, APPWA, and CCA. Effectiveness data were defined from meta-analyses of randomized clinical trials. The clinical end points were avoidance of hospital mortality and avoidance of major complications. Hospital costs were estimated by the cost of corresponding diagnosis-related groups. RESULTS Both goal-directed therapy strategies evaluated were more effective and less costly than CCA. Perioperative mortality and the rate of major complications were reduced by the use of ED and APPWA. Cost reduction was mainly due to the decrease in the rate of major complications. APPWA was dominant compared with ED in 71.6% and 27.6% and dominated in 23.8% and 20.8% of the cases when the end point considered was "major complications avoided" and "death avoided," respectively. Regarding cost per death avoided, APPWA was more likely to be cost-effective than ED in a wide range of willingness to pay. CONCLUSIONS Cardiac output monitoring during high-risk abdominal surgery is cost-effective and is associated with a reduced rate of hospital mortality and major complications, whatever the device used. The two devices evaluated had negligible costs compared with the observed reduction in hospital costs. Our comparative studies suggest a larger effect with APPWA that needs to be confirmed by further studies.
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Affiliation(s)
- Guillaume Legrand
- Department of Urology and Transplantation, Saint-Louis Hospital, Paris, France; Center of Research, Medicine, Sciences, Mental Health, Society (CERMES 3), Villejuif, France.
| | - Laura Ruscio
- Department of Anesthesia and Reanimation, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Dan Benhamou
- Department of Anesthesia and Reanimation, Bicêtre Hospital, Le Kremlin Bicêtre, France; French Society of Anesthesia and Reanimation (SFAR), Paris, France
| | - Nathalie Pelletier-Fleury
- Team 1 "Health Economic - research on Health Service". Center of Research in Epidemiology and Health of Populations (UMR 1018), Villejuif, France
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de Montblanc J, Ruscio L, Mazoit JX, Benhamou D. A systematic review and meta-analysis of the i-gel®vs laryngeal mask airway in adults. Anaesthesia 2014; 69:1151-62. [DOI: 10.1111/anae.12772] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J. de Montblanc
- Hôpitaux Universitaires Paris-Sud (AP-HP); Hôpital de Bicêtre; Le Kremlin Bicetre Cedex France
| | - L. Ruscio
- Hôpitaux Universitaires Paris-Sud (AP-HP); Hôpital de Bicêtre; Le Kremlin Bicetre Cedex France
| | - J. X. Mazoit
- Hôpitaux Universitaires Paris-Sud (AP-HP); Hôpital de Bicêtre; Le Kremlin Bicetre Cedex France
| | - D. Benhamou
- Hôpitaux Universitaires Paris-Sud (AP-HP); Hôpital de Bicêtre; Le Kremlin Bicetre Cedex France
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Begin M, Ruscio L, Ratte L, Bartier O, Gagey O, Soubeyrand M. Hinged elbow fixator: an extracorporeal technique to position the hinge based on an original guidewire device. ACTA ACUST UNITED AC 2013; 32:210-8. [PMID: 23731669 DOI: 10.1016/j.main.2013.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/29/2012] [Revised: 04/19/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The application of a hinged elbow external fixator is technically demanding because the hinge axis must coincide exactly with the flexion-extension axis of the elbow. The standard technique involves inserting a 3-mm K-wire freehand into the distal humerus to materialize the flexion-extension axis. We designed a guidewire device for extracorporeal hinge positioning without K-wire insertion. In a cadaver study, we compared freehand K-wire insertion and our extracorporeal technique. METHODS In 12 cadaveric elbows, we induced acute elbow instability by sectioning the medial collateral ligament complex and the anterior and posterior capsule. A hinged external fixator was applied to each elbow using both techniques. The outcome measures were procedure duration, number of image-intensifier shots (as a measure of radiation exposure), and passive motion range after fixator implantation. RESULTS Compared with the freehand K-wire technique, the extracorporeal technique provided greater range of motion and significantly lower values for procedure duration and number of image-intensifier shots. Data dispersion was less marked with the extracorporeal technique, indicating better reproducibility. CONCLUSION The extracorporeal technique based on a guidewire device enabled non-invasive positioning of a hinged elbow external fixator. This technique was faster, less irradiating, and more reproducible than the freehand K-wire technique.
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Affiliation(s)
- M Begin
- Centre hospitalier de Bicêtre, AP-HP, 94270 Paris, France.
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Conti G, Spadetta G, Rocco M, Antonelli M, Ruscio L, Gionfrida E, Angiuli G. Non invasive ventilation in the treatment of FUdr-induced lesional pulmonary oedema. Minerva Anestesiol 2000; 66:561-4. [PMID: 10965737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
2-deoxy-5-fluorouridine, also known as floxuridine (FUdr) is a fluoropyridine antimetabolite, used in the treatment of metastatic renal cell carcinoma. We report the first case of lesional pulmonary oedema developed after receiving Fudr, recently treated in our unit. The patient refused endotracheal intubation, and was successfully treated associating noninvasive ventilation (NIV) with full-face mask to steroid treatment. The authors conclude that mechanical ventilation via face-mask can be an effective, comfortable, dignified method of support for patients with end-stage disease and acute respiratory failure.
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Affiliation(s)
- G Conti
- Università degli Studi Roma La Sapienza
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