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Tropis C, Pey V, Sallese M, Pereira O, Le-Gonidec S, Labaste F, Valet P, Minville V, Dray C. Implication du tissu adipeux de l’individu obèse dans le développement des dysfonctions cognitives postopératoires. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ruiz S, Concordet D, Lanot T, Georges B, Goudy P, Baklouti S, Mané C, Losha E, Vinour H, Rousset D, Lavit M, Minville V, Conil JM, Gandia P. Hydroxychloroquine lung pharmacokinetics in critically ill patients with COVID-19. Int J Antimicrob Agents 2020; 57:106247. [PMID: 33259916 PMCID: PMC7698654 DOI: 10.1016/j.ijantimicag.2020.106247] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/27/2020] [Accepted: 11/22/2020] [Indexed: 12/27/2022]
Abstract
HCQ pharmacokinetics in COVID-19 patients cannot be predicted using data from lupus or rheumatoid arthritis patients. Bronchoalveolar lavage fluid may be a more instructive matrix than plasma on the degree of HCQ lung exposure. Low plasma concentrations should not induce an increase in drug dosage because lung exposure could already be high.
Different dosage regimens of hydroxychloroquine (HCQ) have been used to manage COVID-19 (coronavirus disease 2019) patients, with no information on lung exposure in this population. The aim of our study was to evaluate HCQ concentrations in the lung epithelial lining fluid (ELF) in patients infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the virus that causes COVID-19. This was a retrospective, observational, multicentre, pharmacokinetic study of HCQ in critically ill COVID-19 patients. No additional interventions or additional samples compared with standard care of these patients were conducted in our teaching hospital. We included all intubated COVID-19 patients treated with crushed HCQ tablets, regardless of the dosage administered by nasogastric tube. Blood and bronchoalveolar lavage samples (n = 28) were collected from 22 COVID-19 patients and total HCQ concentrations in ELF were estimated. Median (interquartile range) HCQ plasma concentrations were 0.09 (0.06–0.14) mg/L and 0.07 (0.05–0.08) mg/L for 400 mg × 1/day and 200 mg × 3/day, respectively. Median HCQ ELF concentrations were 3.74 (1.10–7.26) mg/L and 1.81 (1.20–7.25) for 400 mg × 1/day and 200 mg × 3/day, respectively. The median ratio of ELF/plasma concentrations was 40.0 (7.3–162.7) and 21.2 (18.4–109.5) for 400 mg × 1/day and 200 mg × 3/day, respectively. ELF exposure is likely to be underestimated from HCQ concentrations in plasma. In clinical practice, low plasma concentrations should not induce an increase in drug dosage because lung exposure may already be high.
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Affiliation(s)
- S Ruiz
- CHU de Toulouse, Réanimation Polyvalente Hôpital Rangueil, Pôle d'Anesthésie-Réanimation, 1 avenue du Professeur Jean Poulhès, 31059, Toulouse cedex 9, France.
| | - D Concordet
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, BP 87614, 31076, Toulouse cedex 3, France
| | - T Lanot
- CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - B Georges
- CHU de Toulouse, Réanimation Polyvalente Hôpital Rangueil, Pôle d'Anesthésie-Réanimation, 1 avenue du Professeur Jean Poulhès, 31059, Toulouse cedex 9, France
| | - P Goudy
- CHU de Toulouse, Réanimation Polyvalente Hôpital Rangueil, Pôle d'Anesthésie-Réanimation, 1 avenue du Professeur Jean Poulhès, 31059, Toulouse cedex 9, France
| | - S Baklouti
- CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - C Mané
- CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - E Losha
- CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - H Vinour
- CHU de Toulouse, Réanimation Polyvalente URM, Pôle d'Anesthésie-Réanimation, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - D Rousset
- CHU de Toulouse, Réanimation Neurochirurgicale, Pôle d'Anesthésie-Réanimation, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - M Lavit
- CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - V Minville
- CHU de Toulouse, Réanimation Polyvalente Hôpital Rangueil, Pôle d'Anesthésie-Réanimation, 1 avenue du Professeur Jean Poulhès, 31059, Toulouse cedex 9, France
| | - J-M Conil
- CHU de Toulouse, Réanimation Polyvalente Hôpital Rangueil, Pôle d'Anesthésie-Réanimation, 1 avenue du Professeur Jean Poulhès, 31059, Toulouse cedex 9, France
| | - P Gandia
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, BP 87614, 31076, Toulouse cedex 3, France; CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
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Jourdes A, Lafaurie M, Martin-Blondel G, Delobel P, Faruch M, Charpentier S, Minville V, Silva S, Thalamas C, Sommet A, Moulis G. Clinical characteristics and outcome of hospitalized patients with SARS-CoV-2 infection at Toulouse University hospital (France). Results from the Covid-clinic-Toul cohort. Rev Med Interne 2020; 41:732-740. [PMID: 33077266 PMCID: PMC7540209 DOI: 10.1016/j.revmed.2020.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/06/2020] [Accepted: 08/29/2020] [Indexed: 01/08/2023]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide from epicenter of Wuhan, China since December 2019. The aim of our study was to describe the clinical characteristics and outcome of hospitalized patients with SARS-CoV-2 pneumonia at the Toulouse university hospital, France. Patients and methods We selected the patients included from March 7, 2020 to April 20, 2020 in the retrolective Covid-clinic-Toul cohort that follows all hospitalized patients with SARS-CoV-2 infection at the Toulouse Hospital. Cases were confirmed by real-time reverse transcriptase polymerase chain reaction. We report demographics, clinical, biological and radiological features, as well as unfavorable outcome at Day 14 after admission (admission in an intensive care unit, mechanical ventilation, death). Results Among 263 hospitalized patients, the median age was 65 years and 155 (58.9%) were males. Two hundred and twenty-seven patients (86.3%) had at least one comorbidity. The median time from first symptom to hospital admission was 7.0 days (interquartile range: 4–10). On day 14 after admission, 111 patients (42.2%) had been transferred to intensive care unit (ICU), including 50 (19.0%) on Day 1; 61 (23.1%) needed mechanical ventilation and 19 patients (7.2%) had died. Patients admitted to ICU at Day 1 of admission (n = 50) were more frequently men (66.0% vs 57.3%), smokers (25.0% vs 7.1%), with obesity (42.0% vs 24.7%) and had a higher mean level of C-reactive protein (median: 110.9 mg/L vs 46.2 mg/L). Conclusion This cohort provides epidemiological data on SARS-CoV-2 in hospitalized patients in a University hospital in the South of France.
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Affiliation(s)
- A Jourdes
- Service des maladies infectieuses et tropicales, CHU de Toulouse, Toulouse, France
| | - M Lafaurie
- Centre d'investigation clinique 1436, CHU de Toulouse, Toulouse, France; Service de pharmacologie médicale et clinique, CHU de Toulouse, Toulouse, France.
| | - G Martin-Blondel
- Service des maladies infectieuses et tropicales, CHU de Toulouse, Toulouse, France
| | - P Delobel
- Service des maladies infectieuses et tropicales, CHU de Toulouse, Toulouse, France
| | - M Faruch
- Service de radiologie et imagerie médicale, CHU de Toulouse, Toulouse, France
| | - S Charpentier
- Service des urgences, CHU de Toulouse, Toulouse, France
| | - V Minville
- Service de réanimation, CHU de Toulouse, Toulouse, France
| | - S Silva
- Service de réanimation, CHU de Toulouse, Toulouse, France
| | - C Thalamas
- Centre d'investigation clinique 1436, CHU de Toulouse, Toulouse, France; Service de pharmacologie médicale et clinique, CHU de Toulouse, Toulouse, France
| | - A Sommet
- Centre d'investigation clinique 1436, CHU de Toulouse, Toulouse, France; Service de pharmacologie médicale et clinique, CHU de Toulouse, Toulouse, France
| | - G Moulis
- Centre d'investigation clinique 1436, CHU de Toulouse, Toulouse, France; Service de médecine interne, CHU de Toulouse, Toulouse, France
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Dolsan A, Bruneteau L, Roche C, Ferré F, Labaste F, Sommet A, Conil JM, Minville V. Comparison of intubating conditions after induction with propofol and remifentanil or sufentanil : Randomized controlled REMIDENT trial for surgical tooth extraction. Anaesthesist 2020; 69:262-269. [PMID: 32112114 DOI: 10.1007/s00101-020-00739-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/05/2019] [Accepted: 12/13/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to compare tracheal intubation conditions after induction of anesthesia with a bolus of propofol-sufentanil or propofol-remifentanil and a rapid induction technique. MATERIAL AND METHODS A total of 70 patients (American Society of Anesthesiologists (ASA) classification I‑II) undergoing outpatient surgery under general anesthesia with intubation for tooth extraction were randomly assigned to two groups in this double-blind study. Patients received either a bolus of remifentanil (3 μg/kg) or sufentanil (0.3 μg/kg) together with 2.5 mg/kg propofol for intubation. The primary outcome was the percentage of excellent intubation conditions and the secondary outcomes were the percentage of patients with a decrease of over 20% in mean arterial pressure (MAP) or heart rate (HR), time to achieve spontaneous respiration, time between the end of surgery and extubation and time to achieve an Aldrete score of 10. VAS pain score was >3 or having laryngeal pain 15 min after arriving in the postanesthesia care unit (PACU) were also analyzed. RESULTS Intubating conditions (perfect + good conditions) were significantly better with remifentanil than with sufentanil (88.5% vs. 68.6%; p = 0.01). When using remifentanil, the hemodynamic conditions were good. Using remifentanil did not significantly increase the pain score or the laryngeal pain in the recovery room. This was confirmed by no significant differences between the groups for morphine consumption. Remifentanil significantly decreased the time to achieve an Aldrete score of 10. CONCLUSION When intubation without muscle relaxants is required, intubating conditions are much better when a remifentanil bolus is used compared to a sufentanil bolus. The remifentanil/propofol rapid induction technique is a valuable technique to quickly intubate and achieve good conditions.
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Affiliation(s)
- A Dolsan
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France
| | - L Bruneteau
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France
| | - C Roche
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France
| | - F Ferré
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France
| | - F Labaste
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France
| | - A Sommet
- Laboratory of Medical and Clinical Pharmacology, Pharmacoepidemiology, Inserm U1027, Toulouse University, Faculty of Medicine, Toulouse, France
| | - J-M Conil
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France
| | - V Minville
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France.
- INSERM, U1048, Université Paul Sabatier, Institute of Metabolic and Cardiovascular Diseases, I2MC, 31432, Toulouse, France.
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Ferré F, Pommier M, Laumonerie P, Ferrier A, Menut R, Bosch L, Balech V, Bonnevialle N, Minville V. Hemidiaphragmatic paralysis following ultrasound‐guided anterior vs. posterior suprascapular nerve block: a double‐blind, randomised control trial. Anaesthesia 2020; 75:499-508. [DOI: 10.1111/anae.14978] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2019] [Indexed: 12/26/2022]
Affiliation(s)
- F. Ferré
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - M. Pommier
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - P. Laumonerie
- Département d'Orthopédie Traumatologie Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - A. Ferrier
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - R. Menut
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - L. Bosch
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - V. Balech
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - N. Bonnevialle
- Département d'Orthopédie Traumatologie Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - V. Minville
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
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Beloeil H, Albaladejo P, Sion A, Durand M, Martinez V, Lasocki S, Futier E, Verzili D, Minville V, Fessenmeyer C, Belbachir A, Aubrun F, Renault A, Bellissant E, Bedague D, Blanié A, Casez M, Chanques G, Chaize C, Dessertaine G, Ferré F, Gaide Chevronnay L, Hébrard A, Hespel A, Jaber S, de Jong A, Lahjaouzi A, Marino M, Moury P, Neau A, Protar D, Rhem D, Rineau E, Robin S, Rossignol E, Soucemarianadin M, Veaceslav S. Multicentre, prospective, double-blind, randomised controlled clinical trial comparing different non-opioid analgesic combinations with morphine for postoperative analgesia: the OCTOPUS study. Br J Anaesth 2019; 122:e98-e106. [DOI: 10.1016/j.bja.2018.10.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/14/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022] Open
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Faguer S, Tardif E, Mayeur N, Labaste F, Grunenwald E, Minville V, Marcheix B, Schanstra J. Incidence et facteurs prédictifs d’insuffisance rénale aiguë après chirurgie cardiaque sous circulation extracorporelle : cohorte prospective monocentrique de 509 patients. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ducos G, Mathe O, Balardy L, Lozano S, Kurrek M, Ruiz J, Riu-Poulenc B, Fourcade O, Silva S, Minville V. Influence of Age on Decision-Making Process to Limit or Withdraw Life-Sustaining Treatment in the Intensive Care Unit - A Single Center Prospective Observational Study. J Frailty Aging 2018; 6:148-153. [PMID: 28721432 DOI: 10.14283/jfa.2017.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The increasing age in the industrialized countries places significant demands on intensive care unit (ICU) resources and this triggers debates about end-of-life care for the elderly. OBJECTIVES We sought to determine the impact of age on the decision-making process to limit or withdraw life-sustaining treatment (DWLST) in an ICU in France. We hypothesized that there are differences in the decision-making process for young and old patients. DESIGN, SETTING, PARTICIPANTS We prospectively studied end-of-life decision-making for all consecutive admissions (n=390) to a tertiary care university ICU in Toulouse, France over a period of 11 months between January and October 2011. RESULTS Among the 390 patients included in the study (age ≥70yo, n=95; age <70yo, n=295) DWLST were more common for patients 70 years or older (43% for age ≥70yo vs. 16% for age <70yo, p <0.0001). Reasons for DWLST were different in the 2 groups, with the 'no alternative treatment options' and 'severity of illness' as the most frequent reasons cited for the younger group whereas it was 'severity of illness' for the older group. 'Advanced age' led to DWLSTs in 43% of the decisions in the group ≥70yo (vs. 0% in the group <70yo, p <0.0001). Multivariate logistic regression showed a high SAPS II score and age ≥70yo as independent risk factors for DWLSTs in the ICU. We did not find age ≥70yo as an independent risk factor for mortality in ICU. CONCLUSION We found that age ≥70yo was an independent risk factor for DWLSTs for patients in the ICU, but not for their mortality. Reasons leading to DWLSTs are different according to the age of patients.
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Affiliation(s)
- G Ducos
- Prof. Vincent Minville, Department of Anesthesiology and Intensive Care, Toulouse University Hospital, Institut des Maladies Métaboliques et Cardiovasculaires, INSERM U1048, Université de Toulouse, UPS, Toulouse, France, Avenue, Jean Poulhès,Toulouse, France, , phone: +33 5 61 32 27 91 Fax: +33 5 61 32 31 40
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Delmas C, Zapetskaia T, Conil JM, Georges B, Vardon-Bounes F, Seguin T, Crognier L, Fourcade O, Brouchet L, Minville V, Silva S. 3-month prognostic impact of severe acute renal failure under veno-venous ECMO support: Importance of time of onset. J Crit Care 2017; 44:63-71. [PMID: 29073534 DOI: 10.1016/j.jcrc.2017.10.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 08/07/2017] [Revised: 09/19/2017] [Accepted: 10/17/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Veno-venous ECMO is increasingly used for the management of refractory ARDS. In this context, acute kidney injury (AKI) is a major and frequent complication, often associated with poor outcome. We aimed to identify characteristics associated with severe renal failure (Kidney Disease Improving Global Outcome (KDIGO) 3) and its impact on 3-month outcome. METHODS Between May 2009 and April 2016, 60 adult patients requiring VV-ECMO in our University Hospital were prospectively included. RESULTS AKI occurrence was frequent (75%; n=45), 51% of patients (n=31) developed KDIGO 3 - predominantly prior to ECMO insertion - and renal replacement therapy was required in 43% (n=26) of cases. KDIGO 3 was associated with a lower mechanical ventilation weaning rate (24% vs 68% for patients with no AKI or other stages of AKI; p<0.001) and a higher 90-day mortality rate (72% vs 32%, p=0.002). Multivariate logistic regression suggested that KDIGO 3 occurrence prior to ECMO insertion, as well as PaCO2>57mmHg and mSOFA>12 were independent risks factors for 90-day mortality. CONCLUSION KDIGO 3 AKI occurrence is correlated with the severity of patients' clinical condition prior to ECMO insertion and is negatively associated with 90-day survival.
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Affiliation(s)
- C Delmas
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France; Intensive Cardiac care, Cardiology department, Rangueil University Hospital, 1 Av Jean-Poulhes, 31059 Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, INSERM 1048, Rangueil, Toulouse, France.
| | - T Zapetskaia
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
| | - J M Conil
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
| | - B Georges
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
| | - F Vardon-Bounes
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, INSERM 1048, Rangueil, Toulouse, France
| | - T Seguin
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
| | - L Crognier
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
| | - O Fourcade
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
| | - L Brouchet
- Thoracic Surgery department, Larrey University Hospital, 24 chemin de Pouvourville, TSA 30030, 31059 Toulouse, France
| | - V Minville
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, INSERM 1048, Rangueil, Toulouse, France
| | - S Silva
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
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Atallah F, Letocart P, Malavaud B, Ahmad M, Mazerolles M, Minville V. Can We Predict Morbidity and Mortality of Patients Aged 75 Years and Older Undergoing Cystectomy? J Frailty Aging 2017; 6:72-75. [PMID: 28555706 DOI: 10.14283/jfa.2017.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Radical cystectomy is associated with a high postoperative mortality and morbidity in older patients. We aimed to define the predictive value of comorbidity scores and determine the prognostic factors of postoperative complications. Preoperative associated morbidities were collected and graded according to the American Society of Anesthesiologists (ASA) score system, the Adult Comorbidity Evaluation (ACE) scale and the Charlson comorbidity index. Surgical complications were graded according to Clavien classification. Early and late complications were recorded. Data are from 49 consecutive patients aged ≥ 75 years who had an open surgery for bladder cancer. The most commonly associated conditions were smoking, renal insufficiency, and arterial hypertension. Incidence of early and late complications was 49% and 16%, respectively. Four and 25 death events occurred during the early and late follow-up, respectively. The incidence of morbidity and mortality were not related to ASA, ACE or Charlson scores. Preoperative malnutrition, renal insufficiency, higher need of perioperative blood transfusions, and prolonged ileus were identified as risk factors of postoperative morbidity. Late complications seemed related to low weight.
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Affiliation(s)
- F Atallah
- Fouad Atallah, MD, Department of anesthesiology and Intensive Care Medicine, University Hospitals of Toulouse, France,
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Martin C, Gonzalez H, Ruiz S, Ribes D, Franchitto N, Minville V. Acute respiratory distress syndrome following verapamil overdose treated with intravenous lipid emulsion: A rare life-threatening complication. ACTA ACUST UNITED AC 2014; 33:e101-2. [DOI: 10.1016/j.annfar.2014.05.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gobin J, Lonjaret L, Pailhas A, Bayoumeu F, Minville V. Accidental dural puncture: combination of prophylactic methods to avoid post-dural puncture headache. ACTA ACUST UNITED AC 2014; 33:e95-7. [PMID: 24821339 DOI: 10.1016/j.annfar.2014.03.019] [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: 12/08/2013] [Accepted: 03/31/2014] [Indexed: 11/29/2022]
Abstract
Accidental dural puncture (ADP) is a common complication of epidural catheter insertion, and may lead to post-dural puncture headache (PDPH), especially in obstetric patients. Epidural blood patch (BP) is the most effective treatment of PDPH. Prophylactic BP has shown its efficacy to prevent PDPH; nevertheless, this method may be insufficient. We report an ADP case before induction of labor in a 28-year-old parturient. To avoid PDPH, an intrathecal catheter was immediately inserted after ADP and an epidural catheter was also inserted at the interspace above. Catheters were kept in place for more than 24hours. A prophylactic BP was performed immediately after removal of the intrathecal catheter. The patient did not experience any headache. This combination of treatments (intrathecal catheter insertion+prophylactic BP) may be a good alternative approach to prevent PDPH, even if it has to be warranted by other clinical studies.
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Affiliation(s)
- J Gobin
- Département d'anesthésie et réanimation, CHU de Toulouse, université Paul Sabatier, hôpital Purpan, place du Dr-Baylac, 31059 Toulouse cedex 9, France.
| | - L Lonjaret
- Département d'anesthésie et réanimation, CHU de Toulouse, université Paul Sabatier, hôpital Purpan, place du Dr-Baylac, 31059 Toulouse cedex 9, France
| | - A Pailhas
- Département d'anesthésie et réanimation, CHG d'Albi, 22, boulevard Général-Sibille, 81000 Albi, France
| | - F Bayoumeu
- Département d'anesthésie et réanimation, CHU de Toulouse, université Paul Sabatier, hôpital Purpan, place du Dr-Baylac, 31059 Toulouse cedex 9, France
| | - V Minville
- Département d'anesthésie et réanimation, CHU de Toulouse, université Paul Sabatier, hôpital Purpan, place du Dr-Baylac, 31059 Toulouse cedex 9, France
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Abstract
The number of elderly patients undergoing anesthesia is increasing. At the same time aging is associated with decreased functional reserve of all major organ systems and an increase in comorbid conditions, requiring a comprehensive perioperative evaluation to minimize morbidity and mortality. The preoperative assessment should focus on the risk/benefit analysis vis-à-vis the proposed intervention, allowing the practitioner to adapt surgical and anesthetic care, as well optimize health and functional status. In addition to the usual evaluation for cardiac and pulmonary risk, the preoperative assessment in the older patient should also address the risk of postoperative cognitive dysfunction and delirium. 'Do-not-resuscitate' orders must be clarified with the patients or substitute decision maker. Studies have not been able to clearly show the superiority of one anesthetic approach for the geriatric patient, although there are probably advantages to using regional anesthetic techniques. Overall the patient's preoperative functional status along with the proposed intervention is the primary determinants of the patient's long term functional outcome and wellbeing. The elderly patient may be at his most vulnerable during the postoperative phase, and a relatively high frequency of adverse events in the elderly, including respiratory insufficiency, myocardial and cerebrovascular ischemia, renal failure, infectious complications as well as delirium and postoperative cognitive dysfunction have been observed. Perioperative interventions should target modifiable risk factors and the avoidance of even minor complications with an ultimate goal of improving long-term outcome.
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Affiliation(s)
- M M Kurrek
- Matt M. Kurrek, 150 College Street, Room 121, Fitzgerald Building, Toronto, ON M5S 3E2, Canada, Tel: (416) 987-4306, Fax: (416) 978-2408,
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Aya AGM, Minville V, Ripart J. [A poorly known cause of peripartum hemorrhage]. Ann Fr Anesth Reanim 2013; 32:644-645. [PMID: 24119789 DOI: 10.1016/j.annfar.2013.09.003] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- A G M Aya
- Division anesthésie-réanimation-douleur-urgence, faculté de médecine Montpellier-Nîmes, université Montpellier I, CHU Caremeau, place du Pr-Debré, 30029 Nîmes cedex 09, France
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Couat JF, Cegarra J, Rodsphon T, Geeraerts T, Lelardeux C, Sol JC, Lagarrigue P, Minville V, Lubrano VF. A prospective video-based observational and analytical approach to evaluate management during brain tumour surgery at a university hospital. Neurochirurgie 2013; 59:142-8. [PMID: 23953035 DOI: 10.1016/j.neuchi.2013.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 09/17/2012] [Revised: 04/24/2013] [Accepted: 05/24/2013] [Indexed: 11/18/2022]
Abstract
The operating room (OR) is a high-risk complex setting, where patient safety relies on the coordinated efforts of multiple team members. However, little attention has been paid to evaluating the strategies employed by OR practitioners to prevent and correct incidents that inevitably occur during surgery. Therefore, we were prompted to investigate human factor (HF) engineering methods that have been used in an innovative way in order to systematically observe and analyze the management of incidents in the neurosurgical OR of a French university hospital. A technical case report illustrates our approach that associates the following procedures: the recording of OR team member activities and behaviour by video cameras and direct observation of a HF researcher, with the description and the explicit demonstration of safety related procedures in self- and cross-confrontation interviews of OR team members. This technical report emphasizes complementary aspects of clinical performance related to safety skills. Moreover, individual and team performances rely on complementary abilities that associate practical knowledge, skills, and attitudes, which are engaged at various degrees to prevent and manage incidents. This report also enlightens new quality-improvement opportunities as well as further objectives for future studies.
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Affiliation(s)
- J-F Couat
- UMR CNRS 5263, CUFR Jean-François-Champollion, France; SGRL, CUFR Jean-François-Champollion, 81012 Albi, France
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Masquère P, Lonjaret L, Fourcade O, Minville V. [Video laryngoscopic tracheal intubation under sedation]. Ann Fr Anesth Reanim 2013; 32:358-360. [PMID: 23607984 DOI: 10.1016/j.annfar.2013.03.005] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 03/13/2013] [Indexed: 06/02/2023]
Abstract
We report a video laryngoscopic tracheal intubation under sedation in a patient with a hip fracture. Preoperative assessment revealed signs of difficult airway management linked to a cervical spine immobilization. Here we describe an alternative method to awake fiber optic flexible intubation.
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Affiliation(s)
- P Masquère
- Coordination d'anesthésie, département d'anesthésie et réanimation, université Paul-Sabatier, hôpital Purpan, centre hospitalier universitaire de Toulouse, place du Dr-Baylac, Toulouse cedex 9, France
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Lonjaret L, Lairez O, Minville V, Bayoumeu F, Fourcade O, Mercier F. Embolie pulmonaire et grossesse. ACTA ACUST UNITED AC 2013; 32:257-66. [DOI: 10.1016/j.annfar.2013.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
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Lonjaret L, Lairez O, Fourcade O, Minville V. [Continuous spinal anesthesia and pulmonary arterial hypertension]. ACTA ACUST UNITED AC 2012; 31:810-2. [PMID: 22925944 DOI: 10.1016/j.annfar.2012.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 07/18/2012] [Indexed: 11/29/2022]
Abstract
We report the use of continuous spinal anesthesia for hip fracture surgery in a patient with pulmonary arterial hypertension. Preoperative evaluation, anesthetic technique and preoperative monitoring are discussed.
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Affiliation(s)
- L Lonjaret
- Coordination d'anesthésie, université Paul-Sabatier, hôpital Purpan, centre hospitalier universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex 9, France.
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Brenier G, Minville V, Fourcade O, Geeraerts T. [Medical handovers in ICU: a snapshot of practice in the South West of France]. ACTA ACUST UNITED AC 2012; 31:208-12. [PMID: 22309619 DOI: 10.1016/j.annfar.2011.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 12/08/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Medical handover is critical for quality of care in ICU. Time assigned to medical handovers can vary across different units, with significant impact on the organization of medical work. We aimed to study the time spent for medical handover in ICU and its variation across academic, general and private hospitals in the area of the South West of France, the Midi-Pyrénées region. METHODS Between August and October 2010, we questioned by phone, 86 physicians issued from 19 different ICUs. This prospective observational study mainly focused on four items: unit's characteristics, health diaries organization, medical handovers procedures, and self-assessment of satisfaction for medical handover (numeric scale from 0 to 10). RESULTS Eleven general hospital centers, three private hospitals, five university hospitals were concerned by the survey. The mean time spent for medical handover was 59±35 min on monday morning, significantly longer than other days, evening, and to weekend handovers (P<0.001 for all comparisons). When reporting it to the number of ICU bed, the time spent for handover per patient was significantly shorter in private hospital compared to general and academic hospital (P<0.05 for all comparison). CONCLUSION Time spent for medical handover is important, with an approximate total time of 1h 30 min on monday, and 1h the other days. Physician in private hospitals spend less time for medical handovers. This fact should be considered for medical timework organization, especially in academic hospital and in hospital with large ICU.
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Affiliation(s)
- G Brenier
- Département d'anesthésie-réanimation, CHU Toulouse Purpan, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
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Abstract
Hip femur is extremely common in the elderly and is one of the most common reasons for admission in trauma care. The main reported causes of death after hip fracture were cardiovascular (29%), neurological (20%) and pulmonary. Large epidemiological studies have shown a relatively small decrease in mortality for 20 years despite an active approach to medical and surgical management. Yet 57% of deaths occurring within 30 days post-surgery are preventable because they are not related to a pre-existing disease. Preoperative management to optimize these patients could help to reduce morbidity and mortality and is thus a crucial issue. The anesthesia consultation is used to evaluate the perioperative risk, treat pain, manage treatment and stabilize the patient. An operative delay of more than 48hours after admission increases mortality. This period should not be prolonged by unnecessary investigations that will not change the perioperative management. The preoperative period is a key moment because it allows to choose the anesthetic technique. Even if this choice is controversial, continuous spinal anesthesia (titrated) do not modify the cardiovascular and neurological physiological balance of these precarious patients.
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Affiliation(s)
- F Ferré
- Département D'anesthésie et de Réanimation, Faculté de Médecine Toulouse-Rangueil, Université Toulouse III Paul-Sabatier, CHU de Toulouse, Institut Louis-Bugnard (IFR 150), 31000 Toulouse, France
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Verniolle M, Brunel E, Olivier M, Serres I, Mari A, Gonzalez H, Benhaoua H, Cougot P, Minville V. Évaluation des démarches de limitation et d’arrêt de traitement en salle d’accueil des urgences vitales. ACTA ACUST UNITED AC 2011; 30:625-9. [DOI: 10.1016/j.annfar.2011.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 04/20/2011] [Indexed: 10/17/2022]
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Minville V, Fourcade O, Mazoit J, Girolami J, Tack I. Ondansetron does not block paracetamol-induced analgesia in a mouse model of fracture pain. Br J Anaesth 2011; 106:112-8. [DOI: 10.1093/bja/aeq277] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Silva S, Bataille B, Jucla M, Minville V, Samii K, Fourcade O, Démonet JF, Loubinoux I. Temporal analysis of regional anaesthesia-induced sensorimotor dysfunction: a model for understanding phantom limb. Br J Anaesth 2010; 105:208-13. [DOI: 10.1093/bja/aeq144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Minville V, Lavidalle M, Bayoumeu F, Parrant O, Fourcade O. Rachianesthésie assistée par l’échographie chez une parturiente avec une scoliose corrigée. ACTA ACUST UNITED AC 2010; 29:501-2. [DOI: 10.1016/j.annfar.2010.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 04/14/2010] [Indexed: 10/19/2022]
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Mayeur N, Minville V, Jaafar A, Tack I. Pressure-controlled hemorrhagic shock in mice: a new model of acute kidney injury. Crit Care 2010. [PMCID: PMC2934552 DOI: 10.1186/cc8754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Minville V, Fourcade O, Girolami JP, Tack I. Opioid-induced hyperalgesia in a mice model of orthopaedic pain: preventive effect of ketamine. Br J Anaesth 2009; 104:231-8. [PMID: 20031953 DOI: 10.1093/bja/aep363] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the preventative effect of ketamine on the exaggerated postoperative pain observed in sufentanil-treated mice and its ability to improve the analgesic effectiveness of morphine during the postoperative period in an orthopaedic model of pain. METHODS In this study, we assessed the effects of ketamine on sufentanil enhancement of pain behaviour induced by fracture and the effects of ketamine on postoperative morphine-induced analgesia. Three tests were used to assess pain behaviour: von Frey filament application, hot-plate test, and a subjective pain scale. RESULTS When administered 1 day after surgery in mice treated with sufentanil on D0 (before surgery), morphine induced an analgesic effect as observed by the nociceptive threshold increase in saline- and ketamine-treated mice. Morphine was more effective in ketamine-treated (1 and 50 mg kg(-1)) mice. CONCLUSIONS Our results suggest that pre-emptive use of ketamine is useful in orthopaedic surgery in this mice model to diminish short- and long-term hyperalgesia, but also to improve morphine effectiveness leading to a better mobilization and more rapid rehabilitation.
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Affiliation(s)
- V Minville
- Department of Anesthesiology and Intensive Care, Toulouse University Hospital Rangueil, Toulouse, France.
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Guaussiat F, Astolfi AC, Mercury P, Breden A, Minville V. [Malmignatte (black widow spider) envenomation in France: latrodectism]. Ann Fr Anesth Reanim 2009; 28:260-261. [PMID: 19303244 DOI: 10.1016/j.annfar.2009.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Minville V, Asehnoune K, Delussy A, Fourcade O, Colombani A, Rabinowitz A, Samii K. Hypotension during surgery for femoral neck fracture in elderly patients: effect of anaesthetic techniques. A retrospective study. Minerva Anestesiol 2008; 74:691-696. [PMID: 19034248] [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: 05/27/2023]
Abstract
BACKGROUND The aim of this retrospective study was to compare the incidence of hypotension between different anaesthetic techniques, including general anaesthesia (GA), spinal anaesthesia single injection (SA), continuous spinal anaesthesia with 2.5 mg bolus injections as needed (CSA 2.5) or 5 mg bolus injections as needed (CSA 5) in elderly patients (>75 yrs old) undergoing surgery for femoral neck fractures. METHODS Demographic, surgical and hemodynamic data from 333 patients over a four year period within a single hospital were recorded and examined. RESULTS Forty-two patients underwent GA, 109 underwent SA, 61 underwent CSA 5, and 121 underwent CSA 2.5. Patients receiving GA, SA or CSA 5 had a higher incidence of hypotension (83%, 68%, and 34%, respectively) than patients who underwent CSA 2.5 (4%; P<0.05). The CSA 2.5 group required less colloid infusion (490+/-50 mL) than the GA and SA groups (810+/-330 and 645+/-230 mL, respectively). The CSA 2.5 group also required less crystalloid infusion volume (760+/-371 mL) than the GA group (1140+/-770 mL). Ephedrine infusion was higher in the GA and SA groups (30+/-10 and 26+/-9 mg, respectively) than the CSA 2.5 (15+/-8 mg; P<0.05). CONCLUSION This study demonstrated that CSA 2.5 causes fewer episodes of hypotension than other anaesthetic techniques for surgical repair of hip fracture in elderly patients.
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Affiliation(s)
- V Minville
- Department of Anaesthesiology and Intensive Care, University Hospital of Toulouse, University of Paul Sabatier, Toulouse, France.
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Pianezza A, Galas T, Minville V, Destrubé M, Laffosse JM. [Femoral intramedullary nailing in men on fracture table: beware of the risk of postoperative erectile dysfunction!]. Ann Fr Anesth Reanim 2008; 27:110-111. [PMID: 18068942 DOI: 10.1016/j.annfar.2007.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Nguyen L, Minville V, Bensafi H, Laffosse JM, Chassery C, Archambaud M, Wagner A, Chaminade B, Bonnet E. Sepsis atypique à Bacillus cereus dans les fractures de jambe. ACTA ACUST UNITED AC 2007; 26:780-3. [PMID: 17629655 DOI: 10.1016/j.annfar.2007.05.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 05/11/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate leg fractures infected with Bacillus cereus in a traumatology-orthopedic ward of a university hospital. METHODS All B. cereus strains isolated from patients with leg fracture hospitalized in the traumatology-orthopedic ward between 1995 and 2004 were included in this retrospective study. RESULTS Five hundred and four patients had leg fracture during this period. Thirty-four patients were included in this retrospective study. B. cereus strains clinical isolates were mainly isolated from patients who had initially leg fractures with telluric contamination (wound contamination with terrestrial environments) before admission. Betalactam antibiotics used for prophylactic chemotherapy were not effective against B. cereus. CONCLUSION In this study, we underscore the significance of Sfar recommendations concerning prophylactic chemotherapy. However, B. cereus could be termed an emerging pathogen and physicians need to be aware of its potential importance in trauma cases. In this purpose, a systematic screening for B. cereus at admission should be necessary in front of patients with open fractures associated with telluric contamination. Furthermore, if B. cereus is isolated, chemotherapy should be based upon ciprofloxacin during 2 or 6 weeks.
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Affiliation(s)
- L Nguyen
- Département d'anesthésie et de réanimation, CHU de Toulouse, hôpital Rangueil, université Paul-Sabatier, Toulouse, France
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Idabouk L, Minville V, Salau S, Castel A, Franchitto N, Pourrut JC. Œdème pulmonaire après une arthroscopie du genou. ACTA ACUST UNITED AC 2006; 25:1007-10. [PMID: 16891092 DOI: 10.1016/j.annfar.2006.03.043] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 03/28/2006] [Indexed: 10/24/2022]
Abstract
Negative pressure pulmonary oedema is one form of non cardiogenic pulmonary oedema that can occur following any general anaesthesia in which the patient was intubated. This complication can be severe, resulting in death/life-threatening if not diagnosed and treated promptly. We report a case of negative pressure pulmonary oedema, in a 26-year-old man, secondary to inspiratory effort with laryngeal spasm. Patient was transferred to intensive care unit for monitoring and non invasive ventilation. Prevention, early diagnosis, and prompt treatment allowed a rapid and uncomplicated resolution.
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Affiliation(s)
- L Idabouk
- Département d'anesthésie et de réanimation, CHU de Toulouse, université Paul-Sabatier, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 09, France
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Minville V, Gozlan C, Asehnoune K, Zetlaoui P, Chassery C, Benhamou D. Fascia-iliaca compartment block for femoral bone fracture in prehospital medicine in a 6-yr-old child. Eur J Anaesthesiol 2006; 23:715-6. [PMID: 16805944 DOI: 10.1017/s0265021506271126] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2006] [Indexed: 11/08/2022]
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Asehnoune K, Azoulay D, Andreani P, Gillon MC, Naili S, Minville V, Benhamou D. [Cardiac perforation and tamponade during TIPS placement]. Ann Fr Anesth Reanim 2006; 25:899-901. [PMID: 16859879 DOI: 10.1016/j.annfar.2006.03.041] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 03/21/2006] [Indexed: 05/11/2023]
Abstract
A patient developed an acute severe haemodynamic compromise immediately after a transjugular intrahepatic portosystemic shunt (TIPS) procedure for intractable ascites. Rapid clinical and echographic evaluation disclosed pericardial blood and cardiac tamponade, probably due to right heart perforation from guidewire and catheter manipulation. Needle drainage of pericardial fluid restored the haemodynamic status. A right ventricular perforation was then successfully treated (sternotomy and closure of right ventricle perforation) and the patient survived. Cardiac tamponade should be considered in the differential diagnosis of patients who develop hypotension and haemodynamic impairment during or immediately after TIPS placement.
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Affiliation(s)
- K Asehnoune
- Département d'Anesthésie-Réanimation et Unité Propre de Recherche de l'Enseignement Supérieur, Equipe d'Accueil (UPRES-EA 3540), Hôpital de Bicêtre, 94275 Le Kremlin-Bicêtre, France.
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Minville V, Pianezza A, Asehnoune K, Cabardis S, Smail N. Prehospital intravenous line placement assessment in the French emergency system. Eur J Anaesthesiol 2006; 23:594-7. [PMID: 16507183 DOI: 10.1017/s0265021506000202] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2006] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Out-of-hospital intravenous line placement is used daily. All available studies take place using paramedics, e.g. US-American emergency medical system. The aim of this study was to assess the intravenous line placement feasibility (time and success rate) in the French emergency medical system. METHODS A prospective observational study was performed by a French out-of-hospital team during 3-month assessing the timing and success rates for intravenous line placement. All patients were enrolled at the emergency medical service of a university hospital in France. Six hundred and sixty-nine consecutive patients were included, 388 (58%) had at least one intravenous line placement in the out-of-hospital setting. RESULTS Success rate was 76% at the first attempt and 98% at the second attempt. The overall success rate for intravenous line placement was 99.7% (only one failure), and the average successful intravenous line time was 4.4+/-2.8 min. Attempts ranged from 1 to 8. The time for intravenous line placement with blood sampling (58% of patients) is statistically longer than without (4.6+/-2.5 vs. 4.3+/-3 min, P<0.05). Seventeen of the enrolled patients were trauma patients, and 83% were non-trauma patients. Four hundred and twenty-seven intravenous lines were placed, intravenous 10% had more than one intravenous line. Seventy-one percent of the intravenous lines were used to infuse drugs, the others were security intravenous. No significant difference was noticed between trauma and non-trauma patients in regard to the success rate and the time to place the intravenous line. CONCLUSION The out-of-hospital team was skilled at intravenous line placement (success rate=99.7%), and the time required to performed intravenous line access was short.
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Affiliation(s)
- V Minville
- University of Paul Sabatier, University Hospital of Toulouse, Department of Anesthesiology and Intensive Care, Toulouse, France.
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Minville V, Saada J, Cartron G, Legac YT, Desprats R. Césarienne chez une patiente atteinte d'un déficit en inhibiteur du C1 estérase (œdème angioneurotique). ACTA ACUST UNITED AC 2006; 25:315-6. [PMID: 16310338 DOI: 10.1016/j.annfar.2005.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Indexed: 11/24/2022]
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Amathieu R, Minville V, Poloujadoff MP, Adnet F, Smail N. [Interest of prehospital use of cardiac output monitoring with partial CO2 rebreathing technique: a case report]. ACTA ACUST UNITED AC 2005; 24:1387-9. [PMID: 16257502 DOI: 10.1016/j.annfar.2005.06.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Accepted: 06/02/2005] [Indexed: 11/21/2022]
Abstract
We report the case of a 68-year-old man with severe hypoxemic pneumopathy having cardiac output monitoring with the NICO system in prehospital medicine. This monitoring permitted the diagnosis of a compressive pneumothorax during the transfer to the intensive care unit. This ease of use technique based on partial carbon dioxide rebreathing, allows non-invasive, continuous and reliable cardiac output monitoring. We discuss the interest of this device in prehospital medicine.
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Affiliation(s)
- R Amathieu
- Département d'anesthésie et de réanimation, CHU Purpan, 31059 Toulouse cedex, France.
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Nguyen L, Minville V, Riu B, Atallah F, Fourcade O. Anaesthetic management of a patient with epidermolysis bullosa undergoing percutaneous nephrolithotomy. Eur J Anaesthesiol 2005; 22:558-60. [PMID: 16045151 DOI: 10.1017/s0265021505260945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gozlan C, Minville V, Asehnoune K, Raynal P, Zetlaoui P, Benhamou D. Bloc iliofascial en médecine préhospitalière pour les fractures du fémur. ACTA ACUST UNITED AC 2005; 24:617-20. [PMID: 15885976 DOI: 10.1016/j.annfar.2005.03.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2004] [Accepted: 03/21/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to assess the feasibility and efficacy of fascia iliaca compartment bloc (FIB) in prehospital care performed by emergency physicians. STUDY DESIGN Prospective observational study. PATIENTS AND METHODS Fifty-two patients victim of a femoral bone fracture were included consecutively. All FIB had been performed by emergency physicians trained to the technique. Lidocaine 1.5% with epinephrine has been used. Block efficacy was assessed by testing sensitive block in the anterior, lateral and medial part of the thigh. Pain levels were noted using a simplified numeric scale (SNS). RESULTS No complete was reported. Ninety-four percent of blocks were successful. SNS values significantly decrease 10 minutes after block performance. CONCLUSION Emergency medicine physicians trained to the technique can perform FIB with a high success rate.
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Affiliation(s)
- C Gozlan
- Département d'anesthésie et de réanimation, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le-Kremlin-Bicêtre, France.
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Abstract
BACKGROUND AND OBJECTIVE The combination of non-opioid analgesic drugs, though widely used, has been rarely evaluated. The aim of this study was to compare the efficacy of propacetamol and the non-steroidal analgesic drug ketoprofen, alone or in combination, on pain relief after thyroid surgery performed using remifentanil. METHODS Ninety-seven patients were randomly allocated to one of the three groups: propacetamol 2 g (32), ketoprofen 100 mg (33) and propacetamol 2 g + ketoprofen 100 mg (32). Each regimen was administered intravenously (i.v.) 30 min before the end of surgery and then every 6 h. If pain was not relieved, patients received an i.v. bolus of tramadol 100 mg. Tramadol consumption and pain intensity using a visual analogue scale was recorded at 1, 2, 8 and 14 h after the end of surgery. RESULTS Pain scores were significantly higher with propacetamol compared with ketoprofen 2 h after surgery (35 +/- 3.7, 21 +/- 2.6, respectively; P < 0.01). The number of patients receiving tramadol was higher with propacetamol alone compared with the two other groups, 1 h (14/32, 4/33, 2/32, respectively; P > 0.01) and 2 h (24/32, 6/33, 8/32, respectively; P < 0.01) after surgery. There was no difference between ketoprofen alone and ketoprofen plus propacetamol, and there was no difference between the three groups from the 8th hour onward. CONCLUSIONS In the immediate postoperative period after thyroid surgery performed using remifentanil, the concomitant use of propacetamol and ketoprofen does not improve analgesia compared with ketoprofen alone.
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Affiliation(s)
- O Fourcade
- University of Toulouse, Purpan Hospital, Anaesthesia Department, France.
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Amathieu R, Minville V, Poloujadoff MP, Vigué B. [Cervical post-traumatic pneumomyelogram: do not ignore this entity]. ACTA ACUST UNITED AC 2005; 23:1089-92. [PMID: 15581726 DOI: 10.1016/j.annfar.2004.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Accepted: 08/24/2004] [Indexed: 11/20/2022]
Abstract
We report the case of a post-traumatic pneumomyelogram in a 51-year-old woman. The pneumomyelogram associated with a skull base fracture was revealed by systematic total body scan. The discovery of a traumatic pneumomyelogram will be probably more frequently discovered with the largest use of modern helical CT-scan in traumatized patients. We discuss the etiologies and the implications for the anesthesiologist and the intensivist of this entity.
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Affiliation(s)
- R Amathieu
- Samu 93 - EA 3409, université Paris-XIII, hôpital Avicenne, 93000 Bobigny, France.
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N'Guyen L, Minville V, Chassery C, Pourrut JC, Samii K. Intérêt de la perfusion continue de naloxone sur l’analgésie et la dépression respiratoire après injection de morphine intrathécale. ACTA ACUST UNITED AC 2004; 23:1016-7. [PMID: 15501635 DOI: 10.1016/j.annfar.2004.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Minville V, Roche Tissot C, Samii K. Épuration extrarénale, supplémentation en L-carnitine et intoxication à l’acide valproïque. ACTA ACUST UNITED AC 2004; 23:357-60. [PMID: 15120780 DOI: 10.1016/j.annfar.2003.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2003] [Revised: 11/28/2003] [Accepted: 11/28/2003] [Indexed: 10/26/2022]
Abstract
We report the case of a severe valproic acid poisoning in a 36-year-old man. In front of a high serum concentration of valproic acid at the admission, haemodialysis was initiated to decrease serum valproic acid concentration. A L-carnitine therapy (50 mg/kg per day) was also started. A cerebral oedema appeared at the third day, but the patient recovered without any sequela.
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Affiliation(s)
- V Minville
- Département d'anesthésie réanimation, hôpital de Rangueil, CHU de Toulouse, 31403 Toulouse cedex 04, France.
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