1
|
Suria S, Galy R, Bordenave L, Motamed C, Bourgain JL, Guerlain J, Moya-Plana A, Elmawieh J. High Frequency Jet Ventilation or Mechanical Ventilation for Panendoscopy for Cervicofacial Cancer: A Retrospective Study. J Clin Med 2023; 12:4039. [PMID: 37373732 DOI: 10.3390/jcm12124039] [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: 05/16/2023] [Revised: 06/05/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction-the upper airway panendoscopy, performed under general anesthesia, is mandatory for the diagnosis of cervicofacial cancer. It is a challenging procedure because the anesthesiologist and the surgeon have to share the airway space together. There is no consensus about the ventilation strategy to adopt. Transtracheal high frequency jet ventilation (HFJV) is the traditional method in our institution. However, the COVID-19 pandemic forced us to change our practices because HFJV is a high risk for viral dissemination. Tracheal intubation and mechanical ventilation were recommended for all patients. Our retrospective study compares the two ventilation strategies for panendoscopy: high frequency jet ventilation (HFJV) and mechanical ventilation with orotracheal intubation (MVOI). Methods-we reviewed all panendoscopies performed before the pandemic in January and February 2020 (HFJV) and during the pandemic in April and May 2020 (MVOI). Minor patients, patients with a tracheotomy before or after, were excluded. We performed a multivariate analysis adjusted on unbalanced parameters between the two groups to compare the risk of desaturation. Results-we included 182 patients: 81 patients in the HFJV group and 80 in the MVOI group. After adjustments based on BMI, tumor localization, history of cervicofacial cancer surgery, and use of muscle relaxants, the patients from the HFJV group showed significantly less desaturation than the intubation group (9.9% vs. 17.5%, ORa = 0.18, p = 0.047). Conclusion-HFJV limited the incidence of desaturation during upper airway panendoscopies in comparison to oral intubation.
Collapse
Affiliation(s)
- Stephanie Suria
- Department of Anesthesiology, Gustave Roussy, Paris-Saclay, F-94805 Villejuif, France
| | - Raphaëlle Galy
- Department of Anesthesiology, Gustave Roussy, Paris-Saclay, F-94805 Villejuif, France
| | - Lauriane Bordenave
- Department of Anesthesiology, Gustave Roussy, Paris-Saclay, F-94805 Villejuif, France
| | - Cyrus Motamed
- Department of Anesthesiology, Gustave Roussy, Paris-Saclay, F-94805 Villejuif, France
| | - Jean-Louis Bourgain
- Department of Anesthesiology, Gustave Roussy, Paris-Saclay, F-94805 Villejuif, France
| | - Joanne Guerlain
- Department of Cervico Facial Oncology, Gustave Roussy, Paris-Saclay, F-94805 Villejuif, France
| | - Antoine Moya-Plana
- Department of Cervico Facial Oncology, Gustave Roussy, Paris-Saclay, F-94805 Villejuif, France
| | - Jamie Elmawieh
- Department of Anesthesiology, Gustave Roussy, Paris-Saclay, F-94805 Villejuif, France
| |
Collapse
|
2
|
Motamed C. Intraoperative Monitoring of Neuromuscular Blockade. Life (Basel) 2023; 13:life13051184. [PMID: 37240830 DOI: 10.3390/life13051184] [Citation(s) in RCA: 2] [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: 03/13/2023] [Revised: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
There is a global trend of new guidelines highly recommending quantitative neuromuscular monitoring in the operating room. In fact, it is almost certain that quantitatively monitoring the depth of intraoperative muscle paralysis may permit the rational use of muscle relaxants and avoid some of the major related complications, namely postoperative pulmonary complications. A specific culture related to this issue is necessary to integrate quantitative monitoring of muscle relaxants as part of a major monitoring entity in anesthetized patients. For this purpose, it is necessary to fully understand the physiology, pharmacology and concept of monitoring as well as the choice of pharmacological reversal, including the introduction of sugammadex a decade ago.
Collapse
Affiliation(s)
- Cyrus Motamed
- Institut de Cancérologie Gustave Roussy, 94080 Villejuif, France
| |
Collapse
|
3
|
Salama G, Motamed C, Elmawieh J, Suria S. Impact of Preemptive Postoperative Pressure Support Ventilation and Physiotherapy on Postoperative Pulmonary Complications after Major Cervicofacial Cancer Surgery: A before and after Study. Medicina (Kaunas) 2023; 59:medicina59040722. [PMID: 37109680 PMCID: PMC10142708 DOI: 10.3390/medicina59040722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023]
Abstract
Introduction: Complex cervicofacial cancer surgery with free flap reconstruction is known to have a high incidence of postoperative pulmonary complications (PPCs). We hypothesized that by implementing an optimized respiratory protocol, including preemptive postoperative pressure support ventilation, physiotherapy, and critical respiratory support and follow-up, we could decrease the incidence of PPCs. Patients and methods: We evaluated the incidence of PPCs over two periods in two groups of patients having a routine or optimized postoperative respiratory protocol: 156 adult patients undergoing major cervicofacial cancer surgery were assessed; 91 were in Group 1 (routine) and 65 were in Group 2 (optimized). In Group 1, no ventilatory support sessions were performed. The incidence of pulmonary complications in both groups was compared using a multivariate analysis. Mortality was also compared until one year postoperatively. Results: In Group 2 with an optimized protocol, the mean number of ventilatory support sessions was 3.7 ± 1 (minimum 2, maximum 6). The incidence of respiratory complications, which was 34% in Group 1 (routine), was reduced by 59% OR = 0.41 (0.16; 0.95), p = 0.043) to 21% for the optimized Group 2. No difference in mortality was found. Conclusions: The present retrospective study showed that using an optimized preemptive respiratory pressure support ventilation combined with physiotherapy after a major cervicofacial surgery could possibly help reduce the incidence of pulmonary complications. Prospective studies are needed to verify these findings.
Collapse
Affiliation(s)
- Guillaume Salama
- Department of Anesthesia, Institut de Cancérologie Gustave Roussy, 94080 Villejuif, France
| | - Cyrus Motamed
- Department of Anesthesia, Institut de Cancérologie Gustave Roussy, 94080 Villejuif, France
| | - Jamie Elmawieh
- Department of Anesthesia, Institut de Cancérologie Gustave Roussy, 94080 Villejuif, France
| | - Stéphanie Suria
- Department of Anesthesia, Institut de Cancérologie Gustave Roussy, 94080 Villejuif, France
| |
Collapse
|
4
|
Evrard E, Motamed C, Pagès A, Bordenave L. Opioid Reduced Anesthesia in Major Oncologic Cervicofacial Surgery: A Retrospective Study. J Clin Med 2023; 12:jcm12030904. [PMID: 36769551 PMCID: PMC9917718 DOI: 10.3390/jcm12030904] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/15/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Opioid sparing is one of the new challenges in anesthesia and perioperative medicine. Opioid reduced anesthesia (ORA) is part of this approach, and it consists of a multimodal analgesia-associating non-opioid analgesic regional anesthesia to reduce intraoperative opioid requirements. Major cervicofacial oncologic surgery could specifically benefit from ORA, since it is known to generate intense and prolonged postoperative pain, with a high risk of pulmonary complications. METHODS This is a retrospective case-controlled study of 172 patients with major cervicofacial oncologic surgery. Group ORA (dexmedetomidine and lidocaine), n = 86, was compared to patients treated with standard opioid based anesthesia, Group control, n = 86. The main endpoint was to study perioperative opioid consumption and postoperative pain scores, and the secondary endpoint was to observe opioid related side effects. RESULTS The ORA group received 6.2 ± 3.1 mg morphine titration at the end of surgery, while the control group received 10.1 ± 3.7 mg p < 0.0001; there was no significant difference in post-operative analgesia requirements and pain scores between the groups. Intraoperatively, the ORA protocol yielded bradycardia in 4 persons, while in the control group, only 2 persons had bradycardia necessitating intervention, p < 0.05. Postoperatively, episodes of hypoxemia (50%) and the need for additional pressure-assisted ventilation (6%), was significantly different in the ORA group than in the control group (70% and 19%), p < 0.05. There was no difference between the two groups for the incidence of nausea and vomiting, ileus, or postoperative delirium. DISCUSSION ORA was not associated with a decrease in postoperative pain and opioid requirement, but possibly reduced the incidence of hypoxemia and the use of additional pressure-assisted ventilation, although we cannot rule out confounding factors. The possible benefits of ORA remain to be demonstrated by prospective studies.
Collapse
Affiliation(s)
- Emma Evrard
- Department of Anesthesiology, Gustave Roussy, 94805 Villejuif, France
- Faculty of Medicine, University of Paris-Saclay, 94270 Le Kremlin Bicêtre, France
| | - Cyrus Motamed
- Department of Anesthesiology, Gustave Roussy, 94805 Villejuif, France
- Correspondence:
| | - Arnaud Pagès
- Department of Biostatistics and Epidemiology, Gustave Roussy, 94805 Villejuif, France
| | | |
Collapse
|
5
|
Motamed C. Sugammadex in Emergency Situations. J Pers Med 2023; 13:jpm13010159. [PMID: 36675820 PMCID: PMC9867288 DOI: 10.3390/jpm13010159] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Sugammadex may be required or used in multiple emergency situations. Moderate and high doses of this compound can be used inside and outside the operating room setting. In this communication, recent developments in the use of sugammadex for the immediate reversal of rocuronium-induced neuromuscular blockade were assessed. In emergency surgery and other clinical situations necessitating rapid sequence intubation, the tendency to use rocuronium followed by sugammadex instead of succinylcholine has been increasing. In other emergency situations such as anaphylactic shock caused by rocuronium or if intubation or ventilation is not possible, priority should be given to resuming ventilation maintaining hemodynamic stability, in accordance with the traditional guidelines. If necessary for the purpose of resuming ventilation, reversal of neuromuscular blockade should be done in a timely fashion.
Collapse
Affiliation(s)
- Cyrus Motamed
- Departement of Anesthesia, Gustave Roussy Cancer Campus, 94080 Villejuif, France
| |
Collapse
|
6
|
Motamed C, Servin F, Billard V. Adding Low-Dose Propofol to Limit Anxiety during Target-Controlled Infusion of Remifentanil for Gastrointestinal Endoscopy: Respiratory Issues and Safety Recommendations. Medicina (Kaunas) 2022; 58:medicina58091285. [PMID: 36143961 PMCID: PMC9502783 DOI: 10.3390/medicina58091285] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022]
Abstract
Backgroundand Objectives: Remifentanil-based sedation is one of many protocols proposed for endoscopy procedures in spontaneous ventilation, alone or in combination with propofol. However, the effect of these small doses of propofol on the efficacy and safety of remifentanil target-controlled infusion (TCI) deserves to be examined in this context. The objective of this study was to assess the adverse respiratory and cardiovascular effects of small boluses of propofol combined with remifentanil, in comparison with remifentanil alone, and balanced with the quality of sedation and recovery. Materials andMethods: This was an observational bicenter study, representing a subgroup of a larger study describing remifentanil-based procedural sedation. In center 1, patients scheduled for gastrointestinal (GI) endoscopy had remifentanil TCI alone. In center 2, patients had a 10 mg propofol bolus before TCI and other boluses were allowed during the procedure. Remifentanil TCI was started at a target of 2 ng/mL then adapted by 0.5 ng/mL steps according to patient response to endoscopy stimulations. Results: Center 1 included 29 patients, while center 2 included 60 patients. No difference was found in the patients’ characteristics, incidence of success, average remifentanil consumption, or cardiovascular variables. Light sedation was achieved when propofol was added. The incidence of respiratory events, such as bradypnea, desaturation < 90%, and apnea requiring rescue maneuvers, were significantly higher with propofol. Conclusions: Adding propofol boluses to a remifentanil TCI for GI endoscopy ensures light sedation that may be necessary for anxiolysis but increases respiratory events, even after administration of small-dose boluses. Its safety is acceptable if the procedure is performed in an equipped environment with sedation providers trained to manage respiratory events and drugs titrated to minimal doses.
Collapse
Affiliation(s)
- Cyrus Motamed
- Department of Anesthesia, Institut Gustave Roussy, 94805 Villejuif, France
- Correspondence:
| | | | - Valerie Billard
- Department of Anesthesia, Institut Gustave Roussy, 94805 Villejuif, France
| |
Collapse
|
7
|
Motamed C, Mariani L, Suria S, Weil G. Serum Albumin Kinetics in Major Ovarian, Gastrointestinal, and Cervico Facial Cancer Surgery. Int J Environ Res Public Health 2022; 19:ijerph19063394. [PMID: 35329082 PMCID: PMC8955132 DOI: 10.3390/ijerph19063394] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 02/01/2023]
Abstract
Hypoalbuminemia in major cancer surgery can lead to postoperative short and long-term complications. Our study was designed to detect albumin variations in three major cancer surgeries: ovarian debulking (DBK), major abdominal gastrointestinal surgery (ABD), and major cervico-facial, or ear, nose and throat cancer surgery (ENT). Single-center prospective study inclusion criteria were non-emergency procedures scheduled to last at least five hours. We performed hourly perioperative monitoring of the patients’ albuminemia and hemoglobinemia. Electronic charts were followed for at least five years for survival analysis. Sixty-three patients were analyzed: 30 in the DBK group, 13 in the ABD group, and 20 in the ENT group. There was a significant difference in albumin decrease between the ENT group and the two others (−19% at six hours in the ENT group versus -49% in the debulking group and −31% in the ABD group (p < 0.05). There was no significant difference between the DBK and ABD groups. The decrease in hemoglobin was not significantly different between the groups, and no significant difference was observed in long-term survival. DBK and ABD surgery yielded significant hypoalbuminemia. Therefore, the extent of decrease in serum albumin is probably not the only etiology of the specific postoperative complications of these major surgeries. No significant difference was noticed in five-year mortality, and no correlation was found in relation to the degree of intraoperative albumin kinetics.
Collapse
Affiliation(s)
- Cyrus Motamed
- Department of Anesthesia, Institut de Cancerologie Gustave Roussy, 94080 Paris, France;
- Correspondence:
| | - Lucie Mariani
- Department of Anesthesia and Intensive Care, APHP Hopital Pitié Salpétrière, 75013 Paris, France;
| | - Stéphanie Suria
- Department of Anesthesia, Institut de Cancerologie Gustave Roussy, 94080 Paris, France;
| | - Gregoire Weil
- Anesthesia Department, Centre Hospitalier d’Orleans, 45100 Orléans, France;
| |
Collapse
|
8
|
Motamed C. Clinical Update on Patient-Controlled Analgesia for Acute Postoperative Pain. Pharmacy 2022; 10:pharmacy10010022. [PMID: 35202071 PMCID: PMC8877436 DOI: 10.3390/pharmacy10010022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
Patient-controlled analgesia (PCA) is an effective method for controlling acute pain, including postoperative pain in adults and in children from five years of age, pain resulting from labor, trauma, or other medical situations, or chronic and malignant pain. The treatment consists of a mini-computer-controlled infusion pump permitting the administration of on-demand, continuous, or combined doses of analgesic (mainly opioid) variations in response to therapy, which allows pain to be significantly controlled. Intravenous (IV)-PCA minimizes individual pharmacodynamics and pharmacokinetic differences and is widely accepted as a reference method for mild or severe postoperative pain. IV-PCA is the most studied route of PCA; other delivery methods have been extensively reported in the literature. In addition, IV-PCA usually voids the gap between pain sensation and analgesic administration, permitting better recovery and fewer side effects. The most commonly observed complications are nausea and vomiting, pruritus, respiratory depression, sedation, confusion and urinary retention. However, human factors such as pharmacy preparation and device programming can also be involved in the occurrence of these complications, while device failure is much less of an issue.
Collapse
Affiliation(s)
- Cyrus Motamed
- Department of anesthesia, Gustave Roussy Cancer Campus, 94080 Villejuif, France
| |
Collapse
|
9
|
Motamed C, Weil G, Bourgain JL. Impact of extending prevention of postoperative nausea and vomiting for cancer surgical patients in the PACU: a before and after retrospective study. Braz J Anesthesiol 2021; 72:762-767. [PMID: 34216701 PMCID: PMC9660008 DOI: 10.1016/j.bjane.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/24/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022] Open
Abstract
Backgrounds Procedures for Postoperative Nausea and Vomiting (PONV) prevention are mostly based on identification of the risk factors before administering antiemetic drugs. The purpose of this study was to evaluate the impact of the extended use of antiemetic on the PONV in the Postanesthetic Care Unit (PACU). Methods Two separate 4-year periods (2007...2010, P1, and (2015...2018, P2) were evaluated. During P1, the protocol consisted of dexamethasone and droperidol for patients with a locally adapted high PONV score, followed by ondansetron for rescue in the PACU. For Period 2, dexamethasone (8 mg) and ondansetron (4 mg) were administered in patients under general or regional anesthesia, or sedation longer than 30 minutes, while droperidol (1.25 mg) in rescue was injected in cases of PONV in the PACU. An Anesthesia Information Management System was used to evaluate the intensity score of PONV (1 to 5), putative compliance, sedation, and perioperative opioid consumption upon arrival in the PACU. Results A total of 27,602 patients were assessed in P1 and 36,100 in P2. The administration of dexamethasone and ondansetron increased several fold (p < 0.0001). The high PONV scores were more improved in P2 than in P1, with scores (3+4+5) for P1 vs. P2, p < 0.0001. Overall, 99.7% of the patients in P2 were asymptomatic at discharge. Morphine consumption decreased from 6.9..1.5 mg in P1 to 3.5 .. 1.5 mg in P2 (p < 0.0001). Discussion The extension of pharmacological prevention of PONV was associated with a decrease in the intensity of severe PONV. However, uncertainty regarding confounding factors should not be ignored. IRB n.. 92012/33465
Collapse
Affiliation(s)
- Cyrus Motamed
- Gustave Roussy Institute, Department of Anesthesia, Villejuif, France.
| | - Grégoire Weil
- Gustave Roussy Institute, Department of Anesthesia, Villejuif, France
| | | |
Collapse
|
10
|
Asehnoune K, Le Moal C, Lebuffe G, Le Penndu M, Josse NC, Boisson M, Lescot T, Faucher M, Jaber S, Godet T, Leone M, Motamed C, David JS, Cinotti R, El Amine Y, Liutkus D, Garot M, Marc A, Le Corre A, Thomasseau A, Jobert A, Flet L, Feuillet F, Pere M, Futier E, Roquilly A. Effect of dexamethasone on complications or all cause mortality after major non-cardiac surgery: multicentre, double blind, randomised controlled trial. BMJ 2021; 373:n1162. [PMID: 34078591 PMCID: PMC8171383 DOI: 10.1136/bmj.n1162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the effect of dexamethasone on complications or all cause mortality after major non-cardiac surgery. DESIGN Phase III, randomised, double blind, placebo controlled trial. SETTING 34 centres in France, December 2017 to March 2019. PARTICIPANTS 1222 adults (>50 years) requiring major non-cardiac surgery with an expected duration of more than 90 minutes. The anticipated time frame for recruitment was 24 months. INTERVENTIONS Participants were randomised to receive either dexamethasone (0.2 mg/kg immediately after the surgical procedure, and on day 1) or placebo. Randomisation was stratified on the two prespecified criteria of cancer and thoracic procedure. MAIN OUTCOMES MEASURES The primary outcome was a composite of postoperative complications or all cause mortality within 14 days after surgery, assessed in the modified intention-to-treat population (at least one treatment administered). RESULTS Of the 1222 participants who underwent randomisation, 1184 (96.9%) were included in the modified intention-to-treat population. 14 days after surgery, 101 of 595 participants (17.0%) in the dexamethasone group and 117 of 589 (19.9%) in the placebo group had complications or died (adjusted odds ratio 0.81, 95% confidence interval 0.60 to 1.08; P=0.15). In the stratum of participants who underwent non-thoracic surgery (n=1038), the primary outcome occurred in 69 of 520 participants (13.3%) in the dexamethasone group and 93 of 518 (18%) in the placebo group (adjusted odds ratio 0.70, 0.50 to 0.99). Adverse events were reported in 288 of 613 participants (47.0%) in the dexamethasone group and 296 of 609 (48.6%) in the placebo group (P=0.46). CONCLUSIONS Dexamethasone was not found to significantly reduce the incidence of complications and death in patients 14 days after major non-cardiac surgery. The 95% confidence interval for the main result was, however, wide and suggests the possibility of important clinical effectiveness. TRIAL REGISTRATION ClinicalTrials.gov NCT03218553.
Collapse
Affiliation(s)
- Karim Asehnoune
- CHU Nantes, Université de Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France
| | - Charlene Le Moal
- Service d'Anesthésie, Centre Hospitalier Le Mans, Le Mans, France
| | - Gilles Lebuffe
- Centre Hospitalier Universitaire (CHU) Lille, Pôle Anesthésie Réanimation, Lille, France
| | - Marguerite Le Penndu
- CHU Nantes, Université de Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France
| | | | - Matthieu Boisson
- CHU de Poitiers, Université de Poitiers, Service d'Anesthésie-Réanimation, Poitiers, France
| | - Thomas Lescot
- Hôpital Saint Antoine, Service d'Anesthésie Réanimation Chirurgicale, Assistance publique des hôpitaux de Paris, Paris, France
| | - Marion Faucher
- Institut Paoli Calmette, Service d'Anesthésie, Marseille, France
| | - Samir Jaber
- Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Thomas Godet
- Service d'Anesthésie et Réanimation, Hôpital Estaing, CHU Clermont Ferrand, Clermont-Ferrand, France
| | - Marc Leone
- Department of Anesthesiology and Critical Care Medicine, Hôpital Nord, Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Cyrus Motamed
- Département d'Anesthésie & VVC, Gustave Roussy Cancer Center, Villejuif, France
| | - Jean Stephane David
- Service d'Anesthésie Réanimation, Groupe Hospitalier Sud, Civils de Lyon, Pierre Benite, France
| | - Raphael Cinotti
- CHU Nantes, Université de Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôpital Guillaume et René Laennec, Saint-Herblain, France
| | | | - Darius Liutkus
- Service d'Anesthésie, Centre Hospitalier Le Mans, Le Mans, France
| | - Matthias Garot
- Centre Hospitalier Universitaire (CHU) Lille, Pôle Anesthésie Réanimation, Lille, France
| | - Antoine Marc
- CHU Nantes, Université de Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France
| | - Anne Le Corre
- Service d'Anesthésie, Hôpital Privé du Confluent, Nantes, France
| | - Alexandre Thomasseau
- CHU de Poitiers, Université de Poitiers, Service d'Anesthésie-Réanimation, Poitiers, France
| | - Alexandra Jobert
- CHU de Nantes, Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Nantes, France
| | - Laurent Flet
- CHU Nantes, Service Pharmacie, Hôtel Dieu, Nantes, France
| | - Fanny Feuillet
- Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France
| | - Morgane Pere
- CHU de Nantes, Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Nantes, France
| | - Emmanuel Futier
- Service d'Anesthésie et Réanimation, Hôpital Estaing, CHU Clermont Ferrand, Clermont-Ferrand, France
| | - Antoine Roquilly
- CHU Nantes, Université de Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France
| |
Collapse
|
11
|
Motamed C, Demiri M, Colegrave N. Comparison of Train of Four Measurements with Kinemyography NMT DATEX and Accelerography TOFscan. Med Sci (Basel) 2021; 9:medsci9020021. [PMID: 33805406 PMCID: PMC8103272 DOI: 10.3390/medsci9020021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction: This study was designed to compare the Datex neuromuscular transmission (NMT) kinemyography (NMTK) device with the TOFscan (TS) accelerometer during the onset and recovery of neuromuscular blockade. Patients and methods: This prospective study included adult patients who were scheduled to undergo elective surgery with general anesthesia and orotracheal intubation. The TS accelerometer was randomly placed at the adductor pollicis on one hand, and the NMTK was placed on the opposite arm. Anesthesia was initiated with remifentanil target-controlled infusion (TCI) and 2.0–3.0 mg/kg of propofol. Thereafter, 0.5 mg/kg of atracurium or 0.6 mg/kg of rocuronium was injected. If needed, additional neuromuscular blocking agents were administered to facilitate surgery. First, we recorded the train of four (TOF) response at the onset of neuromuscular blockade to reach a TOF count of 0. Second, we recorded the TOF response at the recovery of neuromuscular blockade to obtain a T4/T1 90% by both TS and NMTK. Results: There were 32 patients, aged 38–83 years, with the American Society of Anesthesiologists (ASA) Physical Status Classification I–III included and analyzed. Surgery was abdominal, gynecologic, or head and neck. The Bland and Altman analysis for obtaining zero responses during the onset showed a bias (mean) of 2.7 s (delay) of TS in comparison to NMTK, with an upper/lower limit of agreement of [104; −109 s] and a bias of 36 s of TS in comparison to NMTK, with an upper/lower limit of agreement of [−21.8, −23.1 min] during recovery (T4/T1 > 90%). Conclusions: Under the conditions of the present study, the two devices are not interchangeable. Clinical decisions for deep neuromuscular blockade should be made cautiously, as both devices appear less accurate with significant variability.
Collapse
|
12
|
Motamed C, Roubineau R, Depoix JP, Servin F, Roche G, Billard V. Efficacy of target controlled infusion of remifentanil with spontaneous ventilation for procedural sedation and analgesia (Remi TCI PSA): A double center prospective observational study. J Opioid Manag 2021; 17:69-78. [PMID: 33735429 DOI: 10.5055/jom.2021.0615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Remifentanil, a rapid onset rapid offset synthetic opioid and potent analgesic, is often used for procedural conscious sedation in spontaneous ventilation, especially when delivered in target controlled infusion (TCI), which allows precise titration. We assessed efficacy, tolerance, and adverse events related with the use of remifentanil TCI during various procedures. DESIGN Prospective, observational. SETTING Two teaching hospitals. PATIENTS We enrolled 434 patients undergoing procedures suitable for conscious sedation. INTERVENTIONS The following procedures considered suitable were included: interventional radiology, gastrointestinal (GI) endoscopy, interventional cardiology, and peripheral dermatology. Sedation options were determined during the preoperative anesthesia assessment. MAIN OUTCOME MEASURES Demographics were recorded as well as success rate, remifentanil dosage, pain scores, respiratory or cardiovascular events, and patient and operator satisfaction. RESULTS The procedure was successful in 429 patients (99 percent), canceled in four patients because of agitation, apnea, desaturation, and converted to general anesthesia in two for major pain. The maximal remifentanil target was around 2-3 ng/ml for most procedures, but it was 3-5 ng/ml for GI endoscopy and urology. A total of 172 patients (40 percent) had bradypnea < 8 min-1, but only 26 (6 percent) had hypoxemia < 90 percent. Eighteen patients (4 percent) required mandibular luxation, and twelve needed face mask ventilation. There were no major cardiovascular adverse events. CONCLUSIONS Remifentanil TCI is a suitable protocol for procedural sedation, but respiratory depression is a permanent concern. This risk requires equipped environment and competent medical personnel on hand to adjust the target before hypoxemia occurs. Respiratory rate monitoring, based on capnography or thoracic impedance is of a great help in anticipating this threat.
Collapse
Affiliation(s)
- Cyrus Motamed
- Department of Anaesthesia, Gustave Roussy Cancer Centre,Villejuif, France
| | - Romain Roubineau
- Department of Anaesthesia, Bichat Claude Bernard University Hospital, Paris, France
| | - Jean-Pol Depoix
- Department of Anaesthesia, Bichat Claude Bernard University Hospital, Paris, France
| | - Frédérique Servin
- Department of Anaesthesia, Bichat Claude Bernard University Hospital, Paris, France
| | - Geraldine Roche
- Department of Anaesthesia, Gustave Roussy Cancer Centre, Villejuif, France
| | - Valérie Billard
- Department of Anaesthesia, Gustave Roussy Cancer Centre, Villejuif, France
| |
Collapse
|
13
|
Motamed C, Bourgain JL. Comparison of the Time to Extubation and Length of Stay in the PACU after Sugammadex and Neostigmine Use in Two Types of Surgery: A Monocentric Retrospective Analysis. J Clin Med 2021; 10:jcm10040815. [PMID: 33671391 PMCID: PMC7921908 DOI: 10.3390/jcm10040815] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 12/19/2022] Open
Abstract
Sugammadex provides a rapid pharmacological reversal of aminosteroid, as well as fewer pulmonary complications, a better physiological recovery, and shorter stays in the postanesthetic recovery unit (PACU). This retrospective analysis of our Centricity anesthesia database in 2017–2019 assessed the efficiency of sugammadex in real-life situations in two groups of surgical cancer patients (breast and abdominal surgery) based on the extubation time, operating room exit time, and length of PACU stay. Overall, 382 anesthesia records (131 breast and 251 abdominal surgeries) were extracted for the pharmacological reversal of neuromuscular blockades by neostigmine or sugammadex. Sugammadex was used for reversal in 91 breast and 204 abdominal surgeries. Sugammadex use did not affect the extubation time, operating room exit time, or length of PACU stay. However, the time to reach a 90% train of four (TOF) recovery was significantly faster in sugammadex patients: 2 min (1.5–8) in breast surgery and 2 min (1.5–7) in abdominal surgery versus 10 (6–20) and 9 min (5–20), respectively, for neostigmine (p < 0.05). Most patients who were reversed with sugammadex (91%) reached a TOF ratio of at least 90%, while 54% of neostigmine patients had a 90% TOF ratio recorded (p < 0.05). Factors other than pharmacological reversal probably influence the extubation time, operating room exit time, or PACU stay; however, sugammadex reliably shortened the time so as to reach a 90% TOF ratio with a better level of reversal.
Collapse
|
14
|
Demiri M, Colegrave N, Motamed C, Billard V. Comparison of the four-train measurement with a new TOF Cuff® device versus TOF Watch® accelerometer. Anaesth Crit Care Pain Med 2020; 39:891-892. [PMID: 33038558 DOI: 10.1016/j.accpm.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/16/2020] [Accepted: 02/16/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Migena Demiri
- Department of Anaesthesia, Gustave Roussy, 94800 Villejuif, France.
| | - Nora Colegrave
- Department of Anaesthesia, Gustave Roussy, 94800 Villejuif, France
| | - Cyrus Motamed
- Department of Anaesthesia, Gustave Roussy, 94800 Villejuif, France
| | - Valerie Billard
- Department of Anaesthesia, Gustave Roussy, 94800 Villejuif, France
| |
Collapse
|
15
|
Plaud B, Baillard C, Bourgain JL, Bouroche G, Desplanque L, Devys JM, Fletcher D, Fuchs-Buder T, Lebuffe G, Meistelman C, Motamed C, Raft J, Servin F, Sirieix D, Slim K, Velly L, Verdonk F, Debaene B. Guidelines on muscle relaxants and reversal in anaesthesia. Anaesth Crit Care Pain Med 2020; 39:125-142. [PMID: 31926308 DOI: 10.1016/j.accpm.2020.01.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To provide an update to the 1999 French guidelines on "Muscle relaxants and reversal in anaesthesia", a consensus committee of sixteen experts was convened. A formal policy of declaration and monitoring of conflicts of interest (COI) was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE®) system to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making strong recommendations based on low-quality evidence were stressed. Few of the recommendations remained ungraded. METHODS The panel focused on eight questions: (1) In the absence of difficult mask ventilation criteria, is it necessary to check the possibility of ventilation via a facemask before muscle relaxant injection? Is it necessary to use muscle relaxants to facilitate facemask ventilation? (2) Is the use of muscle relaxants necessary to facilitate tracheal intubation? (3) Is the use of muscle relaxants necessary to facilitate the insertion of a supraglottic device and management of related complications? (4) Is it necessary to monitor neuromuscular blockade for airway management? (5) Is the use of muscle relaxants necessary to facilitate interventional procedures, and if so, which procedures? (6) Is intraoperative monitoring of neuromuscular blockade necessary? (7) What are the strategies for preventing and treating residual neuromuscular blockade? (8) What are the indications and precautions for use of both muscle relaxants and reversal agents in special populations (e.g. electroconvulsive therapy, obese patients, children, neuromuscular diseases, renal/hepatic failure, elderly patients)? All questions were formulated using the Population, Intervention, Comparison and Outcome (PICO) model for clinical questions and evidence profiles were generated. The results of the literature analysis and the recommendations were then assessed using the GRADE® system. RESULTS The summaries prepared by the SFAR Guideline panel resulted in thirty-one recommendations on muscle relaxants and reversal agents in anaesthesia. Of these recommendations, eleven have a high level of evidence (GRADE 1±) while twenty have a low level of evidence (GRADE 2±). No recommendations could be provided using the GRADE® system for five of the questions, and for two of these questions expert opinions were given. After two rounds of discussion and an amendment, a strong agreement was reached for all the recommendations. CONCLUSION Substantial agreement exists among experts regarding many strong recommendations for the improvement of practice concerning the use of muscle relaxants and reversal agents during anaesthesia. In particular, the French Society of Anaesthesia and Intensive Care (SFAR) recommends the use of a device to monitor neuromuscular blockade throughout anaesthesia.
Collapse
Affiliation(s)
- Benoît Plaud
- Université de Paris, Assistance publique-Hôpitaux de Paris, service d'anesthésie et de réanimation, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Christophe Baillard
- Université de Paris, Assistance publique-Hôpitaux de Paris, service d'anesthésie et de réanimation, hôpital Cochin-Port Royal, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Jean-Louis Bourgain
- Institut Gustave-Roussy, service d'anesthésie, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Gaëlle Bouroche
- Centre Léon-Bérard, service d'anesthésie, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - Laetitia Desplanque
- Assistance publique-Hôpitaux de Paris, service d'anesthésie et de réanimation, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75877 Paris cedex, France
| | - Jean-Michel Devys
- Fondation ophtalmologique Adolphe-de-Rothschild, service d'anesthésie et de réanimation, 29, rue Manin, 75019 Paris, France
| | - 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
| | - Thomas Fuchs-Buder
- Université de Lorraine, CHU de Brabois, service d'anesthésie et de réanimation, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - Gilles Lebuffe
- Université de Lille, hôpital Huriez, service d'anesthésie et de réanimation, rue Michel-Polonovski, 59037 Lille, France
| | - Claude Meistelman
- Université de Lorraine, CHU de Brabois, service d'anesthésie et de réanimation, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - Cyrus Motamed
- Institut Gustave-Roussy, service d'anesthésie, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Julien Raft
- Institut de cancérologie de Lorraine, service d'anesthésie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Frédérique Servin
- Assistance publique-Hôpitaux de Paris, service d'anesthésie et de réanimation, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75877 Paris cedex, France
| | - Didier Sirieix
- Groupe polyclinique Marzet-Navarre, service d'anesthésie, 40, boulevard d'Alsace-Lorraine, 64000 Pau, France
| | - Karem Slim
- Université d'Auvergne, service de chirurgie digestive et hépatobiliaire, hôpital d'Estaing, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - Lionel Velly
- Université Aix-Marseille, hôpital de la Timone adultes, service d'anesthésie et de réanimation, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - Franck Verdonk
- Sorbonne université, hôpital Saint-Antoine, 84, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Bertrand Debaene
- Université de Poitiers, service d'anesthésie et de réanimation, CHU de Poitiers, BP 577, 86021 Poitiers cedex, France
| |
Collapse
|
16
|
Weil G, Motamed C, Monnet X, Eghiaian A, Le Maho AL. End-Expiratory Occlusion Test to Predict Fluid Responsiveness Is Not Suitable for Laparotomic Surgery. Anesth Analg 2020; 130:151-158. [DOI: 10.1213/ane.0000000000004205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
17
|
Weil G, Motamed C, Eghiaian A, Monnet X, Suria S. Comparison of Proaqt/Pulsioflex® and oesophageal Doppler for intraoperative haemodynamic monitoring during intermediate-risk abdominal surgery. Anaesth Crit Care Pain Med 2019; 38:153-159. [DOI: 10.1016/j.accpm.2018.03.011] [Citation(s) in RCA: 2] [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: 01/16/2018] [Revised: 03/22/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022]
|
18
|
Hoslin L, Motamed C, Maurice-Szamburski A, Legoupil C, Pons S, Bordenave L. Impact of hypnosis on patient experience after venous access port implantation. Anaesth Crit Care Pain Med 2019; 38:609-613. [PMID: 30831308 DOI: 10.1016/j.accpm.2019.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/30/2019] [Accepted: 02/17/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Hypnosis has been reported to decrease pain and anxiety in surgical context, but data studying its impact on patient experience using a validated scale are scarce. In the present study, we assessed the effect of an audio hypnosis session on patient satisfaction during venous access port implantation under local anaesthesia in adult cancer patients using the EVAN-LR Score. METHODS After informed consent, patients were randomised to receive either hypnosis or standard care. The hypnosis group listened to a 26 minutes recorded audio hypnosis session through the ongoing implantation procedure. The primary outcome was the result of the EVAN-LR questionnaire, assessing perioperative experience in patients undergoing anaesthesia without loss of consciousness. This score describes a global index and 5 dimensions of experience: comfort, pain attention, information and waiting. It is scaled from 0 to 100 with 100 indicating the best possible level of satisfaction. Secondary outcomes included patient's anxiety, heart rate before and after procedure, procedure duration and several Visual Analogic Scale to match EVAN-LR dimensions. RESULTS Overall, 148 patients were enrolled in the study. The global index of Evan-LR was significantly higher in the hypnosis session group (78 ± 14) compared to the standard care group (71 ± 17) (P = 0.006). No difference was reported in secondary outcomes. CONCLUSION A recorded audio hypnosis session during subcutaneous venous port implantation under local anaesthesia in cancer patients significantly improved patient satisfaction.
Collapse
Affiliation(s)
- Laura Hoslin
- Department of anaesthesia, Gustave-Roussy Institute, 39, rue Camille-Demoulins, Villejuif, France
| | - Cyrus Motamed
- Department of anaesthesia, Gustave-Roussy Institute, 39, rue Camille-Demoulins, Villejuif, France.
| | | | - Clemence Legoupil
- Department of Biostatistics and epidemiology, Gustave-Roussy Institute, France
| | - Stephanie Pons
- Department of anaesthesia, Gustave-Roussy Institute, 39, rue Camille-Demoulins, Villejuif, France
| | - Lauriane Bordenave
- Department of anaesthesia, Gustave-Roussy Institute, 39, rue Camille-Demoulins, Villejuif, France
| |
Collapse
|
19
|
Bouroche G, Motamed C, de Guibert J, Hartl D, Bourgain J. Rescue transtracheal jet ventilation during difficult intubation in patients with upper airway cancer. Anaesth Crit Care Pain Med 2018; 37:539-544. [DOI: 10.1016/j.accpm.2017.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/24/2017] [Accepted: 10/14/2017] [Indexed: 01/08/2023]
|
20
|
Weil G, Motamed C. Adjusting the Ventilator? Not Only Size Matters! Anesth Analg 2018; 127:e28-e30. [PMID: 29889709 DOI: 10.1213/ane.0000000000003468] [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] [Indexed: 11/05/2022]
Affiliation(s)
- Grégoire Weil
- Department of Anesthesiology, Gustave Roussy Cancer Campus, Villejuif, France,
| | | |
Collapse
|
21
|
Motamed C, Audibert J, Albi-Feldzer A, Bouroche G, Jayr C. Postoperative pain scores and opioid consumption in opioid-dependent patients with cancer after intraoperative remifentanil analgesia: A prospective case-controlled study. J Opioid Manag 2017; 13:221-228. [PMID: 28953314 DOI: 10.5055/jom.2017.0390] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Opioid dependency is becoming increasingly common among surgical patients with cancer, and can lead to inadequate pain relief during the initial postoperative period. No guidelines are currently available for the management of perioperative and postoperative morphine administration in these patients. As a first approach, the authors assessed the opioid requirements of these patients during the early postoperative period. METHODS A group of 35 consecutive surgical patients with cancer on opioid therapy (opioid-dependent group) for cancer pain were compared to a matched group of 44 surgical opioid-naive patients (control group). All patients underwent major head and neck or abdominal surgery. The following parameters were recorded and compared: preoperative and postoperative morphine consumption, patient-controlled analgesia records and Visual Analog Scale scores, intraoperative remifentanil and desflurane consumption, Bispectral Index monitoring values, heart rate, and blood pressure. RESULTS Remifentanil requirements were significantly higher (1.4-fold) in the opioid-dependent group compared to the control group (p < 0.05). On postoperative day 1, morphine requirements were significantly higher in the opioid-dependent group (2.3-fold) compared to the control group (p < 0.05). Baseline heart rate was significantly higher in the opioid-dependent group and this difference remained significant during surgery, no significant difference in blood pressure was observed between the two groups. CONCLUSION This study shows a 40 percent increase of intraoperative remifentanil requirements in opioid-dependent patients during cancer surgery. Morphine requirements during the postoperative period were increased by up to 140 percent.
Collapse
|
22
|
Weil G, Motamed C, Biau DJ, Guye ML. Learning curves for three specific procedures by anesthesiology residents using the learning curve cumulative sum (LC-CUSUM) test. Korean J Anesthesiol 2017; 70:196-202. [PMID: 28367291 PMCID: PMC5370306 DOI: 10.4097/kjae.2017.70.2.196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/03/2016] [Revised: 11/25/2016] [Accepted: 11/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The learning curve cumulative sum (LC-CUSUM) test is an innovative tool that allows quantitative monitoring of individual medical performance during the learning process by determining when a predefined acceptable level of performance is reached. This study used the LC-CUSUM test to monitor the learning process and failure rate of anesthesia residents training for specific subspecialty anesthesia procedures. METHODS The study included 490 tracheal punctures (TP) for jet ventilation, 340 thoracic epidural analgesia (TEA) procedures, and 246 fiberoptic nasal intubations (FONI) performed by 18 residents during their single 6-month rotation. RESULTS Overall, 27 (14-52), 19 (5-41), and 14 (6-33) TP, TEA, and FONI procedures were performed, respectively, by each resident. In total, 2 of 18 residents achieved an acceptable failure rate for TEA according to the literature and 4 of 18 achieved an acceptable failure rate for FONI, while none of the residents attained an acceptable rate for TP. CONCLUSIONS A single 6-month rotation in a reference teaching center may not be sufficient to train residents to perform specific or sub-specialty procedures as required. A regional learning network may be useful. More patient-based data are necessary to conduct a risk adjustment analysis for such specific procedures.
Collapse
Affiliation(s)
- Gregoire Weil
- Department of Anesthesia, Institute Gustave Roussy, Villejuif, France
| | - Cyrus Motamed
- Department of Anesthesia, Institute Gustave Roussy, Villejuif, France
| | - David J Biau
- Department of Anesthesia, Institute Gustave Roussy, Villejuif, France
| | | |
Collapse
|
23
|
Motamed C, Chedevergne K, Deschamps F, Tselikas L, Jayr C. Contribution of Low-Dose Computerized Tomography With Digital Multiplanar Reconstructions in Thoracic Epidurography and Correlation With Sensory Block in Postoperative Analgesia. Anesth Pain Med 2016; 6:e37577. [PMID: 27847694 PMCID: PMC5101418 DOI: 10.5812/aapm.37577] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/16/2016] [Accepted: 04/29/2016] [Indexed: 11/16/2022] Open
Abstract
Background The level of sensory block in postoperative epidural analgesia has been correlated with conventional contrast epidurography in only one study, while low-dose CT scan epidurography with multiplanar reconstruction may be a better tool for this purpose. Objectives The primary objective of this study was to evaluate, by CT imaging and digital multiplanar reconstruction, the spread and distribution of contrast medium injected into the epidural space through a catheter inserted in a low thoracic position for postoperative analgesia. Materials and Methods Ten patients undergoing major abdominal cancer surgery with effective epidural analgesia were prospectively included at postoperative day three. Two consecutive boluses of 5 mL of a mixture of ropivacaine and contrast medium were injected at 15 minutes intervals into the epidural space. Multislice low-dose CT scan epidurography and an assessment of the sensory block were performed before and after injection of the second bolus. The primary objective was to assess the contribution of CT scan epidurography to predict a correlation between the level of sensory block and the spread of the contrast medium in the epidural space; the secondary objective was to determine the agreement between the two methods. Results The spread of contrast material and the clinical sensory block significantly increased after the second injection (32%; P < 0.05). However, no highly significant correlation was observed between the two methods. A gap of two spinal segments of CT opacification was observed in two patients and was confirmed by clinical assessment. Conclusions CT epidurography is not closely correlated with a clinical assessment of epidural block; thus, a clinical assessment of the sensory block is mandatory. The use of opioid analgesia in combination with local anesthetics may compensate for the lack of efficacy of local anesthetics alone.
Collapse
Affiliation(s)
- Cyrus Motamed
- Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France
- Corresponding author: Cyrus Motamed, Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France, E-mail:
| | - Karin Chedevergne
- Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France
| | - Frederic Deschamps
- Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France
| | - Lambros Tselikas
- Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France
| | | |
Collapse
|
24
|
Guye ML, Motamed C, Chemam S, Leymarie N, Suria S, Weil G. Remote peripheral tissue oxygenation does not predict postoperative free flap complications in complex head and neck cancer surgery: A prospective cohort study. Anaesth Crit Care Pain Med 2016; 36:27-31. [PMID: 27320053 DOI: 10.1016/j.accpm.2016.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients undergoing free flap reconstruction after head and neck cancer may develop free flap complications. In the perioperative period, haemoglobin content and oxygen tissue saturation (StO2) measured directly on the free flap reflect peripheral tissue oxygenation. However, in this type of surgery, StO2 cannot always be applied directly or proximate to the free flap. The aim of this study was to assess the possible value of StO2 measured at the thenar eminence and other 24hour perioperative factors on free flap complications. METHODS Inclusion criteria corresponded to patients with head and neck cancer with free flap surgery in whom direct StO2 could not be monitored on the flap nor in its peripheral area. Patient characteristics and intraoperative data, such as haemoglobin and fluid management, were prospectively collected. StO2 was measured remotely on the thenar eminence. Data were collected for 24hours and free flap complications were recorded for up to 15days after surgery. Patients were thereafter classified into two groups: with or without free flap complications and the data were compared in consequence. RESULTS Forty consecutive patients were prospectively included. Ten patients had postoperative free flap complications and were compared to the 30 other patients without complications. The haemoglobin level at the reperfusion of the flap: (AUC 0.80 [0.65-0.91], threshold 9.9g/dL, P<0.001) and body mass index [BMI] (AUC 0.80 [0.64-0.72], threshold 24.5kg/m2, P<0.01) were significantly related to complications. CONCLUSION In head and neck complex oncologic reconstructive surgery, haemoglobin and BMI were the most sensitive tools for predicting postoperative free flap complications, while thenar eminence StO2 was not.
Collapse
Affiliation(s)
- Marie-Laurence Guye
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Cyrus Motamed
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
| | - Sarah Chemam
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Nicolas Leymarie
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Stéphanie Suria
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Grégoire Weil
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| |
Collapse
|
25
|
Colegrave N, Billard V, Motamed C, Bourgain JL. Comparison of the TOF-Scan™ acceleromyograph to TOF-Watch SX™: Influence of calibration. Anaesth Crit Care Pain Med 2016; 35:223-7. [DOI: 10.1016/j.accpm.2016.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
|
26
|
Motamed C, Bourgain JL. An anaesthesia information management system as a tool for a quality assurance program: 10years of experience. Anaesth Crit Care Pain Med 2016; 35:191-5. [PMID: 26773168 DOI: 10.1016/j.accpm.2015.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/01/2014] [Accepted: 11/14/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Anaesthesia Information Management Systems (AIMS) generate large amounts of data, which might be useful for quality assurance programs. This study was designed to highlight the multiple contributions of our AIMS system in extracting quality indicators over a period of 10years. METHODS The study was conducted from 2002 to 2011. Two methods were used to extract anaesthesia indicators: the manual extraction of individual files for monitoring neuromuscular relaxation and structured query language (SQL) extraction for other indicators which were postoperative nausea and vomiting (PONV), pain, sedation scores, pain-related medications, scores and postoperative hypothermia. For each indicator, a program of information/meetings and adaptation/suggestions for operating room and PACU personnel was initiated to improve quality assurance, while data were extracted each year. RESULTS The study included 77,573 patients. The mean overall completeness of data for the initial years ranged from 55 to 85% and was indicator-dependent, which then improved to 95% completeness for the last 5years. The incidence of neuromuscular monitoring was initially 67% and then increased to 95% (P<0.05). The rate of pharmacological reversal remained around 53% throughout the study. Regarding SQL data, an improvement of severe postoperative pain and PONV scores was observed throughout the study, while mild postoperative hypothermia remained a challenge, despite efforts for improvement. DISCUSSION The AIMS system permitted the follow-up of certain indicators through manual sampling and many more via SQL extraction in a sustained and non-time-consuming way across years. However, it requires competent and especially dedicated resources to handle the database.
Collapse
Affiliation(s)
- Cyrus Motamed
- Department of Anaesthesia, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.
| | - Jean Louis Bourgain
- Department of Anaesthesia, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| |
Collapse
|
27
|
Ahouandjinou ASRM, Motamed C, Ezin EC. A temporal belief-based hidden markov model for human action recognition in medical videos. Pattern Recognit Image Anal 2015. [DOI: 10.1134/s1054661815030025] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
28
|
Bousetouane F, Vandewiele F, Motamed C. Occlusion management in distributed multi-object tracking for visual-surveillance. Pattern Recognit Image Anal 2015. [DOI: 10.1134/s1054661815020042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
29
|
Motamed C, Bourgain J. Benefits and possible improvements of an anaesthesia information management system in a quality assurance programme. Br J Anaesth 2014; 113:885-6. [DOI: 10.1093/bja/aeu358] [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] [Indexed: 11/12/2022] Open
|
30
|
Motamed C, Philippe D. The effect of defasciculating doses of pancuronium and atracurium on succinylcholine neuromuscular blockade. Anesth Pain Med 2014; 4:e18488. [PMID: 25337472 PMCID: PMC4199212 DOI: 10.5812/aapm.18488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/07/2014] [Accepted: 04/28/2014] [Indexed: 11/23/2022] Open
Abstract
Background: A defasciculating dose of non-depolarizing muscle relaxant administered prior succinylcholine decrease its side effects including fasciculations and postoperative myalgias; however it is believed that the dosage of succinylcholine should be increased when such a pre-treatment is used. Objectives: We hypothesized that a defasciculating dose of pancuronium as a pre-treatment could prolong its duration of effect. Patients and Methods: Forty patients scheduled for elective orthopaedic surgery were consecutively assigned into 5 groups, a first group without pre-treatment (succinylcholine 1 mg/kg) and 4 subsequent groups of pretreatment with atracurium 0.05 mg/kg + succinylcholine 1 or 1.5 mg/kg and pancuronium 7.5 µg /kg + succinylcholine 1 and 1.5 mg/kg. The muscle relaxant effect of succinylcholine was assessed with a force transducer using train of four stimulations every 12 seconds. Kruskall Wallis Anova test was used to compare results. Results: The duration of succinylcholine induced paralysis (1 and 1.5 mg/kg) was significantly prolonged with pre-treatment with pancuronium but succinylcholine 1mg/kg did not reached maximum blockade after pre-treatment with atracurium. After pancuronium, full recovery after succinylcholine 1.5 and 1 mg/kg occurred respectively after 18 and 15 minutes. P < 0.05 vs. 12 minutes for succinylcholine 1mg/kg alone. Conclusions: This study highlights potentiation effect of a defasciculating dose of pancuronium on succinylcholine paralysis suggesting the lack of justification to increase succinylcholine dosage.
Collapse
Affiliation(s)
- Cyrus Motamed
- Department of Anesthesia, Gustave Roussy Institute, Rue Camille Desmoulins 94080 Villejuif, France University of Paris 11, Paris, France
- Corresponding author: Motamed Cyrus, Department of Anesthesia, Gustave Roussy Institute, Rue Camille Desmoulins 94080 Villejuif, France University of Paris 11, Paris, France. Tel: +33-142114436 Fax: +33-142115209, E-mail:
| | - Duvaldestin Philippe
- Department of Anesthesia, Hospital Henri Mondor, Avenue de Lattre de Tassigny 94010 Créteil, France University of Paris 12, Paris, France
| |
Collapse
|
31
|
Motamed C, Bourgain JL. Benefits and possible improvements of an Anesthesia Information Management System (AIMS) in a quality assurance program. Br J Anaesth 2014. [DOI: 10.1093/bja/el_11871] [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: 11/14/2022] Open
|
32
|
Motamed C, Weil G, Deschamps F, Billard V. Remifentanil target-controlled infusion: a safe rescue protocol for unexpected severe postoperative pain. J Opioid Manag 2014; 10:284-288. [PMID: 25162608 DOI: 10.5055/jom.2014.0216] [Citation(s) in RCA: 4] [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: 03/29/2014] [Revised: 05/17/2014] [Accepted: 05/29/2014] [Indexed: 06/03/2023]
Abstract
Three cases are reported here in which remifentanil administered as a target-controlled infusion (TCI) was used in Post Anesthesia Care Unit as a fast rescue treatment for acute and unexpected severe postoperative pain, allowing subsequent clinical evaluation and rational titration of analgesia with longer acting opioids. It illustrates the efficacy of this technique to titrate and compensate for variability in opioid requirements. However, its safety requires full knowledge of TCI technique, continuous monitoring of respiratory function, and assisted ventilation equipment immediately available.
Collapse
Affiliation(s)
- Cyrus Motamed
- Anesthesia Department, Institut Gustave Roussy, Villejuif, France
| | - Grégoire Weil
- Anesthesia Department, Institut Gustave Roussy, Villejuif, France
| | - Frederic Deschamps
- Interventional Radiology Department, Institut Gustave Roussy, Villejuif, France
| | - Valérie Billard
- Anesthesia Department, Institut Gustave Roussy, Villejuif, France
| |
Collapse
|
33
|
Bordenave L, Moya-Plana A, Motamed C, Bourgain JL. [Recurrent syncope in head and neck cancer: a case report]. ACTA ACUST UNITED AC 2014; 33:418-20. [PMID: 24878060 DOI: 10.1016/j.annfar.2014.04.011] [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: 02/28/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
The repeated syncopes in case of head and neck cancer are a complication rarely described in the literature. They occur when the tumor invade the carotid sinus or the afferent fibers of the glossopharyngeal nerve. We report the case of a 62-year-old man presented episodes of syncope synchronous of a recurrent hypopharyngeal tumor scheduled for chemotherapy and gastrostomy. A computerized tomography showed a voluminous tumor expanded to the carotid and parapharyngeal spaces. After treatment by isporenaline chlorhydrate in intensive care unit, a pacemaker was implanted to prevent syncopes and allowed the beginning of the chemotherapy.
Collapse
Affiliation(s)
- L Bordenave
- Service d'anesthésie, institut Gustave-Roussy, 114, rue Paul-Vaillant, 94805 Villejuif, France.
| | - A Moya-Plana
- Service d'anesthésie, institut Gustave-Roussy, 114, rue Paul-Vaillant, 94805 Villejuif, France
| | - C Motamed
- Service d'anesthésie, institut Gustave-Roussy, 114, rue Paul-Vaillant, 94805 Villejuif, France
| | - J-L Bourgain
- Service d'anesthésie, institut Gustave-Roussy, 114, rue Paul-Vaillant, 94805 Villejuif, France
| |
Collapse
|
34
|
Weil G, Motamed C, Eghiaian A, Guye ML, Bourgain JL. The use of a clinical database in an anesthesia unit: focus on its limits. J Clin Monit Comput 2014; 29:163-7. [PMID: 24838488 DOI: 10.1007/s10877-014-9581-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/07/2014] [Indexed: 11/30/2022]
Abstract
Anesthesia information management system (AIMS) can be used a part of quality assurance program to improve patient care, however erroneous or missing data entries may lead to misinterpretation. This study assesses the accuracy of information extracted for six consecutive years from a database linked to an automatic anesthesia record-keeping system. An observational study was conducted on a database linked AIMS system. The database was filled in real time during surgical/anesthesia procedure and in the post-anesthesia care unit. The following items: name of the anesthetist, duration of anesthesia, duration of monitoring, ventilatory status upon arrival in postoperative care unit, pain scores, nausea and vomiting scores, pain medication (morphine) and anti nausea and vomiting drug consumption (ondansetron) were extracted and analysed in order to determine exhaustivity (percentage of missing data) and accuracy of the database. The analysis covered 55,946 anaesthetic procedures. The rate of missing data was initially high upon installation but decreased over time. It was limited to 5% after 3 years for items such as start of anesthesia or name of the anesthetist. However exhaustivity/completeness of some other variable, such as nausea and vomiting started as low as 50% to reach 20% at 2008. After cross analysing pain and post-operative nausea and vomiting scores with related medication consumption, (morphine and ondansetron) we conclude that missing data was due to omission of a zero score rather than human error. The follow-up of quality assurance program may use data from AIMS provided that missing or erroneous values be mentioned and their impact on calculations accurately analysed.
Collapse
Affiliation(s)
- Grégoire Weil
- Service d'Anesthésie, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | | | | | | | | |
Collapse
|
35
|
Gorphe P, Sarfati B, Janot F, Bourgain JL, Motamed C, Blot F, Temam S. Airway fire during tracheostomy. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:197-9. [PMID: 24703002 DOI: 10.1016/j.anorl.2013.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 02/19/2013] [Revised: 04/17/2013] [Accepted: 07/16/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Twenty-five cases of airway fire during tracheostomy have been reported in the literature. The authors describe a case observed in their centre 3 years ago, discuss the causes and preventive management and propose guidelines for prevention of this complication. CASE REPORT A 66-year-old woman was intubated and ventilated with 100% oxygen during general anaesthesia for tracheostomy. On opening the trachea by monopolar diathermy, the oxygen present in the endotracheal tube caught fire, inducing combustion of the tube spreading to the lower airways. This airway fire was responsible for severe acute respiratory failure and the formation of multiple laryngotracheal stenoses. DISCUSSION Combustion of the endotracheal tube due to ignition of anaesthetic gases induced by the heat generated by diathermy is responsible for airway fire. These various phenomena are discussed. Prevention is based on safety measures and coordination of surgical and anaesthetic teams.
Collapse
Affiliation(s)
- P Gorphe
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - B Sarfati
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - F Janot
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - J L Bourgain
- Service d'anesthésie, institut de cancérologie Gustave-Roussy, 94800 Villejuif, France
| | - C Motamed
- Service d'anesthésie, institut de cancérologie Gustave-Roussy, 94800 Villejuif, France
| | - F Blot
- Service d'anesthésie, institut de cancérologie Gustave-Roussy, 94800 Villejuif, France
| | - S Temam
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| |
Collapse
|
36
|
Motamed C, Baguenard P, Bourgain JL. Possible mitigation of rocuronium-induced anaphylaxis after administration of sugammadex. J Anaesthesiol Clin Pharmacol 2012; 28:127-8. [PMID: 22345962 PMCID: PMC3275947 DOI: 10.4103/0970-9185.92464] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Cyrus Motamed
- Service d'anesthésie Institut Gustave Roussy. Villejuif France. Rue Edouard Vaillant villejuif, France
| | | | | |
Collapse
|
37
|
Abstract
Symptoms of Parkinson's disease are related to a progressive loss of substancia nigra's dopaminergic neurons in addition to persistent activation of N-methyl-D-aspartate receptors. In specific situations such as sedation for minor surgery, tremor and dyskinesia can be very disabling. We report the beneficial effect of the combination of remifentanil (target-controlled infusion mode) and ketamine (boluses IV) to control dyskinesia and tremor for two elderly patients with Parkinson's disease. The patients were scheduled for elective oncological plastic surgery under sedation, for which dyskinesia and tremor needed to be quickly abolished to permit surgery. Both procedures were completed with this drug combination resulting with no major side effects.
Collapse
|
38
|
Motamed C, Devys JM, Debaene B, Billard V. Influence of real-time Bayesian forecasting of pharmacokinetic parameters on the precision of a rocuronium target-controlled infusion. Eur J Clin Pharmacol 2012; 68:1025-31. [PMID: 22349465 DOI: 10.1007/s00228-012-1236-3] [Citation(s) in RCA: 9] [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] [Received: 08/18/2011] [Accepted: 01/30/2012] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Bayesian forecasting has been shown to improve the accuracy of pharmacokinetic/pharmacodynamic (PK/PD) models by adding measured values to a population model. It could be done in real time for neuromuscular blockers (NMB) using measured values of effect. This study was designed to assess feasibility and benefit of Bayesian forecasting during a rocuronium target-controlled infusion (TCI). METHODS After internal review board (IRB) approval and informed consent, 21 women scheduled for breast plastic surgery were included. Anesthesia was maintained with propofol, alfentanil, and controlled ventilation through a laryngeal mask. Rocuronium was delivered in TCI with Stanpump software and the Plaud population model. The target effect was 50% blockade until insertion of breast prosthesis; thereafter it was set to 0%. Response to train of four (TOF) at adductor pollicis was recorded using a force transducer. In ten patients, drug delivery was based on the population model. In the others, repeated measures values were entered in the software, and the PK model was adjusted to minimize the error in predicted effect. Model precision was compared between groups using mean prediction error and mean absolute prediction error. RESULTS At target 50%, model accuracy was not improved with Bayesian adjustments; conversely, post-infusion errors were significantly decreased. The first two measures had the most influence on the model changes. DISCUSSION Below clinical utility, such adjustments may be used to explore cofactors influencing interindividual and intraindividual variability in NMB dose-response relationship. Similar tools may also be developed for drugs in which a quantitative effect is available, such as electroencephalography (EEG) for hypnotics. IMPLICATION Real-time Bayesian forecasting combining measured values of effect with a population model is suitable to guide NMB-agent delivery using Stanpump software.
Collapse
Affiliation(s)
- Cyrus Motamed
- Department of Anesthesiology, Gustave Roussy Institute, Villejuif, France.
| | | | | | | |
Collapse
|
39
|
Soria A, Motamed C, Gaouar H, Chemam S, Amsler E, Francès C. Severe reaction following sugammadex injection: hypersensitivity? J Investig Allergol Clin Immunol 2012; 22:382. [PMID: 23101320] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- A Soria
- Service de dermato-allergologie, Hôpital Tenon, APHP, Paris, France
| | | | | | | | | | | |
Collapse
|
40
|
Motamed C, Bourgain JL. Trend of analgesic consumption and pain scores in the post anesthetic care unit (A 9-year survey in surgical cancer patients). Bull Cancer 2011; 98:bdc.2011.1435. [PMID: 21914578 DOI: 10.1684/bdc.2011.1435] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
As part of a quality assurance program, we assessed the trend of our analgesic consumption using our anesthesia database which include anesthesia and postanesthetic care records for all patients. In recent years, emphasis was made on anesthesia personnel to decrease postoperative opioid analgesic at the expense of non-opioid analgesics in order to decrease opioid related side effects. The following items were recorded: intraoperative opioid consumption, total morphine consumption, non-opioid analgesic consumption pain and sedation scores in the postoperative care unit (PACU). The database consisted of 57,967 patients for 9 consecutive years from 2002 to 2010, mean data exhaustivity was of 95%. Total morphine consumption per patient in the operative room and in the PACU decreased significantly from 11 ± 4 mg in year 2002 to 7 ± 3 mg in 2010, P < 0.05. In the intraoperative period, remifentanil/sufentanil ratio increased significantly from 33/67 to 87/13% of patients (P < 0.05) without affecting pain scores in the PACU. This multi-year trend shows a significant decrease in overall postoperative morphine consumption, in addition we showed that computerized database can easily follow the trend of analgesic consumption and can be used therefore as a powerful tool with easy access as part of a quality assurance program.
Collapse
Affiliation(s)
- Cyrus Motamed
- Institut Gustave-Roussy, service d'anesthésie, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | | |
Collapse
|
41
|
Buckton AJ, Prabhu D, Motamed C, Harris RJ, Hill C, Murphy G, Parry JV, Johnson JA, Lowndes CM, Gill N, Pillay D, Cane PA. Increased detection of the HIV-1 reverse transcriptase M184V mutation using mutation-specific minority assays in a UK surveillance study suggests evidence of unrecognized transmitted drug resistance. HIV Med 2010; 12:250-4. [PMID: 21371237 DOI: 10.1111/j.1468-1293.2010.00882.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to estimate the levels of transmitted drug resistance (TDR) in HIV-1 using very sensitive assays to detect minority drug-resistant populations. METHODS We tested unlinked anonymous serum specimens from sexual health clinic attendees, who had not received an HIV diagnosis at the time of sampling, by both standard genotyping and using minority detection assays. RESULTS By standard genotyping, 21 of 165 specimens (12.7%) showed evidence of drug resistance, while, using a combination of standard genotyping and minority mutation assays targeting three commonly observed drug resistance mutations which cause high-level resistance to commonly prescribed first-line antiretroviral therapy (ART), this rose to 32 of 165 (19.4%). This increase of 45% in drug resistance levels [95% confidence interval (CI) 15.2-83.7%; P=0.002] was statistically significant. Almost all of this increase was accounted for by additional detections of the M184V mutation. CONCLUSIONS Future surveillance studies of TDR in the United Kingdom should consider combining standard genotyping and minority-specific assays to provide more accurate estimates, particularly when using specimens collected from chronic HIV infections in which TDR variants may have declined to low levels.
Collapse
Affiliation(s)
- A J Buckton
- Centre for Infections, Health Protection Agency, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
|
43
|
Motamed C, Combes X, Ndoko SK, Dhonneur G. Effect of pre-incisional continuous regional block on early and late postoperative conditions in tibial osteotomy and total knee arthroplasty. Open Orthop J 2009; 3:22-6. [PMID: 19572031 PMCID: PMC2703831 DOI: 10.2174/1874325000903010022] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 03/18/2009] [Accepted: 04/06/2009] [Indexed: 11/22/2022] Open
Abstract
Background: Postoperative regional anesthesia hastens recovery and reduces the length of hospital stay of orthopedic surgical patients. This study was designed to assess the impact of pre-incisional continuous femoral block on postoperative conditions (POC) of tibial osteotomy and total knee arthroplasty patients. Methods: After insertion of a femoral catheter under peripheral nerve stimulation control, 111 patients scheduled for total knee arthroplasty or tibial osteotomy were randomized to receive either pre-incisionnal (treatment) or postoperative (control) continuous femoral block. Anesthesia and postoperative management was standardized. An assessor blinded to the randomization process recorded early and late postoperative conditions (POC) which included pain scores, opioid demands, length of stay in Postoperative care unit and patients’ satisfaction. Results: Eleven patients were excluded from the final analysis because of catheter disconnection or malfunction. Thus 100 patients (50 in each group) were analyzed for POC. Treatment failed to influence patients overall satisfaction but significantly improved early POC. Subgroup analysis demonstrated that late POC were significantly improved in tibial osteotomy as compared to total knee arthroplasty patients. No complication occurred during the study period. Conclusion: Continuous femoral nerve block before surgery significantly improved early postoperative conditions in both surgery while late postoperative conditions were improved only in tibial osteotomy.
Collapse
Affiliation(s)
- C Motamed
- Service d'Anesthésie - Réanimation, Hôpital Henri Mondor, AP-HP et Université Paris XII, Créteil, France
| | | | | | | |
Collapse
|
44
|
Motamed C, Fanen P, Feiss P, Kirov K, Duvaldestin P. Dose-response effect of serum butyrylcholinesterase activity after clinical doses of pancuronium. Eur J Clin Pharmacol 2008; 64:1043-5. [PMID: 18766333 DOI: 10.1007/s00228-008-0548-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Accepted: 07/18/2008] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Low-dose pancuronium is known to affect serum cholinesterase activity (BChE); however, the dose-response effect of clinical doses of pancuronium on BChE has not been investigated. METHODS Thirteen ASA I-II patients scheduled for elective surgery requiring muscle relaxation were enrolled in this study. All patients had normal BChE before surgery. Incremental doses of pancuronium (10, 20, 50, and 100 microg/kg) were injected in accordance with surgical needs every 45 min. BChE was measured 3 min after injection by an automatic colorimetric method. RESULTS BChE decreased significantly in all except one patient in comparison to the baseline (P < 0.05). However all values remained within normal clinical range. A dose of 100 microg/kg yielded significant decrease in comparison to 10 microg/kg but not to other dosages. Linear regression was not significant for the dose-response relationship (P = 0.05). CONCLUSION After clinical incremental doses of pancuronium, BChE remained within clinical range.
Collapse
Affiliation(s)
- C Motamed
- Department of Anesthesia, Hospital Henri Mondor (APHP) and Faculty of Medicine Paris XII, Créteil, France.
| | | | | | | | | |
Collapse
|
45
|
Motamed C, Bourgain JL. Computerized recording of neuromuscular monitoring and the risk of residual paralysis at the time of extubation. J Clin Monit Comput 2008; 22:315-8. [DOI: 10.1007/s10877-008-9135-y] [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: 04/09/2008] [Accepted: 07/16/2008] [Indexed: 11/24/2022]
|
46
|
Dhonneur G, Kirov K, Motamed C, Amathieu R, Kamoun W, Slavov V, Ndoko SK. Post-tetanic count at adductor pollicis is a better indicator of early diaphragmatic recovery than train-of-four count at corrugator supercilii. Br J Anaesth 2007; 99:376-9. [PMID: 17561516 DOI: 10.1093/bja/aem124] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Because the intensity of neuromuscular block at the diaphragm (DIA) is indirectly assessed, the electromyographic measurements of the DIA (DIA(EMG)) from surface electrodes were related to information provided by visual estimation of neuromuscular transmission at the adductor pollicis (AP) and the corrugator supercilii (CSC) during recovery from vecuronium block. METHODS Twelve adult patients were studied during balanced anaesthesia. After induction of anaesthesia and tracheal intubation without neuromuscular blocking agent, supramaximal stimulations were applied to phrenic, ulnar and facial nerves. During recovery from vecuronium 0.1 mg kg(-1) an independent observer blinded to DIA(EMG) counted visually detectable train-of-four (TOF) at CSC (TOF(CSC)) and post-tetanic AP (PTC(AP)) responses. Times to recovery of PTC(AP) = 1, <or=5, <10 and >10, and TOF(CSC) = 1-4 responses were related to DIA(EMG). Values are means (sd). RESULTS Reappearance of the first response to PTC(AP) occurred significantly (P < 0.05) earlier and for a lower recovery of DIA(EMG) than that of TOF(CSC) [24 (8) min vs 33 (9) min, and 10 (10)% vs 25 (8)%, respectively]. With PTC(AP) <or= 5 response, DIA(EMG) recovery was 21 (11)%. Recovery of TOF(CSC) = 1 and 2 coincided with DIA(EMG) recovery of 25 (8)% and 47 (9)%, respectively. CONCLUSIONS PTC(AP) may better reflect early recovery of vecuronium-induced DIA paralysis than TOF(CSC). The findings suggested that PTC(AP) <or= 5 warranted deep neuromuscular block of the DIA.
Collapse
Affiliation(s)
- G Dhonneur
- Anaesthesia and Intensive Care Department, Jean Verdier University Hospital of Paris, 93143 Bondy Cedex, France.
| | | | | | | | | | | | | |
Collapse
|
47
|
Kirov K, Motamed C, Ndoko SK, Dhonneur G. TOF count at corrugator supercilii reflects abdominal muscles relaxation better than at adductor pollicis. Br J Anaesth 2007; 98:611-4. [PMID: 17383988 DOI: 10.1093/bja/aem048] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A recovery profile from neuromuscular block similar to that of abdominal (AB) muscles, but different to that of the adductor pollicis (AP) muscle, has been demonstrated at the corrugator supercilii (CSC) muscle. We hypothesized that neuromuscular transmission (NMT) monitoring of CSC might provide useful information on AB relaxation compared with AP. We compared the visual estimation of NMT at CSC and AP with electromyographic measurements of AB during recovery from a vecuronium block. METHODS Ten adult patients were studied during balanced anaesthesia. After induction of anaesthesia and tracheal intubation without neuromuscular blocking agents, supramaximal stimulations were applied to three nerves: left 10th intercostal, ulnar, and facial. Electromyographic activity (EMG) of AB was measured (ABemg). After a bolus dose of vecuronium 0.1 mg kg-1, an independent observer blinded to the EMG measurements counted visually detectable train-of-four (TOF) responses at CSC and AP. Values of ABemg associated with 1 to 4 TOF responses at CSC and AP were compared. Values are means (sd). RESULTS Reappearance of the first and second TOF responses at CSC occurred significantly (P<0.05) earlier and at lower ABemg recovery than that of AP [35 (8) and 41 (9) min vs 51 (10) and 56 (12) min; and 17 (8) and 26 (9)% vs 56 (10) and 75 (11)%, respectively]. CONCLUSIONS We demonstrated that the TOF response count at the CSC, compared with the AP, allowed a better quantification of the degree of AB muscle relaxation during recovery from vecuronium block.
Collapse
Affiliation(s)
- K Kirov
- Anaesthesia and Intensive Care Department, Jean Verdier University Hospital of Paris, 93143 Bondy Cedex, France
| | | | | | | |
Collapse
|
48
|
Motamed C, Farhat F, Rémérand F, Stéphanazzi J, Laplanche A, Jayr C. An Analysis of Postoperative Epidural Analgesia Failure by Computed Tomography Epidurography. Anesth Analg 2006; 103:1026-32. [PMID: 17000824 DOI: 10.1213/01.ane.0000237291.30499.32] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this prospective study involving 125 patients, we analyzed epidural analgesia failure after major abdominal surgery using computed tomography (CT) epidurographies to compare the incidence of dislodgement of epidural catheters and leakage of solution from the epidural space between two groups of patients: patients with successful or failed epidural analgesia. Our hypothesis was that the incidence of dislodgement and leakage should be low when epidural analgesia is successful. A thoracic epidural catheter was inserted before general anesthesia and secured by subcutaneous tunneling. Bupivacaine (0.25%) was administered during surgery followed by continuous epidural analgesia with 0.125% bupivacaine (10 mL/h) and morphine (0.25 mg/h) for 48 h. Failure was defined as a visual analog scale pain score at rest more than 30 mm and/or interruption of epidural analgesia before 48 h for any reason. When failure was not due to unintentionally withdrawn, kinked catheters or adverse events (n = 11), a CT scan with contrast injection was performed. Control CT scans were also performed in patients with adequate analgesia (i.e., the success group). The incidence of failure was 24.8% (n = 31). CT scans in the failure group (n = 20) showed seven patients with catheters outside the epidural space, nine with normal distribution, one with unilateral spread, and three with leakage of solution outside the epidural space. In the success group, CT scans (n = 19) showed 11 patients with normal distribution, five with unilateral spread, and three with leakage. We conclude that the major cause of epidural analgesia failure was dislodgment of the catheter. CT scans were mostly useful for detecting leakage of injectate, which may be the early phase of dislodgment.
Collapse
Affiliation(s)
- Cyrus Motamed
- Department of Anesthesia, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, Cedex, France.
| | | | | | | | | | | |
Collapse
|
49
|
Motamed C, Merle JC, Combes X, Yakhou L, Vodinh J, Duvaldestin P. The effect of fentanyl and remifentanil, with or without ketoprofen, on pain after thyroid surgery. Eur J Anaesthesiol 2006; 23:665-9. [PMID: 16805931 DOI: 10.1017/s0265021506000391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 01/27/2006] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES This study was designed to quantify the additional postoperative analgesic efficacy of a single dose of ketoprofen in patients undergoing thyroid surgery using two different intraoperative analgesic regimens. METHODS One hundred and twenty patients were randomly assigned to one of four groups: intraoperative fentanyl or remifentanil with or without ketoprofen (n = 30 for each group). Intravenous ketoprofen (1.5 mg kg-1) or saline was administered 45 min before the end of surgery. Pain scores, opioid demand and length of stay in the postanaesthesia care unit were assessed in a blinded manner. RESULTS Patients receiving intraoperative fentanyl with saline had significantly lower visual analogue scale pain scores in the postanaesthesia care unit compared with those receiving intraoperative remifentanil with saline (55 +/- 10 mm vs. 80 +/- 18 mm, P < 0.05) and they stayed shorter in the postanaesthesia care unit (86 +/- 24 min vs. 126 +/- 37 min). In conjunction with intraoperative fentanyl, ketoprofen significantly decreased postoperative pain scores (40 +/- 10 mm, P < 0.05 compared with fentanyl alone) and opioid demand (4 of 30 patients vs. 14 of 30 patients compared with fentanyl alone, P < 0.05). Patients receiving intraoperative remifentanil had no additional analgesic benefit with ketoprofen. CONCLUSION After thyroid surgery, patients receiving intraoperative fentanyl had lower pain scores and needed less rescue analgesia compared with patients receiving intraoperative remifentanil. The adjunction of ketoprofen further improved analgesia in patients who received intraoperative fentanyl only.
Collapse
Affiliation(s)
- C Motamed
- Université Paris 12, Hôpital Henri Mondor, Service d'Anesthésie Réanimation, APHP, Créteil, France.
| | | | | | | | | | | |
Collapse
|
50
|
Motamed C, Merle JC, Yakhou L, Combes X, Vodinh J, Kouyoumoudjian C, Duvaldestin P. Postoperative pain scores and analgesic requirements after thyroid surgery: comparison of three intraoperative opioid regimens. Int J Med Sci 2006; 3:11-3. [PMID: 16421625 PMCID: PMC1332199 DOI: 10.7150/ijms.3.11] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Accepted: 11/28/2005] [Indexed: 11/05/2022] Open
Abstract
PURPOSE This study was designed to compare the effect on postoperative pain, opioid consumption and the length of stay in postoperative care unit (PACU) after three different intraoperative analgesic regimens in thyroid surgery. METHODS Seventy five patients were enrolled into the study and assigned to one of three groups, fentanyl, sufentanil or remifentanil (n=25 for each group). Before the end of surgery, paracetamol 1 gr and nefopam 20 mg was also administered in all patients. Pain scores, opioid demand and the length of stay in PACU were assessed in a blind manner. RESULTS Post operative pain scores were significantly lower in the fentanyl and sufentanil groups compared to remifentanil group (55 +/- 15, and 60 +/- 10 versus 78+/- 12, P < 0.05). Patients in the remifentanil group stayed longer in the PACU 108+/- 37 min versus 78+/-31 and 73 +/- 25 min, (P< 0.05). CONCLUSION After remifentanil based analgesia, anticipation of postoperative pain with opioid analgesic appears mandatory even for surgery rated as being moderately painful, otherwise longer opioid titration due to higher pain scores might delay discharge time.
Collapse
Affiliation(s)
- C Motamed
- Service d'Anesthesie Réanimation Hospital Henri Mondor, Créteil APHP, Université Paris 12, France.
| | | | | | | | | | | | | |
Collapse
|