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Maurice Szamburski A, Grillo P, Cuvillon P, Gazeau T, Delaunay L, Auquier P, Bringuier S, Capdevila X. Corrigendum to 'Comparison of continuous with single-injection regional analgesia on patient experience after ambulatory orthopaedic surgery: a randomised multicentre trial' (Br J Anaesth 2022; 129: 435-44). Br J Anaesth 2023; 130:111. [PMID: 36283871 DOI: 10.1016/j.bja.2022.09.012] [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: 01/03/2023] Open
Affiliation(s)
| | | | | | | | | | - Pascal Auquier
- Laboratoire de Santé Publique, EA3279, Marseille, France
| | - Sophie Bringuier
- Department of Medical Statistics and Epidemiology, Montpellier University Hospital, Montpellier, France
| | - Xavier Capdevila
- Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France; Montpellier NeuroSciences Institute, Inserm U 1051, Montpellier, France
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Szamburski AM, Capdevila X, Delaunay L, Cuvillon P. Fiche Flash 4 : anesthésie locorégionale de l’adulte. « 5 étapes pour réussir un cathéter à domicile ». Anesthésie & Réanimation 2022. [DOI: 10.1016/j.anrea.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Slim K, Boudemaghe T, Delaunay L, Léger L, Bizard F. Favorable effect of enhanced recovery programs on post-discharge mortality: a French nationwide study. Perioper Med (Lond) 2022; 11:14. [PMID: 35491425 PMCID: PMC9059370 DOI: 10.1186/s13741-022-00252-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Enhanced recovery programs (ERPs) imply early discharge but few papers have assessed the effect of ERPs on post-discharge mortality (PDM).
Methods
A multicenter nationwide case control study based on administrative data was carried out between March and December 2019. Coding for every episode of care whether in the setting of ERP or not is mandatory for hospital funding (public or private). Twelve surgical specialties or procedures were included. The episodes of care coded with ERP were matched with those without ERP code for several factors such as the type of hospital (public or private), age, gender, month of discharge, and updated Charlson score. Ninety-day PDM was the main outcome.
Results
Of 420,031 patients in the database, 78,119 had an ERP code. Finally, 132,600 patients with 66,300 matched pairs were considered for the study. Overall, PDM was significantly reduced after ERPs: 0.075% vs 0.138% (p = 0.00042). Significant one-half and two-thirds reduction in PDM was observed respectively after hip arthroplasty (odds ratio 0.48 [95% CI 0.21–0.99]) and colectomy (odds ratio 0.36 [95% CI 0.16–0.74]).
Conclusion
The findings, based on a large database and a rigorous matching, strongly suggest that ERPs reduce PDM particularly after colectomy and hip arthroplasty. This is likely due to better post-operative care in ERPs.
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Bizard F, Boudemaghe T, Delaunay L, Léger L, Slim K. Medico-economic impact of enhanced rehabilitation after surgery: an exhaustive, nation-wide claims study. BMC Health Serv Res 2021; 21:1341. [PMID: 34906137 PMCID: PMC8672636 DOI: 10.1186/s12913-021-07379-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background Study of the medico economic impact of enhanced rehabilitation after surgery (ERAS), by comparing the cost of patient care with or without ERAS, both from the point of view of the hospitals and the Social Security Health Insurance Program. Methods Retrospective longitudinal study on matched data from March 1, 2019 to December 31, 2019. The data are extracted from the French prospective payment system. We studied 12 of the most commonly performed in ERAS business segments. The primary outcome was the reduction of the average length of hospital stay and its implications on production costs and excess capacity. We also studied the impact on hospital incomes and Social Security Insurance Program expenses. The potential gain in hospital days was computed by comparing the length of stay of ERAS and non-ERAS cases. The cost reduction was estimated using the mean number of avoidable days of hospitalization, and the mean cost of the stays obtained from the national cost study. Finally, we studied an approximation of the additional expense for the Social Security Health Insurance Program on costs standardized by applying public sector rates. Results The average length of stay reduction attributed to ERAS is 1.45 (CI 95% 1.42 to 1.48) day per stay, translating to a cost reduction for the hospitals of € 1060 (CI 95% 995 to 1125) per patient and a total of €65 million (CI 95% 61 to 69). At the same time, the additional expenses for the Social Security Insurance Program can conservatively be approximated to € 1.6 million, breaking into a € 2.2 million increase partially compensated by cost savings of € 0.6 million over subsequent stays for complications. Overall, for each percent of additional ERAS activity over the scope of the study, the marginal cost reduction for the hospitals can be estimated to € 1.8 million (CI 95% 1.7 million to 2.0 million). Conclusions Associated with previously known clinical benefits for the patients, these convincing results in terms of economic gain strongly support expanding the adoption of ERAS. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07379-z.
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Affiliation(s)
| | - Thierry Boudemaghe
- Department of Medical Informatics (S.I.M.M.E.R.), Nîmes University Hospital, Pl Pr Robert Debré, 30 029, Nîmes, France. .,Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Nîmes University Hospital, Montpellier, France.
| | | | - Lucas Léger
- Department of Medical Informatics (S.I.M.M.E.R.), Nîmes University Hospital, Pl Pr Robert Debré, 30 029, Nîmes, France
| | - Karem Slim
- MD. Department of Digestive Surgery, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
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Boselli E, Cuna J, Bernard F, Delaunay L, Virot C. Effects of a training program in medical hypnosis on burnout in anesthesiologists and other healthcare providers: A survey study. Complement Ther Clin Pract 2021; 44:101431. [PMID: 34198240 DOI: 10.1016/j.ctcp.2021.101431] [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: 02/17/2021] [Revised: 05/13/2021] [Accepted: 06/13/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine whether the participation to a medical hypnosis training program reduces the levels of burnout in healthcare providers. DESIGN Survey study. SETTINGS Study conducted from 2014 to 2018 using the MBI-HSS questionnaire assessing three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). PARTICIPANTS Healthcare providers in particular anesthesiologists participating to a one-year medical hypnosis training program. INTERVENTION All participants were asked to fill the MBI-HSS on the first day before the training program had begun, then on the last day of the program once the entire training was completed. PRIMARY AND SECONDARY OUTCOME MEASURES The EE, DP and PA scores and their grade (high, average and low) were compared before and after training and between physicians and caregivers. RESULTS In total, 1850 persons participated to the training sessions, with 1366 participants enrolled before the first session (74%) and 1407 (76%) after the fourth. On the 1366 persons enrolled before training, 1139 (83%) completed the survey and on the 1407 enrolled after training, 1194 (85%) completed the survey. The scores were significantly smaller after training for EE and DP and significantly greater for PA. Before training, EE was significantly greater in physicians than in caregivers as well as DP, with no difference for PA. After training, DP was significantly greater in physicians than in caregivers and PA was smaller, with no difference for EE. Before training, there was high rates of burnout in both healthcare providers but there was a significant trend to smaller rates of burnout after training. CONCLUSIONS This study shows that healthcare providers who participated to a medical hypnosis training program presented improvements in the three dimensions of burnout. Further study is required to investigate and recommend this type of continuous medical education to improve professional satisfaction and wellbeing in healthcare providers.
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Affiliation(s)
- Emmanuel Boselli
- Émergences Institute, Campus Émergences, 30 Boulevard Solférino, Rennes, France; Department of Anesthesiology, Pierre Oudot Hospital Centre, Bourgoin-Jallieu, France; University of Lyon, University Lyon I Claude Bernard, VetAgroSup, APCSe UPSP 2016.A101, Marcy-l'Étoile, France.
| | - Jérémy Cuna
- Émergences Institute, Campus Émergences, 30 Boulevard Solférino, Rennes, France
| | - Franck Bernard
- Department of Anesthesiology, Saint-Grégoire Private Hospital Centre, Saint-Grégoire, France
| | - Laurent Delaunay
- Department of Anesthesiology, Annecy General Clinic, Annecy, France
| | - Claude Virot
- Émergences Institute, Campus Émergences, 30 Boulevard Solférino, Rennes, France
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Affiliation(s)
- Marc Leone
- Department of Anaesthesiology and Intensive Care Unit, Nord Hospital, Assistance Publique Hôpitaux Universitaire de Marseille, Aix Marseille Université, 13015 Marseille, France
| | - Laurent Delaunay
- Department of Anaesthesia, 74295 Clinique Generale d'Annecy, Vivalto Santé, Annecy, France
| | - Hervé Bouaziz
- Department of Anaesthesiology and Intensive Care, University Hospital of Nancy, Nancy, France
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Affiliation(s)
- Laurent Delaunay
- Department of Anesthesia, 74295Clinique Generale d'Annecy, Vivalto Santé, Annecy, France
- Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France
| | - Karem Slim
- Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France
- Department of Digestive Surgery, 55174University Hospital Clermont-Ferrand, Clermont-Ferrand, France
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Capdevila X, Aveline C, Delaunay L, Bouaziz H, Zetlaoui P, Choquet O, Jouffroy L, Herman-Demars H, Bonnet F. Impact of Chloroprocaine on the Eligibility for Hospital Discharge in Patients Requiring Ambulatory Surgery Under Spinal Anesthesia: An Observational Multicenter Prospective Study. Adv Ther 2020; 37:541-551. [PMID: 31828611 PMCID: PMC6979446 DOI: 10.1007/s12325-019-01172-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Indexed: 12/13/2022]
Abstract
Introduction This observational study was designed to assess the use of spinal anesthesia with chloroprocaine in the context of ambulatory surgery. Methods A prospective, multicenter, observational study was carried out among 33 private or public centers between May 2014 and January 2015 and adult patients, scheduled for a short ambulatory surgery under spinal anesthesia with chloroprocaine. The primary outcomes were anesthetic effectiveness, defined as performance of the whole surgical procedure without any additional anesthetic agent, and the time to achieve eligibility for hospital discharge. Secondary outcomes were the effect of chloroprocaine on motor and sensory blocks, patients’ satisfaction, and the use of analgesics in the first 24 h after surgery. Results Among the 615 enrolled patients, 56% were male, the mean age was 47.2 ± 15.2 years, and most patients had an ASA (American Society of Anesthesiologists) status of 1 (63.7%). Main surgical procedures performed were orthopedic (62.6%) and gynecologic (16.1%), and the mean duration of surgery was 26.7 ± 16.7 min. The overall anesthetic success rate was 93.8% (95% CI [91.5%; 95.6%]) for the 580 patients with available data for primary criteria. The failure rate was lower than 7% for all surgical procedures, except for gynecologic surgery (14.8%; 95% CI [8.1%; 23.9%]). The average times of eligibility for hospital discharge and effective discharge were 252.7 ± 82.7 min and 313.8 ± 109.9 min, respectively. The time of eligibility for hospital discharge is defined as the recovery of the patient’s normal clinical parameters and the time of effective discharge is defined as the time for the patient to leave the hospital after surgery. Eligibility for patient’s discharge was achieved more rapidly in private than public hospitals (236.3 ± 77.2 min vs. 280.9 ± 80.7 min, respectively, p < 0.001). Conclusions This study showed positive results on the effectiveness of chloroprocaine as a short-duration anesthetic and could be used to reduce the time to achieve eligibility for hospital discharge. Trial Registration ClinicalTrials.gov identifier, NCT02152293. Registered on May 6, 2014. Date of enrollment of the first participant in the trial May 7, 2014.
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Carles M, Beloeil H, Bloc S, Nouette-Gaulain K, Aveline C, Cabaton J, Cuvillon P, Dadure C, Delaunay L, Estebe JP, Hofliger E, Martinez V, Olivier M, Robin F, Rosencher N, Capdevila X. Anesthésie loco-régionale périnerveuse (ALR-PN). Anesthésie & Réanimation 2019. [DOI: 10.1016/j.anrea.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Poinas G, Blache J, Kassab-Chahmi D, Evrard P, Artus P, Alfonsi P, Rébillard X, Beaussier M, Cerantola Y, Coloby P, Drapier É, Houédé N, Masson-Lecomt A, Rouprêt M, Le Normand L, Gamé X, Bosset P, Delaunay L, Fendler J, Ecoffey C, Cuvelier G. Version courte des recommandations de la récupération ameliorée après chirurgie (RAAC) pour la cystectomie : mesures techniques. Prog Urol 2019; 29:63-75. [DOI: 10.1016/j.purol.2018.12.002] [Citation(s) in RCA: 7] [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: 02/18/2018] [Revised: 11/28/2018] [Accepted: 12/01/2018] [Indexed: 12/20/2022]
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Carles M, Beloeil H, Bloc S, Nouette-Gaulain K, Aveline C, Cabaton J, Cuvillon P, Dadure C, Delaunay L, Estebe JP, Hofliger E, Martinez V, Olivier M, Robin F, Rosencher N, Capdevila X. Anesthésie locorégionale périnerveuse. Anesthésie & Réanimation 2017. [DOI: 10.1016/j.anrea.2017.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Bouaziz H, Aubrun F, Belbachir A, Cuvillon P, Eisenberg E, Jochum D, Aveline C, Biboulet P, Binhas M, Bloc S, Boccara G, Carles M, Choquet O, Delaunay L, Estebe JP, Fuzier R, Gaertner E, Gnaho A, Nouette-Gaulain K, Nouvellon E, Ripart J, Tubert V. Ultrasound-guided regional anesthesia. ACTA ACUST UNITED AC 2013; 32:e119-20. [PMID: 23948024 DOI: 10.1016/j.annfar.2013.07.790] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H Bouaziz
- Département d'anesthésie-réanimation, university hospital of Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
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Delaunay L, Ecoffey C. [Nerve stimulation is not obsolete yet: reply]. ACTA ACUST UNITED AC 2013; 32:627. [PMID: 23953316 DOI: 10.1016/j.annfar.2013.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- L Delaunay
- Clinique générale, 4, chemin de la Tour-La-Reine, 74000 Annecy, France.
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Catoire P, Delaunay L, Dannappel T, Baracchini D, Marcadet-Fredet S, Moreau O, Pacaud L, Przyrowski D, Marret E. Hypnosis versus diazepam for embryo transfer: a randomized controlled study. Am J Clin Hypn 2013; 55:378-86. [PMID: 23724572 DOI: 10.1080/00029157.2012.747949] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Levitas et al. (2006) showed in a cohort study that hypnosis during embryo transfer (ET) increased pregnancy ratio by 76%. In order to evaluate hypnosis during ET in a general population, the authors performed a randomized prospective controlled study comparing diazepam (usual premedication) administered before ET plus muscle relaxation versus hypnosis plus placebo in 94 patients. Additionally, the authors studied anxiety pre and post ET. Anxiety scores were not different in the two groups before and after ET. No difference in pregnancy and birth ratio was found in the two groups. Hypnosis during ET is as effective as diazepam in terms of pregnancy ratio and anxiolytic effects, but with fewer side effects and should be routinely available.
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Delaunay L, Ecoffey C. [Should we continue to use nerve stimulation alone for peripheral nerve blocks?]. Ann Fr Anesth Reanim 2013; 32:217-9. [PMID: 23506955 DOI: 10.1016/j.annfar.2013.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gentili ME, Friguet JL, Sédillot F, Delaunay L. Working older, a challenge for the future. Ann Fr Anesth Reanim 2012; 31:e287-e288. [PMID: 23148977 DOI: 10.1016/j.annfar.2012.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/27/2012] [Indexed: 06/01/2023]
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Villevieille T, Delaunay L, Gentili M, Benhamou D. Chirurgie arthroscopique de l’épaule et complications ischémiques cérébrales. ACTA ACUST UNITED AC 2012; 31:914-8. [DOI: 10.1016/j.annfar.2012.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 08/14/2012] [Indexed: 10/27/2022]
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Bloc S, Delaunay L. [Intraneural injection under ultrasound: what evidence]. Ann Fr Anesth Reanim 2012; 31:e185-e186. [PMID: 22854314 DOI: 10.1016/j.annfar.2012.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- S Bloc
- Service d'anesthésie, CHP Claude Galien, 20, route de Boussy, 91480 Quincy-Sous-Sénart, France.
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Delaunay L, Bloc S. [Is nerve stimulation still necessary in ultrasound-guided regional anaesthesia]. Ann Fr Anesth Reanim 2012; 31:e199-e201. [PMID: 22920328 DOI: 10.1016/j.annfar.2012.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- L Delaunay
- Clinique générale d'Annecy, 4, chemin de Tour-la-Reine, 74000 Annecy, France.
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Delaunay L, Gentilli M, Sfez M, Cittanova ML, Lévy M, Delbos A, Le Hétêt H, Arnaud CM, Dumeix JM, Chariot MP, Yavordios PG, Plantet F. [About anaesthesia without anaesthetist...]. Ann Fr Anesth Reanim 2011; 30:851-852. [PMID: 22018791 DOI: 10.1016/j.annfar.2011.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Bouaziz H, Aubrun F, Belbachir A, Cuvillon P, Eisenberg E, Jochum D, Aveline C, Biboulet P, Binhas M, Bloc S, Boccara G, Carles M, Choquet O, Delaunay L, Estebe JP, Fuzier R, Gaertner E, Gnaho A, Nouette-Gaulain K, Nouvellon E, Ripart J, Tubert V. Échographie en anesthésie locorégionale. ACTA ACUST UNITED AC 2011; 30:e33-5. [DOI: 10.1016/j.annfar.2011.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Jochum D, Bondàr A, Delaunay L, Egan M, Bouaziz H. One size does not fit all: proposed algorithm for ultrasonography in combination with nerve stimulation for peripheral nerve blockade. Br J Anaesth 2009; 103:771-3; author reply 773-4. [DOI: 10.1093/bja/aep283] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Delaunay L, Plantet F. [Learned societies and end of life...]. Ann Fr Anesth Reanim 2009; 28:253-254. [PMID: 19297122 DOI: 10.1016/j.annfar.2009.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Delaunay L, Plantet F, Jochum D. Échographie et anesthésie locorégionale. ACTA ACUST UNITED AC 2009; 28:140-60. [DOI: 10.1016/j.annfar.2008.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 12/05/2008] [Indexed: 10/21/2022]
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Delaunay L, Catoire P, Estèbe JP, Gentili M. [About a neuropathy...]. Ann Fr Anesth Reanim 2009; 28:173-176. [PMID: 19167184 DOI: 10.1016/j.annfar.2008.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Catoire P, Delaunay L, Debaene B. [Should the epidural needle be shown to parturients?]. Can J Anaesth 2007; 54:590-1. [PMID: 17602051 DOI: 10.1007/bf03022331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Affiliation(s)
- L Delaunay
- Service d'anesthésie réanimation, Annecy, France.
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Jochum D, Delaunay L. [Practical anatomy]. ACTA ACUST UNITED AC 2005; 25:220-8. [PMID: 16364590 DOI: 10.1016/j.annfar.2005.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- D Jochum
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Privé du Centre Alsace, 5, avenue Joffre, BP 20129, 68003 Colmar cedex, France
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Souron V, Vincent S, Delaunay L, Laurent D, Bonner F, Francis B. Sedation with target-controlled propofol infusion during shoulder surgery under interscalene brachial plexus block in the sitting position. Eur J Anaesthesiol 2005; 22:853-7. [PMID: 16225721 DOI: 10.1017/s0265021505001444] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to assess target-controlled propofol infusion as a technique of sedation for shoulder surgery under interscalene brachial plexus block in the sitting position and to evaluate the effect of sedation on hypotensive/bradycardic events during this procedure. METHODS One hundred and forty patients undergoing elective shoulder surgery in the sitting position under interscalene brachial plexus block (with 30 mL of ropivacaine 0.75%) were prospectively enrolled. All patients were premedicated with hydroxyzine 1 mg kg(-1), none received beta-blockers. No patients were given atropine except for the patients who experienced a vasovagal event either during the block procedure or intravenous catheter placement. The target-controlled propofol infusion was started immediately after positioning the patient on the operating table. The initial target concentration was 1 microg mL(-1). The infusion rate was adjusted every 15 min by increasing or decreasing the target concentration by 0.2 microg mL(-1) steps to maintain the patient rousable to verbal commands (score of 3 on Wilson sedation scale). The following parameters were assessed: minimal, maximal, optimal target concentration, respiratory and haemodynamic parameters, total propofol dose, additional alfentanil needs, occurrence of hypotensive/bradycardic events, complications. Results are mean +/- SD. Statistical analysis used t-test and chi2-tests. RESULTS The optimal propofol target concentration was 0.8 mug mL(-1). No respiratory complications or conversion to general anaesthesia was reported. Two patients experienced transient and inconsequential intraoperative agitation. The incidence of hypotensive/bradycardic events during the procedure was 5.7% (eight patients). CONCLUSION Target-controlled propofol infusion (0.8-0.9 microg mL(-1)) following hydroxyzine premedication is a safe and effective technique for sedation when combined with interscalene brachial plexus block during shoulder surgery in the sitting position.
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Affiliation(s)
- V Souron
- Clinique Générale, Department of Anaesthesiology, Annecy, France.
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Delaunay L, Souron V, Lafosse L, Marret E, Toussaint B. Analgesia after arthroscopic rotator cuff repair: subacromial versus interscalene continuous infusion of ropivacaine. Reg Anesth Pain Med 2005; 30:117-22. [PMID: 15765452 DOI: 10.1016/j.rapm.2004.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 11/17/2022]
Abstract
OBJECTIVES A continuous infusion of local anesthetic in the subacromial space has been shown to provide superior pain relief compared with placebo. This technique has been considered as an alternative to a continuous interscalene infusion. The aim of our study is to compare these 2 techniques for pain relief after arthroscopic rotator cuff repair. METHODS In a prospective randomized trial, 30 consecutive patients undergoing rotator cuff repair were included. An interscalene brachial plexus block was performed in all patients with mepivacaine 1.5% 30 mL. Then, 15 patients had an indwelling interscalene catheter inserted immediately after the block via a needle. Fifteen other patients had a subacromial catheter placed at the end of surgery by the surgeon. In both groups, a 2 mg/mL ropivacaine continuous infusion (5 mL/h) with PCA bolus (5 mL/30 min) was maintained for 48 hours. Pain was assessed in PACU and at 24 and 48 hours after surgery, at rest, and during passive motion. Total amount of oral morphine self-administered as rescue analgesia and cumulative 24-hour and 48-hour local anesthetic consumption were noted. Patient satisfaction and side effects were also noted. RESULTS Pain during motion in PACU (0 [0 to 60] v 40 [0 to 100] mm) and at 24 hours (10 [0 to 60] v 45 [20 to 100] mm), oral morphine (0 [0 to 6] v 3.5 [0 to 10] morphine capsules), and total amount of local anesthetic at 24 hours (122.5 [120 to 170] v 143 [129 to 250] mg) were lower in the continuous interscalene group. Local anesthetic side effects were less frequent in the continuous subacromial group. Satisfaction was comparable between groups. CONCLUSION After arthroscopic rotator cuff repair, continuous interscalene block provides better analgesia compared with continuous subacromial infusion but with an increased incidence of minor side effects.
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Abstract
OBJECTIVE We describe a unique case of a patient who experienced atelectasis of the lower lobe of the left lung and pleural effusion manifested by chest pain after continuous interscalene brachial plexus block for postoperative analgesia. CASE REPORT A 45-year-old man with no respiratory disease was scheduled for left shoulder arthroscopy for rotator cuff repair under interscalene brachial plexus block and sedation. A continuous interscalene brachial plexus block provided postoperative analgesia. On the first postoperative day, the patient reported left-sided chest pain. The chest x-ray showed elevation of the left hemidiaphragm associated with a left lower lobe atelectasis and a minor pleural effusion. After catheter removal, clinical and radiologic signs resolved within few days without sequela. CONCLUSION If chest pain presents after interscalene brachial plexus block, early postoperative chest x-ray is recommended to rule out pneumothorax, atelectasis, and/or pleural effusion secondary to ipsilateral phrenic block.
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Affiliation(s)
- Vincent Souron
- Department of Anesthesiology, Clinique Générale, Annecy, France.
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Affiliation(s)
- Vincent Souron
- Departments of Anesthesiology and Orthopaedic Surgery Clinique Générale Annecy, France
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Souron V, Delaunay L, Schifrine P. Intrathecal morphine provides better postoperative analgesia than psoas compartment block after primary hip arthroplasty. Can J Anaesth 2003; 50:574-9. [PMID: 12826549 DOI: 10.1007/bf03018643] [Citation(s) in RCA: 41] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Intrathecal morphine and psoas compartment block represent two accepted techniques to provide postoperative analgesia after hip arthroplasty. We designed a prospective, randomized, single-blinded study to compare these two techniques. METHODS Patients scheduled for primary hip arthroplasty under general anesthesia were randomized to receive either an intrathecal administration of 0.1 mg morphine (Group I, n = 27) or a psoas compartment block with ropivacaine 0.475% 25 mL (Group II, n = 26). Pain scores, morphine consumption, associated side-effects were assessed for 48 hr postoperatively. In addition, patient's acceptance and satisfaction of the postoperative analgesic technique were also recorded. RESULTS During the first 24 hr, pain scores (3.3 +/- 9.6 mm vs 22.8 +/- 27.1 at H+6, 3.3 +/- 8.3 mm vs 25 +/- 26.7 mm at H+12, 7 +/- 14.9 mm vs 21.9 +/- 29 mm at H+18) and morphine consumption (0.56 +/- 2.12 mg vs 9.42 +/- 10.13 mg) were lower in Group I than in Group II. Urinary retention was the more frequent side-effect occurring in 37% of cases in Group I vs 11.5% in Group II (P < 0.05). No major complication occurred. Despite better analgesia provided by the use of intrathecal morphine, there was no difference in the satisfaction scores between groups. CONCLUSION 0.1 mg intrathecal morphine administration provides better postoperative analgesia than single-shot psoas compartment block after primary hip arthroplasty.
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Affiliation(s)
- Vincent Souron
- Department of Anesthesiology, Clinique Générale, Annecy, France.
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Abstract
The considerable development of ambulatory surgery has led to an increase in the number of lower extremity procedures performed in an outpatient setting. More recently, the availability of disposable pumps has allowed us to extend the indications of continuous nerve blocks for ambulatory post-operative pain management. Indications for lumbar plexus continuous blocks include anterior cruciate ligament (ACL) reconstruction and patella repairs as well as frozen knee, whereas continuous sciatic blocks are indicated for major foot and ankle surgery. Different modes of local anaesthetic administration have been applied, including the use of repeated bolus, continuous administration and, more recently, patient-controlled perineural infusions. This latter technique seems to be the preferred mode because it offers the advantage of tailoring the amount of local anaesthetics, mostly 0.2% ropivacaine, to the individual need and also maximizes the duration of infusion for a given volume of local anaesthetic. Although the preliminary reports indicate that lower extremity continuous blocks provide effective post-operative ambulatory analgesia and are safe, especially as a part of a multimodal approach, appropriate training in these techniques represents one of the most important limiting factors of the placement of perineural catheters. Additional research is required to determine the optimal conditions in which these techniques are indicated.
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Affiliation(s)
- Jacques E Chelly
- University of Pittsburgh School of Medicine, AI 305 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA
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Gentili ME, Delbos A, Mavoungou P, Jouffroy L, Delaunay L, Souron V, Fabre B. [Is there a place in France for clinical research in private institutions?]. Ann Fr Anesth Reanim 2001; 20:876-7. [PMID: 11803855 DOI: 10.1016/s0750-7658(01)00535-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
PURPOSE Distal blocks are not recommended even for a short procedure when a tourniquet is used. This study was designed to evaluate the tolerance, effectiveness, patient acceptance and safety of distal blocks at the wrist. METHODS Consecutive patients (n=273, mean age 53 +/-15 yr) undergoing endoscopic carpal tunnel release with a pneumatic tourniquet were included in this study. The median nerve was blocked 6 cm above the wrist crease by injecting 10 mL of 2% lidocaine and 0.5% bupivacaine (v/v). The ulnar nerve was blocked by injecting 8 mL of the same anesthetic mixture below the flexor carpi ulnaris tendon 6 cm above the wrist crease. Finally, 2 mL of local anesthetic were infiltrated sc and laterally below the crease to block the musculocutaneous nerve. The intensity of the block was evaluated after five, ten and 20 min. In addition, pain associated with block performance and tolerance of the tourniquet were evaluated. Finally, neurological complications associated with this technique were investigated. Data are presented as means +/- SD. RESULTS At ten minutes after the block was performed, 9% and 32% of patients required an additional injection to complete the block in the median and ulnar territories, respectively. In more than 75% of patients, performance of the block was associated with either no or mild pain. The tourniquet was inflated for 12.6 +/- 5.4 min and was well tolerated in 99% of patients. Finally, neither transient nor permanent neurological deficit were recorded postoperatively. CONCLUSION Blocks at the wrist are effective, well accepted by the patient and safe when a pneumatic tourniquet is used for a short procedure.
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Affiliation(s)
- L Delaunay
- Département d'anesthésiologie, Clinique Générale, Annecy, France
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Delaunay L, Chelly JE. [A new anterior approach to the sciatic nerve]. Ann Fr Anesth Reanim 2000; 19:f 121-2. [PMID: 10941459] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Abstract
BACKGROUND Although several anterior approaches to sciatic nerve block have been described, they are used infrequently. The authors describe a new anterior approach that allows access to the sciatic nerve with the patient in the supine position. METHOD Sciatic nerve blocks were performed in 22 patients. A line was drawn between the inferior border of the anterosuperior iliac spine and the superior angle of the pubic symphysis tubercle. Next, a perpendicular line bisecting the initial line was drawn and extended 8 cm caudad. The needle was inserted perpendicularly to the skin, and the sciatic nerve was identified at a depth of 10.5 cm (9.5-13.5 cm; median and range) using a nerve stimulator and a 15-cm b-beveled insulated needle. After appropriate localization, either 30 ml mepivacaine, 1.5% (group 1 = knee arthroscopy; n = 16), or 15 ml mepivacaine, 1.5%, plus 15 ml ropivacaine, 0.75%, (group 2 = other procedures; n = 6) was injected. RESULTS Appropriate landmarks were determined within 1.3 min (0.5-2.0 min). The sciatic nerve was identified in all patients within 2.5 min (1.2-5 min), starting from the beginning of the appropriate landmark determination to the stimulation of its common peroneal nerve component in 13 cases and its tibial nerve component in 9 cases. A complete sensory block in the distribution of both the common peroneal nerve component and the tibial nerve component was obtained within 15 min (5-30 min). A shorter onset was observed in patients who received mepivacaine alone compared with those who received a mixture of mepivacaine plus ropivacaine (10 min [5-25 min] vs. 20 min [10-30 min]; P < 0.05). Recovery time was 4.6 h (2.5-5.5 h) after mepivacaine administration. The addition of ropivacaine produced a block of a much longer duration 13.8 h (5.2-23.6 h); P < 0.05. No complications were observed. CONCLUSIONS This approach represents an easy and reliable anterior technique for performing sciatic nerve blocks.
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Affiliation(s)
- J E Chelly
- Department of Anesthesiology, The University of Texas Medical School-Houston, 77030-1503, USA.
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Abstract
UNLABELLED Clonidine is commonly given for premedication, and it impairs normal thermoregulatory responses to warm and cold stimuli while depressing sympathetic tone. We studied the effect of premedication by clonidine on redistribution hypothermia induced by the induction of anesthesia. Sixteen ASA physical status I or II patients were randomly assigned to receive either clonidine 150 micrograms or a placebo. Anesthesia was induced 45 min later by thiopental, fentanyl, and vecuronium i.v. and was maintained by the administration of 0.6% isoflurane. We monitored central core (tympanic) temperature and skin surface temperatures at the forearm and the fingertip during the 2 h after the induction of anesthesia before surgery. We estimated skin blood flow at the level of the forearm by using laser Doppler during the same period. The core temperature decreased comparably in the two groups of patients, from 37.1 +/- 0.2 degrees C to 35.3 +/- 0.4 degrees C and from 37.1 +/- 0.2 degrees C to 35.5 +/- 0.3 degrees C in the clonidine and placebo groups, respectively. The forearm-fingertip surface temperature gradient decreased similarly in the two groups. There was no evidence of cutaneous vasoconstriction. The laser Doppler index at the fingertip increased similarly in the two groups, as did the forearm-fingertip temperature gradient. We conclude that premedication with clonidine does not significantly impair the profile of central hypothermia induced by heat redistribution after the induction of anesthesia. IMPLICATIONS The induction of general anesthesia is associated with redistribution hypothermia. This study shows that premedication with oral clonidine does not worsen the decrease in core temperature resulting from general anesthesia.
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Affiliation(s)
- J M Bernard
- Département d'Anesthésie Réanimation, Hôpital Tenon, Paris, France
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Durand-Zaleski I, Delaunay L, Langeron O, Belda E, Astier A, Brun-Buisson C. Infection risk and cost-effectiveness of commercial bags or glass bottles for total parenteral nutrition. Infect Control Hosp Epidemiol 1997; 18:183-8. [PMID: 9090546 DOI: 10.1086/647584] [Citation(s) in RCA: 8] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine whether the greater daily expense of administering total parenteral nutrition (TPN) via plastic bags changed once daily, compared to glass bottles changed thrice daily, could be offset by savings from a reduction in nosocomial infections. DESIGN The costs and potential benefits of commercially available TPN bags and TPN in glass containers were compared. Costs were computed from the viewpoint of the hospital, first in a general model and then for two specific examples, Crohn's disease and intensive-care unit (ICU) patients. The extra cost of using bags was $20 per day. The total cost of nosocomial bacteremia was estimated at $6,000. The monetary benefits of using TPN bags were $6,000XT, where XT was the percentage of nosocomial infections averted. We also considered that reduction in intravenous (IV)-line manipulation could reduce bacteremia-related mortality and computed a cost-per-life-saved ratio. RESULTS Modeling showed that TPN in bags could yield a net benefit when the absolute reduction in the daily risk of nosocomial bacteremia reached the threshold value of 0.3%. Such a reduction could not be attained in patients with Crohn's disease, and corresponded to a 50% to 60% reduction of infection rates in ICU patients. Varying the risk of mortality attributable to IV-line-related infection from 1% to 13% resulted in a cost effectiveness of using TPN bags ranging from $90,000 to $7,000 per life saved in ICU, assuming a two-thirds reduction in IV-line infections, and from $180,000 to $14,000 if the infection rate was reduced by one third. CONCLUSION The baseline cost-minimization analysis concluded that the extra cost of TPN bags was not justified by the extra savings. The cost-effectiveness analysis, however, found that the cost per life saved fell within the accepted range of public health interventions, provided a large fraction of infections are averted using TPN bags.
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Affiliation(s)
- I Durand-Zaleski
- Department of Public Health, Hôpital Henri Mondor, Créteil, France
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Durand-Zaleski I, Delaunay L, Langeron O, Belda E, Astier A, Brun-Buisson C. Infection Risk and Cost-Effectiveness of Commercial Bags or Glass Bottles for Total Parenteral Nutrition. Infect Control Hosp Epidemiol 1997. [DOI: 10.2307/30141979] [Citation(s) in RCA: 11] [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: 11/10/2022]
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Darmon PL, Catoire P, Delaunay L, Wigdorowicz C, Bonnet F. Utility of transesophageal echocardiography in heart collection decision making. Transplant Proc 1996; 28:2895. [PMID: 8908114] [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: 02/03/2023]
Affiliation(s)
- P L Darmon
- Henri Mondor Hospital, Surgical Intensive Care Unit, Créteil, France
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Delaunay L, Denis V, Darmon PL, Catoire P, Bonnet F. Initial cardiac arrest is a risk factor for failure of organ procurement in brain-dead patients. Transplant Proc 1996; 28:2894. [PMID: 8908113] [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: 02/03/2023]
Affiliation(s)
- L Delaunay
- Henri Mondor Hospital, Surgical Intensive Care Unit, Créteil, France
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Abstract
We tested the hypothesis that clonidine produces a dose-dependent increase in the sweating threshold but does not reduce the gain of sweating. Six healthy male volunteers were evaluated, each on three separate days in random order. In one, saline was administered; in another, a 2-micrograms/kg bolus of clonidine was followed by an infusion at 2 micrograms.kg-1.h-1, and on a third day, a 4-micrograms/kg bolus was followed by an infusion at 4 micrograms.kg-1.h-1. Core temperature was measured at the tympanic membrane and mean skin temperature was determined from four sites. A chest sweating rate of 40 g.m-2.h-1 was considered significant. The core temperature triggering sweating, adjusted to a designated mean skin temperature of 34 degrees C, identified the threshold for this response. Gain was defined by the adjusted core temperature increase required to augment sweating from 100 to 300 g.m-2.h-1. degree C-1. Plasma clonidine concentrations were 0.8 +/- 0.1 and 1.6 +/- 0.2 ng/mL on the small- and large-dose days, respectively. Clonidine administration increased the sweating threshold approximately 0.4 degree C (P < 0.05), but the increase was comparable at each dose. The gain of sweating was approximately 0.2 degree C and was not influenced by clonidine administration. The thermoregulatory effects of clonidine thus resemble those of volatile anesthetics, opioids, and propofol. These data suggest that the antishivering effect of clonidine results from central thermoregulatory inhibition rather than a specific peripheral action on thermogenic muscular activity. Unlike other sedatives and anesthetics, the concentration-dependence of clonidine demonstrates a ceiling beyond which the administration of an additional drug fails to enhance the effect, suggesting that the thermoregulatory effect of clonidine may be limited, even at high plasma concentrations. The gain of sweating was well preserved indicating that this response remains effective in the presence of sedatives and anesthetics.
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Affiliation(s)
- L Delaunay
- Département d'Anesthésie-Réanimation, Hôpital Henri Mondor, Creteil, France
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Delaunay L, Herail T, Sessler DI, Lienhart A, Bonnet F. Clonidine Increases the Sweating Threshold, but Does Not Reduce the Gain of Sweating. Anesth Analg 1996. [DOI: 10.1213/00000539-199610000-00033] [Citation(s) in RCA: 28] [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] [Indexed: 11/05/2022]
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Abstract
A case of bilateral adrenal haemorrhage complicating anaphylactic shock is reported. Hypovolemic shock related to peritoneal haemorrhage was the main feature landing to laparotomy. Ultrasonographic examination was not contributive, but CT scan easily documented the adrenal haemorrhage and must be considered a valuable diagnostic tool when adrenal haemorrhage is suspected.
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Affiliation(s)
- N Lefevre
- Réanimation Chirurgicale, Hôpital Henri Mondor, Creteil, France
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Delaunay L, Bonnet F, Cherqui D, Rimaniol JM, Dahan E, Atlan G. Laparoscopic cholecystectomy minimally impairs postoperative cardiorespiratory and muscle performance. Br J Surg 1995; 82:373-6. [PMID: 7796015 DOI: 10.1002/bjs.1800820331] [Citation(s) in RCA: 12] [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] [Indexed: 01/27/2023]
Abstract
Surgery elicits a subjective feeling of postoperative fatigue, at least partly related to an impairment in cardiorespiratory function and muscle performance. Laparoscopic surgery is reported to impair the patient's condition minimally. The aim of this study was to assess exercise performance in patients scheduled for elective laparoscopic cholecystectomy. Nine patients assessed as having American Society of Anesthesiologists (ASA) grade I were enrolled in the study. Subjective feelings of fatigue (measured on a visual analogue scale), and heart rate, systemic arterial pressure oxygen consumption and carbon dioxide production responses to graded exercise testing, were assessed before operation and on days 3 and 10 after operation. There were no significant differences in any of these measurements, at rest or during exercise, between the preoperative and postoperative values. Uncomplicated laparoscopic cholecystectomy does not impair postoperative cardiorespiratory and muscle performance or induce significant postoperative fatigue in patients with ASA I, allowing rapid recovery.
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Affiliation(s)
- L Delaunay
- Réanimation Chirurgicale, Hôpital Henry Mondor, Créteil, France
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Catoire P, Orliaguet G, Liu N, Delaunay L, Guerrini P, Beydon L, Bonnet F. Systematic transesophageal echocardiography for detection of mediastinal lesions in patients with multiple injuries. J Trauma 1995; 38:96-102. [PMID: 7745670 DOI: 10.1097/00005373-199501000-00025] [Citation(s) in RCA: 44] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A prospective study assessing the interest in and the results of systematic transesophageal echocardiography (TEE) examination in nonselected intubated multiple injury patients was carried out from January 1992 through June 1993. Seventy patients were included and divided into two groups according to the results of admission screening, including clinical examination, EKG, CK-MB and chest radiograph. Group 1 (60 patients) had abnormalities on initial screening, while group 2 (10 patients) had no symptom of thoracic or mediastinal injury. TEE was performed within 48 hours following admission and its results were compared with those of the initial screening. TEE usefulness was evaluated on a score grade from 0 (no interest) to 4 (outstanding interest). Myocardial contusion was suspected in 25 patients. TEE invalidated 18 suspected and found 5 unsuspected myocardial contusions. Pericardial effusion was suspected in only one case, while TEE documented 13 additional cases. A mediastinal enlargement was seen in 13 patients, but TEE invalidated aortic lesions in all these cases and made an unsuspected diagnosis of aortic tears. Eight cases of severe hypovolemia and seven cases of left ventricle dysfunction were detected by TEE. The score of interest showed that TEE allowed new interesting diagnoses in 70% of group I patients and in 33% of group II patients. TEE is of utmost importance in multiple injury patients, with or without any evidence of thoracic or mediastinal injury, providing a safe and rapid examination of the mediastinal structures and an evaluation of the hemodynamic status.
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Affiliation(s)
- P Catoire
- Surgical Intensive Care Unit, Henri Mondor Hospital, Créteil, France
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