La Tunisie médicale
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La Tunisie médicale · Jun 2014
Randomized Controlled Trial Comparative StudyLower incidence of hypotension following spinal anesthesia with 6% hydroxyethyl starch preload compared to 9 ‰ saline solution in caesarean delivery.
Hypotension is a common complication following spinal anesthesia for cesarean delivery. Techniques to prevent hypotension include preloading intravenous fluid. ⋯ The incidence of hypotension was lower after preloading of 500 mL of HES 130/0.4 than preloading with 1500 mL of 9‰ saline solution.
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La Tunisie médicale · Jun 2014
[Implementation of the safe surgery checklist of the World Health Organization at the University Hospital of Monastir (Tunisia)].
To evaluate the impact of introduction of the WHO safe surgery checklist in the university hospital of Monastir over a period of five months. ⋯ The surgical checklist control contributes to the development of a safety culture in the operating room. Maintaining its use should be supported by incentives such as certification and accreditation.
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La Tunisie médicale · May 2014
[Radiation protection in orthopedic surgery at the Charles Nicolle hospital of Tunis].
Orthopaedic theatre personnel (OTP) are exposed to ionizing radiation by the use of Image intensification in the operating room. But :The aims of this study are to determine OTP knowledge about ionizing radiation risks and the availability of radiation protection clothes, to propose appropriate corrective measures. methods: This descriptive study was performed during an orthopaedic operating theatre equipped with a mobile Image intensifier unit in Charles Nicolle hospital, in March 2010. We have performed an orthopaedic theatre visit to identify the availability of radiation protection clothes. We used a questionnaire in order to identity OTP knowledge about ionizing radiation. We established a global score of knowledge to classify our population. results: We identified 65 professionals exposed to ionizing radiation. 54 of them (83%) responded to our questionnaire. 65% were men and sex ratio was 0,54. The median of the age was 32 years (23-51). Orthopaedic theatre personnel were 35% surgeons, 32% nurses, 20% superior technicians and 13% service workers. The mean of the Global score of knowledge was 8,4 /20 (3,6 -15,2). The Kruskal-Wallis test showed that this score increases significantly with grade. Because availability of lead aprons, they were worn by 67% of the staff. ⋯ In the present study, the results indicate insufficiency in OTP knowledge and in radioprotection tools availability. In order to minimize all unnecessary radiation, attempts should be made to increase orthopaedic theatre personnel knowledge about radiation protection. Safety culture is a referral method to reduce radiation exposure as low as possible.
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La Tunisie médicale · Apr 2014
Clinical TrialEvaluation of a new supraglottic airway device in ambulatory surgery: the I-gel.
The I-gel® is a new single-use supraglottic airway device with a non-inflatable cuff. It is composed of a thermoplastic elastomer and a soft gel-like cuff that adapts to the hypopharyngeal anatomy. Its tube is profiled to facilitate and stabilize its insertion. aim : The aim of our study is to state the efficiency and the place of I-gel® in airway management in adult anaesthetic practice. methods: One hundred patients, ASA I-II, scheduled for shortduration elective surgery under general anaesthesia were included in this prospective study. Patients with neck pathology, previous or anticipated airway problems, increased risk of regurgitation or aspiration, ASA III and above and undergoing emergency surgery were not included in the study. We collected the following data: adequacy of the size recommended to the patient, ease in inserting the I-gel®, leak fraction, gastric leak, complications during insertion and removal, ease in inserting the gastric tube, haemodynamic and ventilatory parameters, stability during patient movement and satisfaction of the anaesthetists. results: The success rate of insertion and the use of the I-gel was respectively 99% and 96%. The device was inserted at the first attempt in 92% of cases. The introduction of the I-gel® was rated easy in 99% of cases taking a median of 13 seconds. Complications of insertion were restricted to coughing in 5 patients and hiccups in 7 patients. There were no significant increase in heart rate and mean arterial blood pressure compared to pre-insertion values. An audible leak was recorded in 14.6% of cases. The need for additional manoeuvres was less than or equal to 2 in 96.9 % of patients. The mean of the recorded peak airway pressure values was 18 cmH2O. After a fibreoptic exam via the airway tube, the glottis was completely seen in 74% of cases and partially seen in 14.6%. Two cases of gastric inflation were recorded. There was no case of regurgitation or hypoxemic episode during this trial. Post-operatively sore-throat was reported by one patient in recovery. After I-gel withdrawal, trace of blood was observed in 5 devices. One case of dental trauma was noted. 95% of the anaesthetists were satisfied with the use of the I-gel in their pratice. ⋯ This study showed that I-gel® can be used safely and effectively in patients undergoing short-duration elective surgery because the I-gel® has a very good insertion success rate and few complications. The fibreoptic position of the device was correct and the ventilation was highly effective. These elements must be corroborated in larger series.
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La Tunisie médicale · Feb 2014
Case ReportsUltrasound-guided spinal anesthesia in an obese patient.
We describe the case of 62-year-old man with a body mass index of 53, hypertension, diabetes mellitus and obstructive sleep apnea that was proposed for transurethral resection of prostate under spinal anesthesia. The surface landmark-guided approach was difficult and was abandoned after many unsuccessful attempts. Spinal anesthesia was achieved in one attempt with ultrasound guidance using the midline approach at the identified level. The trajectory was determined from the transducer angle.