Anaesthesia, critical care & pain medicine
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Anaesth Crit Care Pain Med · Aug 2017
Observational StudyA targeted remifentanil administration protocol based on the analgesia nociception index during vascular surgery.
The intraoperative modulation of opioids continues to be based on clinical signs. This may result in adverse events such as sympathetic reactivity or opioid-induced hyperalgesia. Recently, the Analgesia/Nociception Index (ANI), a non-invasive 0-100 index derived from heart rate variability analysis, has been proposed for nociception assessment. However, the ability of the ANI to adequately guide intraoperative opioid administration has never been demonstrated. We designed a prospective study to evaluate the ability of the ANI to guide remifentanil administration in vascular surgery. ⋯ This prospective study demonstrated that the ANI can be used to adequately guide intraoperative remifentanil administration during vascular surgery. Such guidance resulted in low remifentanil consumption, low postoperative pain rates and low opioid rescue analgesia.
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Anaesth Crit Care Pain Med · Aug 2017
Observational StudyPostoperative complications after craniotomy for brain tumor surgery.
After elective craniotomy for brain tumour surgery, patients are usually admitted to an intensive care unit (ICU) for monitoring. Our goal was to evaluate the incidence and timing of neurologic and non-neurologic postoperative complications after brain tumour surgery, to determine factors associated with neurologic events and to evaluate the timing and causes of ICU readmission. ⋯ Postoperative complications, especially PONV, are frequent after brain tumour surgery. Moreover, 16% of patients presented a neurological complication, probably justifying the ICU postoperative stay for early detection. The absence of preoperative motor deficit and intraoperative bleeding seems to predict postoperative neurologic complications. Finally, patients may present complications after ICU discharge, especially patients with fossa posterior surgery, suggesting that ICU hospitalization may be longer in this type of surgery.
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Anaesth Crit Care Pain Med · Aug 2017
GuidelinePreventing medication errors in anesthesia and critical care (abbreviated version).
Drug medication errors remain a major safety issue in anaesthesia and intensive care, and prevention measures need to be strengthened. This is why the French Society of Anaesthesia and Intensive Care and the French Society of Clinical Pharmacy have profoundly reviewed their previous recommendations published in 2007. The 2017 recommendations are based on the literature but also on feedback from field professionals targeting patient safety. ⋯ A risk mapping must be established a priori and medication errors reporting is imperative in order to analyze them a posteriori in departmental meetings (REMED). Self-assessment, or external assessment, must be conducted. All of the proposed recommendations reinforce the culture of safety, which is essential to the practice of anaesthesia and intensive care.