Anaesthesia, critical care & pain medicine
-
Anaesth Crit Care Pain Med · Feb 2016
Observational StudyReversal of neuromuscular blockade by sugammadex in laparoscopic bariatric surgery: in support of dose reduction.
Sugammadex is the first molecule able to antagonize steroidal muscle relaxants with few adverse effects. Doses are adjusted to body weight and the level of neuromuscular blockade. Sleeve gastrectomy is becoming a very popular form of bariatric surgery. It requires deep muscle relaxation followed by complete and rapid reversal to decrease postoperative and especially post-anaesthetic morbidity. Sugammadex is therefore particularly indicated in this setting. The objective of this study was to evaluate the deep neuromuscular blockade reversal time after administration of various doses of sugammadex (based on real weight or at lower doses). Secondary endpoints were the interval between the sugammadex injection and extubation and transfer from the operating room to the recovery room. We then investigated any complications observed in the recovery room. ⋯ Reversal of deep neuromuscular blockades by sugammadex in obese subjects can be performed at doses of 4mg/kg of ideal weight plus 35-50% with no clinical consequences and no accentuation of adverse effects.
-
Anaesth Crit Care Pain Med · Feb 2016
The perioperative surgical home: An innovative, patient-centred and cost-effective perioperative care model.
Contrary to the intraoperative period, the current perioperative environment is known to be fragmented and expensive. One of the potential solutions to this problem is the newly proposed perioperative surgical home (PSH) model of care. The PSH is a patient-centred micro healthcare system, which begins at the time the decision for surgery is made, is continuous through the perioperative period and concludes 30 days after discharge from the hospital. ⋯ To reduce said variation in care, the entire continuum of the perioperative process must evolve into a unique care environment handled by one perioperative team and coordinated by a leader. Anaesthesiologists are ideally positioned to lead this new model and thus significantly contribute to the highest standards in transitional medicine. The unique characteristics that place Anaesthesiologists in this framework include their systematic role in hospitals (as coordinators between patients/medical staff and institutions), the culture of safety and health care metrics innate to the specialty, and a significant role in the preoperative evaluation and counselling process, making them ideal leaders in perioperative medicine.
-
Anaesth Crit Care Pain Med · Dec 2015
A major trauma course based on posters, audio-guides and simulation improves the management skills of medical students: Evaluation via medical simulator.
Medical competence requires the acquisition of theoretical knowledge and technical skills. Severe trauma management teaching is poorly developed during internship. Nevertheless, the basics of major trauma management should be acquired by every future physician. For this reason, the major trauma course (MTC), an educational course in major traumatology, has been developed for medical students. Our objective was to evaluate, via a high fidelity medical simulator, the impact of the MTC on medical student skills concerning major trauma management. ⋯ This study shows improvement in student skills for major trauma management, which we attribute mainly to the major trauma course developed in our institution.
-
Anaesth Crit Care Pain Med · Dec 2015
Observational StudyMini-fluid challenge can predict arterial pressure response to volume expansion in spontaneously breathing patients under spinal anaesthesia.
The objective of this study was to test whether stroke volume (SV) variations in response to a fixed mini-fluid challenge (ΔSV100) measured by impedance cardiography (ICG) could predict an increase in arterial pressure with volume expansion in spontaneously breathing patients under spinal anaesthesia. ⋯ A ΔSV100 over 5% accurately predicted arterial pressure response to volume expansion during surgery.
-
Anaesth Crit Care Pain Med · Dec 2015
Observational StudyBaseline cerebral oximetry values depend on non-modifiable patient characteristics.
The aim of the present study was to evaluate baseline regional cerebral oxygen saturation (rSO2) values and identify factors influencing preoperative rSO2 in elective minor surgery. ⋯ Non-modifiable patient characteristics (ASA physical status, sex, chronic renal failure, body weight and height) influence baseline rSO2.