Praticien en Anesthesie Reanimation最新文献

{"title":"Transmissions au bloc operatoire","authors":"Emmanuelle Dolla","doi":"10.1016/j.pratan.2023.12.002","DOIUrl":"https://doi.org/10.1016/j.pratan.2023.12.002","url":null,"abstract":"<div><p>La survenue d’évènements indésirables liés à un défaut de transmission entre professionnels de santé est fréquente et particulièrement critique dans l’environnement du bloc opératoire. Les temps de communication sont nombreux allant de la consultation d’anesthésie jusqu’à la sortie de salle de surveillance post-interventionnelle. L'ensemble des professionnels doivent être rompus et formés aux échanges formalisés indispensables à la prise en charge des patients. Afin de nous y aider, desoutils existent tels que la checklist de bloc opératoire ainsi que de guides formalisant les conditions et le contenu de la transmission d’information. L’apprentissage repose également sur l’acquisition de compétences non techniques qui doivent être incluses dans la formation médicale.</p></div><div><p>Adverse events are commonly related to failure of appropriate communication between health care professionals about patients’ care, especially in the setting of operating theatre. Written and/or oral exchanges concerning patients’ entrusting are frequent in this setting, beginning with the information about the conclusions of the preoperative anaesthetic consultation until discharge from the recovery room. Healthcare professionals are committed to be confident with formalized concerning patients’ management. The preoperative checklist is one of the supporting tools as well as several guidelines and recommendations fixing the condition of inter professional communication. Education about non-technical expertise should be an entire part of professional training.</p></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 1","pages":"Pages 47-51"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1279796023001717/pdfft?md5=ef5abdea49ac4feed1e3b69ff19c67f4&pid=1-s2.0-S1279796023001717-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139908228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bloc paravertébral et splanchnique : une histoire d’Outre-Rhin","authors":"Marc Gentili,&nbsp;Jean-Louis Scholtes","doi":"10.1016/j.pratan.2024.01.001","DOIUrl":"10.1016/j.pratan.2024.01.001","url":null,"abstract":"","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 1","pages":"Pages 56-58"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139831359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthésie et maladie de Parkinson","authors":"Inanna Gabriel","doi":"10.1016/j.pratan.2024.01.006","DOIUrl":"10.1016/j.pratan.2024.01.006","url":null,"abstract":"<div><p>La maladie de Parkinson (MP) est incurable et son traitement est symptomatique, essentiellement médicamenteux par voie orale, parfois chirurgical. Le traitement se complexifie avec la progression de la maladie et induit beaucoup d’effets secondaires. Sa mauvaise gestion est une cause majeure de détérioration clinique. La prise en charge périopératoire des patients souffrant de MP a pour objectif de ne pas déséquilibrer le traitement afin d’éviter des complications graves. En effet, l’état des patients parkinsoniens s’aggrave lors d’une hospitalisation, en particulier par méconnaissance des soignants, de la pathologie et des impératifs du traitement. En périopératoire, il ne doit pas être interrompu et un moyen alternatif d’administration doit être défini au préalable en cas de chirurgie longue et/ou de non-disponibilité de la voie digestive, par sonde gastrique, par voie sous-cutanée ou transdermique. Quand il existe un neurostimulateur, il doit être éteint avant la chirurgie et remis en route en postopératoire. En cas d’impossibilité, il doit faire l’objet des mêmes précautions qu’un stimulateur cardiaque. Les agents anesthésiques actuels ne présentent aucune contre-indication du fait de la MP. Les précautions et/ou contre-indications concernant certaines médications non anesthésiques sont à connaître en raison de leurs effets antidopaminergiques ou d’interactions avec un médicament spécifique.</p></div><div><p>There is no curative treatment for Parkinson disease (PD) but symptomatic: medications mainly given orally and neurostimulative surgery. Medication regimen becomes more complex as the disease progresses and induces many side effects. Incorrect medication management is the main factor to deterioration of PD symptoms during hospital stay. Anesthesia in PD aims at maintaining clinical status in order to avoid critical complications. Indeed, patient's neurological status is likely to deteriorate during hospital stay, in particular because of the ignorance by the healthcare providers about the disease. For that reason, it is recommended to maintain the usual treatment perioperatively. In case of prolonged surgery and/or non-availability of digestive absorption, alternative routes of administration should be defined beforehand, either by gastric or by subcutaneous or transdermal routes. The neurostimulator, if any, should be turned off before surgery and resumed immediately afterwards. If not possible, cautions taken for cardiac stimulator should be applied. There are no contraindications for current anesthetics agents. Cautions and contraindications of some non-anesthetic drugs should be known, either because of their hidden anti-dopaminergic properties or because of potential interactions with a specific medication.</p></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 1","pages":"Pages 11-21"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1279796024000068/pdfft?md5=071f24e094579973c9cf5bed375d3b7d&pid=1-s2.0-S1279796024000068-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139886024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facteurs d’asynchronisme patient-ventilateur en réanimation","authors":"Soumia Merrou ,&nbsp;Nourhane Elkhayar ,&nbsp;Souhail Lakim ,&nbsp;Younes Laabid ,&nbsp;Baslam Abdelmounaim ,&nbsp;Ouhaz Zakaria ,&nbsp;Rachid Mounir ,&nbsp;Ahmed Rhassane El Adib","doi":"10.1016/j.pratan.2024.01.008","DOIUrl":"10.1016/j.pratan.2024.01.008","url":null,"abstract":"<div><p>Les asynchronismes patient-ventilateur (APV) sont fréquentes en réanimation et concernent plus de la moitié des patients ventilés. Le temps d’asynchronisme est souvent supérieur à 10 % du temps de ventilation. L’asynchronisme patient-ventilateur peut prendre différentes formes : efforts inefficaces (EI) et doubles cycles (DC) notamment. Les facteurs de risque d’asynchronisme sont ceux qui témoignent d’une altération importante des échanges gazeux (rapport PaO₂/FiO₂), volume courant réglé, fréquence respiratoire (FR) et l’état du circuit. La différence entre les FR des patients et celles préréglées (ΔFR) est en lien avec le développement des EI. Ces paramètres doivent faire l’objet d’une attention particulière et analysés pour permettre une correction de l’asynchronisme.</p></div><div><p>More than half of the intensive care patients, documents patient-ventilator asynchronies (PVA) in intensive care units. Asynchrony index is commonly greater than 10% under invasive and non-invasive ventilation as well. Patients experience various forms of asynchrony, predominantly ineffective efforts and double cycles. Risk factors account for impaired gazes exchanges, such as the PaO₂/FiO₂ ratio, the preset tidal volume (Vt), the respiratory rate, and the circuit status. Moreover, a close association was found between pH and inspiratory assist pressure (Pai) (<em>P</em> <!-->=<!--> <!-->&lt;<!--> <!-->0.01), as well as between pH and PaCO₂ (<em>P</em> <!-->=<!--> <!-->0.044). Additionally, the difference between actual patient RR and preset RR (ΔRR) was found to be significantly associated to the development of IE. These parameters need to be closely monitored and correctly analyzed to decrease the incidence of patient-ventilation asynchronies.</p></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 1","pages":"Pages 22-30"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139883095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Masque laryngé : un potentiel sous-exploité","authors":"Yoann Elmaleh ,&nbsp;Olivier Imauven","doi":"10.1016/j.pratan.2024.01.002","DOIUrl":"10.1016/j.pratan.2024.01.002","url":null,"abstract":"<div><p>Les masques laryngés sont des dispositifs mis au point depuis 40 ans. Ils sont largement introduits dans la pratique courante mais restent encore sous-utilisés en France en raison de freins psychologiques sans rationnel scientifique. Le but de cette mise au point est d’offrir un aperçu des avantages et inconvénients liés à l’utilisation de ces dispositifs et, à l’aide d’une revue de la littérature, de déconstruire certaines contre-indications qui n’ont pas lieu d’être : cœlioscopie, patient obèse, positions peropératoires variées et chirurgies prolongées…</p></div><div><p>Laryngeal masks are devices commonly used for the past 40<!--> <!-->years, but are still under-exploited in France due to psychological barriers with non or low scientific rational. The aim of this article is to provide an overview of the advantages and drawbacks of laryngeal masks, and, with the support of a literature review, to deconstruct unjustified contraindications: laparoscopy, obese patients, variable intraoperative positions and prolonged surgical procedures…</p></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 1","pages":"Pages 3-10"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139640848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lu pour vous","authors":"","doi":"10.1016/j.pratan.2023.11.002","DOIUrl":"https://doi.org/10.1016/j.pratan.2023.11.002","url":null,"abstract":"","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 1","pages":"Pages 59-62"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139908229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bloc pudendal et bloc clunéal inférieur échoguidés","authors":"Adrien Lemoine","doi":"10.1016/j.pratan.2024.01.004","DOIUrl":"10.1016/j.pratan.2024.01.004","url":null,"abstract":"<div><p>L’infiltration périneurale des nerfs périnéaux est indiquée soit dans le cadre des douleurs chroniques pour en préciser le diagnostic et potentiellement en assurer une partie du traitement, soit pour le bloc pudendal, assurer l’analgésie postopératoire après chirurgie hémorroïdaire. Plusieurs techniques d’approches ont été décrites parmi lesquelles, après apprentissage, l’échographie constitue une solution simple à mettre en pratique.</p></div><div><p>This article describes the performance of pudendal and cluneal blocks under ultrasonographic guidance. These blocks are diagnostic tools in case of chronic perineal pain and may potentially participate to the therapeutic approach. The pudendal block is also used to guarantee pain control after haemorrhoidal surgery. Different techniques have been described among which the ultrasonographic guidance is easy to perform at bedside after an appropriate training.</p></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 1","pages":"Pages 34-37"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139814725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Formation à la gestion des voies aériennes difficiles par simulation haute-fidélité : retour d’expérience 10 ans après","authors":"Antoine Duwat ,&nbsp;Romain Deransy ,&nbsp;Vincent Hubert ,&nbsp;Hervé Dupont","doi":"10.1016/j.pratan.2024.01.007","DOIUrl":"10.1016/j.pratan.2024.01.007","url":null,"abstract":"<div><p>Le contrôle des voies aériennes est un enjeu majeur dans la prise en charge des patients en anesthésie-réanimation. Nous avons développé une formation par simulateur haute-fidélité afin d’enseigner les techniques et les algorithmes de prise en charge des voies aériennes. Cette formation a permis de conserver les compétences acquises, le respect des algorithmes recommandés et le maintien des performances techniques jusqu’à 1 an après. Un retour d’expérience en situation réelle a été organisé pour tous les médecins ayant bénéficié de cette formation, sous la forme d’une auto-évaluation (délai moyen de formation à 6 ans). La prise de décision ainsi que la maîtrise technique ont été estimées satisfaisantes pour les dispositifs supra-glottiques, la fibroscopie et même pour la cricothyroïdotomie. Douze cricothyroïdotomies ont été effectuées au cours de cette période avec respect systématique de l’algorithme d’oxygénation et succès technique. Le recours à cet abord sous-glottique d’urgence s’est avéré nécessaire dans des contextes très différents comme le bloc opératoire, la réanimation et la médecine préhospitalière chez des patients souffrant en majorité de pathologies ORL. Les praticiens ont déclaré que la formation leur semblait encore utile, mais qu’elle devrait avoir lieu tous les 3 à 5 ans pour maintenir un niveau suffisant de compétences techniques et non techniques.</p></div><div><p>Airway management is a critical aspect of patient care in anesthesia and intensive care. We developed a high-fidelity simulator training program to teach airway management techniques and algorithms. The study demonstrated sustained competence, adherence to recommended algorithms, and maintenance of technical proficiency up to one year post-training. We conducted a real-world feedback experience through self-assessment for all physicians who underwent this training (average time since training: 6 years). Decision-making and technical proficiency were assessed as satisfactory for supraglottic devices, fibroscopy, and cricothyroidotomy. Twelve cricothyroidotomies were performed during this period, consistently following the oxygenation algorithm with technical success. Emergency subglottic access was necessary in diverse settings such as the operating room, intensive care, and pre-hospital medicine, primarily for patients with ENT pathologies. Physicians reported that the training remained valuable, even remotely, but suggested that it could occur every 3 to 5 years to maintain an adequate level of technical and non-technical skills.</p></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 1","pages":"Pages 52-55"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139872921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GO NO-GO : une décision difficile","authors":"Hervé Bouaziz","doi":"10.1016/j.pratan.2024.01.005","DOIUrl":"10.1016/j.pratan.2024.01.005","url":null,"abstract":"","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 1","pages":"Pages 1-2"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139873199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Que retiennent les patients de la consultation d’anesthésie","authors":"Marie Grellier ,&nbsp;Julien Kallout ,&nbsp;Vincent Compère","doi":"10.1016/j.pratan.2023.12.001","DOIUrl":"https://doi.org/10.1016/j.pratan.2023.12.001","url":null,"abstract":"<div><p>La consultation pré-anesthésie couvre les objectifs du médecin anesthésiste, les attentes du patient et les aspects réglementaires. L’information délivrée est primordiale pour planifier l’organisation du processus anesthésique et assurer la sécurité du patient. Bien qu’étant le moment privilégié pour informer le patient, la consultation pré anesthésie demeure un moment complexe au cours du parcours patient et reste soumise à de nombreuses contraintes notamment logistiques, dans un contexte parfois anxiogène pour le patient. Indépendamment de la durée et de la qualité de la consultation, la mémorisation des multiples informations dispensées n’est pas toujours optimale. Le renforcement de l’information après la consultation est une nécessité qui dans un modèle hybride se fait au minimum via un support écrit, mais peut être aussi porté par des outils multimédias en adéquation avec l’air du temps via la vidéo, une application ou un agent conversationnel.</p></div><div><p>The pre-anaesthesia consultation covers the objectives of the health care providers, the expectations of the patients and takes into account regulatory constraints. The information provided is critical for understanding the organisation of the clinical anaesthetic pathway of the patients and contributes to their safety. Although being a special moment to provide information, the pre anaesthetic consultation is submitted to many logistical constraints, moreover facing patient’ anxiety. Whatever the duration and the quality of the communication, storing of information by the patient is far from optimal. Strengthening of the information provided, is mandatory. It can be supported by written instructions but also through videos and/or dedicated websites.</p></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 1","pages":"Pages 38-46"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139908227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}