Praticien en Anesthesie Reanimation最新文献

{"title":"Risque thrombotique ou risque hémorragique périopératoire : suivez les recommandations","authors":"Francis Bonnet,&nbsp;Nathalie Durieux","doi":"10.1016/j.pratan.2024.09.009","DOIUrl":"10.1016/j.pratan.2024.09.009","url":null,"abstract":"<div><div>L’arrêt ou non des anticoagulants avant une intervention fait souvent l’objet de contestation judiciaire lorsqu’une complication thrombotique ou hémorragique survient. La difficulté vient de l’appréciation des risques respectifs thrombotiques et hémorragique. L’adhésion aux recommandations et des explications préopératoires claires concernant l’attitude adoptée constituent la meilleure prévention des suites judiciaires.</div></div><div><div>Interruption or continuation of anticoagulants treatments before surgery is one of the reasons for legal action against physicians in case of complications. It can be however somehow difficult to evaluate respectively thrombotic and haemorrhagic risks in order to determine the appropriate attitude concerning anticoagulant treatments before surgery. The avoid to be sought in law, it is appropriate to provide clear information to patients and their relatives concerning the risks and to stick to recommendations of the national scientific societies concerning perioperative maintenance or interruption of anticoagulants before surgery.</div></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 6","pages":"Pages 364-366"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142723669","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":"Analyse des évènements indésirables graves : une préoccupation constante et un mode d’évaluation de la qualité des soins","authors":"Francis Bonnet","doi":"10.1016/j.pratan.2024.09.010","DOIUrl":"10.1016/j.pratan.2024.09.010","url":null,"abstract":"","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 6","pages":"Pages 309-310"},"PeriodicalIF":0.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142723661","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":"Quels seuils transfusionnels faut-il recommander en postopératoire et pour qui ?","authors":"Maëva Campfort ,&nbsp;Sigismond Lasocki","doi":"10.1016/j.pratan.2024.09.007","DOIUrl":"10.1016/j.pratan.2024.09.007","url":null,"abstract":"<div><div>L’anémie est fréquente en préopératoire et, bien entendu, encore plus en postopératoire. La question de la transfusion sanguine est également fréquente et son intérêt a été évalué dans de nombreuses études ces dernières années. En effet, la transfusion en concentrés d’érythrocytaires, bien que parfois indispensable, n’est pas dénuée de risques. Elle est associée à un moins bon devenir des patients, a un coût non négligeable pour la société et n’est pas une ressource illimitée. Les recommandations actuelles soutiennent les stratégies transfusionnelles restrictives avec un seuil à 7,0 g/dL d’hémoglobine chez tous les patients, et autour de 8,0–9,0 g/dL d’hémoglobine en cas de syndrome coronarien aigu. Dans tous les cas, la gestion de l’anémie périopératoire doit s’inscrire dans une stratégie globale de Patient Blood Management, incluant la supplémentation martiale.</div></div><div><div>Anemia is common preoperatively and, of course, even more so postoperatively. The question of blood transfusion is thus also common, and its benefits have been evaluated in numerous studies over the last few years. Although sometimes lifesaving, transfusion with erythrocytes concentrates is not always safe. It is associated with poorer outcomes, has a significant cost for the society and is not an unlimited resource. Current recommendations support a restrictive transfusion strategy with a threshold of 7.0 g/dL hemoglobin for all patients, possibly raised to 8.0–9.0 g/dL in case of acute coronary syndrome. In all cases, the management of perioperative anemia must be part of an overall Patient Blood Management strategy, including iron supplementation.</div></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 5","pages":"Pages 279-284"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428665","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":"La chambre à pression différentielle de Sauerbruch : conception d’hier et peut-être pour demain","authors":"Marc Gentili","doi":"10.1016/j.pratan.2024.09.006","DOIUrl":"10.1016/j.pratan.2024.09.006","url":null,"abstract":"","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 5","pages":"Pages 303-305"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428669","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 pour sismothérapie","authors":"Dany Hijazi,&nbsp;David Ditchi,&nbsp;Gaël Deme,&nbsp;Chung Hi Do,&nbsp;Philippe Fossati,&nbsp;Alice Jacquens,&nbsp;Vincent Degos","doi":"10.1016/j.pratan.2024.09.004","DOIUrl":"10.1016/j.pratan.2024.09.004","url":null,"abstract":"<div><div>La pratique de la sismothérapie est croissante notamment du fait de son indication dans les états dépressifs graves. L’objectif est d’obtenir une crise convulsive généralisée. Les patients ont souvent plusieurs séances consécutives. Les appareils qui délivrent l’électrochoc peuvent aussi enregistrer l’activité électroencéphalographique. La sismothérapie s’effectue sous anesthésie générale. Tous les psychotropes interfèrent avec le seuil épileptogène mais peu d’entre eux doivent être interrompus avant sismothérapie de ce fait. L’arrêt des anticoagulants avant sismothérapie n’est pas systématique. L’anesthésie qui s’effectue souvent hors bloc doit garantir toutes les conditions de sécurité. Elle peut être réalisée avec un hypnotique (propofol/étomidate) associé à un curare (succinylcholine ou rocuronium associé à une antagonisation) en ventilation au masque. Trois types de complications peuvent survenir : cardiovasculaires (bradycardie, hypertension), état de mal convulsif et traumatiques.</div></div><div><div>Electroconvulsive therapy is more and more commonly indicated in some psychiatric disorders including depression. The aim is to induce a grand mal seizure. Patients’ schedules for electroconvulsive therapy undergo several sequences over a few days or weeks. Devices delivering the electroshock are also used for recording of the electroencephalographic activity. Patients may commonly take psychotropic agents interfering with the epileptic threshold. Anticoagulants are not obligatorily interrupted before sismotherapy. Anaesthesia, commonly performed outside the operating room, is achieved with a short acting hypnotic and requires the use of celocurine or rocuronium plus sugammadex to avoid post-seizure traumas. Other complications include hypertension, cerebral haemorrhage, bradycardia and grand mal seizures.</div></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 5","pages":"Pages 285-291"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428666","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":"Ciprofol : l’évaluation d’un nouvel hypnotique nécessite de la rigueur méthodologique","authors":"Aurélie Gouel-Chéron","doi":"10.1016/j.pratan.2024.09.002","DOIUrl":"10.1016/j.pratan.2024.09.002","url":null,"abstract":"","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 5","pages":"Pages 255-257"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428378","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":"Éviter des suites médicojudiciaires après une complication de l’analgésie neuroaxiale","authors":"Francis Bonnet,&nbsp;Nathalie Durieux","doi":"10.1016/j.pratan.2024.08.002","DOIUrl":"10.1016/j.pratan.2024.08.002","url":null,"abstract":"<div><div>Les complications neurologiques des blocs neuroaxiaux font souvent l’objet de poursuite judiciaire. La prévention s’appuie sur le maintien d’un suivi et d’un accompagnement des patients dans la prise en charge à long terme de ces complications.</div></div><div><div>Complications of neuroaxial blocks commonly lead to legal action against physicians. To avoid to be sought in law and for the sake of patients, it is important for physicians to continue providing assistance and to guide to their patients for long-term management of their complications.</div></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 5","pages":"Pages 300-302"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428668","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":"Gestion périopératoire des nouveaux traitements médicamenteux de l’insuffisance cardiaque","authors":"Marie-Charlotte Delignette ,&nbsp;Camille Chaffard ,&nbsp;Maxime Orion ,&nbsp;Alice Blet","doi":"10.1016/j.pratan.2024.09.003","DOIUrl":"10.1016/j.pratan.2024.09.003","url":null,"abstract":"<div><div>L’insuffisance cardiaque (IC) est une pathologie chronique fréquente touchant 1 à 2 % de la population générale et plus de 10 % des personnes de plus de 70 ans. La gestion préopératoire de l’IC est cruciale pour prévenir les complications postopératoires. Les inhibiteurs des récepteurs de l’angiotensine-néprilysine (ARNI), les inhibiteurs du co-transporteur sodium-glucose de type 2 (SGLT-2), les agonistes de la guanylate cyclase ou les agonistes du <em>glucagon-like peptide-1</em> (GLP-1) sont des traitements modernes de l’IC, diminuant sa mortalité, avec des recommandations spécifiques en période périopératoire. Les ARNI, comme le sacubitril/valsartan, sont associés à un risque accru d’hypotension artérielle et doivent être interrompus le matin de la chirurgie. Les SGLT-2 peuvent provoquer une acidocétose euglycémique, il est recommandé de les arrêter au moins 3<!--> <!-->jours avant une chirurgie à risque intermédiaire ou élevé. Les agonistes de la guanylate cyclase peuvent provoquer une hypotension artérielle et leur interruption le jour de la chirurgie est conseillée. Les agonistes du GLP-1 peuvent entraîner des effets gastro-intestinaux indésirables et un risque accru de régurgitation et d’inhalation du contenu gastrique ; ils doivent être interrompus le jour de la procédure pour les administrations quotidiennes et une semaine avant pour les doses hebdomadaires. Une collaboration étroite entre cardiologues et anesthésistes est essentielle pour optimiser les résultats chirurgicaux et minimiser les complications postopératoires.</div></div><div><div>Heart failure (HF) is a common chronic condition affecting 1 to 2% of the general population and close to 10% of people over 70 years old. Preoperative management of HF is crucial to prevent postoperative complications. Angiotensin receptor-neprilysin inhibitors (ARNIs), sodium-glucose co-transporter-2 (SGLT-2) inhibitors, guanylate cyclase agonists and glucagon-like peptide-1 (GLP-1) agonists are modern HF treatments, decreasing mortality, with specific perioperative management guidelines. ARNIs, such as sacubitril/valsartan, are associated with an increased risk of hypotension and should be discontinued the morning of the surgery. Guanylate cyclase agonists, like vericiguat, can cause hypotension and discontinuation on the day of surgery is advised. SGLT-2 inhibitors can cause euglycemic ketoacidosis, it is recommended to stop them at least 3 days before intermediate or high-risk surgeries. GLP-1 agonists may cause gastrointestinal side effects and an increased risk of gastric regurgitation and aspiration; they should be discontinued on the day of the procedure for daily administrations and one week before for weekly doses. Close collaboration between cardiologists and anesthesiologists is crucial to optimize surgical outcomes and minimize postoperative complications.</div></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 5","pages":"Pages 267-278"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428308","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":"Prédire pour prévenir les complications respiratoires après chirurgie abdominale : quand, avec quels outils, et pour quels patients ?","authors":"Antoine Monsel ,&nbsp;Alexandre Sitbon","doi":"10.1016/j.pratan.2024.08.003","DOIUrl":"10.1016/j.pratan.2024.08.003","url":null,"abstract":"<div><div>Les complications respiratoires sont fréquentes après chirurgie digestive majeure. Elles augmentent la mortalité à court et moyen terme, allongent significativement la durée de séjour hospitalier et induisent un surcoût. Les facteurs de risque de complications respiratoires qui dépendent du statut médical du patient et de l’intervention chirurgicale, sont nombreux. Leur inventaire préopératoire, qui permet d’établir des scores validés, permet de hiérarchiser le risque et d’optimiser la prévention dans le cadre d’une politique de récupération améliorée après chirurgie.</div></div><div><div>Postoperative respiratory complications commonly occur after major abdominal surgery. Their occurrence increases morbidity and postoperative mortality, prolongs hospital stay and induces an important extra cost. Risk factors depend on the patient's medical status and the surgical procedure. They can be listed to provide validated predictive scores. Accordingly, patients can be included in pre and postoperative enhanced recovery programmes notably aiming to decrease the incidence of postoperative complications.</div></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 5","pages":"Pages 258-262"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428731","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":"Douleur chronique du genou : radiofréquence des nerfs géniculés","authors":"Cyril Quémeneur ,&nbsp;Daniela Del Valle y Fuentes","doi":"10.1016/j.pratan.2024.09.005","DOIUrl":"10.1016/j.pratan.2024.09.005","url":null,"abstract":"<div><div>La radiofréquence est une technique interventionnelle qui utilise un champ électromagnétique pour cibler des nerfs responsables de syndromes douloureux. Elle peut être pulsée (PRF) ou continue (CRF) avec un degré variable d’atteinte sur les tissus nerveux. Cet article décrit l’utilisation de la radiofréquence dans la gestion de la douleur du genou, en se concentrant sur ses applications spécifiques à la gonarthrose et aux douleurs postarthroplastie. Les essais contrôlés randomisés et les méta-analyses récentes soutiennent son efficacité pour la gonarthrose, montrant une amélioration significative des scores de douleur et de fonction par rapport aux traitements conservateurs. Des études supplémentaires sont nécessaires pour confirmer ces résultats à long terme. Dans l’attente la radiofréquence du genou doit être utilisée dans le cadre de protocoles de recherche rigoureux avec un suivi systématique des patients.</div></div><div><div>Radiofrequency is an interventional technique that uses an electromagnetic field to target pain-causing nerves. It can be pulsed (PRF) or continuous (CRF), with varying degrees of impact on nerve tissues. This article examines the use of radiofrequency in managing knee pain, focusing on its specific applications for arthrosis and post-arthroplasty pain. Recent randomized controlled trials and meta-analyses support its efficacy in this setting, documenting significant improvements in pain and functional scores compared to conservative treatments. However, the place of radiofrequency in managing postoperative pain is not yet well defined, and further studies are necessary to confirm its long-term efficacy and safety. Meanwhile, the use of radiofrequency should be conducted within rigorous research protocols with systematic patient follow-up.</div></div>","PeriodicalId":52613,"journal":{"name":"Praticien en Anesthesie Reanimation","volume":"28 5","pages":"Pages 292-299"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428667","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}