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Publisher: Elsevier   (Total: 3162 journals)

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Showing 1 - 200 of 3162 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 34, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 23, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 97, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 26, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 37, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 411, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 10, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 253, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 28, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 16, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 151, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 14, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 33, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 8, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 9)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 24)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 28, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 58, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 16, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 23, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 7, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 18, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 17, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 12)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 9)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 64)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 398, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 11, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 34, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 342, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 455, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 41, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 3)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 57, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 10)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 51, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 54, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 45, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 27, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 47)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 211, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 65, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 28, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 38, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 62, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 17, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 42, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 178, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 11, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 197, SJR: 1.58, CiteScore: 3)

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Journal Cover
Anaesthesia Critical Care & Pain Medicine
Journal Prestige (SJR): 0.411
Citation Impact (citeScore): 1
Number of Followers: 17  
 
  Full-text available via subscription Subscription journal
ISSN (Online) 2352-5568
Published by Elsevier Homepage  [3162 journals]
  • Haemodynamic changes and incisional bleeding after scalp infiltration of
           dexmedetomidine with lidocaine in neurosurgical patients
    • Abstract: Publication date: Available online 27 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Hyunzu Kim, Seung-Ho Choi, Sang-Hee Ha, Won-Seok Chang, Gyoung-A Heo, Jimyeong Jeong, Kyeong Tae Min Background: The purpose of this randomised controlled study is to compare the haemodynamic changes and the degree of incisional bleeding after scalp infiltration of lidocaine and dexmedetomidine versus lidocaine and epinephrine for patients with hemi-facial spasm undergoing microvascular decompression.Methods: Fifty-two patients were injected with 5 ml of 1% lidocaine with either dexmedetomidine (2 ㎍/㎖) or epinephrine (1:100,000 dilution) to reduce scalp bleeding. Mean blood pressure and heart rate were recorded every minute for 15 minutes after scalp infiltration. The primary outcome was the incidence of predefined hypotension, which was treated with administration of 4 mg ephedrine as often as needed. The number of administrations and total amount of ephedrine administered were also recorded as a measure of the severity of hypotension. The neurosurgeon scored incisional bleeding by numeric rating scale from 0 (worst) to 10 (best).Results: The incidence of hypotension (68% vs. 34.8%, P = 0.02) and the frequency (P = 0.02) and total dose (P = 0.03) of ephedrine administered were lower in the dexmedetomidine group than in the epinephrine group. In addition, there was no difference in mean blood pressure between the two groups but heart rates were lower in the dexmedetomidine group (P = 0.01). Incisional site bleeding was better with epinephrine (median [interquartile range] of the numeric rating score: 6 [4] in the dexmedetomidine group and 8 [2] in the epinephrine group; P 
       
  • 2008-2018: Ten years of gradual changes in the sedation guidelines for
           critically ill patients
    • Abstract: Publication date: Available online 26 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Gérald Chanques, Xavier Drouot, Jean-Francois Payen
       
  • Evolution of neurological recovery during the first year after
           subarachnoid haemorrhage in a French university centre
    • Abstract: Publication date: Available online 25 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Raphaël Cinotti, Jean-Baptiste Putegnat, Karim Lakhal, Hubert Desal, Amandine Chenet, Kévin Buffenoir, Denis Frasca, Bernard Allaouchiche, Karim Asehnoune, Bertrand Rozec Introduction: The evolution of neurological recovery during the first year after aneurysmal Subarachnoid Haemorrhage (SAH) is poorly described.Patients: Patients with SAH in one university hospital from March the 1st 2010, to December 31st 2012, with a one-year follow-up.Method: Evaluation was performed via phone call at 3, 6 and 12 months. Primary endpoint was poor neurological recovery (modified Rankin Scale 3-4-5-6), one year after SAH. Secondary endpoints were the incidence of lack of self-perceived previous health status recovery and incidence of cognitive disorders, one year after SAH. Risk factors of poor neurological recovery were retrieved with multivariable logistic regression.Results: Two hundred and eleven patients were included and 208 had a complete follow-up. One hundred and twenty (57.7%) patients were female, 112 (53.8%) had a WFNS grade I-II-III. Seventy (33.6%) patients displayed one-year poor neurological outcome and risk factors of poor outcome were age, baseline Glasgow coma score ≤ 8, external ventricular drainage, intra-cranial hypertension and angiographic vasospasm. We observed an improvement in good outcome at 3months (112 (53.8%) patients), 6 months (127 (61.1%) patients) and one-year (138 (66.3%) patients). Fifty-nine (35.3%) patients recovered previous health status, 96 (57.5%) had persistent behaviour disorders, and 71 (42.5%) suffered from memory losses at one year.Discussion: Neurological recovery seems to improve over time. The same key complications should be targeted worldwide in SAH patients.Conclusion: Neurological complications in the following of SAH should be actively treated in order to improve outcome. The early neuro-ICU phase remains a key determinant of long-term recovery.
       
  • Role of a long-lasting uterotonic drug in the implementation of a fast
           track rehabilitation protocol after caesarian section
    • Abstract: Publication date: Available online 25 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Suela Demiri, Fleur Kefelian, Monique Berl, François Goffinet, Thibaut Rackelboom
       
  • French intensive care unit organisation
    • Abstract: Publication date: Available online 25 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Marc Leone, Jean-Michel Constantin, Claire Dahyot-Fizelier, Caroline Duracher-Gout, Olivier Joannes-Boyau, Olivier Langeron, Matthieu Legrand, Yazine Mahjoub, Sébastien Mirek, Ségolène Mrozek, Laurent Muller, Jean-Christophe Orban, Christophe Quesnel, Antoine Roquilly, Antoine Virat, Xavier Capdevila Anaesthesia, Critical Care and Pain Medicine is the journal of the French Society of Anaesthesia and Intensive Care Medicine (Société Francaise d’Anesthésie et de Réanimation), aimed at promoting the French approach to anaesthesiology, critical care and perioperative medicine. Here, the Intensive Care Committee of the French Society of Anaesthesia and Intensive Care Medicine provides an overview of the organisation of the 400 French Intensive Care Units (ICU), which are polyvalent (50%), surgical (20%), or medical (12%). Around 150,000 patients are admitted to these units each year. Law Decrees govern the frame of practices, including architecture, nurse staffing - two nurses for five patients and one nurse-assistant for four patients - and 24/7 medical coverage. The daily cost of ICU hospitalisation is around 1425 €, entirely ensured by the National Health System. The clinical practices are variable but guidelines produced by intensivists are invited to adhere to guidelines available and freely accessible. End-of-life practices are framed by a Law Decree (Claeys Léonetti) aiming at protecting patients against stubbornly and unreasonable cares. The biomedical research plays a critical role in the French ICU, and practices are performed under the supervision of the Jardé Law. An Institutional Research Board approval is required for prospective studies. In conclusion, the French ICU practice is surrounded by a legal frame
       
  • MANAGEMENT IF ANTIPLATELET THERAPY FOR NON-ELECTIVE INVASIVE PROCEDURES OF
           BLEEDING COMPLICATIONS: PROPOSALS FROM THE FRENCH WORKING GROUP ON
           PERIOPERATIVE HAEMOSTATSIS (GIHP) AND THE FRENCH STUDY GROUP ON THROMBOSIS
           AND HAEMOSTASIS (GFHT), IN COLLABORATION WITH THE FRENCH SOCIETY OF
           ANAESTHESIA AND INTENSIVE CARE MEDICINE (SFAR)
    • Abstract: Publication date: Available online 23 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): A Godier, D Garrigue, D Lasne, P Fontana, F Bonhomme, JP Collet, E de Maistre, B Ickx, Y Gruel, M Mazighi, P Nguyen, A Vincentelli, P Albaladejo, T Lecompte The French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Haemostasis and Thrombosis (GFHT) in collaboration with the French Society for Anaesthesia and Intensive Care Medicine (SFAR) drafted up-to-date proposals on the management of antiplatelet therapy for non-elective invasive procedures or bleeding complications. The proposals were discussed and validated by a vote; all proposals could be assigned with a high strength.Emergency management of oral antiplatelet agents (APA) requires knowledge on their pharmacokinetic/pharmacodynamics parameters, evaluation of the degree of the alteration of haemostatic competence and the associated bleeding risk. Platelet function testing may be considered. When APA-induced bleeding risk may worsen the prognosis, measures should be taken to neutralise antiplatelet therapy by considering not only the efficacy of available means (which can be limited for prasugrel and even more for ticagrelor) but also the risks that these means expose the patient to. The measures include platelet transfusion at the appropriate dose and haemostatic agents (tranexamic acid; rFVIIa for ticagrelor). When possible, postponing non-elective invasive procedures at least for a few hours until the elimination of the active compound (which could compromise the effect of transfused platelets) or if possible a few days (reduction of the effect of APA) should be considered.
       
  • Understanding the impact of pathophysiological alterations during critical
           illness on drug pharmacokinetics
    • Abstract: Publication date: Available online 22 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Janattul-Ain Jamal, Claire Roger, Jason A. Roberts
       
  • Measure it to manage it: a bevy of ICU quality-of-care indicators
    • Abstract: Publication date: Available online 19 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Eric Kipnis, Marc Leone
       
  • CRRT and ECMO: dialysis catheter or connection to the ECMO circuit'
    • Abstract: Publication date: Available online 19 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Miet Schetz, Matthieu Legrand
       
  • Coming to an agreement with recent guidelines and real life about airway
           management and future challenges!
    • Abstract: Publication date: Available online 19 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Robin Florian, Guen Morgan Le
       
  • We should move forward by using our knowledge to improve surgical patient
           care
    • Abstract: Publication date: Available online 19 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Guinot Pierre-Grégoire
       
  • The deliberate clinical inertia, a source of professional satisfaction for
           the end-of-life decision-makers'
    • Abstract: Publication date: Available online 19 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Armelle Nicolas-Robin
       
  • Acute respiratory distress syndrome after chest trauma: epidemiology,
           specific physiopathology and ventilation strategies
    • Abstract: Publication date: Available online 17 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Severin Ramin, Jonathan Charbit, Samir Jaber, Xavier Capdevila
       
  • Levosimendan in Patients with Low Cardiac Output Syndrome Undergoing
           Cardiac Surgery: a systematic review and meta-analysis
    • Abstract: Publication date: Available online 17 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Junchen Zhu, Yu Zhang, Lvlin Chen, Yan He, Xiaoming Qing Levosimendan is an inotropic agent that has been shown in small studies to treat low cardiac output syndrome in cardiac surgery. However, large randomised controlled trials (RCTs) have been recently published and presented neutral results. We sought to determine the effect of levosimendan on mortality in adults with low ejection fraction undergoing cardiac surgery. We searched different databases: Medline, Embase, Cochrane Central Register of Controlled Trials, and clinical trial registries. We included RCTs comparing events in the levosimendan versus placebo in adult patients with ejection fraction≤ 35% undergoing cardiac surgery. Outcomes were mortality at 30-day, mortality beyond 30-day, acute kidney injury and myocardial infarction. Five trials with total of 1519 patients were selected. Four trials were rated as low risk of bias. Our meta-analysis showed no significant difference between levosimendan versus placebo mortality at 30-day (odds radio [OR], 0.62; 95% confidence intervals [CI], 0.32 to 1.20; I2 = 33%; high quality evidence) and mortality beyond 30-day (OR, 0.71; 95% CI, 0.46 to 1.11; I2 = 0%). Similarly, there were no significant differences between the levosimendan versus placebo in the incidence of acute kidney injury (OR, 0.61, 95% CI, 0.33-1.13) and myocardial infarction (OR 0.41, 95% CI 0.08 to 1.22). The current evidence suggests that levosimendan is not associated with significantly reduced mortality in patients with reduced ejection fraction undergoing cardiac surgery.
       
  • Sedation with dexmedetomidine prolongs the analgesic duration of brachial
           plexus block: a randomised controlled trial
    • Abstract: Publication date: Available online 16 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Boohwi Hong, Choonho Jung, Yumin Jo, Hyemin Kang, Woosuk Chung, Yoon-Hee Kim, ChaeSeong Lim, YoungKwon Ko Purpose:Dexmedetomidine, an alpha 2 receptor agonist, prolongs nerve block duration when administered in conjunction with peripheral nerve blocks. We hypothesised that sedation with dexmedetomidine could also significantly prolong the analgesic duration of brachial plexus block (BPB) during orthopaedic surgery on the upper extremities.Materials and Methods: One hundred and two patients received upper extremity surgery under BPB. The patients were randomly sedated with dexmedetomidine (D group) or midazolam (M group) following BPB using 25 ml of local anaesthetics (1:1 mixture of 1% lidocaine and 0.75% ropivacaine). Adequate sedation was evaluated with the modified Ramsay Sedation Scale. Primary outcome was measured as the time the patient first requested analgesic via a patient-controlled analgesia device. Total opioid consumption during the first 24 postoperative hours was also measured as secondary outcomes.Results:Time to first request for analgesia (mean ± standard deviation) was significantly longer in the D group (616.9 ± 158.2 min) than in the M group (443.7 ± 127.2 min) (p 
       
  • Big Data and Targeted Machine Learning in action to assist medical
           decision in the ICU
    • Abstract: Publication date: Available online 16 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): PIRRACCHIO Romain, Mitchell J COHEN, MALENICA Ivana, COHEN Jonathan, CHAMBAZ Antoine, Maxime Cannesson, Christine Lee, RESCHE-RIGON Matthieu, HUBBARD Alan, the ACTERREA Research Group Historically, personalised medicine has been synonymous with pharmacogenomics and oncology. We argue for a new framework for personalised medicine analytics that capitalises on more detailed patient-level data and leverages recent advances in causal inference and machine learning tailored towards decision support applicable to critically ill patients. We discuss how advances in data technology and statistics are providing new opportunities for asking more targeted questions regarding patient treatment, and how this can be applied in the intensive care unit to better predict patient-centred outcomes, help in the discovery of new treatment regimens associated with improved outcomes, and ultimately how these rules can be learned in real-time for the patient.
       
  • A GIANT THORACIC AORTIC ANEURYSM CAUSING MULTIPLE FISTULAS AND
           MEDIASTINITIS
    • Abstract: Publication date: Available online 15 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): DORGET Amandine, VODOVAR Dominique, DESSALLE Thomas, DESGRANGES Pascal, MONGARDON Nicolas
       
  • Choosing appropriate size of I-Gel® for initial success insertion: a
           prospective comparative study
    • Abstract: Publication date: Available online 15 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Gilles Guerrier, Christine Agostini, Marion Antona, Fiorella Sponzini, Anne Paoletti, Isabelle Martin, Jean-Michel Ekherian, Christophe Baillard Purpose: The optimal size of the I-Gel® remains unclear since the manufacturer’s weight-based formula (size 3 for weight < 50 kg, size 4 for weight 50–90 kg, and size 5 for weight> 90 kg) for the laryngeal mask airway I-Gel® is not evidence-based. We hypothesised that sex may also guide the choice of I-Gel® size.Methods: Insertion success rates of the I-Gel® chosen according to the weight-based formula were prospectively recorded and compared with those of a patients’ cohort ventilated with an I-Gel® chosen according to the sex-based formula recorded. Two periods of 18 months were randomized in three independent hospitals in France to study each choice strategy. Patients requiring I-Gel® size change were compared with those who where successfully ventilated with the initially chosen device. Complications linked to the I-Gel® and factors for changing the size of the I-Gel® were also recorded and analysed.Results: Data from 900 patients were prospectively collected in the three participating centres. The overall initial ventilation was inadequate in 80 cases, including 7% (n = 31) in the weight-based group and 3% (n = 13) in the sex-based group (p = 0.01). In the weight-based group, changing size of I-Gel® was successful in 28 (90%) cases. In the sex-based group, changing size of I-Gel® was useful in 1 case only. Endotracheal tube insertion was necessary in 15 cases despite changing I-Gel® size, including 3 cases in the weight-based group and 12 cases in the sex-based group. Ease of insertion and postoperative pharyngo-laryngeal problems were similar between groups with or without changing size of I-Gel®.Conclusion: Adequate ventilation is achieved most of the time using size selection for the I-Gel® laryngeal mask airway according to the manufacturer’s weight-based formula. However, our results suggest that the sex-based formula in healthy, anaesthetised, adult patients may also be appropriate for I-Gel® size choice.
       
  • Process and organisation of in-hospital emergencies in France
    • Abstract: Publication date: Available online 9 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Romain JOUFFROY, Xavier BOBBIA, Tobias GAUSS, Pierre BOUZAT, MICHELET Pierre, for the ACUTE committee of the French Society of Anaesthesia and Intensive Care Medicine
       
  • Prolonged continuous wound infiltration with a local anesthetic after
           total mastectomy: pharmacokinetics and preliminary results on
           postoperative pain
    • Abstract: Publication date: Available online 4 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Daniel Francon, Camille Riff, Olivier Blin, Monique Cohen, Romain Guilhaumou
       
  • Increased middle cerebral artery Doppler velocities after stroke
           thrombectomy performed under general anaesthesia: a pilot monocentric
           retrospective study
    • Abstract: Publication date: Available online 4 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Arnaud Valent, Anne-Claire Lukaszewicz, Marc-Antoine Labeyrie, Didier Payen
       
  • Anaesthetic strategy during endovascular therapy
    • Abstract: Publication date: Available online 4 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Haesebaert Julie, Caroline Dereux, Anne-Claire Lukaszewicz
       
  • Cranial nerves VII and XII palsy after shoulder surgery
    • Abstract: Publication date: Available online 4 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Thierry Garnaud, Marmoud Muheish, Muriel Cholot, Thibaut Austruy A 46-year-old man underwent a left shoulder surgery in the beach chair position with general anaesthesia and oro-tracheal intubation preceded by a left interscalenic block. Patient's head was attached to the headrest in a position of soft extension and moderate right rotation with adhesive tape surrounding his forehead and mandible. Surgery was marked by repeated vertical tractions on the left arm and by blood resorption of the arthroscopy’s irrigation fluid, including epinephrine, which translated in a heart rate and arterial blood pressure rise. Upon waking the patient had severe headaches, left Horner’s sign, left facial paresis and a left lingual paralysis. MRI and CT scan did not show any carotid dissection or parapharyngeal lesion. Electromyogram and neurological examination confirmed a VII and XII cranial nerve peripheral lesion, which took several months to regress. An ischaemic complication was suspected although the most probable cause of the patient’s symptoms was subsequent to an Eagle’s syndrome neurapraxia related to a long styloid process.
       
  • Serious adverse events and deaths linked to poor ventilator use: a report
           of four closed claims
    • Abstract: Publication date: Available online 4 October 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): A. Theissen, V. Piriou, F Fuz, M. Autran, P. Albaladejo, P. Trouiller Through this series of four closed claims, we highlight examples of accidents stemming from poor ventilator use. We then review the main issues in this regard as reported in the literature and by learned societies. This case series has led us to emphasise the need for safety procedures involving systematic checks prior to use, declaration and analysis of the risk, as well as feedback and teaching regarding ventilation systems.
       
  • Low doses of ketamine reduce delirium but not opiate consumption in
           mechanically ventilated and sedated ICU patients: a randomised double
           blind control trial
    • Abstract: Publication date: Available online 27 September 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Perbet Sebastien, Verdonk Franck, Godet Thomas, Jabaudon Matthieu, Chartier Christian, Cayot Sophie, Guerin Renaud, Morand Dominique, Bazin Jean-Etienne, Futier Emmanuel, Pereira Bruno, Constantin Jean-Michel ContextLow-doses of ketamine are commonly used to decrease opiates tolerance, hyperalgesia and delirium in perioperative theatre but these properties have never been studied in Intensive Care Unit (ICU) patients.PurposeTo determine the impact of ketamine infusion on opiates consumption when added to standard care in ICU patients requiring sedation for mechanical ventilation.MethodsPatients admitted in a general ICU of a university hospital and undergoing mechanical ventilation (n = 162) with nurse-driven sedation protocol were randomly assigned into ketamine (2 mg/kg/h) or placebo in a double-blinded control trial. Patients were assessed for sedation and analgesia levels, opiates consumption and delirium (using the Confusion Assessment Method for ICU).ResultsDaily consumption of remifentanil (7.9 ± 1.0 vs 9.3 ± 1.0 µg/kg/h, p = 0.548) and increase in remifentanil doses required for equianalgesia (0.107 ± 0.17 and 0.11 ± 0.18 μg/kg/min, p = 0.78) were not different between ketamine and control groups. Incidence were higher in the placebo group 30/82 (37%) than in the ketamine group 17/80 (21%) (p = 0.03). The duration of delirium was lower in ketamine group (5.3 ± 4.7 vs 2.8 ± 3 days, p = 0.005). Mortality rates, ventilator-free days and ICU length of stay (LOS) were non statistically different in both groups.ConclusionsWhen the best practices of sedation (nurse-driven sedation, a consistent light-to-moderate sedation level, and delirium monitoring) are used for all patients, the addition of low-doses of ketamine does not decrease opiate consumption but reduces delirium incidence and its duration in medico-surgical ICU patients with no effect on mortality rate and ICU LOS.
       
  • Physicians’ experience in decisions of withholding and withdrawing
           life-sustaining treatments: a multicentre survey into emergency
           departments
    • Abstract: Publication date: Available online 27 September 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Marion DOUPLAT, Laurent JACQUIN, Karim TAZAROURTE, Pierre MICHELET, Pierre LE COZ
       
  • Medical students’ knowledge and feeling about end-of-life decisions:
           a national French survey
    • Abstract: Publication date: Available online 27 September 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): R Jouffroy, M Levy-Soussan, O Langeron, M Le Guen
       
  • Targeted temperature management in the ICU: Guidelines from a French
           expert panel
    • Abstract: Publication date: October 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 5Author(s): Alain Cariou, Jean-Francois Payen, Karim Asehnoune, Gérard Audibert, Astrid Botte, Olivier Brissaud, Guillaume Debaty, Sandrine Deltour, Nicolas Deye, Nicolas Engrand, Gilles Francony, Stéphane Legriel, Bruno Levy, Philippe Meyer, Jean-Christophe Orban, Sylvain Renolleau, Bernard Vigué, Laure de Saint Blanquat, Cyrille Mathien, Lionel Velly Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term “targeted temperature management” (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method. Indications are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of TTM in adult and paediatric critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de réanimation de langue française [SRLF]) and the French Society of Anesthesia and Intensive Care Medicine (Société francaise d’anesthésie réanimation [SFAR]) with the participation of the French Emergency Medicine Association (Société française de médecine d’urgence [SFMU]), the French Group for Pediatric Intensive Care and Emergencies (Groupe francophone de réanimation et urgences pédiatriques [GFRUP]), the French National Association of Neuro-Anesthesiology and Critical Care (Association nationale de neuro-anesthésie réanimation française [ANARLF]), and the French Neurovascular Society (Société française neurovasculaire [SFNV]). Fifteen experts and two coordinators agreed to consider questions concerning TTM and its practical implementation in five clinical situations: cardiac arrest, traumatic brain injury, stroke, other brain injuries, and shock. This resulted in 30 recommendations: 3 recommendations were strong (Grade 1), 13 were weak (Grade 2), and 14 were experts’ opinions. After two rounds of rating and various amendments, a strong agreement from voting participants was obtained for all 30 (100%) recommendations, which are exposed in the present article.
       
  • Comparing McGrath® MAC video laryngoscope with Macintosh direct
           laryngoscopy for novice laryngoscopists in children. Reply
    • Abstract: Publication date: October 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 5Author(s): Antoine Giraudon, Maryline Bordes-Demolis, François Semjen, Matthieu Biais, Karine Nouette-Gaulain
       
  • Assessing usefulness of GlideScope® video laryngoscope in children with
           difficult direct laryngoscopy
    • Abstract: Publication date: October 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 5Author(s): Gui-Zhen Yang, Fu-Shan Xue, Ya-Yang Liu, Hui-Xian Li
       
  • Initial training of French residents in obstetric anaesthesia: A national
           survey
    • Abstract: Publication date: October 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 5Author(s): Ludovic Hilt, Delphine Herbain, Nour-Eddine Baka, Jérôme Feugeas, Hervé Bouaziz, Florence Vial
       
  • Ventilation for thoracic surgery in the newborn: Don’t forget high
           frequency oscillatory ventilation!
    • Abstract: Publication date: October 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 5Author(s): Charlotte Rémond, Chloé Alliana, Karin Jonckheer, Jean-François Lecompte, François de la Brière
       
  • Paediatric minimally invasive abdominal and urological surgeries: Current
           trends and perioperative management
    • Abstract: Publication date: October 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 5Author(s): Myriam Bellon, Alia Skhiri, Florence Julien-Marsollier, Serge Malbezin, Diallo Thierno, Julie Hilly, Alaa ElGhoneimi, Arnaud Bonnard, Daphné Michelet, Souhayl Dahmani Minimally invasive surgery during abdominal, thoracic and urological procedures has become the standard management of many surgical interventions in adults. Recent development of smaller devices has allowed the management of many paediatric surgeries using these minimally invasive techniques. However, the lack of knowledge of (a) adequate management of haemodynamic and respiratory alterations occurring during those procedures and (b) postoperative advantages of these techniques over open surgeries, still impairs their development. The current review aimed to clarify mechanisms of those haemodynamic and respiratory alterations, propose easy rules in order to overcome them and shed the light on potential postoperative advantages of minimally invasive surgery in paediatrics.
       
  • Predictive factors of early postoperative respiratory complications after
           tonsillectomy in children with unidentified risks for this complication
    • Abstract: Publication date: October 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 5Author(s): Florence Julien-Marsollier, Pierre Salis, Rachida Abdat, Thierno Diallo, Thierry Van Den Abbelle, Souhayl Dahmani IntroductionTonsillectomy is considered as a therapeutic option in obstructive sleep apnoea syndrome (OSAS). Postoperative respiratory failure is a complication that can require respiratory support. The main objective of our study is to determine risk factors of postoperative respiratory complications in children undergoing tonsillectomy.Material and methodsThis is a retrospective single centre observational study including patients with unanticipated postoperative respiratory failure. Patients with a planned preoperative intensive care admission were excluded (age is lower than 2 years, overweight (> 95% percentile of BMI), moderate or severe asthma, major medical conditions). Those patients were compared with randomly selected control patients. Factors studied were: age, weight, indication of surgery, ASA status, preoperative illness conditions, durations of surgery and anaesthesia and administered medications. Statistics used a univariate analysis and a multivariate logistic regression.ResultsEight hundred and five patients underwent adenotonsillectomy during the study period and 25 developed postoperative respiratory failure. These patients were compared to 103 non-complicated control patients. Age (
       
  • Effective concentration of levobupivacaine and ropivacaine in 80% of
           patients receiving epidural analgesia (EC80) in the first stage of labour:
           A study using the Continual Reassessment Method
    • Abstract: Publication date: October 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 5Author(s): Agnès Le Gouez, Marie-Pierre Bonnet, Thomas Leclerc, Jean-Xavier Mazoit, Dan Benhamou, Frédéric J. Mercier BackgroundA comparison of the effective dose in 50% of patients (ED50) has suggested that the potency of levobupivacaine lies between that of bupivacaine and ropivacaine. However, for clinical purposes, knowledge and use of doses close to the ED95 are more relevant. This study was designed to determine the EC80 (effective concentration) for both epidural levobupivacaine and ropivacaine using the Continual Reassessment Method (CRM) during obstetric analgesia.MethodsIn this double-blind randomised study, term parturients were included by cohorts of 6 if cervical dilatation was ≤ 5 cm and visual analogue pain score (VAPS) > 30 mm. Efficacy was defined by a decrease of VAPS to a value ≤ 10, thirty minutes after epidural injection of 20 mL of levobupivacaine or ropivacaine. The first cohort received the lowest dose. Every next cohort received a dose according to the response's probability calculated using a Bayesian method, incorporating data from all consecutive previous patients. In addition, a logistic equation was fitted a posteriori to the whole data set to determine the whole dose-probability curve.ResultsFifty-four patients were enrolled. Levobupivacaine 0.17% and ropivacaine 0.2% gave probabilities of success of 82% and 72% respectively. By fitting the logistic model to the data, the concentration leading to a probability of 0.8 (EC80) was 0.14% for levobupivacaine and 0.24% for ropivacaine while the EC50 were 0.09% for levobupivacaine and 0.17% for ropivacaine, respectively.ConclusionThis study suggests that epidural levobupivacaine used as the sole drug for labour analgesia has an EC80 lower than that of ropivacaine.
       
  • Reducing patient harm after ambulatory surgery: Lessons from malpractice
           claims
    • Abstract: Publication date: October 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 5Author(s): Karen B. Domino
       
  • Obstetric anaesthesia: Dynamic and multidirectional research approaches to
           ultimately improve parturient management
    • Abstract: Publication date: October 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 5Author(s): Frédéric J. Mercier, Dan Benhamou
       
  • Ventilation, airway management, complications, perioperative anxiety:
           Children will definitely never be small adults
    • Abstract: Publication date: October 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 5Author(s): Christophe Dadure, Chrystelle Sola
       
  • Training and teaching in anaesthesia and critical care: Towards excellence
    • Abstract: Publication date: October 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 5Author(s): Benoît Plaud, Pierre Bouzat, Mathieu Raux
       
  • Opioid-free anaesthesia. Why and how' A contextual analysis
    • Abstract: Publication date: Available online 13 September 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Patrice Forget If the use of natural opiates, such as opium, is more than millennial, the history of synthetic opioids begins after 1950, with the development of the so-called ‘modern’ anaesthetic techniques. In 1962, in Belgium, the use of fentanyl, the first synthetic opioid for use in anaesthesia, is described. Subsequently, the use of opioids at high doses during surgery became common. However, over the last twenty years, many studies have questioned this practice, highlighting the many unknowns as the side effects of these molecules. The so-called opioid-free anaesthesia (OFA) techniques were developed in parallel with a better understanding of perioperative pain. In this work, the following questions are addressed: Why is the human body producing endogenous opioids' Is the concept of pain valid during general anaesthesia' What are the effects of intraoperative opioids on postoperative pain' Is anaesthesia without opioids actually possible' With these questions, the reader can question the use of intraoperative opioids within an historical and evolutionary perspective. In the same time, if OFA is feasible, the research agenda still includes a formal testing of its added value over classical opioid-sparing techniques.
       
  • Reply to Assessing usefulness of Glidescope video laryngoscope in children
           with difficult direct laryngoscopy
    • Abstract: Publication date: Available online 6 September 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Sola Chrystelle
       
  • A rare case of super-refractory epileptic status in pregnant woman:
           Schizencephaly
    • Abstract: Publication date: Available online 31 July 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Nabil Jbili, Khalil Mounir, Hicham Kechna, Lotfi Bibiche, Jaouad Laoutid, Abdelatif Diai, Imane Traibi, Moulay Ahmed Hachimi Schizencephaly is an anomaly of the subtotal brain development, which occurs as the presence of a cleft lined with grey matter extending from subarachnoid space to the ventricles. It may be manifested by psychomotor retardation, paresis or partial seizures and drug-resistant convulsions. The clinical expression of schizencephaly depends on the bilaterality of the slit, its size and its seat. The diagnostic strategy of schizencephaly in the ante- and postnatal period has been revolutionised by MRI imaging, the only technique able to provide an accurate and complete lesional assessment, particularly in type I. We report the case of a 34-year-old pregnant woman at the 25th weeks of amenorrhea, who presented a super-refractory epileptic-status due to a right schizencephaly. The diagnosis of eclampsia was excluded. This case report is very particular cause of the late appearance of epileptic seizures in this pregnant woman who has never done so.
       
  • Uninterrupted dabigatran for ablation in atrial fibrillation: Peering into
           the black box of intra-procedural anticoagulation
    • Abstract: Publication date: August 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 4Author(s): Anne-Céline Martin, Anne Godier
       
  • Evaluation of the effect of serratus anterior plane block for pain
           treatment after video-assisted thoracoscopic surgery
    • Abstract: Publication date: August 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 4Author(s): Korgün Ökmen, Burcu Metin Ökmen BackgroundAnalgesia following video-assisted thoracoscopic surgery (VATS) is important for the prevention of postoperative pulmonary complications. Various regional methods of anaesthesia are currently being used to achieve this goal. In our study, we aim to assess the effectiveness of SAPB on postoperative VATS analgesia in our study.MethodsA total of 40 patients aged between 18 and 70 years, those who were in the Society of Anaesthesiologists (ASA) I–III class and underwent VATS were included in the study. Patients were randomised to either group T (intravenous patient-controlled analgesia tramadol; n = 20) or group S (intravenous patient-controlled analgesia tramadol + SAPB; n = 20). Visual Analogue Scale (VAS) was used for postoperative pain, the primary outcome measure, were evaluated at post-anaesthetic care unit (PACU), 2, 6, 12, and 24 hours. Secondary outcomes included the postoperative 2nd, 6th, 12th, and 24th hour follow-up results were evaluated to identify the quantity of tramadol use, Ramsay sedation scale (RSS), side effect profile, and additional analgesic use.ResultsThe VAS scores between the two groups were found to be statistically significantly lower in group S during the PACU observation (P 
       
  • Immediate postoperative plasma neutrophil gelatinase-associated lipocalin
           to predict acute kidney injury after major open abdominal aortic surgery:
           A prospective observational study
    • Abstract: Publication date: August 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 4Author(s): Philippe Guerci, Jean-Louis Claudot, Emmanuel Novy, Nicla Settembre, Jean-Marc Lalot, Marie-Reine Losser IntroductionPlasma neutrophil gelatinase-associated lipocalin (pNGAL) has been used as a biomarker in acute kidney injury (AKI). AKI is a common postoperative complication of aortic surgery. We sought to evaluate the performance of the immediately postoperative pNGAL level in comparison with the serum creatinine (SCr) level in predicting AKI and the need for renal replacement therapy (RRT).Patients and methodsProspective non-interventional study in a university hospital. Fifty patients undergoing elective or emergent major intra-abdominal aortic surgery were included. Comparisons between groups of patients with or without postoperative AKI, according to KDIGO staging, were made. Performance of NGAL was determined by examining the area under receiver operating characteristic (AUROC) curve.ResultsThe incidence of AKI was 36%. At H + 2, pNGAL values in AKI and non-AKI patients, respectively, were 221 [133–278] versus 50 [50–90] ng/mL (P 
       
  • New markers for early detection of acute kidney injury after transcatheter
           aortic valve implantation
    • Abstract: Publication date: August 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 4Author(s): Cédrick Zaouter, Frédérique Priem, Lionel Leroux, Guillaume Bonnet, Marie-Lise Bats, Marie-Christine Beauvieux, Alain Rémy, Alexandre Ouattara BackgroundAcute kidney injury (AKI) is a frequent complication after a transcatheter aortic valve implantation (TAVI). Biomarkers such as urinary G1 cell cycle arrest proteins (TIMP-2 and IGFBP7) and sonographic evaluation (Doppler Renal Resistive Index [RRI]) have been advocated to predict AKI at an early stage after a TAVI-procedure. The primary aim was to determine the predictive value of these markers to detect AKI after a TAVI-procedure at an early phase.Patients and methodsIn a prospective observational study, 62 consecutive patients were scheduled for a TAVI. AKI was assessed based on the KDIGO criteria. Biomarkers and RRI were measured concomitantly before TAVI, at the first micturition post-implantation and the first micturition on the morning after the procedure.ResultsTwenty-two patients (35%) developed AKI. On the first day after the TAVI-procedure, urinary TIMP-2 and IGFBP7 concentrations increased significantly in patients who developed AKI (0.1, [interquartile] [0.1–0.35] to 0.40 [0.10–1.00] vs. 0.2 [0.1–0.5] to 0.10 [0.10–0.20], P = 0.012) with an area under the receiver-operating characteristic curve of 0.71 [0.55–0.83]. Sensitivity was 0.57 and specificity was 0.83 for a cut-off value of 0.35. No significant increases in RRI were found in patients who developed AKI.ConclusionsBased on the current guidelines for the diagnosis of AKI, the urinary proteins TIMP-2 and IGFBP7 do not detect AKI at an early stage accurately in patients undergoing a TAVI-procedure.
       
  • Perioperative coagulation management: Evolving strategies
    • Abstract: Publication date: August 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 4Author(s): Jerrold H. Levy
       
  • Can a stable coronary artery disease patient be at high ischaemic risk for
           scheduled non-cardiac surgery'
    • Abstract: Publication date: August 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 4Author(s): Benoit Lattuca, Guillaume Cayla, Gilles Montalescot
       
  • Updated French practical guidelines on the management of
           dabigatran-treated patients
    • Abstract: Publication date: August 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 4Author(s): Isabelle Gouin-Thibault, Jean-Christophe Gris
       
  • From universal postoperative pain recommendations to procedure-specific
           pain management
    • Abstract: Publication date: August 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 4Author(s): Helene Beloeil, Francis Bonnet, the Prospect working group
       
  • Should we add tranexamic acid to postpartum haemorrhage protocols after
           the WOMAN trial publication'
    • Abstract: Publication date: August 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 4Author(s): Anne-Sophie Ducloy-Bouthors, Anne Godier
       
  • Determining the editorial policy of Anaesthesia Critical Care and Pain
           Medicine
    (ACCPM)
    • Abstract: Publication date: August 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 4Author(s): Jean-Yves Lefrant, Emmanuel Lorne, Karim Asehnoune, Sylvain Ausset, Pierre Beaulieu, Matthieu Biais, Jean-François Brichant, Beny Charbit, Jean-Michel Constantin, Philippe Cuvillon, Christophe Dadure, Souhayl Dahmani, Jean-Stéphane David, Thomas Fuchs-Buder, Thomas Geeraerts, Anne Godier, Jean-Luc Hanouz, Olivier Joannes-Boyau, Eric Kipnis, Vincent Laudenbach
       
  • Sepsis and thrombosis: An unusual extensive inferior vena cava thrombosis
    • Abstract: Publication date: August 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 4Author(s): Melanie Fromentin, Patrice Talec, Jean Stephanazzi, Charles Marc Samama
       
  • Reply letter to: Eyes should be taped closed during rapid sequence
           induction of anaesthesia
    • Abstract: Publication date: Available online 27 July 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Hawa Keita, Jacques Ripart, Isabelle Cochereau, Dominique Fletcher
       
  • SNAKE ENVENOMATIONS IN FRENCH GUIANA: FIRST CLINICAL ASSESSMENT OF AN
           ANTIVENOM IMPORTED FROM MEXICO
    • Abstract: Publication date: Available online 17 July 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): A. Nadaud, F. Perotti, L. de Haro, D. Boels
       
  • ACUTE LIVER FAILURE AND MISDIAGNOSIS: DO NOT FORGET VIRAL HEPATITIS E
    • Abstract: Publication date: Available online 11 July 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Thomas Laumon, Hélène Dietrich, Laurent Muller, C. Roger
       
  • Predictors of a successful medial canthus block for eye surgery
    • Abstract: Publication date: Available online 2 June 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Gilles Guerrier, Sylvie Rondet, Dalila Hallal, Jacques Levy, Christophe Baillard
       
  • Ambulatory paediatric surgery in French non-paediatric surgical ambulatory
           units: Results of a nationwide survey: The OPERA study
    • Abstract: Publication date: Available online 2 June 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): C. Ecoffey, F. Aubrun, J.-L. Bosson, P. Albaladejo
       
  • Learning medial canthus retrobulbar anaesthesia for eye surgery:
           Ophthalmic surgeons versus anaesthetists
    • Abstract: Publication date: Available online 2 June 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Gilles Guerrier, Pierre-Raphaël Rothschild, Mathieu Lehmann, Francine Behar-Cohen, Christophe Baillard
       
  • Tumescent local anaesthesia for breast cancer surgery in elderly women:
           about 6 cases
    • Abstract: Publication date: Available online 1 June 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): C. Riff, A. Diaz, O. Blin, M. Leone, R. Guilhaumou, A. Bourgoin
       
  • Biomarkers of renal injury, time for a grey-zone approach'
    • Abstract: Publication date: Available online 1 June 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Antoine G. Schneider, Nicolas Mongardon, Laurent Muller
       
  • Health related quality of life and predictive factors six months after
           intensive care unit discharge
    • Abstract: Publication date: Available online 1 June 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Nathan Ferrand, Cédrick Zaouter, Brigitte Chastel, Karim Faye, Catherine Fleureau, Hadrien Roze, Antoine Dewitte, Alexandre Ouattara BackgroundAdvances in critical care medicine have improved patients’ survival rate. However, physical and cognitive sequels after Intensive Care Unit (ICU) discharge remain substantial. Our objectives were to evaluate the Health-related Quality of Life (HRQL) at 6-month after ICU discharge and identify the risk factors of this outcomes.MethodsWe performed a single-centre prospective observational study. The components of Short Form 36 (SF-36) were analysed for assessing HRQL on preadmission and at 3- and 6-month after ICU discharge.ResultsDuring the study period, 438 patients were eligible for recruitment and 220 of them were included in the trial. During the follow-up period, bodily pain and role limitations relating to emotion were both improved in comparison to the preadmission status while physical role component was lower at 3- and 6- month after ICU discharge. There was no other significant change in the SF-36 domains. Mental as well as physical aggregates remained also unchanged. Most of preadmission SF-36 scores were lower in patients who died within the first 6 months of follow-up compared to those who are still alive. Factors independently associated with the 6-month HRQL were age, preadmission HRQL score, SAPS II, prolonged mechanical ventilation (> 3 days) and the occurrence of acute respiratory distress syndrome.ConclusionIn our Cohort, ICU stay does not seem to alter globally neither the mental nor the physical component of the HRQL at 6-month after the discharge. However, some domains of the SF-36 are subject to significant changes.
       
  • Oxygen through suction port: use of a three way stopcock during fiberoptic
           bronchoscopy
    • Abstract: Publication date: Available online 1 June 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Amarjeet Kumar, Neeraj Kumar, Chandni Sinha
       
  • Can intraoperative Surgical Pleth Index values be predictive of acute
           postoperative pain'
    • Abstract: Publication date: Available online 29 May 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): L. Bapteste, A.S. Szostek, D. Chassard, F.P. Desgranges, L. Bouvet
       
  • Strategic proposal for a national trauma system in France
    • Abstract: Publication date: Available online 29 May 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Tobias Gauss, Paul Balandraud, Julien Frandon, Julio Abba, Francois Xavier Ageron, Pierre Albaladejo, Catherine Arvieux, Sandrine Barbois, Benjamin Bijok, Xavier Bobbia, Jonathan Charbit, Fabrice Cook, Jean-Stephane David, Guillaume De Saint Maurice, Jacques Duranteau, Delphine Garrigue, Emmanuel Gay, Thomas Geeraerts, Julien Ghelfi, Sophie Hamada In this road map for trauma in France, we focus on the main challenges for system implementation, surgical and radiology training and upon innovative training techniques. Regarding system organisation: procedures for triage, designation and certification of trauma centres are mandatory to implement trauma networks on a national scale. Data collection with registries must be created, with a core dataset defined and applied through all registries. Regarding surgical and radiology training, diagnostic-imaging processes should be standardised and the role of the interventional radiologist within the trauma team and the trauma network should be clearly defined. Education in surgery for trauma is crucial and recent changes in medical training in France will promote trauma surgery as a specific sub-specialty. Innovative training techniques should be implemented and be based on common objectives, scenarios and evaluation, so as to improve individual and team performances. The group formulated 14 proposals that should help to structure and improve major trauma management in France over the next 10 years.
       
  • Difficult intubation and extubation in adult anaesthesia
    • Abstract: Publication date: Available online 23 May 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): O. Langeron, J.-L. Bourgain, D. Francon, J. Amour, C. Baillard, G. Bouroche, M. Chollet Rivier, F. Lenfant, B. Plaud, P. Schoettker, D. Fletcher, L. Velly, K. Nouette-Gaulain ObjectiveTo provide an update to French guidelines about “Difficult intubation and extubation in adult anaesthesia 2006”.DesignA consensus committee of 13 experts was convened. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Few recommendations were ungraded.MethodsThe panel focused on 6 questions: 1) Why must oxygen desaturation be avoided during intubation and what preoxygenation and oxygenation techniques should be used to prevent it' 2) Should videolaryngoscopes be used instead of standard laryngoscopy with or without a long stylet to achieve a better success rate of intubation after the first attempt during anticipated difficult intubation off fiberoptic intubation' 3) Should TCI or target controlled inhalation anaesthesia (TCIA) be used instead of bolus sedation for airway control in the event of suspected or proven difficulty in a patient spontaneously breathing' 4) What mode of anaesthesia should be performed in patients with difficult intubation criteria and potentially difficult mask ventilation' 5) In surgical patients, what criteria predict difficulties encountered during postoperative tracheal extubation' 6) Should decision trees and algorithms be employed to direct decision-making for the management of difficult intubation, whether foreseen or not' (based on the information from the preceding five issues). Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE® methodology.ResultsThe SFAR Guideline panel provided 13 statements on difficult intubation and extubation in adult anaesthesia. After two rounds of discussion and various amendments, a strong agreement was reached for 99% of recommendations. Of these recommendations, five have a high level of evidence (Grade 1±), 8 have a low level of evidence (Grade 2±). No recommendation was provided for one question.ConclusionsSubstantial agreement exists among experts regarding many strong recommendations for the best care of patients with difficult intubation and extubation in adult anaesthesia.
       
  • Confirmation of endotracheal tube placement with ultrasound – direct
           visualisation with anterior neck compression and continued surveillance
    • Abstract: Publication date: Available online 22 May 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Jui Shih Kao, Desmond Mao, Ruei-Fang Wang, Chee-Fah Chong, Kuo-Chih Chen
       
  • A combined approach for the early recognition of acute kidney injury after
           adult cardiac surgery
    • Abstract: Publication date: Available online 17 May 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Cédrick Zaouter, Julien Potvin, Marie-Lise Bats, Marie-Christine Beauvieux, Alain Remy, Alexandre Ouattara BackgroundCardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent complication. The current criteria to detect CSA-AKI rise only when organic dysfunction has occurred. The Doppler Renal Resistive Index (RRI) and the urinary G1 cell cycle arrest proteins (TIMP-2 and IGFBP7) have been advocated to predict CSA-AKI at an early stage after cardiac surgery. The primary objective was to determine the predictive value of these new markers to detect CSA-AKI after elective heart surgery in patients at risk to develop AKI.MethodsIn a prospective observational trial, we studied 50 patients scheduled for elective on-pump heart surgery at high risk for CSA-AKI. The primary outcome was the incidence of AKI according to the KDIGO criteria recording the urine output every hour until ICU discharge and measuring the serum creatinine levels on each postoperative day until the post-procedure peak values were reached or until the 7th postoperative day. The RRI and the urinary proteins [TIMP-2]*[IGFBP7] were measured concomitantly: before surgery, 1 hour (H1), 4-hour (H4), 12-hour (H12), and 24-hour (H24) after surgery.ResultsThirty-seven patients (74%) developed CSA-AKI. Urinary [TIMP-2]*[IGFBP7] at H12 were significantly higher in patients that developed AKI (0.62, [interquartile] [0.20–1.18] vs. 0.30 [0.07–0.47] P = 0.044) with an area under the receiver-operating characteristic curve of 0.69 [0.53–0.84]. The best sensitivity (65%) and specificity (62%) was achieved for a cutoff value of 0.3 (ng.mL−1)2.1000−1. The H12 time-point was the only in which the RRI values measured showed a trend toward statistical significance in patients that developed AKI (0.72 (Standard deviation) ± (0.06) vs. 0.68 ± (0.07) P = 0.065). The combination of the two markers ([TIMP-2]*[IGFBP7] + RRI) at H12 showed an increased performance of the accuracy with an area under the receiver-operating characteristic curve of 0.78 [0.62–0.93].ConclusionsIn a population at risk of developing CSA-AKI, neither the RRI nor urinary [TIMP-2]*[IGFBP7] detect CSA-AKI occurring in the first post-operative week within the first 24 postoperative hours.
       
  • Management of bleeding and emergency invasive procedures in patients on
           dabigatran: Updated guidelines from the French Working Group on
           Perioperative Haemostasis (GIHP) – September 2016
    • Abstract: Publication date: Available online 2 May 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Pierre Albaladejo, Gilles Pernod, Anne Godier, Emmanuel de Maistre, Nadia Rosencher, Jean Louis Mas, Pierre Fontana, Charles Marc Samama, Annick Steib, Sylvie Schlumberger, Emmanuel Marret, Stéphanie Roullet, Sophie Susen, Samia Madi-Jebara, Philippe Nguyen, Jean François Schved, Fanny Bonhomme, Pierre Sié, members of the French Working Group on Perioperative Haemostasis In 2013, the GIHP published guidelines for the management of severe haemorrhages and emergency surgery. This update applies to patients treated with dabigatran, with a bleeding complication or undergoing an urgent invasive procedure. It includes how to handle the available specific antidote (idarucizumab), when to measure dabigatran plasmatic concentration and when to use non-specific measures in these situations. It also includes guidelines on how to perform regional anaesthesia and analgesia procedures.
       
  • Effect of fluid challenge on renal resistive index after major orthopaedic
           surgery: A prospective observational study using Doppler ultrasonography
    • Abstract: Publication date: Available online 21 April 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Fabrice Ferré, Philippe Marty, Cédric Folcher, Matt Kurrek, Vincent Minville BackgroundA postoperative renal resistive index (RRI) > 0.70 has the best threshold to early predict acute kidney injury (AKI). The response of RRI to a postoperative fluid challenge (FC) is unknown. The aim of our study was to assess the impact of a FC on RRI in suspected hypovolaemia patients after orthopaedic surgery.DesignIn this single-centre observational study, we prospectively screened 156 patients in the recovery room after having undergone a hip or knee replacement.InterventionsForty-six patients with a RRI > 0.70 and requiring FC were included. RRI and cardiac output (CO) were measured before and immediately after a fluid challenge with 500 mL of isotonic saline. A decrease in RRI > 5% was considered significant (renal responders).ResultsOverall, FC resulted in a consistent decrease in RRI (from 0.74 [0.72–0.79] to 0.70 [0.68–0.73], P 
       
  • Brain death: Bilateral pneumothorax and pneumoperitoneum after an apnoea
           test
    • Abstract: Publication date: Available online 20 April 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): G. Thery, J. Rosman, G. Julien, F. Chaix, P. Mateu
       
  • Evaluation of locum tenens activity by young anaesthesiologists and
           intensivists: A national survey
    • Abstract: Publication date: Available online 20 April 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Michael Thy, Jean Bardon, Hélène Carbonne
       
  • Comparison of Proaqt/Pulsioflex® and oesophageal Doppler for
           intraoperative haemodynamic monitoring during intermediate-risk abdominal
           surgery
    • Abstract: Publication date: Available online 18 April 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Grégoire Weil, Cyrus Motamed, Alexandre Eghiaian, Xavier Monnet, Stéphanie Suria ObjectiveTo compare cardiac index (CI) between Proaqt/PulsioFlex® and oesophageal Doppler (OD) and the ability of the PulsioFlex® to track CI changes induced by fluid challenge and secondly to assess the impact of the time interval between two auto-calibrations of PulsioFlex® on the accuracy of the measured CI.MethodsIn a single hospital, 49 intermediate-risk oncologic abdominal surgery patients were included in an observational study. We measured the cardiac Index (CI) provided by OD and by the Proaqt/PulsioFlex® before and after internal calibration, which were performed randomly at specific intervals after the initial one (30, 60, 90 and 120 min). The ability to track fluid responsiveness was evaluated by measuring stroke volume variation, pulse pressure variation (PPV) and CI before and after a 250 ml fluid challenge and assessed by a receiver operating characteristic curve analysis.ResultsThe percentages of error before calibration were 51, 58, 82, 81% for 30, 60, 90 and 120 min, they were 39, 57, 65, and 54% after calibration. Trending ability is assumed by a 93% concordance rate after applying a 15% exclusion zone. The trend interchangeability rate was 13.75%. The area under the curve for fluid responsiveness measured by PPV and SVV PulsioFlex were respectively 0.67 [0.57–0.77], P 
       
  • The place of fibrinogen concentrates in the management of perioperative
           bleeding: A position paper from the Francophone Working Group on
           Perioperative Haemostasis (GIHP)
    • Abstract: Publication date: Available online 13 April 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Charles Marc Samama, Brigitte Ickx, Yves Ozier, Annick Steib, Sophie Susen, Anne Godier The consumption of fibrinogen concentrates has been increasing steadily for several years in surgery, trauma and obstetrics. However, data from the literature are conflicting. The French Working Group on Perioperative Haemostasis (GIHP) proposes a position paper based on a narrative review of the literature, and addresses the following questions: What is the exact role of fibrinogen in haemostasis' Which rational support for the use of perioperative fibrinogen' Which thrombotic risk' What are the most recent professional recommendations on the use of fibrinogen concentrates' Then, evidence-based recommendations are proposed: 1) it is suggested not to administer prophylactic FC to prevent haemorrhage; 2) it is suggested not to use FC alone. Haemostatic treatment must be comprehensive, include other haemostatic treatments and must be limited in cases of severe active haemorrhage; 3) the GIHP suggests urgent measurement of fibrinogen plasma concentration in a biology laboratory or functional fibrinogen by viscoelastic methods. The choice between the two methods must be guided by the time to receive the results from a certified organisation with, in particular, authorisation to perform delocalised biologic examinations; 4) it is suggested not to administer FC when the fibrinogen concentration is superior to 1.5 g/L or when there is a functional fibrinogen deficit (with the possible exception in obstetrics where the threshold could be 2.0 g/L); 5) if FC are administered, an initial dose of 25–50 mg/kg is proposed.
       
  • Ultrasound-guided bilateral erector spinae plane block could provide
           effective postoperative analgesia in laparoscopic cholecystectomy in
           paediatric patients
    • Abstract: Publication date: Available online 6 April 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Can Aksu, Yavuz Gürkan
       
  • The efficacy of ultrasound-guided type-I and type-II pectoral nerve blocks
           for postoperative analgesia after breast augmentation: A prospective,
           randomised study
    • Abstract: Publication date: Available online 5 April 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Omer Karaca, Huseyin U. Pınar, Enver Arpacı, Rafi Dogan, Oya Y. Cok, Ali Ahiskalioglu PurposeThe present study was planned to evaluate the efficacy and safety of ultrasound-guided Pecs I and II blocks for postoperative analgesia after sub-pectoral breast augmentation.MethodsFifty-four adult female patients undergoing breast augmentation were randomly divided into two groups: the control group (Group C, n = 27) who were not subjected to block treatment and Pecs group (Group P, n = 27) who received Pecs I (bupivacain 0.25%, 10 mL) and Pecs II (bupivacain 0.25%, 20 mL) block. Patient-controlled fentanyl analgesia was used for postoperative pain relief in both groups, and the patients were observed for the presence of any block-related complications.ResultsThe 24-h fentanyl consumption was smaller in Group P [mean ± SD, 378.7 ± 54.0 μg and 115.7 ± 98.1 μg, respectively; P 
       
  • A ten-year analysis of the reasons for death following ambulatory surgery:
           Nine closed claims declared to the SHAM insurance
    • Abstract: Publication date: Available online 20 March 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): A. Theissen, F. Fuz, M. Bouregba, M. Autran, M. Beaussier IntroductionThe constant development of ambulatory surgery (AS) raises the problem of monitoring patients after discharge and the risk of death in the case of delays in the management of a serious complication.Patients and methodsThe aim of this retrospective study was to describe the deaths observed within the 30-day period following AS declared to the SHAM insurance (Société hospitalière d’assurance mutuelle) over the last 10 years.ResultsDuring the study period 33,962 claims were surgery-related and 11 were for deaths after AS. Two of the death claims were excluded from our study because they occurred after the first month. The surgeries concerned were tonsilectomy (3), cataract (2), inguinal hernia (2), varicose vein stripping (1) and laparoscopy (1). Death occurred on average 5.4 days after the AS, in intensive care (3), during hospitalisation (2), with emergency medical services (1), in an emergency department (1) or at home (2). Anaesthesia was directly implicated in 3 cases: anaphylactic shock (Diamox), pneumoperitoneum (gastric swelling) and hemoperitoneum (mismanagement of anticoagulants). 1 case was due to a pulmonary embolism and 5 to a surgical cause.Discussion–conclusionThere was only one case where the complication was aggravated due to the delay of care provision and this was because of a lack of information on the complications requiring an emergency return (abdominal pain after laparoscopy). In all the other cases, death would also probably have occurred during conventional hospitalisation, either because it was unavoidable or because the patient was too far from the surgery.
       
  • Perioperative management of patients with coronary artery disease
           undergoing non-cardiac surgery: Summary from the French Society of
           Anaesthesia and Intensive Care Medicine 2017 convention
    • Abstract: Publication date: Available online 19 March 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Jean-Luc Fellahi, Anne Godier, Deborah Benchetrit, Francis Berthier, Guillaume Besch, Thomas Bochaton, Eric Bonnefoy-Cudraz, Pierre Coriat, Etienne Gayat, Alex Hong, Sophie Jenck, Arthur Le Gall, Dan Longrois, Anne-Céline Martin, Sébastien Pili-Floury, Vincent Piriou, Sophie Provenchère, Bertrand Rozec, Emmanuel Samain, Rémi Schweizer This review summarises the specific stakes of preoperative, intraoperative, and postoperative periods of patients with coronary artery disease undergoing non-cardiac surgery. All practitioners involved in the perioperative management of such high cardiac risk patients should be aware of the modern concepts expected to decrease major adverse cardiac events and improve short- and long-term outcomes. A multidisciplinary approach via a functional heart team including anaesthesiologists, cardiologists and surgeons must be encouraged. Rational and algorithm-guided management of those patients should be known and implemented from preoperative to postoperative period.
       
  • Parental presence in post-anaesthesia care unit in French university
           paediatric hospitals: An overview of the situation in 2016
    • Abstract: Publication date: Available online 3 March 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Sandrine Lopes, Sylvie Le Nir, Philippe Pilloy, Marc Laffon
       
  • Anxiety during inhalation induction in paediatrics: Sitting versus supine
           position, a randomised trial
    • Abstract: Publication date: Available online 21 February 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Benjamin Cohen, Aude Thévenin, Bénédicte Mille-Zemmoura, Joseph Moënne-Loccoz, Francis Remérand, Marc Laffon Study objectiveWe evaluated if the sitting or supine positions affect anxiety levels induced by the application of a facemask in children.DesignProspective, randomised study.SettingPaediatric hospital, operating room.PatientsTwo to twelve years old children, 1–3 ASA status, undergoing inhalation anaesthesia for elective surgery.InterventionChildren were randomly assigned to a sitting or supine position. After monitoring equipment was established, inhalation was inducted by the application of the mask.MeasurementsChild anxiety was then assessed with the modified Yale Preoperative Anxiety Scale (mYPAS) before the application of the facemask and following mask application.Main resultsOverall, 99 children in the sitting group and 103 in the supine group were analysed. The mYPAS score was not different in both groups before the application of facemask (40 [28–51] versus 40 [28–53]; P = 0.99). It increased (P = 0.005) to a similar extent in both groups following mask application without difference between groups (48 [38–60] versus 48 [35–63]; P = 0.95). Side effects were not different between both groups.ConclusionIn children undergoing inhalation induction, sitting or supine positions did not modify anxiety induced by the application of a facemask, nor adverse effects; therefore, children should be allowed to choose their preferred position.
       
  • Thromboprophylaxis for ambulatory surgery: Results from a prospective
           national cohort
    • Abstract: Publication date: Available online 15 February 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Charles Marc Samama, Dan Benhamou, Frédéric Aubrun, Jean-Luc Bosson, Pierre Albaladejo BackgroundVenous thromboembolism (VTE) prophylaxis is not always part of the usual care of ambulatory surgery patients, and few guidelines are available.ObjectivesTo collect data on the application of VTE prophylaxis in ambulatory patients.DesignThe OPERA study is a large national survey performed in 221 healthcare facilities.PatientsAmong patients, 2174 who underwent one of ten selected procedures over two pre-defined days of investigation.Main outcome measuresAssessment and management of the postoperative VTE risk.ResultsThe postoperative VTE risk was assessed as nil (4.1% of the physicians), low (74%) or moderate (20%). This risk was assessed as lower (71%) in ambulatory surgery as compared to conventional surgery. In most centres (94%), a personal patient history of VTE was recorded preoperatively, and in 72% a prophylaxis protocol was systematically applied but only 40% of the responding centres had a written protocol for VTE prophylaxis. The postoperative period (discharge at home) was covered by a VTE protocol for 75% of the centres, with VTE prophylaxis starting postoperatively in 21% of the patients. In these patients, different treatments were applied: below-knee compression stockings (25%); thigh-length compression stockings (21%); intermittent pneumatic compression in the recovery room (1.2%); unfractionated heparin (2.0%); low molecular weight heparins (65%); vitamin K antagonists (0.5%); other treatments, including direct oral anticoagulants (0.5%).ConclusionThese data underline the need for a better assessment of the VTE risk in ambulatory patients and new studies either with conventional or new agents to be able to build guidelines in this new setting.
       
  • Evaluation and comparison of epidural analgesia in labour related
           information on French and English-speaking websites
    • Abstract: Publication date: Available online 31 January 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Fabien Espitalier, Sabine De Lamer, Mathilde Barbaz, Marc Laffon, Francis Remérand ObjectivesThe medical information on the Internet is better in English than in other languages. The information about Epidural Analgesia In Labour (EAIL) available on French-speaking websites is of poor quality. The quality of the information about EAIL should be better in English, but there is no comparison available. This study has assessed and compared the quality of the information about EAIL available on French and English-speaking websites.MethodKeywords “epidural”, “épidurale” and/or “péridurale” were used in the French, Canadian and American Google® and Yahoo® search engines. Two independent assessors assessed the 20 first websites for each engine search. They used an evaluation form created from French, Canadian and American recommendations. This form assessed the structure quality (Structure Score/25) and the medical information quality (Medical Information Score/30) of the websites. The addition of both scores gives the Global Score (/55).ResultsSeventy-one websites were assessed, 39 French-speaking and 32 English-speaking websites. Structure, Medical Information and Global Scores (expressed as mean (SD)) were respectively 11 (4), 13 (5), 24 (8) for the French-speaking websites and 11 (4), 12 (4), 23 (7) for the English-speaking websites. There was no statistical significant difference between both languages.ConclusionInformation about EAIL available on French and English-speaking websites is of poor quality and there is no difference in the information quality, whatever the language. A consideration on Internet medical information improvement is needed. A high quality dedicated website should be created and broadcasted.
       
  • Paediatric video laryngoscopy and airway management: What's the clinical
           evidence'
    • Abstract: Publication date: Available online 10 January 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Fu-Shan Xue, Ya-Yang Liu, Hui-Xian Li, Gui-Zhen Yang The major complications of paediatric airway management are uncommon, but the outcomes are often severe. Over the last decade, additions and advancements in the devices and technology have significantly improved our ability to manage difficult paediatric airways safely. Videolaryngoscopy involves the use of video and optical technology to facilitate indirect visualisation of the larynx during intubation and has been seen as an evolutionary step in intubation technology. Over the past few years, videolaryngoscopes have been receiving plenty of attention as new airway devices for use in paediatric patients. The objective of this narrative review is to specify the existing clinical evidence regarding the efficiency and safety of videolaryngoscopy in paediatric airway management.
       
  • Management of antiplatelet therapy in patients undergoing elective
           invasive procedures. Proposals from the French Working Group on
           perioperative haemostasis (GIHP) and the French Study Group on thrombosis
           and haemostasis (GFHT). In collaboration with the French Society for
           Anaesthesia and Intensive Care Medicine (SFAR)
    • Abstract: Publication date: Available online 5 January 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Anne Godier, Pierre Fontana, Serge Motte, Annick Steib, Fanny Bonhomme, Sylvie Schlumberger, Thomas Lecompte, Nadia Rosencher, Sophie Susen, André Vincentelli, Yves Gruel, Pierre Albaladejo, Jean-Philippe Collet, P. Albaladejo, S. Belisle, N. Blais, F. Bonhomme, A. Borel-Derlon, J.Y. Borg, J.-L. Bosson The French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Haemostasis and Thrombosis (GFHT) in collaboration with the French Society for Anaesthesia and Intensive Care Medicine (SFAR) drafted up-to-date proposals for the management of antiplatelet therapy in patients undergoing elective invasive procedures. The proposals were discussed and validated by a vote; all proposals but one could be assigned with a high strength. The management of antiplatelet therapy is based on their indication and the procedure. The risk of bleeding related to the procedure can be divided into high, moderate and low categories depending on the possibility of performing the procedure in patients receiving antiplatelet agents (none, monotherapy and dual antiplatelet therapy respectively). If discontinuation of antiplatelet therapy is indicated before the procedure, a last intake of aspirin, clopidogrel, ticagrelor and prasugrel 3, 5, 5 and 7 days before surgery respectively is proposed. The thrombotic risk associated with discontinuation should be assessed according to each specific indication of antiplatelet therapy and is higher for patients receiving dual therapy for coronary artery disease (with further refinements based on a few well-accepted items) than for those receiving monotherapy for cardiovascular prevention, for secondary stroke prevention or for lower extremity arterial disease. These proposals also address the issue of the potential role of platelet functional tests and consider management of antiplatelet therapy for regional anaesthesia, including central neuraxial anaesthesia and peripheral nerve blocks, and for coronary artery surgery.Graphical abstractGraphical abstract for this article
       
  • Eyes should be taped closed during rapid sequence induction of anaesthesia
    • Abstract: Publication date: Available online 5 January 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Hans-Joachim Priebe
       
  • Impact of learners’ role (active participant-observer or observer only)
           on learning outcomes during high-fidelity simulation sessions in
           anaesthesia: A single center, prospective and randomised study
    • Abstract: Publication date: Available online 5 January 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Antonia Blanié, Sophie Gorse, Philippe Roulleau, Samy Figueiredo, Dan Benhamou AimThe increasing use of high-fidelity simulation is limited by the imbalance between the growing number of students and the human resources available in such a way that all residents cannot play a role during scenarios. The learning outcomes of observers need to be studied.MethodsThis prospective randomised study was approved by the institutional review board. Anaesthesia residents attending a one-day training session were enrolled. In each of the four scenarios, three residents played an active role while others observed in a separate room. All participants attended debriefing sessions. Residents were randomised between active participant-observer group (AP-O group) and observer group (O group). A similar questionnaire was distributed before, immediately after the session and after three months and included self-reported assessment of satisfaction, medical knowledge (noted 0–16), and non-technical skills.ResultsA hundred and four questionnaires were analysed. Immediately after the simulation, a significant increase in medical knowledge was recorded but was higher in the AP-O group (6 [5–8] to 10 [8–11]/16) than in the O group (7 [5–8] to 9 [7–10]/16). High scores for non-technical skills were similarly observed in both groups. Satisfaction was high in both groups but was higher in the AP-O group (9 [8–9] versus 8 [8–9]/10, P = 0.019). Decay of knowledge was observed for most main outcomes at three months.ConclusionThis study suggests an immediate improvement of learning outcomes for both roles after immersive simulation but some learning outcomes may be better for residents engaged as players in scenarios.
       
 
 
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