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Publisher: Elsevier   (Total: 3157 journals)

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Showing 1 - 200 of 3160 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: 35, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 24, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 96, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 27, 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: 417, 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: 262, 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: 27, 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)
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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: 7)
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: 17, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 10, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 160, 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: 15, 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: 9, 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: 4)
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: 9, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, 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: 25)
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: 8)
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: 59, 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: 23)
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: 6, 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: 7, 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: 2)
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: 10)
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: 19)
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   (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: 404, 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: 18)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 14)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 47, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 352, 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: 457, 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: 42, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
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: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 11)
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: 10, 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: 10, 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: 53, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 56, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, 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: 29, 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: 223, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, 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: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 18, 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: 185, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 12, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
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: 205, 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: 18  
 
  Full-text available via subscription Subscription journal
ISSN (Online) 2352-5568
Published by Elsevier Homepage  [3157 journals]
  • REPLY TO THE LETTER TO THE EDITOR
    • Abstract: Publication date: Available online 11 January 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Joseph Rinehart, PhilippeVan der Linden, Alexandre Joosten
       
  • Severe Patient Injury Associated with Mechanical Ventilators: A
           “Never Event”
    • Abstract: Publication date: Available online 10 January 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Karen B. Domino
       
  • Haemoperfusion with polymyxin B membrane: Recent results for an old
           debate!
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): Didier Payen
       
  • Brain death: Bilateral pneumothorax and pneumoperitoneum after an apnoea
           test
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): G. Thery, J. Rosman, G. Julien, F. Chaix, P. Mateu
       
  • Oxygen through suction port: use of a three way stopcock during fiberoptic
           bronchoscopy
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): Amarjeet Kumar, Neeraj Kumar, Chandni Sinha
       
  • Transverse subglottic diameter assessment in the third gestation
           trimester: Preeclampsia versus control
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): Olivier Belin, Fabien Espitalier, Francis Remerand, Franck Perrotin, Marc Laffon
       
  • Herpes simplex virus: A rare but treatable cause of fulminant hepatitis
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): V. Guillotin, S. De Guillebon, N. Bui, C. Sazio, A. Boyer
       
  • Anaesthesia management by residents does not alter the incidence of
           self-reported anaesthesia awareness: A teaching hospital-based propensity
           score analysis
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): Aya Takechi, Satoki Inoue, Masahiko Kawaguchi BackgroundIntraoperative awareness during general anaesthesia is rare but represents one of the major anaesthesia-related complications. Intraoperative awareness may be a result of inadequate anaesthesia management. Therefore, the incidence can be related with the experience of anaesthetists. To assess whether the incidence of intraoperative awareness is related to anaesthetists’ experience, we compared the incidence of self-reported intraoperative awareness between patients managed by anaesthesia residents or by experienced anaesthetists.MethodsThis is a retrospective review of an institutional registry containing 21,606 general anaesthesia cases. It was conducted with the ethics board approval. Propensity score analysis was used to generate a set of matched cases (resident managements) and controls (anaesthetist managements), yielding 4940 matched patient pairs. The incidence of self-reported intraoperative awareness compared as primary outcomes. Additionally, a multivariate logistic analysis in the entire cohort, using the incidence of self-reported intraoperative awareness as dependent variable, was conducted to confirm the result of the primary outcome.ResultsIn the unmatched population, contrary to our hypothesis, the incidence of self-reported intraoperative awareness was lower in resident management compared with anaesthetist management (1.1% vs. 1.5%, P = 0.028). However, after propensity score matching, there was no difference in incidences of self-reported intraoperative awareness (1.5% vs. 1.3%, 0.38). The multivariate analysis confirmed the result of the primary outcome from the matched pair analysis and showed that ASA physical status (OR = 1.40, 95% CI = 1.08 to 1.81), emergency case (CI = 2.05, 95% CI = 1.40 to 3.00), and application of postoperative analgesia (OR = 0.70, 95% CI = 0.50 to 0.97) were independently associated with incidence of self-reported intraoperative awareness.ConclusionIn conclusion, when supervised by an anaesthetist, resident anaesthesia management is not more likely to result in complaints about intraoperative recall than anaesthetist management.
       
  • Male requires a higher median target effect-site concentration of propofol
           for I-gel placement when combined with dexmedetomidine
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): M.-M. Han, F.-S. Xue, F. Kang, X. Huang, J. Li ObjectiveThe supraglottic airway device (SAD) can be used for airway management of spontaneous breathing patients, and propofol is commonly applied for the SAD placement. This study was designed to assess the effect of gender on median target effect-site concentration (Ce50) of propofol for I-gel placement when combined with dexmedetomidine.Material and method19 males and 18 females, aged 18 to 59 and undergoing elective surgery, were enrolled. After intravenous infusion of dexmedetomidine 1.0 μg/kg over 10 min followed by continuous infusion of 0.4 μg/kg/h, target-controlled infusion of propofol under Marsh model was started and the initial Ce of propofol was set at 4.79 μg/mL and 4.35 μg/mL in the male and female patients, respectively. The I-gel was inserted when the Ce of propofol reached the pre-set concentration and bispectral index value was less than 60. The Ce of propofol required for I-gel placement was determined by the Dixon up-and-down method.ResultsThe Ce50 (95% confidence interval) of propofol required for I-gel placement were 4.082 μg/mL (3.798–4.332 μg/mL) and 3.509 μg/mL (3.266–3.749 μg/mL) in male and female patients, respectively, with a significantly higher Ce50 in males.ConclusionWhen combined with dexmedetomidine, males require a higher Ce50 of propofol for I-gel placement compared to females.
       
  • Comparison of the acoustic windows for the thoracic paramedian epidural
           approach after shoulder rotation: The lateral decubitus versus the sitting
           position
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): Hyo-Jin Byon, Sung-Jun Hong, Dae-Yu Kim, Joo-Hyeon O, In-Gon Lee, Dong-Ho Seo, Gyoung-A. Heo, Hyunzu Kim BackgroundThe aim of this study was to compare the mean lengths of the posterior longitudinal ligament (PLL) as the acoustic window during the thoracic paramedian epidural approach after shoulder rotation, while subjects were in the lateral decubitus or in the sitting position.MethodsThirty-two adult male volunteers were placed in the right decubitus position or sitting position on a horizontal operating table. To obtain an optimal ultrasound view for the PLL on the right side, thoracic spinal ultrasonography was performed at the T6/7 interspace using the paramedian oblique sagittal plane. PLL length was measured on the ultrasound image before and after right shoulder rotation.ResultsBefore shoulder rotation, the difference in mean PLL length between the sitting (11.1 ± 1.3 mm) and lateral decubitus (10.7 ± 1.2 mm) positions was not statistically significant (P = 0.05). Within-position, the before and after comparison revealed that after shoulder rotation, PLL length was significantly increased to 12.2 ± 1.4 mm (P 
       
  • 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: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(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 
       
  • Postoperative analgesic efficacy of ultrasound-guided
           ilioinguinal-iliohypogastric nerve block compared with medial transverse
           abdominis plane block in inguinal hernia repair: A prospective, randomised
           trial
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): Nidhi Bhatia, Indu Mohini Sen, Banashree Mandal, Ankita Batra PurposeAnalgesic efficacy of ultrasound-guided transverse abdominis plane block, administered a little more medially, just close to the origin of the transverse abdominis muscle has not yet been investigated in patients undergoing unilateral inguinal hernia repair. We hypothesised that medial transverse abdominis plane block would provide comparable postoperative analgesia to ilioinguinal-iliohypogastric nerve block in inguinal hernia repair patients.MethodsThis prospective, randomised trial was conducted in 50 ASA I and II male patients ≥ 18 years of age. Patients were randomised into two groups to receive either pre-incisional ipsilateral ultrasound-guided ilioinguinal-iliohypogastric nerve block or medial transverse abdominis plane block, with 0.3 ml/kg of 0.25% bupivacaine. Our primary objective was postoperative 24-hour analgesic consumption and secondary outcomes included pain scores, time to first request for rescue analgesic and side effects, if any, in the postoperative period.ResultsThere was no significant difference in the total postoperative analgesic consumption [group I: 66.04 mg; group II: 68.33 mg (P value 0.908)]. Time to first request for rescue analgesic was delayed, though statistically non-significant (P value 0.326), following medial transverse abdominis plane block, with excellent pain relief seen in 58.3% patients as opposed to 45.8% patients in ilioinguinal-iliohypogastric nerve block group.ConclusionMedial transverse abdominis plane block being a novel, simple and easily performed procedure can serve as an useful alternative to ilioinguinal-iliohypogastric nerve block for providing postoperative pain relief in inguinal hernia repair patients.
       
  • A new national quality indicator reflecting pain relief in the PACU has
           been launched and initial results show the positive performance of French
           teams
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): Dan Benhamou, Claude Ecoffey, Sophie Calmus, Fréderic Capuano, Marc Dahlet, Arnaud Fouchard
       
  • Acute liver failure: Running fast between the traps
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): Jean-Marc Delay, Audrey de Jong, Catherine Paugam-Burtz, Emmanuel Weiss
       
  • Perioperative haemodynamic therapy: Why are recommendations not being
           adopted'
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): Matthieu Biais, Rupert Pearse
       
  • Evaluation of locum tenens activity by young anaesthesiologists and
           intensivists: A national survey
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): Michael Thy, Jean Bardon, Hélène Carbonne
       
  • A cure for septic AKI: Why not keep the dream alive'
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): Thibault Michel, Olivier Joannes-Boyau, Antoine-Guillaume Schneider
       
  • Ultrasound-guided bilateral erector spinae plane block could provide
           effective postoperative analgesia in laparoscopic cholecystectomy in
           paediatric patients
    • Abstract: Publication date: February 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 1Author(s): Can Aksu, Yavuz Gürkan
       
  • DATA QUALITY AND BLOCKCHAIN TECHNOLOGY
    • Abstract: Publication date: Available online 8 January 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Valentina Bellini, Alberto Petroni, Giuseppina Palumbo, Elena Bignami
       
  • A new SFAR / APSF collaboration: another step towards the common goal of
           patient safety
    • Abstract: Publication date: Available online 8 January 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): A Theissen, X Capdevila, MA Warner, SB Greenberg, P Trouiller
       
  • Optimal amount of calories for critically ill patient
    • Abstract: Publication date: Available online 8 January 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Thomas LESCOT, Jean Charles PREISER
       
  • Active participation in high fidelity simulation might be associated with
           higher stress level and better learning outcomes at three months than
           external observation
    • Abstract: Publication date: Available online 8 January 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Marc Lilot, Jean-Noël Evain, Antoine Duclos, Jean-Jacques Lehot, Thomas Rimmelé
       
  • Bleeding complications following peripheral regional anaesthesia in
           patients treated with anticoagulants or antiplatelet agents: a systematic
           review
    • Abstract: Publication date: Available online 23 December 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): F Joubert, P Gillois, H Bouaziz, E Marret, G Iohom, P Albaladejo Background:Patients on either antiplatelet or anticoagulant therapy may need procedures performed under peripheral nerve blocks in preference to general anaesthesia techniques. The risk of bleeding associated with peripheral nerve blocks under these circumstances remains unknown. This systematic review evaluates the incidence of bleeding complications following peripheral nerve blocks in patients receiving antiplatelet and/or anticoagulant medication.Method:All English, French and Spanish publications on peripheral nerve blocks in patients receiving antiplatelet and/or anticoagulant medication, from 1978 to 2018 from various sources including Pubmed, were reviewed. Publications on neuraxial anaesthesia (spinal or epidural) and eye blocks were excluded.Results:Twenty-four articles were selected, including six observational studies and 18 case reports. Patients received antiplatelet agents only, in 4 studies, anticoagulants only in 14 studies, and both in 6 studies. In the observational studies, 80 bleeding complications (haematoma or minor bleeding at the puncture site) were identified following 9.738 peripheral nerve blocks. Amongst case reports, 15 bleeding complications were noted following 50 peripheral nerve blocks. Bleeding complications were reported mostly with lumbar plexus blocks (1 requirement for blood transfusion, 1 catheter embolization, 1 surgical exploration and 1 death). The overall estimate of the incidence of bleeding complications was 0.82% (0.64%-1.0%).Conclusion: This systematic review found that bleeding complications following peripheral nerve blocks were rare in patients receiving antiplatelet and/or anticoagulant medication.
       
  • Etomidate-induced hypotension: a pathophysiological approach using
           arterial elastance
    • Abstract: Publication date: Available online 21 December 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Osama Abou Arab, Marc Olivier Fischer, Alexis Carpentier, Christophe Beyls, Pierre Huette, Abdel Hchikat, Amar Benammar, Beatris Labont, Yazine Mahjoub, Stéphane Bar, Pierre-Grégoire Guinot, Emmanuel Lorne Introduction: Anaesthesia frequently induces hypotension. Several recent studies have analysed arterial elastance (Ea) in order to describe clinical variations of mean arterial pressure (MAP). The objective of the study was to assess Ea to explain MAP variation following etomidate induction.Methods: We conducted a prospective single-centre study. Inclusion criteria were patients undergoing elective cardiac surgery with invasive blood pressure monitoring. Ea was expressed as Pes/SV (Pes: end systolic pressure, SV: stroke volume). Cardiac index (CI), peripheral vascular resistance (PVR) and arterial compliance (C) was compared before and 2 minutes after etomidate induction. Arterial hypotension was defined as a decrease greater than 15% of the baseline MAP.Results: Of the 45 patients included, 24 (53%) had a preserved MAP and 21 (47%) had an etomidate-induced hypotension. Ea was similar before induction and decreased in the decreased MAP group 2 minutes after induction (2.0 mmHg.ml-1 [1.7-2.4] vs 1.4 mmHg.ml-1 [0.9-1.9]; p = 0.001). Arterial compliance (C) increased in the decreased MAP group 2 minutes after induction (0.8 ml. mmHg-1 [0.6-1.0] vs 0.5 ml. mmHg-1 [0.4-0.6], p 
       
  • EARLY MANAGEMENT OF SEVERE PELVIC INJURY (FIRST 24 HOURS)
    • Abstract: Publication date: Available online 21 December 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Pascal Incagnoli, Alain Puidupin, Sylvain Ausset, Jean Paul Beregi, Jacques Bessereau, Xavier Bobbia, Julien Brun, Elodie Brunel, Clément Buléon, Jacques Choukroun, Xavier Combes, Jean Stephane David, François-Régis Desfemmes, Delphine Garrigue, Jean-Luc Hanouz, Isabelle Plénier, Fréderic Rongieras, Benoit Vivien, Tobias Gauss, Anatole Harrois OBJECTIVE:Pelvic fractures represent 5% of all traumatic fractures and 30% are isolated pelvic fractures. Pelvic fractures are found in 10 to 20% of severe trauma patients and their presence is highly correlated to increasing trauma severity scores. The high mortality of pelvic trauma, about 8 to 15%, is related to actively bleeding pelvic injuries and/or associated injuries to the head, abdomen or chest. Regardless of the severity of pelvic trauma, diagnosis and treatment must proceed according to a strategy that does not delay the management of the most severely injured patients. To date, in France, there are no guidelines issued by healthcare authorities or professional societies that address this subject.DESIGN:A consensus committee of 22 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d’Anesthésie et de Réanimation ; SFAR) and the French Society of Emergency Medicine (Société Française de Médecine d’Urgence ; SFMU) in collaboration with the French Society of Radiology (Société Française de Radiologie ; SFR), French Defence Health Service (Service de Santé des Armées ; SSA), French Society of Urology (Association Française d’Urologie ; AFU), the French Society of Orthopaedic and Trauma Surgery (Société Française de Chirurgie Orthopédique et Traumatologique ; SOCFCOT), and the French Society of Digestive Surgery (Société Française de Chirurgie digestive ; SFCD) 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 independently from 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 emphasised.METHODS: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.RESULTS:The SFAR Guideline panel provided 22 statements on prehospital and hospital management of the unstable patient with pelvic fracture. After three rounds of discussion and various amendments, a strong agreement was reached for 100% of recommendations. Of these recommendations, 11 have a high level of evidence (Grade 1 ± ), 11 have a low level of evidence (Grade 2 ± ).CONCLUSIONS:Substantial agreement exists among experts regarding many strong recommendations for management of the unstable patient with pelvic fracture.
       
  • The effect of playing video games on fiberoptic intubation skills
    • Abstract: Publication date: Available online 21 December 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Aysun Ankay Yilbas, Ozgur Canbay, Basak Akca, Filiz Uzumcugil, Asli Melek, Mert Calis, İbrahim Vargel Introduction:The effect on hand-eye coordination and visuospatial skills made videogames popular for training in laparoscopic surgery. Although similar effects may be true for fiberoptic intubation (FOI), it hasn’t been studied before. The aim of this study was to investigate the effect of playing videogames with gamepad on FOI skills.Methods: After obtaining ethical approval and informed consent, 36 anaesthesia residents with no experience on fiberoptic intubation were divided into two groups. Group C (n = 18) consisted of the residents without any videogame experience with gamepad. Group PS (n = 18) played a videogame 30 minutes/day for five days. All residents performed their first nasal FOI on a patient undergoing orthognathic surgery with no known difficult intubation under general anaesthesia under supervision of an experienced anaesthesiologist. Intubation time, success rate, pre- and post-intubation SpO2 and etCO2 values were recorded.Results:Intubation time was shorter (p = 0,017) and success rate at the first attempt was higher in Group PS (p = 0,045) compared to Group C. We performed multivariate linear regression analysis to investigate which independent variables (gender of residents, experience in anaesthesiology, dominant hand, study group and previous history of videogame experience) affected our dependent variable intubation time. Backward analysis revealed previous videogame playing history (previous players vs. non-players) was the only significant predictor of intubation time (p = 0.010).Conclusion:Although we cannot reliably suggest using videogames as an educational tool for FOI, the results of our study showed that videogame playing history may provide an improvement in FOI time of novices in actual operating-theatre environment.
       
  • Is variability a natural phenomenon in patients, providers and
           institutions'
    • Abstract: Publication date: Available online 21 December 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Rashid Nadeem, Jawed Shafaq
       
  • Augmented renal clearance in critically ill trauma patients:a
           pathophysiologic approach using renal vascular index
    • Abstract: Publication date: Available online 21 December 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): CEDRIC CARRIE, ALEXANDRE LANNOU, SEBASTIEN RUBIN, HUGUES DE COURSON, LAURENT PETIT, MATTHIEU BIAIS BACKGROUND:The aim of the present study was to explore the relationship between creatinine clearance (ClCr), cardiac index (CI) and renal vascular index (RVI) in order to assess the potential mechanisms driving ARC in critically ill trauma patient. The secondary objective was to assess the performance of RVI for prediction of ARC.METHODS:Every trauma patient who underwent cardiac and renal ultrasound measurements during their initial ICU management was retrospectively reviewed over a 3-month period. ARC was defined by a 24-hr measured CrCL ≥ 130 ml/min/1.73m². A mixed effect model was constructed to explore covariates associated with ClCr over time. The performance of RVI for prediction of ARC was assessed by receiver operating characteristic (ROC) curve and compared to the ARCTIC (ARC in trauma intensive care) predictive scoring model.RESULTS:Thirty patients, contributing for 121 coupled physiologic data, were retrospectively analysed. There was a significant correlation between ClCr values and RVI (r = -0.495; p = 0.005) but not between ClCr and CI values (r = 0.023; p = 0.967) at day 1. Using a mixed effect model, only age remained associated with ClCr variations over time. The area under the ROC curve of RVI for predicting ARC was 0.742 (95%CI: 0.649 - 0.834; p 
       
  • Sensory selective peripheral nerve block for wide-awake surgery
    • Abstract: Publication date: Available online 18 December 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Subin Yoo, Seunguk Bang, Sang-Eun Park
       
  • [TIMP-2]*[IGFBP7] for Predicting Early AKI
    • Abstract: Publication date: Available online 18 December 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Ankit Luthra, Asha Tyagi
       
  • Immediate haemodynamic impact response to a mini-fluid challenge is
           independent of fluid type: a post-hoc analysis of a randomised double
           blinded controlled trial
    • Abstract: Publication date: Available online 18 December 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Alexandre Joosten, Amelie Delaporte, Philippe Van der Linden, Joseph Rinehart, Brian Hipszer
       
  • Renal replacement therapy: Time to give up on early initiation'
           Perhaps
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Antoine G. Schneider, Stefano Romagnoli
       
  • Spontaneous pure subacute subdural haematoma without subarachnoid
           haemorrhage caused by rupture of middle cerebral artery aneurysm
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Quentin Mathais, Pierre Esnault, Arnaud Dagain, Aurore Sellier, Philippe Yves Simon, Bertrand Prunet, Eric Meaudre
       
  • A massive overdose of potassium pills
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Christopher Schaeffer, Sébastien Poincet, Bettina Teruzzi, Thomas Galas, David Vandroux
       
  • Comparing the performance of different techniques for percutaneous
           dilatational tracheostomy
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Y. Liu, F.S. Xue, Q. Liu, G.Z. Yang
       
  • Use of the TotalTrack VLM for endotracheal intubation in a patient with a
           giant thyroglossal duct cyst and airway compression
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Manuel Ángel Gómez-Ríos, Iria Silva-Carballal, Enrique Freire-Vila
       
  • Postoperative serum levels of Endocan are associated with the duration of
           norepinephrine support after coronary artery bypass surgery
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Adrien Bouglé, Pierre-Antoine Allain, Séverine Favard, Nora Ait Hamou, Aude Carillion, Pascal Leprince, Benjamin Granger, Julien Amour BackgroundCardiopulmonary bypass (CPB) is associated with a systemic inflammatory response and an endothelial dysfunction, whose qualitative assessment appears to be a major issue. Endocan (ESM-1, endothelial cell specific molecule-1) is a protein preferentially expressed by the endothelium and previously associated with prognosis of septic shock or acute respiratory distress syndrome. In this pilot study, we investigated the kinetic of Endocan in planned coronary artery bypass grafting (CABG) surgery with CPB.Patients and methodsWe conducted an observational, prospective, mono centre study. All adult patients with left systolic ejection fraction > 50%, undergoing planned on-pump CABG, were screened for inclusion. A written informed consent was obtained. Measurements and main results Serum Endocan concentrations were respectively 2.4 [2.1–3.0] ng. mL−1, 10.4 [7.4–13.9] ng.mL−1, 5.7 [4.4–8.2] ng.mL−1, and 5.4 [4.1–7.5] ng.mL−1 at day 0, day 1, day 3 and day 5. Endocan concentrations increased at day 1, day 3, and day 5 in comparison with preoperative concentration (P 
       
  • Impact of connecting continuous renal replacement therapy to the
           extracorporeal membrane oxygenation circuit
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Christian de Tymowski, Mathieu Desmard, Brice Lortat-Jacob, Quentin Pellenc, Soleiman Alkhoder, Arezki Alouache, Benedicte Fritz, Philippe Montravers, Pascal Augustin PurposeContinuous veno-venous haemofiltration (CVVH) directly connected to extracorporeal membrane oxygenation (ECMO) may ensure better blood flow and allow prolonged circuit life. The objective of this study was to assess circuit life of CVVH connected to ECMO and to a dialysis catheter.Materials and methodsIn this prospective observational study, patients receiving CVVH via ECMO were compared to time-matched patients receiving CVVH via a conventional dialysis catheter. CVVH circuit life and the safety and efficacy of the two CVVH procedures were analysed. Time to event was estimated using Kaplan-Meier analysis and compared using the log-rank test.ResultsSeventeen patients were included in each group, with 43 sessions in the ECMO group and 56 sessions in the DC group. Median CVVH circuit life was 48 [21–72] vs 20 [6–39] hours in the ECMO and DC groups, respectively (relative risk of termination of the session: 2.4, 95% CI [1.41–3.9], log rank P = 0.0009). CVVH blood flow was higher in the ECMO group. Despite higher anticoagulant doses in the catheter group, the circuit clotting rate was lower in the ECMO group. Effluent volume was slightly higher in the ECMO group (39 ml/kg/h [33–47] vs 34 ml/kg/h [32–39]), but with no biological impact. CVVH via ECMO was well tolerated with no major drawbacks.ConclusionsIn patients requiring ECMO, CVVH connected to ECMO instead of DC could be proposed as an alternative approach, allowing more stable blood flow and prolonged CVVH circuit life.
       
  • Sevoflurane for procedural sedation in critically ill patients: A
           pharmacokinetic comparative study between burn and non-burn patients
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Sebastien Perbet, Daniel Bourdeaux, Alexandre Lenoire, Claire Biboulet, Bruno Pereira, Malha Sadoune, Benoit Plaud, Jean-Marie Launay, Jean-Etienne Bazin, Valerie Sautou, Alexandre Mebazaa, Pascal Houze, Jean-Michel Constantin, Matthieu Legrand, PRONOBURN group BackgroundSevoflurane has anti-inflammatory proprieties and short lasting effects making it of interest for procedural sedation in critically ill patients. We evaluated the pharmacokinetics of sevoflurane and metabolites in severely ill burn patients and controls. The secondary objective was to assess potential kidney injury.MethodsProspective interventional study in a burn and a surgical intensive care unit; 24 mechanically ventilated critically ill patients (12 burns, 12 controls) were included. The sevoflurane was administered with an expired fraction target of 2% during short-term procedural sedation. Plasma concentrations of sevoflurane, hexafluoroisopropanolol (HFIP) and free fluoride ions were recorded at different times. Kinetic Pro (Wgroupe, France) was used for pharmacokinetic analysis. Kidney injury was assessed with neutrophil gelatinase-associated lipocalin (NGAL).ResultsThe mean total burn surface area was 36 ± 11%. The average plasma concentration of sevoflurane was 70.4 ± 37.5 mg·L−1 in burns and 57.2 ± 28.1 mg·L−1 in controls at the end of the procedure (P = 0.58). The volume of distribution was higher (46.8 ± 7.2 vs 22.2 ± 2.50 L, P 
       
  • Comparison of techniques for visualisation of the airway anatomy for
           ultrasound-assisted intubation: A prospective study of emergency
           department patients
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Michael J. Romano, Jacques S. Lee, Jordan Chenkin PurposeUltrasound has been shown to be a highly accurate adjunct for confirming endotracheal tube (ETT) placement, however there is no universally accepted scanning technique. The objective of this study was to determine which ultrasound technique provides the highest rate of adequate airway visualisation in a sample of stable emergency department (ED) patients.MethodsWe conducted a prospective observational study using a convenience sample of ED patients. Airway imaging was performed using the following five techniques: 1) transcricothryoid membrane (TCM), 2) suprasternal notch (SSN) without transducer pressure, 3) SSN with pressure, 4) SSN with pressure to the left of the trachea and 5) SSN with pressure to the right of the trachea. A blinded reviewer scored the adequacy of airway visualisation for each technique.ResultsA total of 100 patients were enrolled in the study. SSN to the left of the trachea with pressure had the highest rate of adequate airway visualisation (93.0%, 95% CI 86.1–97.1%), followed by 82.0% (95% CI 73.1–89.0%) for SSN with pressure, 74.0% (95% CI 64.3–82.3%) for TCM, 44.0% (95% CI 34.1–54.3%) for SSN without pressure, and 1.0% (95% CI 0.0–5.4%) for SSN to the right of the trachea. In 76.0% (95% CI 66.4–84.0%) of patients, the SSN view was improved by moving the probe off the midline towards the patient's left.ConclusionsIn a sample of ED patients, the airway anatomy relevant for use in endotracheal intubation is best visualised at the SSN to the left of the trachea with transducer pressure applied.
       
  • Rescue transtracheal jet ventilation during difficult intubation in
           patients with upper airway cancer
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): G. Bouroche, C. Motamed, J.M. de Guibert, D. Hartl, J.L. Bourgain IntroductionThe failure rates of intubation and/or mask ventilation are higher in patients with neck or upper airway disease. To ensure oxygenation, rescue trans-tracheal jet ventilation (RTTJV) may be used. In this critical situation, a high rate of complications has been reported. The aim of this study was to report RTTJV performed by a jet ventilator with an end-expiratory pressure control in an experienced institution.Patients and methodsFrom a computerised database of 63,905 anaesthesia cases, the anaesthetic reports of patients who underwent emergency RTTJV during intubation were studied retrospectively. The following information were analysed: anaesthetic procedures, data from the monitoring: lowest SpO2, duration of SpO2  90% under jet ventilation.ResultsRTTJV was used in 31 patients, of whom 26 had upper airway cancer, (pre-treatment, n = 9, post-treatment, n = 17). Difficult intubation was anticipated in 15 out of 31 cases including six fiber-optic-aided intubations under spontaneous ventilation. RTTJV was effective in all cases with quick restoration of oxygenation (SpO2 > 90%). During jet ventilation, final airway control was performed either by oral intubation (n = 25) or tracheotomy (n = 1) in a short delay (mean: 8.1 ± 1.7 min). Subcutaneous emphysema was observed in one case without pneumothorax.ConclusionRTTJV with end-expiratory pressure control allowed oxygenation during difficult intubation, with a low rate of complications.
       
  • Comparison of 3 techniques in percutaneous tracheostomy: Traditional
           landmark technique; ultrasonography-guided long-axis approach; and
           short-axis approach – Randomised controlled study
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): I. Kupeli, R.A. Nalbant IntroductionThe aim of this study is to compare the reliabilities of the traditional landmark method, ultrasonography-guided long-axis in-plane application, and ultrasonography-guided short-axis out-of-plane application in percutaneous dilatational tracheostomy.Patients and methodsA total of 60 patients were divided in 3 random groups undergoing percutaneous tracheostomy by using landmark method, ultrasonography-guided out-of-plane method, and ultrasonography-guided in-plane method. While demographic data of the patients were recorded before the procedure, number of punctures, success rate at the first entry, rate of successful tracheostomy tube placement, total tracheostomy time, and complications were recorded during and after the procedure.Results and discussionIt was found that 23 women and 37 men were included in the study, the average age of the cases was 68.0 ± 15.5; mean body mass index was 27.9 ± 4.3; mean APACHE II scores were 27.4 ± 4.6 and there was no significant difference between the groups in terms of demographic data. The ultrasonography-guided out-of-plane application had significantly lower number of punctures, higher first entry success, and fewer complications compared to the other groups. Independently from the groups, first entry success was significantly low in advanced age and number of punctures significantly increased the complication rate.ConclusionIn this randomised controlled study, it was found that ultrasonography-guided out-of-plane application had lower number of punctures, higher first entry success rate, and less complications. It was observed that advanced age negatively affected the first entry success and as number of punctures increased, the complication rate increased. ClinicalTrials.gov ID: NCT02855749.
       
  • New legal framework for human subject research in France: A step
           forward'
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Vanessa Champigny, Shunta Holmes-LeBlanc, Jean-Francois Pittet
       
  • The effect of ketamine on delirium and opioid-induced hyperalgesia in the
           Intensive Care Unit
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Christina J. Hayhurst, Emily Farrin, Christopher G. Hughes
       
  • Renal replacement therapy: Time to give up on early initiation' No
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): O. Joannes-Boyau, J.A. Kellum
       
  • Renal replacement therapy: Time to give up on early initiation' Yes
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Saber Davide Barbar, Stephane Gaudry, Didier Dreyfuss, Jean-Pierre Quenot
       
  • Time to treat metabolic acidosis in ICU with sodium bicarbonate' Maybe
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Samir Jaber, Boris Jung
       
  • Treatment of acute acidaemia in the seriously ill patient: Should base be
           given'
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): Jeffrey A. Kraut
       
  • Time to treat metabolic acidosis in the ICU with sodium bicarbonate'
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): O. Joannes-Boyau, L.G. Forni
       
  • Erratum to “Storage at room temperature does not change cisatracurium
           onset time: A prospective, randomized, double-blind controlled study [Ann.
           Fr. Anesth. Reanim. 31 (2012) 783–787]
    • Abstract: Publication date: December 2018Source: Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 6Author(s): E. Lorne, D. Nuzzo, S. Suzanne, K.-A. Walczak, C. Perret, C. Laigle, N. Mattei, E. Dimov, S. Petiot, J. Godart, C. Pila, M.-C. Verdier, C. Chourbaggi, M. Diouf, A. Friggeri, Y. Mahjoub, H. Dupont
       
  • Ketamine infusions for sedation in ICU
    • Abstract: Publication date: Available online 15 December 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Georges Mion
       
  • T-cell lymphoma with secondary hemophagocytic lymphohistiocytosis as a
           rare cause of acute liver failure T-cell lymphoma as a cause of acute
           liver failure
    • Abstract: Publication date: Available online 13 December 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Yasmina CHOUIK, BLAISE Lorraine, HACHOUF Marina, GIABICANI Mikhaël, ROUX Olivier
       
  • Blood pressure variability in surgical and intensive care patients: Is
           there a potential for closed-loop vasopressor administration'
    • Abstract: Publication date: Available online 1 December 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Joseph Rinehart, Michael Ma, Michael David Calderon, Aurelie Bardaji, Reda Hafiane, Philippe Van der Linden, Alexandre Joosten Blood pressure management in the operating rooms (OR) and intensive care units (ICU) frequently involves manually titrated vasopressor therapy to an optimal range of mean arterial pressure (MAP). Ideally, changes in vasopressor infusion rates have to quickly follow variations in blood pressure measurements. However, such a tightly controlled feedback loop is difficult to achieve. Few studies have examined blood pressure control when vasopressor therapy is administered manually in OR and ICU patients. We extracted MAP data from 3,623 patients (2,530 from the ORs and 1,093 from the ICU) on vasopressors from our electronic medical records. Coefficient of variation (=standard deviation / mean value) * 100) was calculated and the values were additionally categorized into different MAP ranges (MAP 
       
  • 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
       
  • 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
       
  • 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
       
  • 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.
       
 
 
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