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Publisher: Elsevier   (Total: 3042 journals)

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Showing 1 - 200 of 3042 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 19, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 81, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 328, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 205, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 22, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 124, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
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: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 45, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 20, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 24)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 34, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 21, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 58)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 339, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
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: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 308, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 422, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 50, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 10, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 47, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 44, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 30, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 44, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 179, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 33, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 53, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 5)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 160, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 153, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover Anaesthesia Critical Care & Pain Medicine
  [5 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Online) 2352-5568
   Published by Elsevier Homepage  [3042 journals]
  • Saving money: An ideal driver for improved perioperative care'
    • Authors: T.E.F. Abbott; R.M. Pearse
      Pages: 147 - 148
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): T.E.F. Abbott, R.M. Pearse


      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2017.01.006
       
  • Are capillary and arterial lactates interchangeable'
    • Authors: François Dépret; Matthieu Legrand
      First page: 149
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): François Dépret, Matthieu Legrand


      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2017.04.001
       
  • Evaluation of financial burden following complications after major surgery
           in France: Potential return after perioperative goal-directed therapy
    • Authors: Alain Landais; Morgane Morel; Jacques Goldstein; Jerôme Loriau; Annie Fresnel; Corinne Chevalier; Gilles Rejasse; Pascal Alfonsi; Claude Ecoffey
      Pages: 151 - 155
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Alain Landais, Morgane Morel, Jacques Goldstein, Jerôme Loriau, Annie Fresnel, Corinne Chevalier, Gilles Rejasse, Pascal Alfonsi, Claude Ecoffey
      Objective Perioperative goal-directed therapy (PGDT) has been demonstrated to improve postoperative outcomes and reduce the length of hospital stays. The objective of our analysis was to evaluate the cost of complications, derived from French hospital payments, and calculate the potential cost savings and length of hospital stay reductions. Methods The billing of 2388 patients who underwent scheduled high-risk surgery (i.e. major abdominal, gynaecologic, urological, vascular, and orthopaedic interventions) over three years was retrospectively collected from three French hospitals (one public-teaching, one public, and one private hospital). A relationship between mortality, length of hospital stays, cost/patient, and severity scores, based mainly on postoperative complications but also on preoperative clinical status, were analysed. Statistical analysis was performed using Student's t-tests or Wilcoxon tests. Results Our analyses determined that a severity score of 3 or 4 was associated with complications in 90% of cases and this represented 36% of patients who, compared with those with a score of 1 or 2, were associated with significantly increased costs (€ 8205±3335 to € 22,081±16,090; P <0.001, delta of € 13,876) and a prolonged length of hospital stay (mean of 10 to 27 days; P <0.001, delta of 17 days). According to estimates for complications avoided by PGDT, there was a projected reduction in average healthcare costs of between € 854 and € 1458 per patient and a reduction in total hospital bed days from 1755 to 4423 over three years. Based on French National data (47,000 high risk surgeries per year), the potential financial savings ranged from € 40M to € 68M, not including the costs of PGDT and its implementation. Conclusion Our analysis demonstrates that patients with complications are significantly more expensive to care for than those without complications. In our model, it was projected that implementing PGDT during high-risk surgery may significantly reduce healthcare costs and the length of hospital stays in France while probably improving patient access to care and reducing waiting times for procedures.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.11.006
       
  • Comparison of capillary and arterial lactate levels in patients with shock
    • Authors: Olivier Collange; Vincent Garcia; Michel Kindo; Nicolas Meyer; Thomas Lavaux; Paul Michel Mertes; Girish P. Joshi; Pierre Diemunsch
      Pages: 157 - 162
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Olivier Collange, Vincent Garcia, Michel Kindo, Nicolas Meyer, Thomas Lavaux, Paul Michel Mertes, Girish P. Joshi, Pierre Diemunsch
      Objective Several guidelines recommend point-of-care lactate measurements for therapeutic decision-making in patients with shock. The aim of the study was to validate capillary lactate measurements with a bedside micromethod in patients with shock. Study design Prospective observational study. Patients and measurements Capillary lactate levels measured by a micromethod (CAPI) and arterial lactate levels measured by a standard laboratory method (ARTs) were simultaneously and repeatedly assayed in consecutive ICU patients with shock. The validity and clinical acceptability of the CAPI method was assessed from its reproducibility, the arterio-capillary lactate difference (ACLD) and conventional diagnostic indicators. Main results Lactate measurements were available for 139 time-points in 37 patients. CAPI values correlated well with ARTs values (intraclass coefficient correlation: r2 =0.92, P <0.001). CAPI had a sensitivity of 98%, a specificity of 36%, an accuracy of 88% and a positive predictive value of 89% to detect lactate values≥2mmol/L (P <0.0001). The mean bias between the two methods (ACLD: 0.56±2.21mmol/L) was mainly due to higher lactate concentration in capillary blood. Conclusion CAPI was correctly correlated to ARTs. The bias between the two methods is probably acceptable for triage purpose. Patients with elevated capillary lactate or in shock should be monitored with atrial-based lactate.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.08.007
       
  • Postoperative complications following neonatal and infant surgery: Common
           events and predictive factors
    • Authors: Daphné Michelet; Christopher Brasher; Houssam Ben Kaddour; Thierno Diallo; Rachida Abdat; Serge Malbezin; Arnaud Bonnard; Souhayl Dahmani
      Pages: 163 - 169
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Daphné Michelet, Christopher Brasher, Houssam Ben Kaddour, Thierno Diallo, Rachida Abdat, Serge Malbezin, Arnaud Bonnard, Souhayl Dahmani
      Background Data on major non-surgical postoperative complications following neonatal and infant surgery is lacking. The goal of the present study was to describe common major complications and their predictive factors. Material and methods The study consisted of a retrospective review of medical charts of patients less than 6months of age operated in our institution over one calendar year, excluding herniorraphy surgery. The data collected included demographics, preoperative ICU bed status, ASA status, a history of cardiac malformation, hyaline membrane disease (HMD) or necrotizing enterocolitis (NEC), preoperative haemoglobin, emergent surgery status, surgery type and duration, duration of anaesthesia and the need for intraoperative fluid boluses. Complications were analysed until the 30th postoperative day. Analyses included descriptive statistics and the determination of factors associated with non-surgical complications using univariate and multivariate statistics. Results The study included 168 patients. Their postnatal age was 48±48days. Overall, 37 patients experienced major postoperative non-surgical complications. The most common major complications were haemodynamic compromise (n =19, 11.3%), multiple organ dysfunction syndrome (MODS, n =8, 4.8%) and respiratory failure requiring ventilation (n =3, 1.8%). Surgical complications occurred in 8 cases (4.8%). Four factors were identified as being predictive of non-surgical complications: PCA<40 weeks, a history of cardiac malformation, HMD or NEC, preoperative ICU status and intraoperative fluid bolus administration. Conclusion This study describes common non-surgical postoperative complications in neonates and infants, and their risk factors. They were much more common than surgical complications. Further studies should focus on preventive strategies addressing these complications.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.05.012
       
  • What are the factors associated with successful I-gel™ insertion and
           uneventful anaesthesia in children under age two'
    • Authors: Cécile Magne; Vincent Pichenot; Péan Didier; Luc Bérard; Corinne Lejus-Bourdeau
      Pages: 171 - 177
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Cécile Magne, Vincent Pichenot, Péan Didier, Luc Bérard, Corinne Lejus-Bourdeau
      Background Our purpose was to evaluate I-gel™ sizes 1 and 1.5. Methods I-gel™ insertion was attempted in 60 children<2 years of age undergoing short elective surgery. The main endpoints were the determination of independent factors associated with successful first attempt insertion and those associated with uneventful anaesthesia (i.e. no adverse events during insertion or during the intraoperative period of removal). Results Size 1 and size 1.5 I-gel™ devices were used (intraoperatively) in 33 and 27 cases, respectively. Median age and weight were 3 (1–12) months and 4.97 (4.00–9.00) kg. Ventilation modes were spontaneous breathing (8.3%), pressure support (45%), controlled pressure (15%) or volume (31.7%) ventilation. I-gel™ insertion was successful on the first attempt in 45 cases (75%). A time between induction and insertion>11min (OR: 4.85 [1.08–21.77]) and age<6 months (OR: 5.501 [1.20–16.8]) were identified as the independent factors of successful first attempt insertion (AUC: 0.715). Adverse events were reported in 35 (58.3%) cases, during insertion in 18 (30%) cases, during the intraoperative period in 25 (41.7%) cases and/or during recovery in 3 (5.08%) cases. Age<6 months (OR: 4.497 [1.197–16.89]) and I-gel™ removal in the operating room (OR: 6.034 [1.153–31.577]) were identified as independent factors associated with uneventful anaesthesia (AUC: 0.761). Conclusion I-gel™ sizes 1 and 1.5 were interesting alternatives to intubation with all ventilation modes. However, the high incidence of adverse events calls for careful monitoring. The superiority of removal under anaesthesia must be confirmed.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.07.003
       
  • Predicting postoperative morphine consumption in children
    • Authors: Vilnis Silins; Christopher Brasher; Freedom Antus; Daphné Michelet; Julie Hilly; Robert Grace; Souhayl Dahmani
      Pages: 179 - 184
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Vilnis Silins, Christopher Brasher, Freedom Antus, Daphné Michelet, Julie Hilly, Robert Grace, Souhayl Dahmani
      Background Morphine is the most commonly used postoperative analgesic for moderate to severe pain in paediatric patients, but there is little research into predictive factors correlating with postoperative morphine consumption. Methods All patients undergoing surgery who received morphine postoperatively over eight months were prospectively enrolled. Data analysed included total morphine consumption to day 3, age, weight, type of surgery, ASA status, preoperative opioid administration, predicted postoperative pain intensity (according to French Society of Anaesthesiology and Intensive Care classification) and surgery duration. Two cohorts were constructed: the first over 6months to construct a statistical model and the second over 2months to validate the model. ANOVA univariate analyses and multivariate linear analysis were performed. Results One hundred and fifty-three patients were included in the construct cohort and 40 in the validation cohort. Multivariate analysis demonstrated that total morphine consumption through postoperative day 3 was independently increased by a decreased age, female gender, an increased duration of surgery and an increased morphine titration in PACU. Overall, the model explained 57% of morphine requirement variability. When the model was applied to the validation cohort, a significant correlation was demonstrated between observed and predicted values: r =0.67, P <0.0001. Conclusion Age, gender, duration of surgery and doses of titrated morphine in PACU proved to be strong predictors of postoperative morphine consumption by day 3 during paediatric surgery. Knowledge of such factors may help clinicians to better manage postoperative pain in children.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.08.005
       
  • The risk of atrial fibrillation after pneumonectomy is not impaired by
           preoperative administration of dexamethasone. A cohort study
    • Authors: Sacha Rozencwajg; Carole Desthieux; Olga Szymkiewicz; Yacine Ynineb; Jean-Pierre Fulgencio; Francis Bonnet
      Pages: 185 - 189
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Sacha Rozencwajg, Carole Desthieux, Olga Szymkiewicz, Yacine Ynineb, Jean-Pierre Fulgencio, Francis Bonnet
      Introduction Atrial fibrillation (AF) is one of the most frequent complications occurring after thoracic surgery especially after lung resection. It is associated with an increase in postoperative morbidity and mortality. Recent data having documented the preventive role of corticosteroids on the occurrence of AF in cardiac surgery, we sought to evaluate the effect of preoperative administration of dexamethasone on the incidence of AF after pneumonectomy. Methods We reviewed the files of all consecutive patients who underwent a pneumonectomy in one single centre between July 2004 and July 2012. For each patient, demographics, medical status, the surgical procedure and treatments administered including dexamethasone, were recorded. The data were analysed using a univariate analysis and a multivariate logistic regression. Results Among them, 153 patients were included and analysed; 35 (23%) presented with at least one episode of AF occurring within 48hours after surgery. Mortality was higher in these patients (26.5% versus 12.1%, P =0.06). The univariate analysis indicated that patients who had a postoperative course complicated by the occurrence of AF were older (P =0.003), had a higher SAPS2 score (P =0.002) and a higher CHADS score (P =0.05). Older age (OR=1.08; P =0.048) and preoperative treatment by anti-arrhythmics (OR=3.9; P =0.029) were documented as independent risk factors in the multivariate analysis. Preoperative administration of dexamethasone 8–12mg did not impair the incidence of AF. Discussion AF is a frequent complication after pneumonectomy associated with increased mortality. Whereas corticosteroids have been documented as preventing AF following cardiac surgery, no such effect was found after pneumonectomy.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.04.005
       
  • Are pain and PONV so predominant in ambulatory surgery: Survey of call on
           D1 in 11,104 patients'
    • Authors: Eric Bourgeois; Anouchka Cousin; Céline Chatel; Marc Edouard Gentili
      Pages: 193 - 194
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Eric Bourgeois, Anouchka Cousin, Céline Chatel, Marc Edouard Gentili


      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.10.006
       
  • Where do ultrasounds have to go?
    • Authors: Paul J. Zetlaoui; Dan Benhamou
      Pages: 77 - 78
      Abstract: Publication date: April 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 2
      Author(s): Paul J. Zetlaoui, Dan Benhamou


      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2017.03.002
       
  • Aprotinin as an alternative to tranexamic acid in cardiac surgery – Is
           this where we started from?
    • Authors: Anne Godier; Beverley J. Hunt
      Pages: 79 - 81
      Abstract: Publication date: April 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 2
      Author(s): Anne Godier, Beverley J. Hunt


      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2017.03.001
       
  • Comparison of a GPS needle-tracking system, multiplanar imaging and 2D
           imaging for real-time ultrasound-guided epidural anaesthesia: A
           randomized, comparative, observer-blinded study on phantoms
    • Authors: Cécilia Menacé; Olivier Choquet; Bertrand Abbal; Sophie Bringuier; Xavier Capdevila
      Pages: 83 - 89
      Abstract: Publication date: April 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 2
      Author(s): Cécilia Menacé, Olivier Choquet, Bertrand Abbal, Sophie Bringuier, Xavier Capdevila
      Background The real-time ultrasound-guided paramedian sagittal oblique approach for neuraxial blockade is technically demanding. Innovative technologies have been developed to improve nerve identification and the accuracy of needle placement. The aim of this study was to evaluate three types of ultrasound scans during ultrasound-guided epidural lumbar punctures in a spine phantom. Methods Eleven sets of 20 ultrasound-guided epidural punctures were performed with 2D, GPS, and multiplanar ultrasound machines (660 punctures) on a spine phantom using an in-plane approach. For all punctures, execution time, number of attempts, bone contacts, and needle redirections were noted by an independent physician. Operator comfort and visibility of the needle (tip and shaft) were measured using a numerical scale. Results The use of GPS significantly decreased the number of punctures, needle repositionings, and bone contacts. Comfort of the physician was also significantly improved with the GPS system compared with the 2D and multiplanar systems. With the multiplanar system, the procedure was not facilitated and execution time was longer compared with 2D imaging after Bonferroni correction but interaction between the type of ultrasound system and mean execution time was not significant in a linear mixed model. There were no significant differences regarding needle tip and shaft visibility between the systems. Conclusions Multiplanar and GPS needle-tracking systems do not reduce execution time compared with 2D imaging using a real-time ultrasound-guided paramedian sagittal oblique approach in spine phantoms. The GPS needle-tracking system can improve performance in terms of operator comfort, the number of attempts, needle redirections and bone contacts.

      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2016.05.002
       
  • Ultrasound-guided intermediate cervical block versus superficial cervical
           block for carotid artery endarterectomy: The randomized-controlled
           CERVECHO trial
    • Authors: Arslane Alilet; Pascal Petit; Benedicte Devaux; Corinne Joly; Emmanuel Samain; Sebastien Pili-Floury; Guillaume Besch
      Pages: 91 - 95
      Abstract: Publication date: April 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 2
      Author(s): Arslane Alilet, Pascal Petit, Benedicte Devaux, Corinne Joly, Emmanuel Samain, Sebastien Pili-Floury, Guillaume Besch
      Introduction The value of ultrasound guidance for intermediate cervical blocks in patients undergoing carotid artery endarterectomy is poorly described. This study aimed at comparing the efficacy of ultrasound-guided intermediate cervical block to superficial cervical block for carotid artery endarterectomies. Patients and methods We conducted a single-centre randomized-controlled study in a French University Hospital, from April 2011 to March 2012. The anaesthesia technique was randomly allocated to patients scheduled for carotid artery endarterectomy under regional anaesthesia (ropivacaine 4.75mg/mL): superficial cervical block in the Control group, and ultrasound-guided intermediate cervical block in the Echo group. The main outcome measure was the percentage of surgery performed without supplemental topical anaesthesia. The secondary outcomes were: rate of conversion to general anaesthesia, amount of supplemental topical lidocaine and block-related complications. P <0.05 was considered significant. Results Demographic data for the 86 patients included [mean (SD) age 73 (11) years] did not differ between groups. Surgery was performed without supplemental topical lidocaine in 23% and 7% of the patients in the Echo and Control groups, respectively (P =0.068). Conversion to general anaesthesia for inadequate analgesia was needed in 0 and 2 patients in the Echo and Control groups, respectively. The mean dose of topical lidocaine was not different between groups. No complication directly related to a cervical block was observed. Conclusions Ultrasound-guided intermediate cervical plexus block and superficial cervical blocks performed for carotid artery surgery seems to provide similar results, but this study was probably underpowered to detect any difference. Trial registration European Union Drug Regulating Authorities Clinical Trials (Eudra-CT) registration number: 2010-A 01490-39.

      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2016.03.007
       
  • Critical incidents in a French department of paediatric anaesthesia
    • Authors: Elisa Kupersztych-Hagege; Caroline Duracher-Gout; Rocio Ortego; Pierre Carli; Gilles Orliaguet
      Pages: 103 - 107
      Abstract: Publication date: April 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 2
      Author(s): Elisa Kupersztych-Hagege, Caroline Duracher-Gout, Rocio Ortego, Pierre Carli, Gilles Orliaguet
      Background Several studies have highlighted the importance of critical incident (CI) reporting in order to enhance patient safety. We have implemented an anonymous procedure for CI reporting in our department of paediatric anaesthesia. This study aims at analysing those CIs so as to improve patient care and risk management. Material and methods CIs were reported by the anaesthetic team using the World Health Organization classification and analysed using the ORION methodology. CIs were classified according to type, surgery and complications. Risk factors and consequences for patients and for the institution were analysed. Risk factors with high degree of harm for the patient were identified using a univariate analysis and odds ratios (OR). Results Over an 18-month period, 114 CIs were reported for 103 patients (median age: 7.0 years [95% CI: 3.6–9.8]). We found that 29.9% of reported CIs had consequences for the patients and 76.3% were considered preventable. The two main types of CI were “respiratory” (28.8%) and “drug-related” (22.8%) incidents. The main risk factor was ‘human error’ (42.3%). Several consequences for the patient and the hospital were identified. An ASA score≥3 (OR: 2.52; [95% CI: 1.10–5.78]) was an independent risk factor for a high degree of patient harm. Conclusion Improving quality of care must be a priority for paediatric anaesthesiologists as most of the CIs observed are preventable and have consequences for the patient and the institution.

      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2016.04.004
       
  • The efficacy of intra-articular lidocaine administration in chronic knee
           pain due to osteoarthritis: A randomized, double-blind, controlled study
    • Authors: H. Evren Eker; Oya Yalcin Cok; Anis Aribogan; Gulnaz Arslan
      Pages: 109 - 114
      Abstract: Publication date: April 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 2
      Author(s): H. Evren Eker, Oya Yalcin Cok, Anis Aribogan, Gulnaz Arslan
      Background Intra-articular injections for the treatment of knee pain due to osteoarthritis are performed when conservative therapies have failed. The intra-articular injection of lidocaine may be an effective treatment modality due to its neuronal membrane-stabilizing effect and long-lasting anti-inflammatory action. In this study, we compared the efficacy of intra-articular 0.5% lidocaine versus saline injection on pain, stiffness and physical function in patients with osteoarthritis. Methods Patients with osteoarthritis were randomly allocated to two groups. Group I (n =26) received 7mL 0.5% lidocaine and group II (n =26) received 7mL saline into the painful knee for a series of three injections spaced by 1 week intervals under ultrasound guidance. Knee pain was measured with a numeric rating score (NRS) at baseline and 3 months after the 3rd injection. WOMAC scales, including pain (WOMAC-P), stiffness (WOMAC-S) and physical function (WOMAC-F), were assessed and recorded at baseline, 30minutes after the 1st injection, immediately prior to the 2nd and 3rd injections and 3 months after the 3rd injection. Results Demographic data were comparable between groups. The NRS after 3 months was significantly lower in group I (P =0.001). The WOMAC-P, immediately prior to the 3rd injection and 3 months afterwards, was significantly lower in group I (P =0.006, P =0.001, respectively). The WOMAC-S was improved prior to the 3rd injection and sustained until 3 months in group I (P =0.035, P =0.004, respectively). The WOMAC-F was improved after the 1st injection and sustained until 3 months in group I (P =0.002, P <0.0001 and P <0.0001, respectively). Conclusions Intra-articular 0.5% lidocaine injection under ultrasound guidance has a potential role in the management of chronic knee pain due to osteoarthritis for a 3-month period.

      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2016.05.003
       
  • Ready-to-use pre-filled syringes of atropine for anaesthesia care in
           French hospitals – a budget impact analysis
    • Authors: Dan Benhamou; Vincent Piriou; Cyrille De Vaumas; Pierre Albaladejo; Jean-Marc Malinovsky; Marianne Doz; Antoine Lafuma; Hervé Bouaziz
      Pages: 115 - 121
      Abstract: Publication date: April 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 2
      Author(s): Dan Benhamou, Vincent Piriou, Cyrille De Vaumas, Pierre Albaladejo, Jean-Marc Malinovsky, Marianne Doz, Antoine Lafuma, Hervé Bouaziz
      Background Patient safety is improved by the use of labelled, ready-to-use, pre-filled syringes (PFS) when compared to conventional methods of syringe preparation (CMP) of the same product from an ampoule. However, the PFS presentation costs more than the CMP presentation. Objective To estimate the budget impact for French hospitals of switching from atropine in ampoules to atropine PFS for anaesthesia care. Methods A model was constructed to simulate the financial consequences of the use of atropine PFS in operating theatres, taking into account wastage and medication errors. The model tested different scenarios and a sensitivity analysis was performed. Results In a reference scenario, the systematic use of atropine PFS rather than atropine CMP yielded a net one-year budget saving of €5,255,304. Medication errors outweighed other cost factors relating to the use of atropine CMP (€9,425,448). Avoidance of wastage in the case of atropine CMP (prepared and unused) was a major source of savings (€1,167,323). Significant savings were made by means of other scenarios examined. The sensitivity analysis suggests that the results obtained are robust and stable for a range of parameter estimates and assumptions. Study limitations The financial model was based on data obtained from the literature and expert opinions. Conclusion The budget impact analysis shows that even though atropine PFS is more expensive than atropine CMP, its use would lead to significant cost savings. Savings would mainly be due to fewer medication errors and their associated consequences and the absence of wastage when atropine syringes are prepared in advance.

      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2016.03.009
       
  • Chloride toxicity in critically ill patients: What's the evidence?
    • Authors: Sabri Soussi; Axelle Ferry; Maité Chaussard; Matthieu Legrand
      Pages: 125 - 130
      Abstract: Publication date: April 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 2
      Author(s): Sabri Soussi, Axelle Ferry, Maité Chaussard, Matthieu Legrand
      Crystalloids have become the fluid of choice in critically ill patients and in the operating room both for fluid resuscitation and fluid maintenance. Among crystalloids, NaCl 0.9% has been the most widely used fluid. However, emerging evidence suggests that administration of 0.9% saline could be harmful mainly through high chloride content and that the use of fluid with low chloride content may be preferable in major surgery and intensive care patients. Administration of NaCl 0.9% is the leading cause of metabolic hyperchloraemic acidosis in critically ill patients and side effects might target coagulation, renal function, and ultimately increase mortality. More balanced solutions therefore may be used especially when large amount of fluids are administered in high-risk patients. In this review, we discuss physiological background favouring the use of balanced solutions as well as the most recent clinical data regarding the use of crystalloid solutions in critically ill patients and patients undergoing major surgery.

      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2016.03.008
       
  • Spinal bupivacaine and clonidine for orthopaedic and general paediatric
           surgery in remote location
    • Authors: Marc. E. Gentili; Jean-Noël Ligier; Jacques Dermer; Jean-Christian Sleth
      Pages: 131 - 132
      Abstract: Publication date: April 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 2
      Author(s): Marc. E. Gentili, Jean-Noël Ligier, Jacques Dermer, Jean-Christian Sleth


      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2016.09.003
       
  • Protective ventilation during cardiac surgery: More than tidal volume?
    • Authors: Benoît Courteille; Jennifer Brunet; Alexandre Ouattara; François Stéphan; Jean-Louis Gérard; Emmanuel Lorne; Marc-Olivier Fischer
      Pages: 133 - 134
      Abstract: Publication date: April 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 2
      Author(s): Benoît Courteille, Jennifer Brunet, Alexandre Ouattara, François Stéphan, Jean-Louis Gérard, Emmanuel Lorne, Marc-Olivier Fischer


      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2016.11.003
       
  • Diaphragmatic ultrasound cannot replace medical reasoning
    • Authors: Laurent Zieleskiewicz; Belaid Bouhemad
      Pages: 1 - 2
      Abstract: Publication date: February 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 1
      Author(s): Laurent Zieleskiewicz, Belaid Bouhemad


      PubDate: 2017-02-25T21:13:20Z
      DOI: 10.1016/j.accpm.2016.09.001
       
  • Physiological and self assessed psychological stress induced by a high
           fidelity simulation course among third year anaesthesia and critical care
           residents: an observational study
    • Authors: Pr Thomas Geeraerts
      Abstract: Publication date: Available online 23 June 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Pr Thomas Geeraerts
      Introduction The use of high-fidelity simulators in Medicine can improve knowledge, behavior and practice but may be associated with significant stress. Our objective was to measure physiological and psychological self-assessed intensity of stress before and after a planned simulation training session among third year anesthesia and critical care residents. Methods A convenience sample of 27 residents participating in a simulation training course was studied. Stress was evaluated by self-assessment using a numerical scale and by salivary amylase concentration before and after the session. Technical and non-technical (using the Aberdeen Anaesthetists’ Non Technical Skills scale) performances were assessed through videotapes analysis. Results The median stress score was 5 [2-8] before and 7 [2-10] after the simulation session (p<0.001). For 48% of residents studied, the stress score after the session was superior or equal to 8/10. Salivary amylase concentration increased significantly after the session compared to before the session, respectively (1 250 440 ± 1 216 667 vs. 727 260 ± 603 787 IU / L, p = 0.008). There was no significant correlation between stress parameters and non-technical performance. Discussion Simulation-induced stress, as measured by self-assessment and biological parameter, is high before the session and increases significantly during the course. While this stress did not seem to impact performance negatively, it should be taken into account.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2017.06.002
       
  • Debriefing values in high-fidelity simulation
    • Authors: Antonia Blanié; Morgan Le Guen
      Abstract: Publication date: Available online 16 June 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Antonia Blanié, Morgan Le Guen


      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2017.06.001
       
  • Predictive factors of intraoperative Cell Salvage during Pediatric
           Scoliosis Surgery
    • Authors: Daphné Michelet; Florence Julien-Marsollier; Julie Hilly; Thierno Diallo; Christophe Vidal; Souhayl Dahmani
      Abstract: Publication date: Available online 22 May 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Daphné Michelet, Florence Julien-Marsollier, Julie Hilly, Thierno Diallo, Christophe Vidal, Souhayl Dahmani
      Introduction blood saving strategy during spinal surgery in children often includes recombinant erythropoietin (rEPO) and antifibrinolytic therapapy (AFT). The aim of this study was to investigate the efficacy of intraoperative blood salvage in decreasing homologous blood transfusion. Material and Methods using the prospective data from patients operated during a one year period for scoliosis correction, we calculate the predictable hematocrit at day postoperative 1 without the use of blood salvage and compare it to the target hematocrit transfusion according to patient's status. Predictors analyzed were: age, weight, surgical indication, Cobb's angle, ASA status, preoperative hemoglobin, number of level fused, sacral fusion and thoracoplasty. Statistical analyses were performed using a classification tree analysis. Results this study included 147 patients. Blood salvage was estimated avoiding homologous blood transfusion in 17 patients. Predictors of the efficacy of blood salvage were: neuromuscular indications, number of level fused and BMI. Blood salvage was found totally ineffective in: patients with no neuromuscular diseases with either: surgeries interesting < 13 levels fused or surgeries interesting > 13 levels with a preoperative BMI ≥ 21. In all other cases, blood salvage can decrease homologous transfusion. The model exhibited 97 % of accurate for the prediction if the inefficacy of blood salvage. The AUCROC of the model was 0.93 [95 % confidence interval 0.9 to 0.99] and the overall validation was 60.1 % of explained variability. Conclusion The present study indicates that blood salvage is ineffective under certain circumstances. More studies are mandatory to confirm these results.

      PubDate: 2017-05-24T21:11:14Z
      DOI: 10.1016/j.accpm.2017.03.003
       
  • Transient neurologic symptoms after intrathecal injection of ropivacaine
           through a dural tap during an attempted epidural for labour pain relief
    • Authors: A Blanie; S Figueiredo; G Lorre; D Benhamou
      Abstract: Publication date: Available online 22 May 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): A Blanie, S Figueiredo, G Lorre, D Benhamou


      PubDate: 2017-05-24T21:11:14Z
      DOI: 10.1016/j.accpm.2017.03.004
       
  • A pilot study of mechanical chest compression with the LifeLine ARM device
           during simulated cardiopulmonary resuscitation: Reply
    • Authors: Jean Cotte
      Abstract: Publication date: Available online 17 April 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Jean Cotte


      PubDate: 2017-04-21T14:58:48Z
      DOI: 10.1016/j.accpm.2017.04.005
       
  • The clinical impact and prevalence of emergency point-of-care ultrasound:
           a prospective multicentre study
    • Authors: Xavier Bobbia; Laurent Zieleskiewicz Christophe Pradeilles Hudson Laurent Muller Pierre
      Abstract: Publication date: Available online 13 April 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Xavier Bobbia, Laurent Zieleskiewicz, Christophe Pradeilles, Chloé Hudson, Laurent Muller, Pierre Géraud Claret, Marc Leone, Jean-Emmanuel de La Coussaye
      Objective The main objectives of our study were to evaluate the prevalence of emergency point-of-care ultrasound (POCUS) use and to assess the impact of POCUS on: diagnostic, therapeutic, patient-orientation and imaging practices. Methods This was a one-day, prospective, observational study carried out across multiple centres. Fifty emergency departments (EDs) recorded all POCUS performed over a 24h period. The prevalence of POCUS was defined as the number of POCUS/number of patients seen in all units. The “diagnostic impact” was defined as a POCUS-induced confirmation or change to the initial clinical diagnosis. The “therapeutic impact” was defined as a POCUS-induced change in treatment. The “orientation impact” was defined as an ultrasound-induced confirmation or change in the initial orientation. The “imaging change” was defined as a radiologic imaging prescription modification. Results Two hundred and twenty nine (5 %) POCUS were performed on 192 patients (4 %) from among the 4671 patients seen on the study-day in the 50 EDs. No ultrasound procedural guidance was given during the study day. The diagnostic, therapeutic and orientation impacts were respectively 82 %, 47 % and 85 %. In 101 cases (44 %), POCUS led to at least one imaging change. The clinical value of POCUS, i.e. considering at least one impact and/or imaging change, was assessed at 95 %. Conclusion This study shows that POCUS is used on a minority of emergency patients. However, when used, it significantly affects diagnostic and therapeutic practices in the emergency setting.

      PubDate: 2017-04-13T14:28:00Z
       
  • Video-laryngoscopes for intubation in paediatrics: is a better view makes
           everything?
    • Authors: Souhayl Dahmani
      Abstract: Publication date: Available online 13 April 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Souhayl Dahmani


      PubDate: 2017-04-13T14:28:00Z
       
  • Preventing Medication Errors in Anesthesia and Critical Care (abbreviated
           version)
    • Authors: Vincent Piriou; Alexandre Theissen; Ségolène Arzalier-Daret; Marie Marcel; Pierre Trouiller; Stéphanie Parat; Catherine Stamm; Rémy Collomp
      Abstract: Publication date: Available online 10 April 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Vincent Piriou, Alexandre Theissen, Ségolène Arzalier-Daret, Marie Marcel, Pierre Trouiller, Stéphanie Parat, Catherine Stamm, Rémy Collomp


      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2017.04.002
       
  • Successful management of a neck hematoma following simulation training
    • Authors: Marie-Ève Bélanger; Issam Tanoubi; Mihai Georgescu; Roger Perron; Arnaud Robitaille; Marie-Pierre Charron; Pierre Drolet
      Abstract: Publication date: Available online 10 April 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Marie-Ève Bélanger, Issam Tanoubi, Mihai Georgescu, Roger Perron, Arnaud Robitaille, Marie-Pierre Charron, Pierre Drolet
      Simulation-based education is gaining widespread acceptance in many medical specialties as an effective method to teach technical and non-technical skills. The ultimate goal of simulation is to improve health care and patient safety. Boet et al. [1] published a review on simulation-based crisis resources management (CRM) teaching, looking for evidence that it can lead to improved workplace practices and patient safety. Amongst hundreds of studies pertaining to CRM, he found only nine that were relevant, and only one that showed reduced mortality. Elaborating and putting forward studies designed to measure the impact of simulation on patient safety and outcomes is by no mean an easy task [2]. Indeed, most studies present various problems, such as biases introduced by the use of historical cohorts rather than control groups, and sample sizes based on convenience rather than power analysis. Furthermore, many significant outcomes such as mortality and major morbidity rates need to be measured over an extended period of time, which leaves room for variables other than the introduction of a simulation-based teaching program to play a confounding role [2]. These are some of the reasons why the majority of publications in simulation-based teaching are focusing mostly if not exclusively on measuring participants’ satisfaction and performance in a simulated environment. At the Université de Montréal, we developed surgical high-fidelity simulation-based CRM scenarios focusing on teamwork. The specific simulation based training on CRM, which includes this airway management scenario, is given only once a year, in the beginning of their second year of residency. This highly appreciated training [3] place surgical residents in rare and urgent situations, but within a safe simulated environment. One of these scenarios focuses on the management of neck hematoma after thyroidectomy. It teaches a step-by-step approach that emphasizes, amongst other things, the need for bedside evacuation in the setting of significant and life-threatening airway obstruction (figure 1). The purpose of this case report is to describe how a postgraduate year 3 (PGY 3) surgical residents used and credited the training acquired during a simulation-based CRM scenario for positively influencing a patient's outcome.

      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2017.04.003
       
  • Perioperative use of gabapentinoids in France
    • Authors: Valéria Martinez; Michel Carles; Emmanuel Marret; Hélène Beloeil
      Abstract: Publication date: Available online 28 March 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Valéria Martinez, Michel Carles, Emmanuel Marret, Hélène Beloeil
      Background Gabapentinoids have governmental health agency approval for “chronic neuropathic pain.” Over the last decade, however, the perioperative prescription of gabapentinoids has become more popular among anaesthesiologists due to their anxiolytic and antihyperalgesic proprieties, despite weak scientific evidence supporting the risk/benefit ratio for this indication. Methods Our aim was to extensively describe the use of perioperative gabapentinoids by French anaesthesiologists. An online questionnaire was sent to the French Society of Anaesthesiology members. The questionnaire, focusing on gabapentinoid prescriptions, included questions on demographic data, patient conditions and types of surgeries, mode of prescription, motives, and presumed side effects (dizziness, confusion, desaturation and visual disorders). Results 508 questionnaires were analysed, among which 70 % reported gabapentinoid use. Twenty five per cent of prescribers stated using gabapentinoids in all types of surgeries, 30 % in outpatient surgeries and 46 % in combination with regional anaesthesia. In 66 % of the cases, preoperative and postoperative prescriptions were combined. Sedation, dizziness and visual disturbance were expected side effects according to 68 %, 45 % and 20 % of anaesthesiologists, respectively. Reported reasons in favour of gabapentinoid prescription were prevention of chronic pain (93 %), expected high postoperative acute pain, i.e. painful surgeries (91 %), a history of chronic pain (72 %), and patient opioid dependence (72 %). Discussion French Anaesthesiologists have recently included gabapentinoids in the multimodal management of postoperative pain but they are unaware of certain frequent side-effects. Moreover, their expectations about the prevention of chronic pain are not validated. Our survey is a call to moderate the systematic prescription of these drugs in the perioperative period.

      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2017.01.010
       
  • ULTRASOUND GUIDED SERRATUS PLANE BLOCK FOR MANAGEMENT OF ACUTE THORACIC
           HERPES ZOSTER
    • Authors: Ahiskalioglu Ali; Alici Haci Ahmet; Yayik Ahmet Murat; Celik Mine; Oral Ahiskalioglu Elif
      Abstract: Publication date: Available online 21 March 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Ahiskalioglu Ali, Alici Haci Ahmet, Yayik Ahmet Murat, Celik Mine, Oral Ahiskalioglu Elif


      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2017.01.008
       
  • Hypercarbia complicating endoscopic sphincterotomy
    • Authors: Marc- E Gentili; Aurélien Colleu; Sébastien Lemière; Jean-Robert Robert
      Abstract: Publication date: Available online 18 March 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Marc- E Gentili, Aurélien Colleu, Sébastien Lemière, Jean-Robert Robert


      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2017.01.009
       
  • Is a two-tiered prehospital response system which engages an emergency
           physician relevant for less emergent patients? Preliminary data from an
           observational study with the Paris Fire Brigade
    • Authors: Olga Maurin; Daniel Jost; Paola Vanhaecke; François-Valéry Viard; Olivier YAVARI-SARTAKHTI
      Abstract: Publication date: Available online 18 March 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Olga Maurin, Daniel Jost, Paola Vanhaecke, François-Valéry Viard, Olivier YAVARI-SARTAKHTI


      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2017.02.005
       
  • Rationale, study design, and analysis plan of the Lung Imaging morphology
           for Ventilator settings in acute respiratory distress syndrome study (LIVE
           study): study protocol for a randomised controlled trial
    • Authors: Matthieu Jabaudon; Thomas Godet; Emmanuel Futier; Jean-Etienne Bazin; Vincent Sapin; Laurence Roszyk; Bruno Pereira; Jean-Michel Constantin
      Abstract: Publication date: Available online 18 March 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Matthieu Jabaudon, Thomas Godet, Emmanuel Futier, Jean-Etienne Bazin, Vincent Sapin, Laurence Roszyk, Bruno Pereira, Jean-Michel Constantin
      Different acute respiratory distress syndrome (ARDS) phenotypes may explain controversial results in clinical trials. Lung-morphology is one of the ARDS-phenotypes and physiological studies suggest different responses in terms of positive-end-expiratory-pressure (PEEP) and recruitment-manoeuvres (RM) according to loss of aeration. To evaluate whether tailored ventilator regimens may impact ARDS outcomes, our group has designed a randomised-clinical-trial of ventilator settings according to lung morphology in moderate-to-severe ARDS (LIVE study). Method Patients will be enrolled within the first 12hours of ARDS onset. In both groups, volume-controlled ventilation with low tidal-volumes (Vt) will be used to target a plateau pressure ≤ 30 cmH2O. In the control group, the PEEP level and inspired fraction of oxygen (FiO2) will be set using the ARDSNet table; a Vt of 6 mL/kg of predicted body weight (PBW) will be set, and prone position (PP) will be applied. In the intervention arm, the ventilator will be set according to lung morphology (focal/non-focal) that will be assessed according to CT-scan ± chest x-ray + lung echography. For focal ARDS patients, a Vt of 8 mL/kg PBW will be used along with low PEEP and PP. For non-focal ARDS patients, a Vt of 6 mL/kg PBW will be used with RM and PEEP to reach a plateau pressure ≤ 30 cmH2O. The primary outcome is all-cause 90-day mortality, and the secondary outcomes are: in-hospital mortality, mortality at day 28, 60, 180 and 365; ventilator-free days at day 30, quality of life at one year; ventilator-associated pneumonia rate; barotrauma; ICU and hospital length of stay. This RCT is registered on Clinicaltrials.gov under identifier NCT02149589.

      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2017.02.006
       
  • Burnout among French anaesthetists and intensivists: adequate progress is
           still lacking
    • Authors: Georges Mion; Kani Boiguile; Annick Bidou; Marion Limare
      Abstract: Publication date: Available online 11 March 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Georges Mion, Kani Boiguile, Annick Bidou, Marion Limare


      PubDate: 2017-03-13T02:49:05Z
      DOI: 10.1016/j.accpm.2017.02.004
       
  • A pilot study of mechanical chest compression with the LifeLine ARM device
           during simulated cardiopulmonary resuscitation
    • Authors: Jolanta MAJER; Jaroslaw KEDZIORA; Marcin MADZIAŁA
      Abstract: Publication date: Available online 11 March 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Jolanta MAJER, Jaroslaw KEDZIORA, Marcin MADZIAŁA


      PubDate: 2017-03-13T02:49:05Z
      DOI: 10.1016/j.accpm.2017.01.007
       
  • Guidelines on smoking management during the perioperative period
    • Authors: Sébastien Pierre; Caroline Rivera; Béatrice Le Maitre; Anne-Marie Ruppert; Benoît Chaput; Hervé Bouaziz; Nathalie Wirth; Jacques Saboye; Alain Sautet; Alain Charles Masquelet; Jean-Jacques Tournier; Yves Martinet; Bertrand Dureuil
      Abstract: Publication date: Available online 24 February 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Sébastien Pierre, Caroline Rivera, Béatrice Le Maitre, Anne-Marie Ruppert, Benoît Chaput, Hervé Bouaziz, Nathalie Wirth, Jacques Saboye, Alain Sautet, Alain Charles Masquelet, Jean-Jacques Tournier, Yves Martinet, Bertrand Dureuil


      PubDate: 2017-02-25T21:13:20Z
      DOI: 10.1016/j.accpm.2017.02.002
       
  • A special article following the relicence of aprotinin injection in Europe
    • Authors: David ROYSTON; Stefan De Hert; Jan van der Linden; Alexandre OUATTARA; Kai Zacharowski
      Abstract: Publication date: Available online 13 February 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): David ROYSTON, Stefan De Hert, Jan van der Linden, Alexandre OUATTARA, Kai Zacharowski


      PubDate: 2017-02-19T16:59:02Z
      DOI: 10.1016/j.accpm.2017.02.001
       
  • Formalized Expert Recommendations Chest Trauma: First 48hours management
    • Authors: Pierre Bouzat; Mathieu Raux; Jean Stéphane David; Karim Tazarourte; Michel Galinski; Thibault Desmettre; Delphine Garrigue; Laurent Ducros; Pierre Michelet
      Abstract: Publication date: Available online 16 January 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Pierre Bouzat, Mathieu Raux, Jean Stéphane David, Karim Tazarourte, Michel Galinski, Thibault Desmettre, Delphine Garrigue, Laurent Ducros, Pierre Michelet
      Chest Trauma remains an issue for health services for both severe and apparently mild trauma management. Severe chest trauma is associated with high mortality and is considered liable for 25% of mortality in multiple traumas. Moreover, mild trauma is also associated with significant morbidity especially in patients with preexisting conditions. Thus, whatever the severity, a fast-acting strategy must be organized. At this time there are no guidelines available from scientific societies. These expert recommendations aim to establish guidelines for chest trauma management in both pre hospital an in hospital settings, for the first 48hours. The « Société Française d’Anesthésie Réanimation » and the « Société Française de Médecine d’Urgence » worked together on the 7 following questions: • Criteria defining severity and for appropriate hospital referral. • Diagnosis strategy in both pre and in hospital settings. • Indications and guidelines for ventilatory support • Management of analgesia • Indications and guidelines for chest tube placement • Surgical and endovascular repair indications in Blunt chest trauma. • Definition, medical and surgical specificity of penetrating chest trauma For each question, prespecified « crucial » (and sometimes also « important ») outcomes were identified by the panel of experts because it mattered for patients. We rated evidence across studies for these specific clinical outcomes. After a systematic GRADE® approach, we defined 60 recommendations. Each recommendation has been evaluated by all the experts according to the DELPHI method.

      PubDate: 2017-01-17T18:00:43Z
      DOI: 10.1016/j.accpm.2017.01.003
       
 
 
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