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Sentilhes L, Galley-Raulin F, Boithias C, Sfez M, Goffinet F, Le Roux S, Benhamou D, Garnier JM, Paysant S, Bounan S, Michel C, Coudray J, Elleboode B, Rozé JC, Ducloy-Bouthors AS. [Not Available]. Gynecol Obstet Fertil Senol 2019; 47:393-394. [PMID: 30904141 DOI: 10.1016/j.gofs.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- L Sentilhes
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société française de médecine périnatale (SFMP), 128, rue La Boétie, 75008 Paris, France; Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - F Galley-Raulin
- Collège national des sages-femmes de France (CNSF), 136, avenue Émile-Zola, 75015 Paris, France; Pôle mère-enfant, CHI Verdun St-Mihiel, 2, rue d'Anthouard, BP 20713, 55107 Verdun, France
| | - C Boithias
- Société française de médecine périnatale (SFMP), 128, rue La Boétie, 75008 Paris, France; Société française de néonatologie (SFN), 49, boulevard Béranger, 37044 Tours, France; Réanimation pédiatrique et néonatale, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), 78, avenue du Général-Leclerc, 94270 Le Kremlin- Bicêtre, France
| | - M Sfez
- Société française d'anesthésie-réanimation (SFAR), 74, rue Raynouard, 75016 Paris, France; Clinique Oudinot, 2, rue Rousselet, 75007 Paris, France; Club d'anesthésie-réanimation en obstétrique (CARO), 23, boulevard de Port-Royal, 75014 Paris, France
| | - F Goffinet
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société française de médecine périnatale (SFMP), 128, rue La Boétie, 75008 Paris, France; Maternité Port-Royal, université Paris Descartes, DHU risques et grossesse, hôpitaux universitaires Paris-centre, Assistance publique-Hôpitaux de Paris (AP-HP), 123, boulevard de Port-Royal, 75014 Paris, France
| | - S Le Roux
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Pôle femme-mère-enfant, centre hospitalier Annecy-Genevois, 74000 Annecy, France
| | - D Benhamou
- Société française d'anesthésie-réanimation (SFAR), 74, rue Raynouard, 75016 Paris, France; Club d'anesthésie-réanimation en obstétrique (CARO), 23, boulevard de Port-Royal, 75014 Paris, France; Pôle d'anesthésie-réanimation, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - J-M Garnier
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Polyclinique de l'Atlantique, avenue Claude-Bernard, 44819 Saint-Herblain, France
| | - S Paysant
- Collège national des sages-femmes de France (CNSF), 136, avenue Émile-Zola, 75015 Paris, France; Centre hospitalier du Cateau-Cambrésis, 28, boulevard Paturle, 59310 Le Cateau-Cambrésis, France
| | - S Bounan
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Centre hospitalier de Saint-Denis, 2, rue du Dr-Delafontaine, 93200 Saint-Denis, France
| | - C Michel
- Société française de néonatologie (SFN), 49, boulevard Béranger, 37044 Tours, France; Pôle santé Léonard-de-Vinci, 1, avenue du Professeur-Alexandre-Minkowski, 37170 Chambray-Lès-Tours, France
| | - J Coudray
- Fédération française des réseaux de soins en périnatalité (FFRSP), 6, rue Pétrarque, 31000 Toulouse, France
| | - B Elleboode
- ELSAN, 58 bis, rue La Boétie, 75008 Paris, France
| | - J-C Rozé
- Société française de médecine périnatale (SFMP), 128, rue La Boétie, 75008 Paris, France; Société française de néonatologie (SFN), 49, boulevard Béranger, 37044 Tours, France; Pôle de néonatologie, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - A-S Ducloy-Bouthors
- Société française d'anesthésie-réanimation (SFAR), 74, rue Raynouard, 75016 Paris, France; Club d'anesthésie-réanimation en obstétrique (CARO), 23, boulevard de Port-Royal, 75014 Paris, France; Pôle d'anesthésie-réanimation, maternité Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, 1, avenue Eugène-Avinée, 59000 Lille, France
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Abstract
The increasing use of laparoscopic surgery in children is associated with the enlargement of the spectrum of indications to appendicectomy, extramucosal pylorotomy and cure of oesophageal reflux. It is also linked with new problems, mainly due to physiologic modifications elicited by pneumoperitoneum and patient's posture. Although sufficient data are not yet available, the respiratory and cardiovascular modifications are probably similar to those occurring in adults, at least in children more than 4-month-old, as long as the intra-abdominal pressure remains under 15 mmHg. The use of higher intra-abdominal pressures has not been reported in children. In this case, the cardiovascular changes consist mainly in an increase in arterial pressure. In some children, non specific decreases in heart rate and in blood pressure can be observed. The latter can be elicited by a surgical complication, hypovolaemia, head-elevated position or deep anaesthesia. In the newborn and infant under 6 months, intra-abdominal pressures of 15 mmHg or more carry a risk of low cardiac output due to a decrease in contractility and compliance of the left ventricle. In this group of age it is therefore recommended to establish a pressure not higher than 6 mmHg. Moreover, in these very young children, the risk for reopening of the right-left shunts can result in heart insufficiency and systemic gas embolism. Peroperative respiratory changes include an increase in PetCO2 and more rarely a decrease in SaO2. The interpretation of the former depends on the site of gas sampling in the anaesthetic system. It is easily controlled by an increased minute ventilation. Various causes, such as bronchial intubation, inhalation of gastric contents or gas embolism, can decrease SaO2. Contra-indications for laparoscopic surgery include hypovolaemia, heart diseases, increased intracranial pressure and alveolar distension. Therefore newborns are patients at high risk in so far as their foramen ovale or their ductus arteriosus is patent, the pulmonary arterial resistances remain increased and a bronchodysplasia is existing. In some cases a special disease is often associated. As an example recurrent bronchitis or asthma is associated with an oesophageal reflux and a sickle-cell disease in patients with cholelithiasis. These patients require special pre-, per- and postoperative care for prevention of complications. Anaesthesia for laparoscopic surgery does not require a major extension of the usual security regulations. Special attention must be paid to arterial pressure. Therefore end-expiratory concentration of the halogenated anaesthetic agent should not be kept higher than 1.5 times the MAC related to the age during maintenance of anaesthesia.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- M Sfez
- Clinique Chirurgicale, Boulogne-Billancourt
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Goutail-Flaud MF, Sfez M, Berg A, Laguenie G, Couturier C, Barbotin-Larrieu F, Saint-Maurice C. Central venous catheter-related complications in newborns and infants: a 587-case survey. J Pediatr Surg 1991; 26:645-50. [PMID: 1941448 DOI: 10.1016/0022-3468(91)90001-a] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In an attempt to identify factors determining central venous catheter-related complications in newborns and infants, 587 cases have been retrospectively analyzed. Attention has been paid to the influence of the incidence of babies' body weight, site of insertion, and technique of placement of the catheter and the material used, ie, silicone (SI) or polyurethane (PU). Overall complications occurred in 28% of the catheters with 2 deaths due to cardiac tamponade. Mechanical complications happened in 22% of the catheters, including dislodgement (11.6%), extracorporeal perforation (5.3%), and obstruction (5%). Septic complications occurred in 4% catheters, including proven bacteriemia (2.5%), abscess at the entry site (1%), and isolated fever (0.8%). Clinically evident caval thrombosis occurred in 1% of the catheters. Overall complications were significantly higher when the body weight was lower than 2,500 g (P less than .01) due to a significantly higher incidence of septic complications (P less than .05). When a proximal site of placement of the catheter was used, both septic and mechanical complications were more frequent than in the distal approach (P less than .01). The incidence of complications was similar in surgically and in percutaneously placed catheters as in SI and PU catheters. Nevertheless, fatal complications occurred only in PU catheters, leading us to avoid the choice of such material in newborns and small infants.
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Affiliation(s)
- M F Goutail-Flaud
- Department of Anesthesia and Intensive Care, University Hospital St Vincent de Paul, Paris, France
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Sfez M, Le Mapihan Y, Levron JC, Gaillard JL, Rosemblatt JM, Le Moing JP. [Comparison of the pharmacokinetics of etomidate in children and in adults]. Ann Fr Anesth Reanim 1990; 9:127-31. [PMID: 2363549 DOI: 10.1016/s0750-7658(05)80051-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Etomidate pharmacokinetics were compared in 12 children (P group) (age 7 to 13 years, weight 22 to 48 kg) and in 4 adult women (A group) (age 28 to 52 years, weight 46 to 72 kg), A.S.A. 1, undergoing minor non abdominal surgery. They were unpremedicated and anaesthetized with alfentanil 100 micrograms.kg-1, and isoflurane 2 vol % in N2O/O2 (1/1). Etomidate was administered as a bolus: 0.3 mg.kg-1 in adults and 0.4 mg.kg-1 in children. Venous plasma samples were frozen until further etomidate assay with a HPLC technique. In all patients but two children, data were fitted to a three rather than a two compartment model. Differences between groups (mean +/- SD values) included Vdc (P: 0.66 +/- 0.31 l.kg-1; A: 0.27 +/- 0.15 l.kg-1; p less than 0.01), t1/2 pi (P: 5.4 +/- 2.9 min; A: 2.7 +/- 5.7 min; p less than 0.05) and plasma clearance (P: 17.2 +/- 4.6 ml.kg-1.min-1; A: 10.9 +/- 3.3 ml.kg-1.min-1; p less than 0.05). No statistical difference was found between A and P groups for the following parameters: t1/2 alpha (37.1 +/- 12.0 min vs 26.8 + 15.1 min), t1/2 beta (260 +/- 99 min vs 175 +/- 99 min), Vdss (2.5 +/- 1.11.kg-1 vs 2.8 +/- 1.61.kg-1), Vd beta (4.1 +/- 2.41.kg-1 vs 4.0 +/- 2.21.kg-1), and MRT (228 +/- 80 min vs 172 +/- 101 min). No age-related difference was found inside P group with regard to pharmacokinetic parameters. In conclusion, a 30% higher etomidate bolus dosage is required in children than in adults to achieve similar plasma concentrations, due to a higher volume of the initial compartment. In comparison to adults the higher clearance suggests higher maintenance dose requirements in children.
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Affiliation(s)
- M Sfez
- Département d'Anesthésie-Réanimation, Hôpital Saint-Vincent de Paul, Paris
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