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Durouchoux A, Liguoro D, Sesay M, Le Petit L, Jecko V. Subarachnoid space of the optic nerve sheath and intracranial hypertension: a macroscopic, light and electron microscopic study. Surg Radiol Anat 2022; 44:759-766. [PMID: 35507023 DOI: 10.1007/s00276-022-02948-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/14/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The optic nerve (ON) is an extension of the central nervous system via the optic canal to the orbital cavity. It is accompanied by meninges whose arachnoid layer is in continuity with that of the chiasmatic cistern. This arachnoid layer is extended along the ON, delimiting a subarachnoid space (SAS) around the ON. Not all forms of chronic intracranial hypertension (ICH) present papilledema. The latter is sometimes asymmetric, unilateral, or absent. The radiological signs of optic nerve sheath (ONS) dilation, in magnetic resonance imaging, are inconsistent or difficult to interpret. The objective of this study was to analyze the anatomy, the constitution, and the variability of the SAS around the ON in its intraorbital segment to improve the understanding of the pathophysiologic mechanism of asymmetric or unilateral or absent papilledema in certain ICH. METHODS The study was carried out on nine cadaveric specimens. In four embalmed specimens, macroscopic analysis of the SAS of the ONS were performed, with description about density of the arachnoid trabecular meshwork in three distinct areas (bulbar segment, mid-orbital segment and the precanal segment). In three other embalmed specimens, after staining of SAS by methylene blue (MB), we performed macroscopic analysis of MB progression in the SAS of the ONS. Then, in two non-embalmed specimens, light and electron microscopy (EM) analysis were also done. RESULTS On the macroscopic level, after staining of SAS, we found in all cases that MB progressed on 16 mm average throughout the SAS of the ONS without reaching the papilla. In four embalmed specimens, in the SAS of the ONS, the density of the arachnoid trabecular meshwork showed inter-individual variability (100%) and intra-individual variability with bilateral variability (50%) and/or variability within the same ONS (88%). On the microscopic level, the arachnoid trabeculae of the ONS are composed of dense connective tissue. The EM perfectly depicted its composition which is mainly of collagen fibers of parallel orientation. CONCLUSION The variability of the SAS around the ONS probably impacts the symmetrical or asymmetrical nature of papilledema in ICH.
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Affiliation(s)
- A Durouchoux
- Neurosurgery B Department, University Hospital Bordeaux, Bordeaux, France.
| | - D Liguoro
- Neurosurgery A Department, Bordeaux Hospital, Bordeaux, France.,Department of Anatomy, University of Bordeaux, Bordeaux, France
| | - M Sesay
- Neuroanesthesia, Bordeaux Hospital, Bordeaux, France
| | - L Le Petit
- Neurosurgery A Department, Bordeaux Hospital, Bordeaux, France
| | - V Jecko
- Neurosurgery A Department, Bordeaux Hospital, Bordeaux, France
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Cavaillez T, Weinmann L, Mouton C, Delassasseigne C, Sesay M, Biais M, James C, Roullet S. A retrospective study of indications and consequences of monitoring direct oral anticoagulant plasma concentrations on patient care in a university hospital: The Retro-AOD study. Thromb Res 2021; 206:76-83. [PMID: 34419866 DOI: 10.1016/j.thromres.2021.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/31/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The use of direct oral anticoagulants (DOAC) is increasing. Specific concentrations are available and have been proven to be reliable and reproducible in optimising patient care. This retrospective, monocentric study aimed to describe the indications and consequences of monitoring DOAC plasma levels on patient care. MATERIALS AND METHODS We collected data of patients hospitalised at the Bordeaux University Hospital between January 2017 and December 2018. These included demographics, indications, type, dose of DOAC, standard coagulation tests, creatinine clearance and DOAC plasma concentration using specifically calibrated rivaroxaban and apixaban anti-Xa and dabigatran anti-IIa assays. The date of last DOAC intake, the time between intake and plasma level measurement were also collected and analysed. RESULTS A total of 2197 DOAC assays in 1488 patients were obtained in various clinical situations: urgent or elective procedures, context of acute renal failure, suspicion or occurrence of ischemic strokes, intra-cranial and other bleeding sites. Interpretation of these assays led physicians to maintain, postpone or cancel invasive and high haemorrhagic risk procedures in 757, 261 and 56 cases respectively. The remaining 1123 assays were associated with no significant modification of patient care. DOAC plasma concentration was ≤30 ng ml-1 (sensitivity 85.4%, specificity 73.6%, positive predictive value 71.1%, negative predictive value 86.7%, AUC 0.81) after a last intake of at least 2 days. CONCLUSIONS Our study is, to date, the largest report of real-life measurement of specific DOAC plasma level at a single institution. Patient care was not modified in more than half of the assays.
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Affiliation(s)
- Thibaud Cavaillez
- CHU Bordeaux, Service d'Anesthésie-Réanimation Tripode, F-33000 Bordeaux, France
| | - Laurent Weinmann
- CHU Bordeaux, Laboratoire d'hématologie, F-33000 Bordeaux, France
| | - Christine Mouton
- CHU Bordeaux, Laboratoire d'hématologie, F-33000 Bordeaux, France
| | | | - Musa Sesay
- CHU Bordeaux, Service d'Anesthésie-Réanimation Tripode, F-33000 Bordeaux, France
| | - Matthieu Biais
- CHU Bordeaux, Service d'Anesthésie-Réanimation Tripode, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, Biologie des maladies cardiovasculaire, U1034, F-33600 Pessac, France
| | - Chloé James
- CHU Bordeaux, Laboratoire d'hématologie, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, Biologie des maladies cardiovasculaire, U1034, F-33600 Pessac, France
| | - Stéphanie Roullet
- CHU Bordeaux, Service d'Anesthésie-Réanimation Tripode, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, Biologie des maladies cardiovasculaire, U1034, F-33600 Pessac, France.
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Angles E, Robin F, Moal B, Roy M, Sesay M, Ouattara A, Biais M, Roullet S, Saillour-Glénisson F, Nouette-Gaulain K. Pre-operative peripheral intravenous cannula insertion failure at the first attempt in adults: Development of the VENSCORE predictive scale and identification of risk factors. J Clin Anesth 2021; 75:110435. [PMID: 34303989 DOI: 10.1016/j.jclinane.2021.110435] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/07/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE Our objective was to develop a clinical scale (the VENSCORE) to predict pre-operative peripheral intravenous cannula (PIVC) insertion failure at the first attempt in adults. DESIGN This was a prospective multicenter cohort study that included internal validation with bootstrapping. SETTING The operating rooms of 14 hospitals in southern France from June 2016 to June 2018. PATIENTS Consecutive adult patients aged 18 years or older were recruited upon arrival to the operating room, regardless of American Society of Anaesthesiology (ASA) physical status. INTERVENTIONS PIVC insertion on arrival to the OR. MEASUREMENTS PIVC insertion failure at the first attempt was the outcome of interest. Data collected included the number of PIVC insertion attempts and potential predictors of the risk of failure (including pre-operative patient characteristics and data relative to the procedure). Uni- and multivariable logistic analyses were performed. Based on these results, the VENSCORE scale was developed to predict the risk of failure of the first PIVC insertion. MAIN RESULTS In total, 3394 patients were included, and 27 were excluded because of protocol violations. The PIVC insertion failure rate at the first attempt was 20.3%. Based on multivariable analysis, a history of difficult PIVC insertions, high-risk surgery, poor vein visibility, and moderate to poor vein palpability were identified as risk factors for insertion failure at the first attempt. The area under the curve of the predictive model was 0.82 (95% confidence interval: 0.80-0.84). A VENSCORE value of 0 points was associated with a failure rate of 7%, versus 97% for a score of 6. CONCLUSIONS The four-item VENSCORE scale could be useful for prospectively identifying adults at risk of first PIVC insertion attempt failure.
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Affiliation(s)
- Emeline Angles
- CHU Bordeaux, Service d'Anesthésie Réanimation Pellegrin, Hôpital Pellegrin, Place Amélie Raba Léon, F-33000 Bordeaux, France
| | - Florian Robin
- CHU Bordeaux, Service d'Anesthésie Réanimation Pellegrin, Hôpital Pellegrin, Place Amélie Raba Léon, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM U12-11, Laboratoire de Maladies Rares: Génétique et Métabolisme (MRGM), 176 Rue Léo Saignat, F-33000 Bordeaux, France
| | - Bertrand Moal
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000 Bordeaux, France; Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France
| | - Maxim Roy
- CHU Bordeaux, Service d'Anesthésie Réanimation Pellegrin, Hôpital Pellegrin, Place Amélie Raba Léon, F-33000 Bordeaux, France; Department of anesthesiology, CHUM, Montreal, Canada
| | - Musa Sesay
- CHU Bordeaux, Service d'Anesthésie Réanimation Pellegrin, Hôpital Pellegrin, Place Amélie Raba Léon, F-33000 Bordeaux, France
| | - Alexandre Ouattara
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Center, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, UMR 1034, , Biology of Cardiovascular Diseases, F-33600 Pessac, France
| | - Matthieu Biais
- CHU Bordeaux, Service d'Anesthésie Réanimation Pellegrin, Hôpital Pellegrin, Place Amélie Raba Léon, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, UMR 1034, , Biology of Cardiovascular Diseases, F-33600 Pessac, France
| | - Stéphanie Roullet
- CHU Bordeaux, Service d'Anesthésie Réanimation Pellegrin, Hôpital Pellegrin, Place Amélie Raba Léon, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, UMR 1034, , Biology of Cardiovascular Diseases, F-33600 Pessac, France
| | - Florence Saillour-Glénisson
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000 Bordeaux, France; Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France
| | - Karine Nouette-Gaulain
- CHU Bordeaux, Service d'Anesthésie Réanimation Pellegrin, Hôpital Pellegrin, Place Amélie Raba Léon, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM U12-11, Laboratoire de Maladies Rares: Génétique et Métabolisme (MRGM), 176 Rue Léo Saignat, F-33000 Bordeaux, France; CHU de Bordeaux, Ecole d'infirmères d'anesthésie, F-33000 Bordeaux, France.
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Tauzin-Fin P, Barrucand K, Sesay M, Roullet S, Gosse P, Bernhard JC, Robert G, Sztark F. Peri-operative management of pheochromocytoma with intravenous urapidil to prevent hemodynamic instability: A 17-year experience. J Anaesthesiol Clin Pharmacol 2020; 36:49-54. [PMID: 32174657 PMCID: PMC7047675 DOI: 10.4103/joacp.joacp_71_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 12/25/2018] [Accepted: 04/09/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Surgery for pheochromocytoma (PCC) can cause excessive catecholamine release with severe hypertension. Alpha blockade is the mainstay of preoperative management. The aim of this study was to evaluate the efficacy and tolerance of intra-venous (IV) urapidil, a competitive short acting α1 receptor antagonist, in the prevention of peri-operative hemodynamic instability of patients with PCC. Material and Methods This retrospective observational study included 75 patients (79 PCC) for PCC removal surgery from 2001 to 2017 at the Bordeaux University Hospital. They received, 3 days before surgery, continuous intravenous infusion of urapidil with stepwise increase to the maximum tolerated dose. Urapidil was maintained during the procedure and stopped after clamping the adrenal vein. Plasma catecholamine concentrations were measured during surgery. Hypertensive peaks (SAP >160 mmHg) and tachycardia >100 beats/min were treated with boluses of nicardipine 2 mg and esmolol 0.5 mg/kg. Results We recorded 20/79 (25%) cases with systolic arterial pressure (SAP) >180 mmHg. Only 11/79 (14%) had hypotension with SAP <80 mmHg. Peaks of catecholamine secretions were observed preferentially during peritoneal insufflation and tumor dissection (P < 0.05). A correlation was found between tumor size (mm) and the highest norepinephrine levels [r = 0.288, P = 0.015], and between hypertensive peaks (mmHg) and the highest norepinephrine levels [r = 0.45, P = 0.017]. No mortality was reported. The median [range] postoperative hospital stay was 4 [2-9] days. Conclusion IV urapidil limits hypertensive and hypotensive peaks during PCC surgery, and corresponds to surgical imperatives allowing a short hospital stay, due to its "on-off" effect.
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Affiliation(s)
- Patrick Tauzin-Fin
- Department of Anesthesia and Critical Care, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
| | - Kévin Barrucand
- Department of Anesthesia and Critical Care, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
| | - Musa Sesay
- Department of Anesthesia and Critical Care, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
| | - Stéphanie Roullet
- Department of Anesthesia and Critical Care, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
| | - Philippe Gosse
- Department of Cardiology, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
| | | | - Gregoire Robert
- Department of Urology, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
| | - François Sztark
- Department of Anesthesia and Critical Care, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France
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de Courson H, Ferrer L, Cane G, Verchère E, Sesay M, Nouette-Gaulain K, Biais M. Evaluation of least significant changes of pulse contour analysis-derived parameters. Ann Intensive Care 2019; 9:116. [PMID: 31602550 PMCID: PMC6787117 DOI: 10.1186/s13613-019-0590-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 09/30/2019] [Indexed: 12/12/2022] Open
Abstract
Background Many maneuvers assessing fluid responsiveness (minifluid challenge, lung recruitment maneuver, end-expiratory occlusion test, passive leg raising) are considered as positive when small variations in cardiac index, stroke volume index, stroke volume variation or pulse pressure variation occur. Pulse contour analysis allows continuous and real-time cardiac index, stroke volume, stroke volume variation and pulse pressure variation estimations. To use these maneuvers with pulse contour analysis, the knowledge of the minimal change that needs to be measured by a device to recognize a real change (least significant change) has to be studied. The aim of this study was to evaluate the least significant change of cardiac index, stroke volume index, stroke volume variation and pulse pressure variation obtained using pulse contour analysis (ProAQT®, Pulsion Medical System, Germany). Methods In this observational study, we included 50 mechanically ventilated patients undergoing neurosurgery in the operating room. Cardiac index, stroke volume index, pulse pressure variation and stroke volume variation obtained using ProAQT® (Pulsion Medical System, Germany) were recorded every 12 s during 15-min steady-state periods. Least significant changes were calculated every minute. Results Least significant changes statistically differed over time for cardiac index, stroke volume index, pulse pressure variation and stroke volume variation (p < 0.001). Least significant changes ranged from 1.3 to 0.7% for cardiac index, from 1.3 to 0.8% for stroke volume index, from 10 to 4.9% for pulse pressure variation and from 10.8 to 4.3% for stroke volume variation. Conclusion To conclude, the present study suggests that pulse contour analysis is able to detect rapid and small changes in cardiac index and stroke volume index, but the interpretation of rapid and small changes of pulse pressure variation and stroke volume variation must be done with caution.
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Affiliation(s)
- Hugues de Courson
- Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France
| | - Loic Ferrer
- Biostatistics Unit, Institut Curie, U900, Hôpital René Huguenin Saint-Cloud, Saint-Cloud, France
| | - Grégoire Cane
- Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France
| | - Eric Verchère
- Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France
| | - Musa Sesay
- Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France
| | - Karine Nouette-Gaulain
- Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France.,INSERM, U12-11, Laboratoire de Maladies Rares: Génétique et Métabolisme (MRGM), Univ. Bordeaux, Bordeaux, France
| | - Matthieu Biais
- Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France. .,Adaptation cardiovasculaire à l'ischémie, U1034, Univ. Bordeaux, 33600, Pessac, France. .,Department of Anaesthesiology and Critical Care Pellegrin, Hôpital Pellegrin, CHU de Bordeaux, 33076, Bordeaux Cedex, France.
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de Courson H, Boyer P, Grobost R, Lanchon R, Sesay M, Nouette-Gaulain K, Futier E, Biais M. Changes in dynamic arterial elastance induced by volume expansion and vasopressor in the operating room: a prospective bicentre study. Ann Intensive Care 2019; 9:117. [PMID: 31602588 PMCID: PMC6787125 DOI: 10.1186/s13613-019-0588-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 09/26/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Dynamic arterial elastance (Eadyn), defined as the ratio between pulse pressure variations and stroke volume variations, has been proposed to assess functional arterial load. We evaluated the evolution of Eadyn during volume expansion and the effects of neosynephrine infusion in hypotensive and preload-responsive patients. METHODS In this prospective bicentre study, we included 56 mechanically ventilated patients in the operating room. Each patient had volume expansion and neosynephrine infusion. Stroke volume and stroke volume variations were obtained using esophageal Doppler, and pulse pressure variations were measured through the arterial line. Pressure response to volume expansion was defined as an increase in mean arterial pressure (MAP) ≥ 10%. RESULTS Twenty-one patients were pressure responders to volume expansion. Volume expansion induced a decrease in Eadyn (from 0.69 [0.58-0.85] to 0.59 [0.42-0.77]) related to a decrease in pulse pressure variations more pronounced than the decrease in stroke volume variations. Baseline and changes in Eadyn after volume expansion were related to age, history of arterial hypertension, net arterial compliance and effective arterial elastance. Eadyn value before volume expansion > 0.65 predicted a MAP increase ≥ 10% with a sensitivity of 76% (95% CI 53-92%) and a specificity of 60% (95% CI 42-76%). Neosynephrine infusion induced a decrease in Eadyn (from 0.67 [0.48-0.80] to 0.54 [0.37-0.68]) related to a decrease in pulse pressure variations more pronounced than the decrease in stroke volume variations. Baseline and changes in Eadyn after neosynephrine infusion were only related to heart rate. CONCLUSION Eadyn is a potential sensitive marker of arterial tone changes following vasopressor infusion.
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Affiliation(s)
- Hugues de Courson
- Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France
| | - Philippe Boyer
- Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France
| | - Romain Grobost
- Department of Anesthesiology and Critical Care, Clermont-Ferrand University Hospital, 63003, Clermont-Ferrand Cedex 1, France
| | - Romain Lanchon
- Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France
| | - Musa Sesay
- Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France
| | - Karine Nouette-Gaulain
- Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France.,INSERM, U12-11, Laboratoire de Maladies Rares: Génétique et Métabolisme (MRGM), Bordeaux, France
| | - Emmanuel Futier
- Department of Anesthesiology and Critical Care, Clermont-Ferrand University Hospital, 63003, Clermont-Ferrand Cedex 1, France.,Équipe R2D2 EA-7281/Faculté de Médecine/Université d'Auvergne, University of Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Matthieu Biais
- Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France. .,INSERM, U1034, Biology of Cardiovascular Diseases, 33600, Pessac, France.
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Tauzin-Fin P, Sesay M, Ryman A, Ballanger P, Combe C. Postoperative Thrombotic Microangiopathy following Radical Cystectomy for Bladder Cancer. Anaesth Intensive Care 2019; 34:672-5. [PMID: 17061648 DOI: 10.1177/0310057x0603400515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This report describes the perioperative management of disseminated intravascular coagulation occurring abruptly during a planned cystectomy for non-metastatic bladder papillary carcinoma. Peroperatively, profuse bleeding and an acute decrease in blood pressure were effectively treated by blood transfusions and fresh frozen plasma. Haematological tests indicated the presence of disseminated intravascular coagulation. On the following three days, acute renal failure, peripheral disseminated intravascular coagulation-related thrombocytopenia and haemolytic anemia with schistocytes were suggestive of thrombotic microangiopathy. Treatment by plasma exchange along with haemodialysis was commenced. An aetiological work-up remained negative. After 21 days of treatment, haemodialysis and plasma exchange were stopped. Urological outcome was favourable. The one-year follow-up did not show any residual renal insufficiency and laboratory parameters returned to normal. In the absence of evidence in favour of an infectious, drug-related or immunological aetiology, we postulated that this thrombotic microangiopathy was caused by disseminated intravascular coagulation and that the tumour manipulation during the surgical procedure was the triggering factor.
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Affiliation(s)
- P Tauzin-Fin
- Departement d'Anesthésie-Réanimation III and Service d'Urologie, Hôpital Pellegrin-Tondu, Bordeaux, France
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Clement O, Dewachter P, Mouton-Faivre C, Nevoret C, Guilloux L, Bloch Morot E, Katsahian S, Laroche D, Audebert M, Benabes-Jezraoui B, Benoit Y, Beot S, Berard F, Berthezene Y, Bertrand P, Bouffard J, Bourrain JL, Boyer B, Carette MF, Caron-Poitreau C, Cavestri B, Cercueil JP, Charpin DA, Collet E, Crombe-Ternamian A, Dalmas J, Decoux E, Defrance MF, Delaval Y, Demoly P, Depriester C, Depriester P, Didier A, Drouet M, Dupas B, Dupre-Goetchebeur D, Dzviga C, Fabre C, Ferretti G, Fourre-Jullian C, Girardin P, Giron J, Gouitaa M, Grenier N, Guenard Bilbault L, Guez S, Gunera-Saad N, Heautot JF, Herbin D, Hoarau C, Jacquot C, Julien C, Laborie L, Lambert C, Larroche P, Leclerc X, Lemaitre L, Leynadier F, Lillo-Le-Louet A, Louvel JP, Louvier N, Lucas MM, Meites G, Mennesson N, Metge L, Meunier Y, Monnier-Cholley L, Musacchio M, Nicolie B, Occelli G, Oesterle H, Paisant-Thouveny F, Panuel M, Railhac N, Rety-Jacob F, Rochefort-Morel C, Roy C, Sarlieve P, Sesay M, Sgro C, Taourel P, Terrier P, Theissen O, Topenot I, Valfrey J, Veillon F, Vergnaud MC, Veyret C, Vincent D, Wallaert B, Wessel F, Zins M. Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study. EClinicalMedicine 2018; 1:51-61. [PMID: 31193689 PMCID: PMC6537532 DOI: 10.1016/j.eclinm.2018.07.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/28/2018] [Accepted: 07/09/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Iodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors. METHODS Patients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed by intradermal tests (IDT) with the culprit CM diluted 1:10, "potentially allergic" IH by positive IDT with pure CM, and non-allergic IH by negative IDT. FINDINGS Among 245 skin-tested patients (ICM = 209; GBCM = 36), allergic IH to ICM was identified in 41 (19.6%) and to GBCM in 10 (27.8%). Skin cross-reactivity was observed in 11 patients with ICM (26.8%) and 5 with GBCM (50%). Allergy frequency increased with clinical severity and histamine and tryptase concentrations (p < 0.0001). Cardiovascular signs were strongly associated with allergy. Non-allergic IH was observed in 152 patients (62%) (ICM:134; GBCM:18). Severity grade was lower (p < 0.0001) and reaction delay longer (11.6 vs 5.6 min; p < 0.001). Potentially allergic IH was diagnosed in 42 patients (17.1%) (ICM:34; GBCM:8). The delay, severity grade, and mediator release were intermediate between the two other groups. INTERPRETATION Allergic IH accounted for < 10% of cutaneous reactions, and > 50% of life-threatening ones. GBCM and ICM triggered comparable IH reactions in frequency and severity. Cross-reactivity was frequent, especially for GBCM. We propose considering skin testing with pure contrast agent, as it is more sensitive than the usual 1:10 dilution criteria.
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Affiliation(s)
- Olivier Clement
- Assistance Publique Hôpital Européen Georges Pompidou, Service de Radiologie 20 rue Leblanc Paris, FR 75015, France
- Inserm U970 Université Paris Descartes Sorbonne Paris Cité, Laboratoire Imagerie 56 rue Leblanc Paris, FR 75015, France
- Corresponding author at: Assistance Publique Hôpital Européen Georges Pompidou, Service de Radiologie 20 rue Leblanc Paris, FR 75015, France
| | - Pascale Dewachter
- Assistance Publique Groupe Hospitalier de Paris-Seine Saint Denis, Université Paris Descartes Sorbonne Paris Cité, Anesthésie-Réanimation Chirurgicale, Bondy, FR 93140, France
| | - Claudie Mouton-Faivre
- CHU Nancy-Brabois, Bâtiment Philippe Canton Rue du Morvan, Vandoeuvre-lès-Nancy, FR 54511, France
| | - Camille Nevoret
- Hôpital Européen Georges Pompidou, Unité d'épidémiologie et de recherche clinique Paris, FR 75015, France
| | - Laurence Guilloux
- Laboratoire Biomnis, Immuno Allergologie, 17/19 avenue Tony Garnier Lyon, FR 69357, France
| | - Evelyne Bloch Morot
- Assistance Publique Hôpital Européen Georges Pompidou, Médecine Interne Allergologie Paris, FR 75015, France
| | - Sandrine Katsahian
- Assistance Publique Hôpital Européen Georges Pompidou, Unité d'épidémiologie et de recherche clinique Paris, FR 75015, France
| | - Dominique Laroche
- Centre Hospitalier Universitaire de Caen, Laboratoire d'Hormonologie Caen cedex 9, FR 14033, France
- Université de Caen Basse-Normandie, UFR de Médecine Caen, FR 14000, France
| | | | | | | | - Yves Benoit
- Unité d'Allergologie-Anesthésie, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Sylvie Beot
- Service de Radiologie, CHU Brabois, Rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France
| | - Frédéric Berard
- Service d'Immunologie clinique et Allergologie, Pavillon 5 F, Centre Hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Benite Cedex, France
| | - Yves Berthezene
- Service d'Imagerie Médicale, Hôpital de la Croix Rousse, 103 Grande Rue de la Croix Rousse, 69317 Lyon Cedex 04, France
| | - Philippe Bertrand
- Service de Radiologie, CHU de Tours, Hôpital Bretonneau, 2 Boulevard Tonnelé, 37044 Tours Cedex, France
| | - Juliette Bouffard
- Service de Radiologie et Imagerie Médicale, Pavillon 3 B, Centre Hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre Benite Cedex, France
| | - Jean-Luc Bourrain
- Département pluridisciplinaire de médecine, Service de Dermatologie, CHU de Grenoble, BP 217, 38043 Grenoble Cedex 09, France
| | - Bruno Boyer
- Service de Radiologie, Centre Alexis Vautrin, 6 avenue de Bourgogne, 54 511 Vandoeuvre cedex, France
| | - Marie-France Carette
- Centre d’Allergologie, Hôpital TENON, 4 rue de la Chine, 75970 Paris Cedex 20, France
| | - Christine Caron-Poitreau
- CHRU Angers, Hôpital Hôtel Dieu, Service de Radiologie, 4 rue Larrey, 49933 Angers Cedex 09, France
| | - Béatrice Cavestri
- Service de Pneumologie du Pr André-Bernard Tonnel, Hôpital Calmette, Boulevard du Professeur Leclerc, 59037 Lille cedex, France
| | - Jean Pierre Cercueil
- Service de Radiologie, CHU de Dijon, Hôpital du Bocage, 2 Bd Mal de Lattre de Tassigny, BP 77908, 21034 Dijon Cedex, France
| | - Denis-André Charpin
- Service de Pneumologie- Allergologie, Hôpital Nord, Chemin des Bourrelys, 13915 Marseille Cedex 20, France
| | - Evelyne Collet
- Service de Dermatologie, CHU de Dijon, Hôpital du Bocage, 2 Bd Mal de Lattre de Tassigny, 21034 Dijon Cedex, France
| | - Arielle Crombe-Ternamian
- Service de Radiologie digestive, Pavillon H, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Jacques Dalmas
- Service d'Imagerie Médicale, Centre Hospitalier de Martigues, 3 bd des Rayettes, BP 50248, 13698 Martigues Cedex, France
| | - Eric Decoux
- Service de Radiologie, Hôpital Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Marie-France Defrance
- Service de Médecine Interne, Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75674 Paris Cedex 14, France
| | - Yvonne Delaval
- Service de Pneumologie, Consultation d'Allergolo-Anesthésie, CHU Pontchaillou, Rue H. Le Guilloux, 35033 Rennes Cedex 09, France
| | - Pascal Demoly
- Service d'Allergologie, CHU de Montpellier, Hôpital Arnaud de Villeneuve, 371 Av Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Claude Depriester
- Service d'Imagerie Médicale, Polyclinique du Bois, 44 avenue Marx Dormoy, 59000 Lille, France
| | | | - Alain Didier
- Service de Pneumologie, CHU de Toulouse, Hôpital Larrey, 24 chemin de Pouvourville, 31059 Toulouse Cedex 9, France
| | - Martine Drouet
- CHRU Angers, Hôpital Hôtel Dieu, Laboratoire d'Allergologie, 4 rue Larrey, 49933 Angers Cedex 09, France
| | - Benoît Dupas
- Service de Radiologie, CHU de Nantes, Hôpital Hôtel Dieu, Place Alexis Ricordeau, 44093 Nantes Cedex 01, France
| | | | - Charles Dzviga
- Service de Radiologie, CHU de Saint-Etienne, Hôpital Nord, Avenue Albert Raymond, 42055 Saint Etienne Cedex 2, France
| | - Christine Fabre
- Service de Pneumologie, Groupe Hospitalo-Universitaire Caremeau, Place du Pr Robert Debré, 30029 Nîmes Cedex 9, France
| | - Gilbert Ferretti
- Service Central de Radiologie et d' Imagerie Médicale, CHU Grenoble, BP 217, 38043 Grenoble Cedex 09, France
| | - Corinne Fourre-Jullian
- Service de Pneumo-allergologie, Centre Hospitalier de Martigues, 3 bd des Rayettes, BP 248, 13698 Martigues Cedex, France
| | - Pascal Girardin
- Service de Dermatologie II, Hôpital Saint-Jacques, 2 Place Saint-Jacques, 25030 Besancon Cedex, France
| | - Jacques Giron
- Service Centrale d'Imagerie médicale, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, 31059 Toulouse Cedex 9, France
| | - Marion Gouitaa
- Service de Pneumologie- Allergologie, Hôpital Nord, Chemin des Bourrelys, 13915 Marseille Cedex 20, France
| | - Nicolas Grenier
- Service de Radiologie B, Groupe Hospitalier Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France
| | - Lydie Guenard Bilbault
- Service Immuno-Allergologie, Hôpital Central, 29, avenue Maréchal de Lattre de Tassigny, 54035 Nancy Cedex, France
| | - Stéphane Guez
- Unité des Maladies Allergiques, Groupe Hospitalier Pellegrin, Bâtiment PQR, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
| | | | - Jean-François Heautot
- Service de Radiologie, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex, France
| | - Dominique Herbin
- Service de Pneumologie, Centre hospitalier Louis Pasteur, 46, rue du val de saire, 50102 Cherbourg Cedex, France
| | - Cyrille Hoarau
- Service d'Immunologie Clinique et Néphrologie, CHRU de Tours, Hôpital Bretonneau, 2 Boulevard Tonnelé, 37 044 Tours Cedex, France
| | - Claude Jacquot
- Département d'Anesthésie Réanimation 1, CHU de Grenoble, Hôpital A.Michallon, BP 127, 38043 Grenoble Cedex 09, France
| | - Christian Julien
- Service d'imagerie médicale, Centre hospitalier Louis Pasteur, 46, rue du val de saire, 50 102 Cherbourg Cedex, France
| | - Laurent Laborie
- Service de Radiologie A, CHRU Jean Minjoz, 22, Bd A. Flemming, 25030 Besancon Cedex, France
| | - Claude Lambert
- Laboratoire Immunologie, Pavillon 5 bis, CHU de Saint-Etienne, Hôpital Bellevue, 42055 Saint Etienne Cedex 2, France
| | - Pascal Larroche
- Service de Radiologie, Hôpital de la Cavale blanche, Boulevard Tanguy Prigent, 29200 BREST Cedex, France
| | - Xavier Leclerc
- Service de Neuroradiologie, CHRU, Hôpital Roger Salengro, Boulevard du Professeur Leclercq, 59037 Lille Cedex, France
| | - Laurent Lemaitre
- Plateau Commun d'Imagerie Médicale, Hôpital Claude Huriez, Rue Michel Polonovski, 59037 Lille Cedex, France
| | - Francisque Leynadier
- Centre d’Allergologie, Hôpital TENON, 4 rue de la Chine, 75970 Paris Cedex 20, France
| | - Agnès Lillo-Le-Louet
- Centre de Pharmacovigilance, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris Cedex 15, France
| | - Jean-Pierre Louvel
- Service de Radiologie, CHU de Rouen, Hôpital de Boisguillaume-147, avenue du Maréchal Juin, 76230, Boisguillaume, France
| | - Nathalie Louvier
- Service Anesthésie Réanimation, Centre Georges Francois Leclerc, 1 rue Professeur Marion, BP 77980, 21079 Dijon Cedex, France
| | - Marie-Madeleine Lucas
- Service de Pneumologie, Consultation d'Allergolo-Anesthésie, CHU Pontchaillou, Rue H. Le Guilloux, 35033 Rennes Cedex 09, France
| | - Geneviève Meites
- Service de Radiologie, Hôpital Rangueil, 1, avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France
| | - Nicolas Mennesson
- Service de Radiologie digestive, Pavillon H, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Liliane Metge
- Département d'Imagerie Médicale, Groupe Hospitalo-Universitaire Caremeau, Place du Pr Robert Debré, 30 029 Nimes Cedex 9, France
| | - Yannick Meunier
- Département d'Anesthésie Réanimation, CHU de Rouen, Hôpital Charles Nicolle, 1, rue de Germont, 76031 Rouen Cedex, France
| | - Laurence Monnier-Cholley
- Service de Radiologie, Hôpital Saint Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Mariano Musacchio
- Service de Radiologie, Hôpitaux civils, Hôpital Pasteur, Neuro Radiologie Pôle 3, 39 avenue de la liberté, 68024 Colmar Cedex, France
| | - Brigitte Nicolie
- CHRU Angers, Hôpital Hôtel Dieu, Unité fonctionnelle d'allergologie, 4 rue Larrey, 49933 Angers Cedex 09, France
| | - Gisèle Occelli
- Service de Pneumologie, CHU de Nice, Hôpital Pasteur, H.O, 30, avenue de la Voie Romaine, 06100 Nice, France
| | - Hélène Oesterle
- Service de Radiologie, Hôpitaux civils, Hôpital Pasteur, Neuro Radiologie Pôle 3, 39 avenue de la liberté, 68024 Colmar Cedex, France
| | - Francine Paisant-Thouveny
- CHRU Angers, Hôpital Hôtel Dieu, Service de Radiologie C, 4 rue Larrey, 49933 Angers Cedex 09, France
| | - Michel Panuel
- Service de Radiologie, Hôpital Nord, Chemin des Bourrelys, 13915 Marseille Cedex 20, France
| | - Nadine Railhac
- Service de Radiologie, Hl Purpan, Place du Dr Baylac, 31059 Toulouse Cedex 9, France
| | - Frédérique Rety-Jacob
- Service de Radiologie et Imagerie Médicale, Pavillon 3 B, Centre Hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre Benite Cedex, France
| | - Cécile Rochefort-Morel
- Service de Pneumologie, Consultation d'Allergolo-Anesthésie, CHU Pontchaillou, Rue H. Le Guilloux, 35033 Rennes Cedex 09, France
| | - Catherine Roy
- Service de Radiologie B, Pavillon Chirurgical A, Hôpital Civil, 1 place de l'Hôpital, BP 426, 67091 Strasbourg Cedex, France
| | - Philippe Sarlieve
- Service de Radiologie A et C, CHRU Jean Minjoz, 22, Bd A.Flemming, 25030 Besancon Cedex, France
| | - Musa Sesay
- Service de Radiologie, Groupe Hospitalier Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France
| | - Catherine Sgro
- Service de Pharmacologie, CHU de Dijon, Hôpital du Bocage, 2 Bd Mal de Lattre de Tassigny, 21034 Dijon Cedex, France
| | - Patrice Taourel
- Service de Radiologie A, CHU de Montpellier, Hôpital Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Patrick Terrier
- Service de Pneumologie, CHU de Rouen, Hôpital Charles Nicolle, 1, rue Germont, 76031 Rouen Cedex, France
| | - Odile Theissen
- Service d'Anesthésie Réanimation Chirurgicale, Hôpitaux civils, Hôpital Pasteur, Pôle 2, 39 avenue de la liberté, 68024 Colmar Cedex, France
| | - Ingrid Topenot
- Service de Dermatologie, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Jocelyne Valfrey
- Département d'Anesthésie, Hôpital Lyautey, 1 rue des Canonniers, 67100 Strasbourg, France
| | - Francis Veillon
- Service de Radiologie 1, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg Cedex, France
| | - Marie-Claude Vergnaud
- Service de médecine polyvalente, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
| | - Charles Veyret
- Service de Radiologie, CHU de Saint-Etienne, Hôpital Nord, Avenue Albert Raymond, 42055 Saint Etienne Cedex 2, France
| | - Denis Vincent
- Service de Pneumologie – Médecine Interne, Groupe Hospitalo-Universitaire Caremeau, Place du Pr Robert Debré, 30029 Nimes Cedex 9, France
| | - Benoit Wallaert
- Service de Pneumologie, CHR de Lille, Clinique des Maladies Respiratoires, RCO - Hôpital Calmette, Boulevard du Professeur Leclercq, 59037 Lille Cedex, France
| | - François Wessel
- Service de Pneumologie, Hôpital G et R Laënnec, Bd Jacques Monod, 44093 Nantes Cedex 1, France
| | - Marc Zins
- Service de Médecine Interne, Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75674 Paris Cedex 14, France
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de Courson H, Sesay M, Nouette-Gaulain K, Biais M. In Reply. Anesthesiology 2018; 128:1044. [DOI: 10.1097/aln.0000000000002142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Georges D, de Courson H, Lanchon R, Sesay M, Nouette-Gaulain K, Biais M. End-expiratory occlusion maneuver to predict fluid responsiveness in the intensive care unit: an echocardiographic study. Crit Care 2018; 22:32. [PMID: 29415773 PMCID: PMC5804059 DOI: 10.1186/s13054-017-1938-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/27/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In mechanically ventilated patients, an increase in cardiac index during an end-expiratory-occlusion test predicts fluid responsiveness. To identify this rapid increase in cardiac index, continuous and instantaneous cardiac index monitoring is necessary, decreasing its feasibility at the bedside. Our study was designed to investigate whether changes in velocity time integral and in peak velocity obtained using transthoracic echocardiography during an end-expiratory-occlusion maneuver could predict fluid responsiveness. METHODS This single-center, prospective study included 50 mechanically ventilated critically ill patients. Velocity time integral and peak velocity were assessed using transthoracic echocardiography before and at the end of a 12-sec end-expiratory-occlusion maneuver. A third set of measurements was performed after volume expansion (500 mL of saline 0.9% given over 15 minutes). Patients were considered as responders if cardiac output increased by 15% or more after volume expansion. RESULTS Twenty-eight patients were responders. At baseline, heart rate, mean arterial pressure, cardiac output, velocity time integral and peak velocity were similar between responders and non-responders. End-expiratory-occlusion maneuver induced a significant increase in velocity time integral both in responders and non-responders, and a significant increase in peak velocity only in responders. A 9% increase in velocity time integral induced by the end-expiratory-occlusion maneuver predicted fluid responsiveness with sensitivity of 89% (95% CI 72% to 98%) and specificity of 95% (95% CI 77% to 100%). An 8.5% increase in peak velocity induced by the end-expiratory-occlusion maneuver predicted fluid responsiveness with sensitivity of 64% (95% CI 44% to 81%) and specificity of 77% (95% CI 55% to 92%). The area under the receiver operating curve generated for changes in velocity time integral was significantly higher than the one generated for changes in peak velocity (0.96 ± 0.03 versus 0.70 ± 0.07, respectively, P = 0.0004 for both). The gray zone ranged between 6 and 10% (20% of the patients) for changes in velocity time integral and between 1 and 13% (62% of the patients) for changes in peak velocity. CONCLUSIONS In mechanically ventilated and sedated patients in the neuro Intensive Care Unit, changes in velocity time integral during a 12-sec end-expiratory-occlusion maneuver were able to predict fluid responsiveness and perform better than changes in peak velocity.
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Affiliation(s)
- Delphine Georges
- Department of Anesthesiology and Critical Care Pellegrin, Bordeaux University Hospital, F-33000 Bordeaux, France
| | - Hugues de Courson
- Department of Anesthesiology and Critical Care Pellegrin, Bordeaux University Hospital, F-33000 Bordeaux, France
| | - Romain Lanchon
- Department of Anesthesiology and Critical Care Pellegrin, Bordeaux University Hospital, F-33000 Bordeaux, France
| | - Musa Sesay
- Department of Anesthesiology and Critical Care Pellegrin, Bordeaux University Hospital, F-33000 Bordeaux, France
| | - Karine Nouette-Gaulain
- Department of Anesthesiology and Critical Care Pellegrin, Bordeaux University Hospital, F-33000 Bordeaux, France
- INSERM, U12-11, Laboratoire de Maladies Rares: Génétique et Métabolisme (MRGM), Bordeaux, France
- University of Bordeaux, Bordeaux, F-33600 France
| | - Matthieu Biais
- Department of Anesthesiology and Critical Care Pellegrin, Bordeaux University Hospital, F-33000 Bordeaux, France
- University of Bordeaux, Bordeaux, F-33600 France
- INSERM, U1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
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Biais M, Larghi M, Henriot J, de Courson H, Sesay M, Nouette-Gaulain K. End-Expiratory Occlusion Test Predicts Fluid Responsiveness in Patients With Protective Ventilation in the Operating Room. Anesth Analg 2017; 125:1889-1895. [DOI: 10.1213/ane.0000000000002322] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Lanchon R, Nouette-Gaulain K, Stecken L, Sesay M, Lefrant JY, Biais M. Dynamic arterial elastance obtained using arterial signal does not predict an increase in arterial pressure after a volume expansion in the operating room. Anaesth Crit Care Pain Med 2017; 36:377-382. [DOI: 10.1016/j.accpm.2017.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/08/2017] [Accepted: 05/17/2017] [Indexed: 11/29/2022]
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Biais M, Mazocky E, Stecken L, Pereira B, Sesay M, Roullet S, Quinart A, Sztark F. Impact of Systemic Vascular Resistance on the Accuracy of the Pulsioflex Device. Anesth Analg 2017; 124:487-493. [DOI: 10.1213/ane.0000000000001591] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bougouin W, Marijon E, Planquette B, Karam N, Dumas F, Celermajer D, Jost D, Lamhaut L, Beganton F, Cariou A, Meyer G, Jouven X, Bureau C, Charpentier J, Salem OBH, Guillemet L, Arnaout M, Ferre A, Geri G, Mongardon N, Pène F, Chiche JD, Mira JP, Labro G, Belon F, Luu VP, Chenet J, Besch G, Puyraveau M, Piton G, Capellier G, Martin M, Lascarrou JB, Le Thuaut A, Lacherade JC, Martin-Lefèvre L, Fiancette M, Vinatier I, Lebert C, Bachoumas K, Yehia A, Henry-Laguarrigue M, Colin G, Reignier J, Privat E, Escutnaire J, Dumont C, Baert V, Vilhelm C, Hubert H, Robert-Edan V, Lakhal K, Quartin A, Hobbs B, Cely C, Bell C, Pham T, Schein R, Geng Y, Ng C, Ehrmann S, Gandonnière CS, Boisramé-Helms J, Le Tilly O, De Bretagne IB, Mercier E, Mankikian J, Bretagnol A, Meziani F, Halimi JM, Le Guellec CB, Gaudry S, Hajage D, Tubach F, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Mayaux J, Nseir S, Ricard JD, Dreyfuss D, Robert R, Garzotto F, Kipnis E, Tetta C, Ronco C, Schnell D, Aurelie B, Reynaud M, Clec’h C, Benyamina M, Vincent F, Mariat C, Bornstain C, Gloulou O, Boussarsar M, Zelmat SA, Batouche DD, Chaffi B, Mazour F, Benatta N, Fathallah I, Aloui R, Zoubli A, Rouleau S, Kouraichi N, Fathallah I, Kouraichi N, Salem S, Vicaut E, Megarbane B, Ambroise D, Loriot AM, Bourgogne E, Megarbane B, Leroy C, Ghadhoune H, Jihene G, Trabelsi I, Allouche H, Brahmi H, Samet M, Ghord HE, Lebeau R, Laplanche JL, Benturquia N, Cohen Y, Megarbane B, Blel Y, M’rad A, Essafi F, Benabderrahim A, Jouffroy R, Resiere D, Sanchez B, Inamo J, Megarbane B, Morel J, Batouche DD, Zerhouni A, Tabeliouna K, Negadi A, Mentouri Z, Le Gall F, Hanouz JL, Normand H, Khoury A, Sall FS, Legrand M, De Luca A, Pugin A, Pazart L, Vidal C, Leroux F, Khoury A, L’Her E, Marjanovic N, Khoury A, Desmettre T, Terreaux J, Lambert C, Ragey SP, Baboi L, Bazin JE, Koffel C, Dhonneur G, Bouzit Z, Bradai L, Ayed IB, Aissa F, Darmon M, Haouache H, Marechal Y, Biston P, Piagnerelli M, Bortolotti P, Colling D, Colas V, Voisin B, Dewavrin F, Onimus T, Cantier M, Girardie P, Saulnier F, Urbina T, Nguyen Y, Druoton AL, Soudant M, Barraud D, Conrad M, Cravoisy-Popovic A, Nace L, Morisot A, Bollaert PE, Martin R, Bitker L, Richard JC, Brossier D, Goyer I, Marquis C, Lampin M, Duhamel A, Béhal H, Guérot E, Dhaoui T, Godeffroy V, Devouge E, Evrard D, Delepoulle F, Racoussot S, Grandbastien B, Lampin M, Heilbronner C, Roy E, Canet E, Masson A, Hadchouel-Duvergé A, Rigourd V, Delacroix E, Wroblewski I, Pin I, Ego A, Payen V, Debillon T, Millet A, De Montmollin E, Denot J, Berthelot V, Thueux E, Reymond M, De Larrard A, Amblard A, Leger PL, Aoul NT, Lemiale V, Oziel J, Voiriot G, Brule N, Moreau AS, Marhbène T, Sellami S, Jamoussi A, Ayed S, Mhiri E, Slim L, Khelil JB, Besbes M, Neuville M, Chawki S, Hamdi A, Ciroldi M, Cottereau A, Obadia E, Zerbib Y, Andrejak C, Ricome S, Dupont H, Baudin F, Timsit JF, Dureau P, Tanguy A, Arbelot C, Ben HK, Charfeddine A, Granger B, Laporte L, Hermetet C, Regaieg K, Khemakhem R, Sonneville R, Chelly H, Cheikh CM, Mountij H, Rghioui K, Haddad W, Cherkab R, Barrou H, Naima A, bennani OM, Regaieg K, Fayssoil A, Douib A, Samet A, Cungi PJ, Nguyen C, Cotte J, D’aranda E, Meaudre E, Avaro JP, Slaoui MT, Mokline A, Stojkovic T, Rahmani I, Laajili A, Amri H, Gharsallah L, Gasri B, Tlaili S, Hammouda R, Messadi AA, Behin A, Ogna A, Lofaso F, Laforet P, Wahbi K, Prigent H, Duboc D, Orlikowski D, Eymard B, Annane D, Le Guennec L, Cholet C, Bréchot N, Hekimian G, Besset S, Lebreton G, Nieszkowska A, Trouillet JL, Leprince P, Combes A, Luyt CE, Griton M, Sesay M, De Panthou NS, Bienvenu T, Biais M, Nouette-Gaulain K, Fossat G, Baudin F, Coulanges C, Bobet S, Dupont A, Courtes L, Benzekri D, Kamel T, Muller G, Bercault N, Barbier F, Runge I, Skarzynski M, Mathonnet A, Boulain T, Jouan Y, Teixera N, Hassen-Khodja C, Guillon A, Gaborit C, Grammatico-Guillon L, Rebière C, Azoulay E, Misset B, Ruckly S, Garrouste-Orgeas M, Kentish-Barnes N, Duranteau J, Thuong M, Joseph L, Renault A, Lesieur O, Larbi AGS, Viquesnel G, Zuber B, Marque S, Kandelman S, Pichon N, Floccard B, Galon M, Chevret S, Kentish-Barnes N, Seegers V, Legriel S, Jaber S, Lefrant JY, Reuter D, Guisset O, Cracco C, Seguin A, Durand-Gasselin J, Thirion M, Cohen-Solal Z, Foulgoc H, Rogier J, Delobbe E, Schortgen F, Asfar P, Julie BH, Grimaldi D, Fabien G, Anguel N, Sigismond L, Matthieu HL, Gonzalez F, François L, Guitton C, Schenck M, Jean-Marc D, Radermacher P, Kentish-Barnes N, Makunza JN, Nathalie MK, Pierre A, Adolphe KM, Mahieu R, Reydel T, Jamet A, Chudeau N, Huntzinger J, Grange S, Courte A, Lemarie J, Gibot S, Champey J, Dellamonica J, Du Cheyron D, Contou D, Tadié JM, Cour M, Beduneau G, Marchalot A, Guérin L, Jochmans S, Terzi N, Preau S, Brun-Buisson C, Dessap AM, Vedrenne-Cloquet M, Breinig S, Jung C, Brussieux M, Marcoux MO, Durrmeyer X, Blondé R, Angoulvant F, Grasset J, Naudin J, Dauger S, Remy S, Kolev-Descamp K, Demaret J, Monneret G, Javouhey E, Chomton M, Sauthier M, Vallieres E, Jouvet P, Geslain G, Guellec I, Rambaud J, Schmidt M, Schellongowski P, Dorget A, Patroniti N, Taccone FS, Miranda DR, Reuter J, Prodanovic H, Pierrot M, Balik M, Park S, Guérin C, Papazian L, Jean R, Ayzac L, Loundou A, Forel JM, Mezidi M, Aublanc M, Perinel-Ragey S, Lissonde F, Louf-Durier A, Tapponnier R, Yonis H, Coudroy R, Frat JP, Boissier F, Thille AW, Richard F, Le Gullou-Guillemette H, Fahri J, Kouatchet A, Bodet-Contentin L, Garot D, Le Pennec D, Vecellio L, Tavernier E, Dequin PF, Messika J, Martin Y, Maquigneau N, Puechberty C, Stoclin A, Villard S, Dechanet A, De Jong A, Monnin M, Girard M, Chanques G, Molinari N, Decavèle M, Campion S, Ainsouya R, Niérat MC, Raux M, Similowski T, Demoule A, Razazi K, Tchir M, May F, Carteaux G, Pauline RB, Marc A, Bedos JP, Mehrsa K, Mauger-Briche C, Mijon F, Trouiller P, Sztrymf B, Cretallaz P, Mermillod-Blondin R, Savary D, Sedghiani I, Doghri H, Jendoubi A, Hamdi D, Cherif MA, Hechmi YZE, Zouheir J, Persico N, Maltese F, Ferrigno C, Bablon A, Marmillot C, Roch A, Sedghiani I, Papin G, Gainnier M, Argaud L, Christophe A, Souweine B, Goldgran-Toledano D, Marcotte G, Dumenil AS, Carole S, Cecchini J, Tuffet S, Fartoukh M, Roux D, Thyrault M, Armand MD, Chauveau S, Wesner N, Monnier-Cholley L, Bigé N, Ait-Oufella H, Guidet B, Dubée V, Labroca P, Lemarié J, Chiesa G, Laroyenne I, Borrini L, Klotz R, Sy QP, Cristina MC, Paysant J, Fillâtre P, Gacouin A, Revest M, Tattevin P, Flecher E, Le Tulzo Y, Jamme M, Daviaud F, Marin N, Thy M, Duceau B, Ardisson F, Sandrine V, Venot M, Schlemmer B, Zafrani L, Pons S, Styfalova L, Bouadma L, Radjou A, Lebut J, Mourvillier B, Dorent R, Dilly MP, Nataf P, Wolff M, Le Gall A, Bourcier S, Tandjaoui-Lambiotte Y, Das V, Alves M, Bigé N, Kamilia C, Rania A, Baccouch N, Turki O, Ben HC, Bahloul M, Bouaziz M, Dupuis C, Perozziello A, Letheulle J, Valette M, Herrmann-Storck C, Crosby L, Elkoun K, Madeux B, Martino F, Migueres H, Piednoir P, Posch M, Thiery G, Huynh-Ky MT, Bouchard PA, Sarrazin JF, Lellouche F, Nay MA, Lortat-Jacob B, Rozec B, Colnot M, Belin N, Barrot L, Navellou JC, Patry C, Chaignat C, Claveau M, Claude F, Aubron C, Mcquilten Z, Bailey M, Board J, Buhr H, Cartwright B, Dennis M, Forrest P, Hodgson C, Mcilroy D, Murphy D, Murray L, Pellegrino V, Pilcher D, Sheldrake J, Tran H, Vallance S, Cooper J, Bombled C, Vidal C, Margetis D, Amour J, Coart D, Dubois J, Van Herpe T, Mesotten D, Bailly S, Lucet J, Lepape A, L’hériteau F, Aupée M, Bervas C, Boussat S, Berger-Carbonne A, Machut A, Savey A, Tudesq JJ, Valade S, Galicier L, De Bazelaire C, Munoz-Bongrand N, Mignard X, Biard L, Mokart D, Nyunga M, Bruneel F, Rabbat A, Perez P, Meert AP, Benoit D, Mariotte E, Ehooman F, Hamidfar-Roy R, Hourmant Y, Mailloux A, Beurton A, Teboul JL, Girroto V, Laura G, Richard C, Monnet X, Dubée V, Merdji H, Dang J, Preda G, Baudel JL, Desnos C, Zeitouni M, Belaroussi I, Parrot A, Blayau C, Fulgencio JP, Quesnel C, Labbe V, De Chambrun MP, Beloncle F, Merceron S, Fedun Y, Lecomte B, Devaquet J, Puidupin M, Verdière B, Amoura Z, Vuillard C, Xavier J, Bourlier D, David A, Caroline S, David M, Gerald S, Olivier S, Humbert M, Laurent S, Dujardin O, Bouglé A, Ait HN, Salem JE, El-Helali N, Coppere Z, Gibelin A, Taconet C, Djibre M, Maamar A, Colobert E, Fillatre P, Uhel F, Camus C, Moraly J, Dahoumane R, Maury E, Tan BK, Emmanuel V, Pauline M, Laurence P, Philippe P, Zahar JR, Catherine H, Christian P, Karim AB, Mounia H, Laura T, Rasoldier VH, Mager G, Eraldi JP, Gelinotte S, Bougerol F, Dehay J, Rigaud JP, Declercq PL, Michel J, Aissa N, Henard S, Guerci P, Latar I, Levy B, Girerd N, Kimmoun A, Abdallah SB, Nakaa S, Hraiech K, Braiek DB, Adhieb A, M’ghirbi A, Ousji A, Hammouda Z, Abroug F, Sellami W, Hajjej Z, Samoud W, Labbene I, Ferjani M, Medhioub FK, Allela R, Algia NB, Cherif S, Attia D, Herinjatovo A, Francois XL, Bouhouri MA, Slaoui MT, Soufi A, Khaleq K, Hamoudi D, Nsiri A, Harrar R, Maury E, Goursaud S, Gauberti M, Labeyrie PE, Gaberel T, Agin V, Maubert E, Vivien D, Gakuba C, Armel A, Abdou R, Kalouch S, Yaqini K, Chlilek A, Sellami W, Yedder SB, Tonnelier A, Hervé F, Halley G, Frances JL, Moriconi M, Saoli M, Garnero A, Demory D, Arnal JM, Canoville B, Daubin C, Brunet J, Ghezala HB, Snouda S, Ben CI, Kaddour M, Ouanes I, Marzouk M, Haniez F, Jaillet H, Maas H, Andrivet P, Darné C, Viau F, Ghezala HB, Ouanes I, Dangers L, Montlahuc C, Perbet S, Ouanes I, Hamouda Z, Nakee S, Ouanes-Besbes L, Meddeb K, Khedher A, Sma N, Ayachi J, Khelfa M, Fraj N, Lakhal HB, Hammed H, Boukadida R, Hafsa H, Chouchene I, Boussarsar M, Ben BD, Ouanes-Besbes L, Benatti K, Dafir A, Aissaoui W, Elallame W, Haddad W, Cherkab R, Elkettani C, Barrou L, Hamou ZA, Repessé X, Charron C, Aubry A, Paternot A, Maizel J, Slama M, Vieillard-Baron A, Trifi A, Abdellatif S, Fatnassi M, Daly F, Nasri R, Ismail KB, Lakhal SB, Bazalgette F, Daurat A, Roger C, Muller L, Doyen D, Plattier R, Robert A, Hyvernat H, Bernardin G, Jozwiak M, Gimenez J, Mercado P, Depret F, Tilouch N, Mater H, Habiba BSA, Jaoued O, Gharbi R, Hassen MF, Elatrous S, Pasquier P, Vuillemin Q, Schaal JV, Martinez T, Duron S, Trousselard M, Schwartzbrod PE, Baugnon T, Dupic L, Gout CD, De Saint Blanquat L, Séguret S, Le Ficher G, Orliaguet G, Hubert P, Bigé N, Leblanc G, Briand R, Brousse L, Brunet V, Chatelain L, Prat D, Jacobs F, Demars N, Hamzaoui O, Moneger G, Sztrymf B, Duburcq-Gury E, Satre-Buisson L, Duburcq T, Poissy J, Robriquet L, Jourdain M, Sécheresse T, Miquet M, Simond A, Usseglio P, Hamdaoui Y, Boussarsar M, Desailly V, Brun P, Iglesias P, Huet J, Masseran C, Claudon A, Ebeyer C, Truong T, Tesnière A, Mignon A, Gaudry S, Resiere D, Valentino R, Fabre J, Roze B, Ferge JL, Charbatier C, Marie S, Scholsser M, Aitsatou S, Raad M, Cabie A, Mehdaoui H, Cousin C, Rousseau C, Llitjos JF, Alby-Laurent F, Toubiana J, Belaidouni N, Cherruault M, Tamburini J, Bouscary D, Fert S, Delile E, Besnier E, Coquerel D, Nevière R, Richard V, Tamion F, Wei C, Louis H, Margaux S, Eliane A, Sophie O, Kimmoun A, Riad Z, Coroir M, Rémy B, Camille B, Joffre J, Aegerter P, Ilic D, Ginet M, Pignard C, Nguyen P, Mourey G, Samain E, Pili-Floury S, Jouffroy R, Nicolas C, Alvarez JC, Tomasso M, Philippe P, Raphalen JH, Frédéric JB, Vivien B, Pierre C, Baud F, Fredj H, Blel Y, Brahmi N, Ghezala HB, Hanak AS, Malissin I, Poupon J, Risede P, Chevillard L, Megarbane B, Barghouth M, M’rad A, Hmida MB, Thabet H, Liang H, Callebert J, Lagard C, Megarbane B, Habacha S, Chatbri B, Camillerapp C, Labat L, Soichot M, Garçon P, Goury A, Kerdjana L, Voicu S, Deye N, Megarbane B, Armel A, Anas B, Othman M, Moumine S, Kalouch S, Yakini KK, Chlilek A, Hajji A, Louati A, Khaldi A, Borgi A, Ghali N, Bouziri A, Menif K, Ben JN, Armel A, Brochon J, Dumitrescu M, Thévenot S, Saulnier JP, Husseini K, Laland C, Cremniter J, Bousseau A, Castel O, Brémaud-Csizmadia C, Diss M, Portefaix A, Berthiller J, Gillet Y, Aoul NT, Douah A, Addou Z, Youbi H, Moussati M, Belhabiche K, Mir S, Abada S, Amel Z, Aouffen N, Bouzit Z, Grati AH, Dhonneur GF, Boussarsar M, Lau N, Mezhari I, Roucaud N, Le Meur M, Paulet R, Coudray JM, Ghomari WI, Boumlik R, Peigne V, Daban JL, Boutonnet M, Lenoir B, Yassine H, Mohamed CC, Khalid A, Ihssan M, Said E, Said S, Jazia AB, Fatima J, Wafa S, Maha B, Khaoula BA, Sami T, Abdallah Taeib B, Medhioub FK, Rollet-Cohen V, Sachs P, Merchaoui Z, Renolleau S, Oualha M, Eloi M, Jean S, Demoulin M, Valentin C, Guilbert J, Walti H, Carbajal R, Leger PL, Karaca-Altintas Y, Botte A, Labreuche J, Drumez E, Devos P, Bour F, Leclerc F, Ahmed A, khaled M, Louati A, Aida B, Ammar K, Narjess G, Ahmed H, Asma B, Jaballah NB, Leger PL, Pansiot J, Besson V, Palmier B, Baud O, Cauli B, Charriaut-Marlangue C, Mansuy A, Michel F, Le Bel S, Boubnova J, Ughetto F, Ovaert C, Fouilloux V, Paut O, Jacquet-Lagrèze M, Tiebergien N, Hanna N, Evain JN, Baudin F, Courtil-Teyssedre S, Bompard D, Lilot M, Chardonal L, Fellahi JL, Claverie C, Pouessel G, Dorkenoo A, Renaudin JM, Eb M, Deschildre A, Leteurtre S, Yassine H, Kamal B, Adil O, Ouafa A, Mouhamed M, Rachid C, Lahoucine B, Dachraoui F, Nakkaa S, Zaineb H, Mlika D. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress. Ann Intensive Care 2017. [PMCID: PMC5225387 DOI: 10.1186/s13613-016-0223-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sesay M, Tauzin-Fin P, Biais M, Vignes JR, Nouette-Gaulain K. Abstract PR168. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492569.15917.8d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tauzin-Fin P, Sesay M, Quinart A, Gosse P, Sztark F. Acute coronary syndrome and sinus node arrest complicating preoperative management of pheochromocytoma. J Anaesthesiol Clin Pharmacol 2015; 31:431-2. [PMID: 26330745 PMCID: PMC4541213 DOI: 10.4103/0970-9185.161749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Carlucci L, Wavasseur T, Bénard A, Sesay M, Delleci C, Goossens D, Vignes JR. Functional variability of sacral roots in bladder control. J Neurosurg Spine 2014; 21:961-5. [DOI: 10.3171/2014.9.spine13667] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Sacral roots are involved in sensory, autonomic, and motor innervation of the lower limbs and perineum. Theoretically, it can be assumed that the S-3 root level innervates the bladder; however, clinical practice shows that this distribution can vary. Few researchers have studied this variability.
Methods
The authors conducted a retrospective study involving 40 patients who underwent surgery requiring an electrophysiological exploration of the sacral roots. They performed stimulations for the monitoring of muscular (3 Hz, 1 V) and bladder responses under cystomanometry (30 Hz, 10 V).
Results
Although the S-3 roots were involved in bladder innervation in all cases, they were exclusively involved (i.e., the only nerve roots involved) in only 8 of 40 cases. In the remaining 32 cases, other sacral nerve roots were involved. The most common association was S-3+S-4 (12 cases), followed by S-2+S-3 (6 cases), S-2+S-3+S-4 (5 cases), and S-3+S-4+S-5 (2 cases). Stimulation of S-2 could sometimes induce bladder contraction (15 cases, 40%); however, the amplitude was often low. S-4 nerve roots were involved in 24 of 40 cases (60%) in the bladder motor function, whereas S-5 roots were only involved 7 times (17%). Occasionally, we noticed a horizontal asymmetry in the response, with a predominant response from the right side in 6 of 7 cases, always with a major S-3 response.
Conclusions
This is the first study showing a significant horizontal and vertical variability in the functional distribution of sacral roots in bladder innervation. These results show the variability of cauda equina syndromes and their forensic implications. These data should help with the monitoring of sacral roots and the performance of several tasks during surgery, including neurostimulation and neuromodulation.
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Affiliation(s)
- Lore Carlucci
- 1Service de Neurochirurgie A, Hôpital Pellegrin, CHU de Bordeaux, and Université Bordeaux Ségalen, Bordeaux
| | - Thomas Wavasseur
- 1Service de Neurochirurgie A, Hôpital Pellegrin, CHU de Bordeaux, and Université Bordeaux Ségalen, Bordeaux
| | - Antoine Bénard
- 3CHU de Bordeaux, Pôle de Santé Publique, USMR et CIC-EC 7, Bordeaux, France,
| | - Musa Sesay
- 2Department of Anesthesia, Hôpital Pellegrin, CHU de Bordeaux
| | - Claire Delleci
- 4Service de Médecine Physique et Réadaptation, Hôpital Tastet Girard, CHU de Bordeaux; and
| | - David Goossens
- 5Service de Médecine Physique et Réadaptation, Tour de Gassies, Bruges, France
| | - Jean-Rodolphe Vignes
- 1Service de Neurochirurgie A, Hôpital Pellegrin, CHU de Bordeaux, and Université Bordeaux Ségalen, Bordeaux
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Tauzin-Fin P, Bernard O, Sesay M, Biais M, Richebe P, Quinart A, Revel P, Sztark F. Benefits of intravenous lidocaine on post-operative pain and acute rehabilitation after laparoscopic nephrectomy. J Anaesthesiol Clin Pharmacol 2014; 30:366-72. [PMID: 25190945 PMCID: PMC4152677 DOI: 10.4103/0970-9185.137269] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Intravenous (I.V.) lidocaine has analgesic, antihyperalgesic and anti-inflammatory properties and is known to accelerate the return of bowel function after surgery. We evaluated the effects of I.V. lidocaine on pain management and acute rehabilitation protocol after laparoscopic nephrectomy. MATERIALS AND METHODS A total of 47 patients scheduled to undergo laparoscopic nephrectomy were included in a two-phase observational study where I.V. lidocaine (1.5 mg/kg/h) was introduced, in the second phase, during surgery and for 24 h post-operatively. All patients underwent the same post-operative rehabilitation program. Post-operative pain scores, opioid consumption and extent of hyperalgesia were measured. Time to first flatus and 6 min walking test (6MWT) were recorded. RESULTS Patient demographics were similar in the two phases (n = 22 in each group). Lidocaine significantly reduced morphine consumption (median [25-75% interquartile range]; 8.5 mg[4567891011121314151617] vs. 25 mg[1920212223242526272829303132]; P < 0.0001), post-operative pain scores (P < 0.05) and hyperalgesia extent on post-operative day 1-day 2-day 4 (mean ± standard deviation (SD); 1.5 ± 0.9 vs. 4.3 ± 1.2 cm (P < 0.001), 0.6 ± 0.5 vs. 2.8 ± 1.2 cm (P < 0.001) and 0.13 ± 0.3 vs. 1.2 ± 1 cm (P < 0.001), respectively). Time to first flatus (mean ± SD; 29 ± 7 h vs. 48 ± 15 h; P < 0.001) and 6MWT at day 4 (189 ± 50 m vs. 151 ± 53 m; P < 0.001) were significantly enhanced in patients with i.v. lidocaine. CONCLUSION Intravenous (I.V.) lidocaine could reduce post-operative morphine consumption and improve post-operative pain management and post-operative recovery after laparoscopic nephrectomy. I.V. lidocaine could contribute to better post-operative rehabilitation.
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Affiliation(s)
- Patrick Tauzin-Fin
- Department of Anesthesiology, Bordeaux University Hospital, Place Amélie Raba Léon, Bordeaux cedex, France
| | - Olivier Bernard
- Department of Anesthesiology, Bordeaux University Hospital, Place Amélie Raba Léon, Bordeaux cedex, France
| | - Musa Sesay
- Department of Anesthesiology, Bordeaux University Hospital, Place Amélie Raba Léon, Bordeaux cedex, France
| | - Matthieu Biais
- Department of Anesthesiology, Bordeaux University Hospital, Place Amélie Raba Léon, Bordeaux cedex, France
| | - Philippe Richebe
- Department of Anesthesiology, Bordeaux University Hospital, Place Amélie Raba Léon, Bordeaux cedex, France
| | - Alice Quinart
- Department of Anesthesiology, Bordeaux University Hospital, Place Amélie Raba Léon, Bordeaux cedex, France
| | - Philippe Revel
- Department of Anesthesiology, Bordeaux University Hospital, Place Amélie Raba Léon, Bordeaux cedex, France
| | - Francois Sztark
- Department of Anesthesiology, Bordeaux University Hospital, Place Amélie Raba Léon, Bordeaux cedex, France
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Kolanek B, Svartz L, Robin F, Boutin F, Beylacq L, Lasserre A, Krol-Houdek MC, Berger V, Altuzarra V, Jecker O, Sesay M, Mertes PM, Rossignol R, Nouette-Gaulain K. Management program decreases postoperative nausea and vomiting in high-risk and in general surgical patients: a quality improvement cycle. Minerva Anestesiol 2014; 80:337-346. [PMID: 24107833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Preventing postoperative nausea and vomiting (PONV) is a major priority for postsurgical patient care. Our objective was to assess the efficacy of a multimodal postoperative nausea and vomiting (PONV) approach, which was associated with a continuous quality improvement program, in maintaining a low PONV incidence in the PACU. METHODS Consecutive adult patients scheduled for surgery (ambulatory surgery or not) were prospectively included. PONV data were recorded in the PACU and over a 24-hour period. The management program was based on a multimodal approach with both changes in anesthetic techniques and anti-emetics, and on a three-stage protocol including: 1) phase I: institutional practice phase based on prospective observational study; 2) protocol implementation; 3) phase II: prospective observational study associated with feedback, scientific session and evaluation to guideline adherence. We used the Apfel risk scoring system to identify patients at high risk of PONV. Feedback with audit results and didactic sessions were scheduled quarterly in the Phase II. RESULTS Thirty-seven/395 (9.4%) and 151/3864 (3.9%) patients experienced PONV in the PACU during Phase I and Phase II respectively (P<0.001). Among the patients with an Apfel risk score that included at least two risk factors, 16.6% and 4.2% experienced PONV in the PACU during Phase I and Phase II respectively (P<0.001). CONCLUSION We highlight the association with a sharp decrease in PONV incidence over a one-year period and a multimodal PONV approach using feedback to clinicians associated with continuous quality improvement program.
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Affiliation(s)
- B Kolanek
- Université de Bordeaux, Maladies Rares: Génétique et Métabolique, Bordeaux, France -
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Gimbert E, Jecko V, Dautheribes M, Pena D, Penna M, Maachi B, Chehab A, Sesay M, Stockle M, Morel-Lequette L, Joubert C, Kolanek B, Liguoro D, Vignes JR. Réduction du taux de tansfusion lors de la chirurgie des crâniosténoses. Neurochirurgie 2013. [DOI: 10.1016/j.neuchi.2013.10.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sesay M, Robin F, Sesay M, Kolanek B, Pena D, Penna M, Morel L, Nouette-Gaulain K. The analgesia nociception index monitor (ANI) can detect indvertent vagal stimulation during surgery of cerebello-pontine angle tumors. Br J Anaesth 2013. [DOI: 10.1093/bja/el_10195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sesay M. Linsidomime is as potent as Papaverine on isolated Serotonin precontracted human cadaveric arteries. Br J Anaesth 2013. [DOI: 10.1093/bja/el_10044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gense de Beaufort D, Sesay M, Stinus L, Thiebaut R, Auriacombe M, Dousset V. Cerebral blood flow modulation by transcutaneous cranial electrical stimulation with Limoge's current. J Neuroradiol 2011; 39:167-75. [PMID: 21835468 DOI: 10.1016/j.neurad.2011.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 06/21/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Transcutaneous cranial electrical stimulation (TCES) delivers a high-frequency (166 kHz) pulsed biphasic balanced current with a pulse repetition frequency of 100 Hz with 40% duty cycle through a negative electrode and two positive electrodes over the skull. TCES has a proven ability to potentiate anesthesia and analgesia, although the physiological mechanisms of this effect remain unclear. We hypothesized that the mechanism is a modulation of CBF in the central endogenous opioid system. This study aimed at determining the effects of TCES on CBF to elucidate its physiological mechanism. METHODS Thirty-six healthy volunteers were randomly assigned to active or placebo TCES, and all assessments were double blind. TCES was performed using the Anesthelec™ device. In the stimulated group, an active cable was used, and in the control group (sham), the cable was inactive. CBF was measured by XeCT™ before and after two hours of TCES. RESULTS Globally, CBF was unchanged by TCES. However, locally, TCES induced a significant CBF decrease in the brainstem and thalamus, which are structures involved in pain and anxiety (TCES and control CBF decrease were 18.5 and 11.9 mL/100g brain tissue/min, respectively). CONCLUSION TCES can modulate local CBF but it has no effect on overall CBF. [Clinical Trials. gov number: NCT00273663].
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Affiliation(s)
- D Gense de Beaufort
- Service de Neuroradiologie, Hôpital Pellegrin, Place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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Sacko O, Lauwers-Cances V, Brauge D, Sesay M, Brenner A, Roux FE. Awake Craniotomy vs Surgery Under General Anesthesia for Resection of Supratentorial Lesions4. Neurosurgery 2011; 68:1192-8; discussion 1198-9. [DOI: 10.1227/neu.0b013e31820c02a3] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
The use of an awake craniotomy in the treatment of supratentorial lesions is a challenge for both patients and staff in the operation theater.
OBJECT:
To assess the safety and effectiveness of an awake craniotomy with brain mapping in comparison with a craniotomy performed under general anesthesia.
METHODS:
We prospectively compared 2 groups of patients who underwent surgery for supratentorial lesions: those in whom an awake craniotomy with intraoperative brain mapping was used (AC group, n = 214) and those in whom surgery was performed under general anesthesia (GA group, n = 361, including 72 patients with lesions in eloquent areas). The AC group included lesions in close proximity to the eloquent cortex that were surgically treated on an elective basis.
RESULTS:
Globally, the 2 groups were comparable in terms of sex, age, American Society of Anesthesiologists score, pathology, size of lesions, quality of resection, duration of surgery, and neurological outcome, and different in tumor location and preoperative neurological deficits (higher in the AC group). However, specific data analysis of patients with lesions in eloquent areas revealed a significantly better neurological outcome and quality of resection (P < .001) in the AC group than the subgroup of GA patients with lesions in eloquent areas. Surgery was uneventful in AC patients and they were discharged home sooner.
CONCLUSION:
AC with brain mapping is safe and allows maximal removal of lesions close to functional areas with low neurological complication rates. It provides an excellent alternative to craniotomy under GA.
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Affiliation(s)
- Oumar Sacko
- UMR Unité 825, Faculté Paul Sabatier, IFR 96
- Pole Neurosciences, Centres Hospitalo-Universitaires de Toulouse, Toulouse, France
| | - Valérie Lauwers-Cances
- Service de Statistiques et d'Epidémiologie, Centres Hospitalo-Universitaires de Toulouse, Toulouse, France
| | - David Brauge
- Pole Neurosciences, Centres Hospitalo-Universitaires de Toulouse, Toulouse, France
| | - Musa Sesay
- Pole d'anesthesie, CHU Pellegrin, Bordeaux, France
| | | | - Franck-Emmanuel Roux
- UMR Unité 825, Faculté Paul Sabatier, IFR 96
- Pole Neurosciences, Centres Hospitalo-Universitaires de Toulouse, Toulouse, France
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Sacko O, Bouillot-Eimer S, Sesay M, Uro-Coste E, Roux FE, Loiseau H. Hemangioblastoma of the corpus callosum: A case report and review of the literature on its origin. Neurochirurgie 2009; 56:382-5. [PMID: 20045160 DOI: 10.1016/j.neuchi.2009.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 06/29/2009] [Indexed: 10/20/2022]
Abstract
A third case of corpus callosum hemangioblastoma (HB) is presented. With no preoperative embolization, surgery was uneventful and the postoperative course was excellent. Based on the literature, we attempted to clarify the histogenesis of HB and to explain why they are exceptional in the supratentorial region in contrast to the posterior cranial fossa. The VHL gene is expressed particularly in Purkinje cells of the cerebellum, but this expression is also possible in supratentorial structures. Its mutation leads to developmental arrest of angioblasts that become potentially neoplastic cells. These CD133-positive pluripotent neoplastic angioblasts, similar to stem cells, may be immature HB in the brain. They also express VEGF, coexpress Epo/EpoR, and are capable of differentiation into primitive vascular structures. This coexpression may not only mediate developmental stagnation, but may also induce HB proliferation. Therefore, HB tumorigenesis may be initiated during embryogenesis and may originate from angiomesenchyma because of the expression of three cell types (stromal cells, pericytes, and endothelial cells) in vimentin. Their capacity for proliferation and differentiation in HB depends on the microenvironment.
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Affiliation(s)
- O Sacko
- Department of Neurosurgery, Pellegrin University Hospital, 33076 Bordeaux, France.
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Sesay M, Jeannin A, Moonen C, Dousset V, Maurette P. Pharmacological control of head motion during cerebral blood flow imaging with CT or MRI. J Neuroradiol 2009; 36:170-3. [DOI: 10.1016/j.neurad.2008.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tauzin-Fin P, Sesay M, Svartz L, Krol-Houdek MC, Maurette P. Wound infiltration with magnesium sulphate and ropivacaine mixture reduces postoperative tramadol requirements after radical prostatectomy. Acta Anaesthesiol Scand 2009; 53:464-9. [PMID: 19226292 DOI: 10.1111/j.1399-6576.2008.01888.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE This prospective, randomized, double-dummy study was undertaken to compare the effects of magnesium sulphate (MgSO(4)) administered by the intravenous vs. the infiltration route on postoperative pain and analgesic requirements. METHODS Forty ASA I or II men scheduled for radical retropubic prostatectomy under general anaesthesia were randomized into two groups (n=20 each). Two medication sets A and B were prepared at the pharmacy. Each set contained a minibag of 50 ml solution for IV infusion and a syringe of 45 ml for wound infiltration. Group MgSO(4).IV patients received set A with 50 mg/kg MgSO(4) in the minibag and 190 mg of ropivacaine in the syringe. Group MgSO(4)/L received set B with isotonic saline in the minibag and 190 mg of ropivacaine +750 mg of MgSO(4) in the syringe. The IV infusion was performed over 30 min at induction of anaesthesia and the surgical wound infiltration was performed during closure. Pain was assessed every 4 h, using a 100-point visual analogue scale (VAS). Postoperative analgesia was standardized using IV paracetamol (1 g/6 h) and tramadol was administered via a patient-controlled analgesia system. The follow-up period was 24 h. RESULTS The total cumulative tramadol consumption was 221 +/- 64.1 mg in group MgSO4.IV and 134 +/- 74.9 mg in group MgSO(4).L (P<0.01). VAS pain scores were equivalent in the two groups throughout the study. No side-effects, due to systemic or local MgSO(4) administration, were observed. CONCLUSION Co-administration of MgSO(4) with ropivacaine for postoperative infiltration analgesia after radical retropubic prostatectomy produces a significant reduction in tramadol requirements.
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Affiliation(s)
- P Tauzin-Fin
- DAR III, Hôpital Pellegrin-Tripode Bordeaux, Place Amélie Raba-Léon, Bordeaux Cedex, France.
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Sacko O, Haegelen C, Mendes V, Brenner A, Sesay M, Brauge D, Lagarrigue J, Loiseau H, Roux FE. SPINAL MENINGIOMA SURGERY IN ELDERLY PATIENTS WITH PARAPLEGIA OR SEVERE PARAPARESIS. Neurosurgery 2009; 64:503-9; discussion 509-10. [DOI: 10.1227/01.neu.0000338427.44471.1d] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
OBJECTIVE
In a multicenter study, 102 patients aged 70 years or older with paraplegia or severe paraparesis, and who underwent operation for spinal meningiomas, are presented to correlate surgery and outcome and to determine the most influential factors that affected this outcome.
METHODS
Five French neurosurgical centers participated in this retrospective study between 1990 and 2007. Pre- and postoperative neurological status were assessed using a grading system. All patients underwent operation, and neurological evaluations were conducted 3 months and 1 year after surgery. The median follow-up period was 49.5 months (range, 12–169 months). Data were analyzed using a multiple logistic regression model.
RESULTS
Twenty-six patients were paraplegic (Grade 4). Complete tumor removal was obtained in 93 patients. There was no surgical mortality, and morbidity was 9%. Three months after surgery, 7 of the patients were unchanged, 87 patients had improved, and 8 were not evaluated. One year after surgery, 7 of the 100 surviving patients were clinically unchanged and 93 had improved. Of those who had improved, 49 patients experienced complete recovery.
CONCLUSION
Advanced age did not seem to contraindicate surgery, even in patients with severe preoperative neurological deficits and/or an American Society of Anesthesiologists class of III. Quality of life can be improved in most cases.
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Affiliation(s)
- Oumar Sacko
- Department of Neurosurgery, Purpan University Hospital, Toulouse, France
- Université Paul-Sabatier, Toulouse, France
| | - Claire Haegelen
- Department of Neurosurgery, Rennes University Hospital, Rennes, France
| | - Vivien Mendes
- Department of Neurosurgery, Centres Hospitalo-universitaires, Clermont Ferrand, France
| | | | - Musa Sesay
- Department of Neuroanesthesiology, Pellegrin University Hospital, Bordeaux, France
| | - David Brauge
- Department of Neurosurgery, Purpan University Hospital, Toulouse, France
| | - Jacques Lagarrigue
- Department of Neurosurgery, Purpan University Hospital, Toulouse, France
- Université Paul-Sabatier, Toulouse, France
- Department of Neurosurgery, Rangueil University Hospital, Toulouse, France
| | - Hugues Loiseau
- Department of Neurosurgery, Pellegrin University Hospital, and Université Victor Segalen Bordeaux 2, Bordeaux, France
| | - Franck-Emmanuel Roux
- Department of Neurosurgery, Purpan University Hospital, Toulouse, France
- Université Paul-Sabatier, Toulouse, France
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Vignes J, Sesay M, Rezajooi K, Gimbert E, Liguoro D. Peritumoral edema and prognosis in intracranial meningioma surgery. J Clin Neurosci 2008; 15:764-8. [DOI: 10.1016/j.jocn.2007.06.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 05/24/2007] [Accepted: 05/30/2007] [Indexed: 12/01/2022]
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Sesay M, Tauzin-Fin P, Verdonck O, Dousset V, Maurette P. A wireless remote controlled infusion pump for anaesthesia during magnetic resonance imaging. Br J Anaesth 2008; 100:862-3. [DOI: 10.1093/bja/aen115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sesay M. A Wireless Remote Controlled Infusion Pump for Anaesthesia during Magnetic Resonance Imaging. Br J Anaesth 2008. [DOI: 10.1093/bja/el_2802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sesay M, Tauzin-Fin P, Gosse P, Ballanger P, Maurette P. Real-Time Heart Rate Variability and Its Correlation with Plasma Catecholamines During Laparoscopic Adrenal Pheochromocytoma Surgery. Anesth Analg 2008; 106:164-70, table of contents. [DOI: 10.1213/01.ane.0000289531.18937.0a] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sacko O, Sesay M, Roux FE, Riem T, Grenier B, Liguoro D, Loiseau H. INTRACRANIAL MENINGIOMA SURGERY IN THE NINTH DECADE OF LIFE. Neurosurgery 2007; 61:950-4; discussion 955. [DOI: 10.1227/01.neu.0000303190.80049.7d] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
The aims of this study are to assess the surgical outcome of elderly patients aged 80 years or more, to analyze the factors influencing postoperative course, and to propose a grading system to standardize the surgical indication of intracranial meningioma in the elderly.
METHODS
Between 1990 and 2005, we surgically treated 74 consecutive patients aged 80 years or more for intracranial meningiomas (47 women, 27 men; mean age, 82 yr; age range, 80–90 yr). The median follow-up period was 94 months (range, 15–147 mo). We retrospectively analyzed the factors influencing surgical outcome and retained the significant factors to form the Sex, Karnofsky Performance Scale, American Society of Anesthesiology Class, Location of Tumor, and Peritumoral Edema (SKALE) grading system.
RESULTS
There was no perioperative mortality, and the 1-year mortality rate was 9.4%. Postoperative mortality was lower in women with a Karnofsky Performance Scale score of 60 or greater, an American Society of Anesthesiology Class of 1 or 2, a noncritical tumor location, and a moderate or absent peritumoral edema. Patients with a SKALE score of more than 8 had an excellent outcome, whereas those with a SKALE score of less than 8 had a poor outcome. The rate of postoperative complications was 9.4%. Large tumors, critical locations, severe peritumoral edema, and total surgical excision were associated with a higher risk of postoperative complications.
CONCLUSION
Surgery of intracranial meningioma in elderly patients is feasible when the SKALE score is 8 or greater. Prospective studies are required to validate this grading system.
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Affiliation(s)
- Oumar Sacko
- Department of Neurosurgery, Pellegrin University Hospital, Bordeaux, France
| | - Musa Sesay
- Department of Anesthesiology, Pellegrin University Hospital, Bordeaux, France
| | | | - Tanguy Riem
- Department of Neurosurgery, Pellegrin University Hospital, Bordeaux, France
| | - Bruno Grenier
- Department of Anesthesiology, Pellegrin University Hospital, Bordeaux, France
| | - Dominique Liguoro
- Department of Neurosurgery, Pellegrin University Hospital, Bordeaux, France
| | - Hugues Loiseau
- Department of Neurosurgery, Pellegrin University Hospital, Bordeaux, France
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Tauzin-Fin P, Sesay M, Svartz L, Krol-Houdek MC, Maurette P. Sublingual oxybutynin reduces postoperative pain related to indwelling bladder catheter after radical retropubic prostatectomy †. Br J Anaesth 2007; 99:572-5. [PMID: 17681969 DOI: 10.1093/bja/aem232] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Bladder discomfort related to an indwelling catheter can exacerbate postoperative pain. It mimics overactive bladder syndrome that is resistant to conventional opioid therapy. Muscarinic receptor antagonists are effective for treatment of the overactive bladder. The aim of this study was to assess the efficacy of oxybutynin in the management of postoperative pain after radical prostatectomy. METHOD Forty-six ASA I or II men undergoing radical retropubic prostatectomy under general anaesthesia were randomly assigned to two groups, in a double-blind fashion: Group O and Group P (n = 23 each). Group O and Group P received, respectively, sublingual oxybutynin 5 mg or placebo every 8 h during the 24 h after surgery. A 16F Foley catheter was placed during the vesico-urethral anastomosis and the balloon inflated with 10 ml of saline. Pain was assessed in the recovery room starting 10 min after extubation using a 100-point visual analogue scale (VAS). The patients were asked to specify whether pain was related to the surgical incision or bladder pain. Standardized postoperative analgesia included acetaminophen and tramadol administered via a patient-controlled analgesia system. RESULTS The incidence of bladder catheter pain was 65% (15 of 23 patients) in Group P compared with 17% (4 of 23 patients) in Group O (P < 0.01). Overall VAS scores at rest were significantly lower in Group O. Cumulative tramadol consumption was 322.9(124.3) mg [mean(sd)] in Group P and 146(48) mg in Group O (P < 0.01). No oxybutynin-related side-effects were reported. CONCLUSIONS Sublingual oxybutynin is an effective treatment for postoperative pain after radical retropubic prostatectomy and produces a significant reduction in tramadol requirements.
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Affiliation(s)
- P Tauzin-Fin
- DAR III, Hôpital Pellegrin-Tondu Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux cedex, France.
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Tauzin-Fin P, Sesay M, Delort-Laval S, Krol-Houdek MC, Maurette P. Intravenous magnesium sulphate decreases postoperative tramadol requirement after radical prostatectomy*. Eur J Anaesthesiol 2006; 23:1055-9. [PMID: 16834789 DOI: 10.1017/s0265021506001062] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2006] [Indexed: 11/06/2022]
Abstract
BACKGROUND The purpose of this study was to assess whether the addition of intravenous magnesium sulphate (Mg) at the induction of anaesthesia to a balanced anaesthetic protocol including wound infiltration, paracetamol and tramadol resulted in improved analgesic efficiency after radical prostatectomy. METHODS We conducted a randomized, double-blind, controlled study. Thirty ASA I or II males scheduled to undergo radical retropubic prostatectomy with general anaesthesia were prospectively assigned to one of the two groups (n = 15 each). The Mg group (Gr Mg) received 50 mg kg-1 of MgSO4 in 100 mL of isotonic saline over 20 min immediately after induction of anaesthesia and before skin incision. The patients in the control group (Gr C) received the same volume of saline over the same period. At the time of abdominal closure, wound infiltration with 190 mg (40 mL) of ropivacaine was performed in both groups. Pain was assessed by a 10-point visual analogue scale in the recovery room starting from the time of tracheal extubation. Standardized postoperative analgesia included paracetamol and tramadol administered via a patient-controlled analgesia device. RESULTS In the postoperative period, both groups experienced an identical pain course evolution. Cumulative mean tramadol dose after 24 h was 226 mg in the magnesium group and 446 mg in the control group (P < 0.001). Postoperative nausea occurred in two patients in each group. Two vs. eight patients required analgesic rescue in magnesium and control groups, respectively (P = 0.053). CONCLUSIONS This study shows that intravenous magnesium sulphate reduces tramadol consumption when used as a postoperative analgesic protocol in radical prostatectomy.
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Affiliation(s)
- P Tauzin-Fin
- DAR III Hôpital Pellegrin-Tondu Bordeaux, Bordeaux Cedex, France.
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Wintermark M, Sesay M, Barbier E, Borbély K, Dillon WP, Eastwood JD, Glenn TC, Grandin CB, Pedraza S, Soustiel JF, Nariai T, Zaharchuk G, Caillé JM, Dousset V, Yonas H. Comparative overview of brain perfusion imaging techniques. J Neuroradiol 2006; 32:294-314. [PMID: 16424829 DOI: 10.1016/s0150-9861(05)83159-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Numerous imaging techniques have been developed and applied to evaluate brain hemodynamics. Among these are: Positron Emission Tomography (PET), Single Photon Emission Computed Tomography (SPECT), Xenon-enhanced Computed Tomography (XeCT), Dynamic Perfusion-computed Tomography (PCT), Magnetic Resonance Imaging Dynamic Susceptibility Contrast (DSC), Arterial Spin-Labeling (ASL), and Doppler Ultrasound. These techniques give similar information about brain hemodynamics in the form of parameters such as cerebral blood flow (CBF) or volume (CBV). All of them are used to characterize the same types of pathological conditions. However, each technique has its own advantages and drawbacks. This article addresses the main imaging techniques dedicated to brain hemodynamics. It represents a comparative overview, established by consensus among specialists of the various techniques. For clinicians, this paper should offers a clearer picture of the pros and cons of currently available brain perfusion imaging techniques, and assist them in choosing the proper method in every specific clinical setting.
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Affiliation(s)
- M Wintermark
- Department of Radiology, Neuroradiology Section, University of California, 505 Parnassus Avenue, Room L358, Box 0628, San Francisco, CA 94143-0628, USA.
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Richebé P, Rivalan B, Baudouin L, Sesay M, Sztark F, Cros AM, Maurette P. Comparison of the anaesthetic requirement with target-controlled infusion of propofol to insert the laryngeal tube vs. the laryngeal mask. Eur J Anaesthesiol 2006; 22:858-63. [PMID: 16225722 DOI: 10.1017/s0265021505001456] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE The target effect-site concentration of propofol to insert a laryngeal mask airway was recently reported as almost 5 microg mL(-1). The present study aimed to determine the target effect-site concentration with target-controlled infusion of propofol to place classical larnygeal mask airway or current laryngeal tube in adult patients. METHODS We included 40 patients scheduled for short gynaecological and radiological procedures under general anaesthesia in a randomized, double-blind manner using the Dixon's up-and-down statistical method. Monitoring included standard cardiorespiratory monitors, and bispectral index monitoring was used for all patients. Anaesthesia was conducted with a target-controlled infusion system: Diprifusor. The initial target plasma concentration of propofol was 5 microg mL(-1), and was changed stepwise by 0.5 microg mL(-1) increments according to Dixon's up-and-down method. Criteria for acceptable insertion were: Muzi's score < or = 2, and mean arterial blood pressure, heart rate or bispectral index variation <20% the baseline values. RESULTS Target effect-site concentration of propofol required to insert laryngeal tube was 6.3 +/- 0.3 microg mL(-1) with Dixon method and ED50 was 6.1 microg mL(-1) (5.9-6.4) with logistic regression method. In the case of larnygeal mask airway they were 7.3 +/- 0.2 microg mL(-1) (Dixon method) and 7.3 microg mL(-1) (7.1-7.5; with logistic regression) respectively (P < 0.05). ED95 (logistic regression) was 6.8 microg mL(-1) (5.9-7.6) for laryngeal tube and 7.7 microg mL(-1) (7.3-8.0) for larnygeal mask airway (P < 0.05). Haemodynamic incidents were 55% in the larnygeal mask airway group vs. 30% in the laryngeal tube group (P < 0.05). CONCLUSIONS The target effect-site concentration of propofol for insertion of laryngeal tube was lower than for larnygeal mask airway (P < 0.05), with a consequent reduction of the propofol induced haemodynamic side-effects.
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Affiliation(s)
- P Richebé
- Centre Hospitalier et Universitaire de Bordeaux, Département d'Anesthésie et Réanimation III, Bordeaux Cedex, France.
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Yonas H, Sesay M, Calli C, Liu HM, Lomena F, Nasel C, Meyer JS, Yunten N, Anckarsater H, Wintermark M. The goal is quantitative cerebral blood flow. J Neuroradiol 2005; 32:291-3. [PMID: 16424828 DOI: 10.1016/s0150-9861(05)83158-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wintermark M, Sesay M, Barbier E, Borbély K, Dillon WP, Eastwood JD, Glenn TC, Grandin CB, Pedraza S, Soustiel JF, Nariai T, Zaharchuk G, Caillé JM, Dousset V, Yonas H. Comparative Overview of Brain Perfusion Imaging Techniques. Stroke 2005. [DOI: 10.1161/01.str.0000177839.03321.25] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Max Wintermark
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - Musa Sesay
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - Emmanuel Barbier
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - Katalin Borbély
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - William P. Dillon
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - James D. Eastwood
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - Thomas C. Glenn
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - Cécile B. Grandin
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - Salvador Pedraza
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - Jean-François Soustiel
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - Tadashi Nariai
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - Greg Zaharchuk
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - Jean-Marie Caillé
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - Vincent Dousset
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
| | - Howard Yonas
- From the Department of Radiology (M.W., W.P.D., G.Z.), Neuroradiology Section, University of California, San Francisco; Department of Radiology (M.W.), University Hospital, Lausanne, Switzerland; Department of Neuroradiology (M.S., J.-M.C., V.D.), Pellegrin University Hospital, Bordeaux, France; INSERM (E.B.), Université Joseph Fourier, NeuroImagerie Fonctionnelle et Métabolique, CHU Michallon - Pav. B, Grenoble, France; Department of Nuclear Medicine (K.B.), National Institute of Neurosurgery,
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Wintermark M, Sesay M, Barbier E, Borbély K, Dillon WP, Eastwood JD, Glenn TC, Grandin CB, Pedraza S, Soustiel JF, Nariai T, Zaharchuk G, Caillé JM, Dousset V, Yonas H. Comparative overview of brain perfusion imaging techniques. Stroke 2005; 36:e83-99. [PMID: 16100027 DOI: 10.1161/01.str.0000177884.72657.8b] [Citation(s) in RCA: 328] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Numerous imaging techniques have been developed and applied to evaluate brain hemodynamics. Among these are positron emission tomography, single photon emission computed tomography, Xenon-enhanced computed tomography, dynamic perfusion computed tomography, MRI dynamic susceptibility contrast, arterial spin labeling, and Doppler ultrasound. These techniques give similar information about brain hemodynamics in the form of parameters such as cerebral blood flow or cerebral blood volume. All of them are used to characterize the same types of pathological conditions. However, each technique has its own advantages and drawbacks. SUMMARY OF REVIEW This article addresses the main imaging techniques dedicated to brain hemodynamics. It represents a comparative overview established by consensus among specialists of the various techniques. CONCLUSIONS For clinicians, this article should offer a clearer picture of the pros and cons of currently available brain perfusion imaging techniques and assist them in choosing the proper method for every specific clinical setting.
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Affiliation(s)
- Max Wintermark
- Department of Radiology, University of California, 505 Parnassus Ave, San Francisco, CA 94143-0628, USA.
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Vignes J, Sesay M, De Sèze M, Le Masson G, Joseph P, Nagy F, Liguoro D. Efficacité et tolérance de la Gabapentine intrathécale versus Baclofène intrathécal dans le traitement des douleurs sous- lésionnelles réfractaires, de l’hypertonie spastique et des troubles vésico-sphinctériens associés aux lésions médullaires chez l’homme. Neurochirurgie 2004. [DOI: 10.1016/s0028-3770(04)98418-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cavagn I, Barreau X, Sesay M, Berge J, Dousset V. P-27 Étude de la perfusion cérébrale avant et après angioplastie carotidienne par TDM au xénon. J Neuroradiol 2004. [DOI: 10.1016/s0150-9861(04)96956-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sesay M, Barreau X, Menegon P, Berge J, Caille J, Dousset V. P-26 Mesure tomodensitométrique du débit sanguin cérébral par inhalation du xénon stable. J Neuroradiol 2004. [DOI: 10.1016/s0150-9861(04)96955-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tauzin-Fin P, Sesay M, Gosse P, Ballanger P. Effects of perioperative alpha1 block on haemodynamic control during laparoscopic surgery for phaeochromocytoma. Br J Anaesth 2004; 92:512-7. [PMID: 14766711 DOI: 10.1093/bja/aeh083] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Laparoscopic surgery for phaeochromocytoma can cause excessive catechol amine release with severe hypertension and sinus tachycardia. i.v. calcium antagonists may be used to prevent increases in blood pressure during phaeochromocytoma resection. We investigated the effects of perioperative alpha(1) adrenergic block with urapidil on intraoperative haemodynamic events. The aim was to block the alpha(1) adrenergic receptors before any acute catecholamine release, to prevent any severe rise in blood pressure. METHODS Eighteen patients with a phaeochromocytoma received a continuous i.v. infusion of urapidil 10-15 mg h(-1) for 3 days before surgery and until the adrenal gland had been removed. Plasma catecholamine concentrations were measured before surgery, after induction of anaesthesia, at the end of pneumoperitoneal insufflation, during gland manipulation, after gland resection, and in the recovery room after extubation. Arterial pressure was recorded concomitantly. Hypertensive events were treated with boluses of nicardipine with or without esmolol. RESULTS All patients had the adrenal tumour removed without any severe rise in blood pressure or other complication. Creation of a pneumoperitoneum and adrenal gland manipulation induced significant catecholamine release associated with hypertension in 6 and 12 patients, respectively. No correlation was found between hypertensive events and plasma catecholamine levels suggesting alpha(1) receptor block with urapidil is efficacious. CONCLUSIONS Perioperative alpha(1) block using i.v. urapidil is a safe and efficient alternative during surgical management of phaeochromocytoma.
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Affiliation(s)
- P Tauzin-Fin
- Department of Anaesthesia, Pellegrin University Hospital, 33076 Bordeaux Cedex, France.
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Vignes JR, De Seze M, Sesay M, Barat M, Guerin J. [Anterior sacral root stimulation with dorsal rhizotomy (Brindley technique)]. Neurochirurgie 2003; 49:383-94. [PMID: 12746715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Patients with spinal cord lesions are exposed to vesico-sphincter dysfunctions which can aggravate the vital or functional prognosis. The pathophysiological characteristics of these neurogenic bladders explains the usefulness of surgical treatment. The objective of the Brindley technique is to improve both voiding and effective continence. Any patient with a stable supra-sacral spinal cord lesion (paraplegia, tetraplegia) with a reflex bladder (incontinence, vesico-sphincter dyssynergia resistant to medical treatment with the risk of upper urinary tract involvement) can benefit from the Brindley technique. The electrodes are placed on the anterior sacral roots in order to obtain the desired micturation. Posterior sacral rhizotomies are indispensable to the technique as they suppress detrusor and sphincter hyperreflexia and improve continence thereby protecting the upper urinary tract. About 90% of the patients considered have an improved quality of life after implantation of the Brindley stimulator. The bladder capacity was constantly improved and the majority of the patients become continent. Micturation was excellent with low residual volume and low rate of urinary tract infections. Complications are analyzed in this review of the literature. The Brindley technique is an excellent alternative to medical treatment in these highly distressed patients. It restores satisfactory continence and improves psychological as well as economical constraints related to auto/hetero catheterisations performed several times a day.
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Affiliation(s)
- J-R Vignes
- Service de Neurochirurgie Ouest, Hôpital Pellegrin, CHU de Bordeaux.
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Abstract
There are five types of oedema: vasogenic, cytotoxic, interstitial, hyperemic and osmotic. The differences lie on the type and localization of the oedema, the state of the blood-brain barrier (BBB) and the pathological context. Under physiological conditions, the osmolarity of extra cellular fluids (ECFs) is equal on both sides of the BBB. However, the pathophysiological variations of circulating osmolarity (including acute hyponatremia and hypernatremia) do not affect, at the same time, the osmolarity of cerebral ECFs. This situation generates an osmotic gradient on either side of the BBB. The latter, if intact, behaves like a semi-permeable membrane allowing water transport according to the osmotic laws. Depending on its direction, water movement could induce cerebral liquid inflation (i.e. osmotic oedema) or cerebral dehydration. In case of osmotic insult, cerebral cell modify their active osmotic molecular contents in order to limit volume variation. There are two types of osmoactive molecules, organic (i.e. ideogenic osmoles: amino acids, polyols and trimethylamines) and non organic (i.e. electrolytes). In the event of plasma hypotonicity, cerebral cells expel active osmotic molecules to reduce the osmotic gradient and water movement thereby reducing edema. The opposite reaction is observed in the case of hypertonic insult. This cerebral osmoregulation becomes more effective, the slower the osmotic disorder. It explains, for example, why patients with chronic and severe hyponatremia could be asymptomatic. Severe osmotic oedema is observed mainly in water intoxication, acute hyponatremia or too rapid reduction of hyperosmolarity. However, osmotic oedema is not limited to extreme clinical circumstances. Hyponatremia, even modest, could modify cerebral blood volume and impair osmoregulation. Generally these minor modifications do not affect normal brain tissue. In the presence of cerebral lesion, osmoregulation operates only in areas of preserved BBB. The pathological zones are therefore exposed to osmotic oedema (even in cases of moderate hyponatremia) with deterioration of both clinical status and intracranial pressure. This authentic phenomenon could be insidious and difficult to differentiate from osmotic central oedema. Hyponatremia constitutes an authentic secondary cerebral insult of systemic origin, an entity clearly identified by experimental studies to justify the choice between crystalloids and colloids in neuroanaesthesia and neurointensive care. These studies have revealed an increase in water content in normal brain tissues after administration of hypotonic solutions. The increase in plasma osmolarity as a treatment modality using mannitol or hypertonic saline is based on the same concepts. The most remote indication is the occurrence of a reactive mydriasis in the context of trauma for example. More recently, therapeutic hypernatremia has been proposed to control intracranial hypertension.
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Affiliation(s)
- G Boulard
- Unité de neuro-anesthésie réanimation, centre hospitalier universitaire Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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Vignes JR, Liguoro D, Sesay M, Barat M, Guerin J. Dorsal rhizotomy with anterior sacral root stimulation for neurogenic bladder. Stereotact Funct Neurosurg 2002; 76:243-5. [PMID: 12378103 DOI: 10.1159/000066725] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A spinal cord lesion above the sacral micturition center results in a loss of voluntary control and development of bladder sphincter dysynergia with hyperreflexia of the detrusor and spasticity of the sphincter. Sacral rhizotomy and implantation of an anterior sacral root stimulator appears as an effective method for the treatment not only of voiding dysfunction but also of defecation and sexual disturbance. The surgical technique is described as are the clinical and electrophysiological controls. The results of our series of operated patients with intradural implantation and sacral deaffentation show a constant improvement. 90% have satisfactory continence and no longer require an incontinence appliance. Bladder capacity and compliance have increased to 120% and urethral closure pressure has decreased. 80% have complete voiding or a post-void residue of not more than 50 ml. So, urinary infection rate is dramatically decreased.
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Affiliation(s)
- J R Vignes
- Department of Neurosurgery, Medical School Hospital, Bordeaux, France.
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Sesay M, Vignes JR, Liguoro D, Crozat P, Boulard G, Guerin J, Barat M, Maurette P. [Autonomic hyperreflexia induced by sacral root stimulation is detected by spectral analysis of the EEG]. Can J Anaesth 2002; 49:936-41. [PMID: 12419720 DOI: 10.1007/bf03016878] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare spectral analysis of the electrocardiogram (ECG) with mean arterial pressure (MAP) and heart rate (HR) monitoring in the detection of autonomic hyperreflexia (AHR) induced by sacral root stimulation. METHODS Ten spinal cord injured patients scheduled for implantation of a sacral root stimulator for bladder retention were included. Under target controlled anesthesia with propofol 4 micro g*mL(-1) and remifentanil 4 ng*mL(-1), the patients were placed in the knee chest position. The sacral roots were exposed by laminectomy (L2-S1) and their function assessed by electrostimulation under urodynamic and cardiovascular monitoring. Online power spectrum densities were calculated from the ECG R-R interval by the MemCalc(TM) software using the maximum entropy method. Low frequency (LF: 0.04-0.15 Hz) and high frequency (HF: 0.15-0.4 Hz) spectra were associated with sympathetic and parasympathetic activities respectively. The most extreme value of each variable was noted before and during each stimulation. A difference ( triangle up ) of more than 10% signified AHR. The comparison ( triangle up LF vs triangle up MAP and triangle up HF vs triangle up HR) was done by a concordance test with a kappa coefficient (k): -1 = total discordance to 1 = total concordance. RESULTS AHR was detected in six patients as an increase in LF and MAP (n = 4); an increase in LF, HF, MAP with a decrease in HR (n = 2). The detection delay was 5.3 +/- 1 sec (LF, HF) and 10.4 +/- 1.2 sec (MAP and HR). Concordance was 85% (LF vs MAP: k = 0.7) and 90% (HF vs HR: k = 0.8). CONCLUSION AHR induced by sacral root stimulation is detected by spectral analysis of the ECG earlier than MAP and HR. Other studies are needed to confirm these results.
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Affiliation(s)
- Musa Sesay
- Du Département d'Anesthésie-réanimation 3, Service de Neurochirurgie A, et Service de Rééducation neurologique, Centre Hospitalier Universitaire Pellegrin, Bordeaux France.
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