WorldCat Identities

Remerand, Francis (1970-....).

Overview
Works: 63 works in 81 publications in 1 language and 117 library holdings
Roles: Thesis advisor, Other, Opponent, Author
Publication Timeline
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Most widely held works by Francis Remerand
Facteurs anesthésiques et chirurgicaux associés aux nausées et vomissements postopératoires après thyroïdectomie totale by Hichem Nouicer( Book )

2 editions published in 2015 in French and held by 3 WorldCat member libraries worldwide

Introduction : Les nausées et vomissements postopératoires (NVPO) sont, avec les douleurs aigües, les effets indésirables les plus fréquents après une intervention. Après chirurgie ambulatoire, ils augmentent le taux de réadmissions non prévues. La chirurgie cervicale est considérée comme pourvoyeuse de NVPO. Plusieurs équipes proposent de réaliser des thyroïdectomies en ambulatoire, après une sélection des patients permettant d'écarter ceux à risque de complication (hématome, hypocalcémie). Le contrôle des NVPO doit alors pouvoir être assuré dans cette population. Objectif : Il était d'évaluer l'incidence des NVPO après thyroïdectomie totale, dans l'optique d'une chirurgie ambulatoire, et d'identifier les facteurs anesthésiques et chirurgicaux qui pourraient y être associés. Matériel et méthode : Etude monocentrique rétrospective sur 502 patients opérés consécutivement de 2009 à 2012. Les NVPO étaient définis comme le recours postopératoire à un traitement antiémétique. L'association des données recueillies avec la survenue de NVPO a été testée par une analyse univariée puis multivariée. Résultats : L'incidence des NVPO était de 11 %, dont 9 patients (2%) ayant eu des NVPO après 20h le jour de l'opération. Le nombre médian de traitement préventif des NVPO était de 1. En analyse multivariée, l'âge, le sexe féminin, le tabagisme, un antécédent de NVPO, un antécédent de mal des transports, étaient associés à la survenue de NVPO. Aucun facteur chirurgical ou anatomopathologique n'y était associé. Conclusion : Après thyroïdectomie totale, malgré un protocole de prévention des NVPO infra optimal, les NVPO sont rares. Les NVPO ne semblent donc pas être un obstacle à une réalisation en ambulatoire. Aucun facteur spécifique à cette intervention (notamment chirurgical) ne semble associé à leur survenue
Etude de la concentration sanguine de céfazoline utilisée en antibioprophylaxie durant les transplantations hépatiques orthotopiques by Isaure Breteau( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction Liver transplantation is the ultimate therapy in severe hepatopathy treatment such as cirrhosis. There is no guideline in France, neither in the rest of the world, regarding antibiotic prophylaxis to prevent post-surgical infection after this kind of surgery. In Regional Hospital Centre of Tours, this antibiotic prophylaxis is based on the French guidelines of the French Society of Anaesthesiology and Intensive Care (SFAR) regarding other hepato-biliary surgeries. Transplanted patients present a severe underlying hepatic condition, adding to the complexity of the surgery, resulting in a high risk of pharmacokinetic modifications of cefazolin. We aimed to determine if the protocol used for antibiotic prophylaxis with cefazolin manages to obtain in-therapeutic range blood concentration of cefazolin for all treated patients. Methods This is a prospective monocentric study including all patients receiving a liver transplantation in the Regional Hospital of Tours (France). Patients received cefazolin at the initial dose of 2g followed by re-injection of 1g every 4 hours during surgery, these doses were doubled in case of obesity (Body Mass Index > 35kg/m² and weight > 100kg). cefazolin blood concentration was dosed at the beginning and at the end of surgery. Medical history and per-procedure data possibly influencing pharmacokinetics were collected. Results This study included 21 patients between April 3rd and July 28th 2020. No sub-therapeutic value was detected in the samples of beginning surgery. Regarding the 18 patients with an end-surgery sample, 4 (19%) presented sub-therapeutic cefazolin concentration. Among the collected data, only massive crystalloid infusion (5875mL vs 2711mL in the rest of the study population) was a risk factor of sub-therapeutic dosage. Conclusion In conclusion, the cefazolin antibiotic prophylaxis used for liver transplant in our hospital present a risk of exposition to sub-therapeutic values for people receiving a higher amount of crystalloid infusion. There is an interest in continuing to explore cefazolin pharmacology in the context of that particular surgery but also to explore the clinical impact of these sub-therapeutic values regarding prevention of post-surgical infection
Rhabdomyolyse après chirurgie de lambeau libre : incidence et complications by Matthieu Dumont( )

2 editions published in 2018 in French and held by 3 WorldCat member libraries worldwide

Introduction: Reconstructive surgery with free flap aims to replace a loss of substance after a wide cancerous excision. Ischemia reperfusion of the flap and the length of the procedure could promote rhabdomyolysis, and its relative metabolic and renal complications. Isolated cases of rhabdomyolysis have been reported after reconstructive surgery. However, the impact of this complication remains unknown in this context. The objective of this study was to evaluate the incidence of rhabdomyolysis and its complications after free flap surgery. Methods: Adult patients, operated on free flap surgery at the University Hospital of Tours and transferred postoperatively in an intensive care unit between August 1, 2009 and October 31, 2017 were retrospectively studied. The primary outcome was the incidence of postoperative rhabdomyolysis, defined by serum CPK greater than or equal to 1000 IU / L. Secondary outcomes were incidence of acute renal injury (AKI), hyperkaliemia, hypocalcemia, hyperphosphatemia, hyperkaliemia requiring treatments, surgical revision, ICU and hospital stay. Subgroup analysis compared the patients with and without rhabdomyolysis. Results: Among the 155 eligible patients, 134 patients were analyzed (after exclusion of 1 free flap surgery 3 days after a failed first free flap and 20 cases without serum CPK dosage). Rhabdomyolysis occurred in 83 patients (62%). The incidence of AKI was 30% (40 patients). Hyperkaliemia occurred in 4.5% (6 cases, 5 of which required specific therapy). Hypocalcemia and hyperphosphatemia occurred in 98% and 5% of patients (respectively 132 and 7 cases). In patients with rhabdomyolysis, incidences of AKI, hyperkaliemia hypocalcemia and hyperphosphatemia were 27%, 6%, 99% and 5%, versus 33%, 2%, 98% and 6% respectively in patients without rhabdomyolysis (p = 0.560, 0.410, 1.000 and 1.000). Bicarbonate infusion or hyperkaliemia treatment were required in 10 of 83 patients with rhabdomyolysis, versus 1 of 51 patients withoutrhabdomyolysis (12% vs 2%, p = 0.051). A surgical revision was required in 23% of patients with rhabdomyolysis, versus in 12% of patients without rhabdomyolysis (p = 0.120). For patients withrhabdomyolysis, the mean length of hospital stay was 23 days, versus 16 days without rhabdomyolysis (p = 0.015).Conclusion: Rhabdomyolysis frequently occurs after free flap surgery (62% of cases). It increases the length of stay in the ICU and in the hospital. These results suggest that rhabdomyolysis should be systematically screened after this type of surgery. Possible prophylactic procedures are discussed
Efficacité et tolérance de la gabapentine dans l'analgésie multimodale post-opératoire : une méta-analyse by Marc-Antoine Badaire( )

2 editions published in 2018 in French and held by 3 WorldCat member libraries worldwide

Introduction: Many studies showed that gabapentin reduces postoperative pain, analgesic consumption, post-operative nausea and vomiting, but induces somnolence, confusion, visual disturbance. In most of these studies, the analgesic protocol used exclusively opioids. This is contradictory with current recommendations, which promote opioid free analgesia, by combining several non opioid analgesics. Therefore, the aim of this study was to evaluate effectiveness and tolerance of gabapentin when combined with a non-opioid multimodal analgesia protocol. Method: meta-analysis of randomized control trials published on PUBMED and COCHRANE databases between 2000 and 2016, including at least one pre-operative administration of gabapentin, combined with a systematic non opioid analgesic administration. The evaluation criteria were pain scores at 24 hours, rescue analgesic consumption, and postoperative side-effects in the first 24 hours. Results were expressed in Standard Mean Difference (SMD) or in relative risk (RR) with a confidence interval of 95% (CI95%). Analyses were carried out using R Sofware (3.2.5 version). Results: 150 studies were selected on their abstract. Finally, 25 fulfilled inclusion criteria and were analyzed, including 1949 patients (980 received gabapentin, 969 received placebo). Combined with Acetaminophen and/or Non Steroidal Anti-Inflammatory Drugs (NSAIDs), gabapentin reduced pain scores on movement at 24h (SMD -0,49 [-0,86 ; -0,12]). Gabapentin also reduced PONV incidence (RR=0,79 IC95% [0,65 ; 0,95]), but increased risk of severe somnolence (RR=3,35 IC95% [1,24 ; 9,05]). Conclusion: Even when combined with non opioid multimodal analgesia, gabapentin improves post-operative analgesia and reduce postoperative nausea and vomiting
Impact sur la pratique quotidienne de trois moniteurs peropératoires de la balance nociception - anti-nociception au cours de l'anesthésie générale combinée à une analgésie locorégionale (étude ANISPINOL) by Margaux Harly( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction: The three most frequently proposed devices in France for monitoring nociception under general anesthesia are ANItm (Analgesia/Nociception Index), SPItm (Surgical Phletysmographic Index) and NOLtm (Nociception Level). The objective of this study is to assess whether monitoring of nociception - anti-nociception (NAN) with any of these three devices is likely to change the per-operative management of analgesia during general anesthesia with locoregional anesthesia (LRA). Method: This study is a monocentric observational study. The three devices were installed in 15 patients who went under orthopedic surgery with general anesthesia and locoregional analgesia. The measurement of each device is automatically recorded from induction to closure. The primary outcome was the percentage of time spent in the target area for each device between induction and the end of cutaneous surgical closure. Target areas were defined as 50-70 for ANItm, 20-50 for SPItm and 10-25 for NOLtm. Results: The time period per patient was 154 +/- 60 minutes. According to the ANI, SPI and NOL, the median times spent in the target were 39%, 53% and 28% respectively (p=0.038). Median times spent « over analgesia » were 38%, 6 % and 45% respectively (p=0.004). Conclusion: In case of general anesthesia with ALR, these three devices may change patient management, but with opposite options. Without any reference and recommendation technique, their systematic use remain an open question
Comparaison des différents scores prédictifs d'intubation difficile pour les sondes mono-lumières au bloc opératoire by Laura Sovi( )

2 editions published in 2019 in French and held by 3 WorldCat member libraries worldwide

Introduction : L'intubation difficile est une des principales causes de mortalité et de morbidité péri-opératoire directement associée à l'anesthésie. Afin d'adapter la prise en charge des patients, plusieurs scores cliniques ont été proposés pour détecter cette situation (Wilson, El-Ganzouri, Arné, Naguib 1999 et 2006, SPIDS (Simplified Predictive Intubation Difficulty Score)). Faute d'études comparatives, la valeur relative de ces scores est encore inconnue. Le but de cette étude était de comparer la capacité de ces 6 scores à prédire la survenue d'intubation difficile. Matériel & méthodes : Etude monocentrique observationnelle prospective ayant inclus des patients intubés avec une sonde monolumière entre janvier 2017 et février 2019. Pour chaque patient, les critères permettant de calculer les 6 scores étaient recueillis avant l'induction. Les intubations difficiles étaient définies par la nécessité de plus de 2 laryngoscopies ou de matériel alternatif (recommandation formalisée d'experts SFAR 2006). Lors de l'analyse, les scores ont été calculés ainsi que leur sensibilité, spécificité, valeurs prédictives positive et négative (VPP et VPN), leur indice de Youden et leur rapport de vraisemblance positif. Résultats : 775 intubations ont été analysées. L'incidence de l'intubation difficile était de 5% (40 cas). L'indice de Youden des scores Wilson, El-Ganzouri, Arné, Naguib 1999 et 2006, SPIDS était respectivement de 0,21-0,21-0,11-0,22-0,26-0,33. Leur valeur prédictive positive était respectivement de 11%, 21%, 15%, 8%, 11%, 10%. Leur valeur prédictive négative était respectivement de 96%, 96%, 95%, 97%, 96%, 97%. Conclusion : Les 6 scores prédictifs d'intubation difficile ont des résultats très proches. Ces scores prédisent finalement assez mal une potentielle intubation difficile (VPP < 20%, Youden < 0,3), mais permettent plutôt d'écarter fiablement une potentielle intubation difficile (VPN > 95%)
Incidence et facteurs de risque des atteintes radiculaires des membres inférieurs chez les parturientes ayant accouché par voie basse sous analgésie péridurale by Anne Bruno( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction : Postpartum neurological symptoms prevalence after epidural anesthesia is low. These neurological deficits can either be of radicular or distal origin. During lower limb neurological postpartum disorders, epidural anesthesia is often suspected. Given considerable risk of morbidity and mortality, it is crucial to evaluate the cause of these disorders and discriminate between anesthesia and obstetrical causes. Therefore, we first embarked upon investigating the incidence of lower limb neurological dysfunctions after vaginal delivery under epidural anesthesia. Then we investigated the origin, radicular or distal, of such dysfunctions in order to identify etiological factors within our two study groups. Method : We undertook a 17-year prospective study to establish the incidence of postpartum neurological dysfunctions after vaginal delivery under epidural anesthesia (from 10/01/2002 to 10/01/2019). Parturient women presenting neurological deficits (motor and/or sensitive) a week after delivery (for the first 11 years) were send to a neurologist for a clinical evaluation and send for electroneuromyography (ENMG) and/or a radiologic evaluation (MRI, TDM). Parturient women were included in either radicular or distal dysfunction groups and matched with 4 controls. Demographic, obstetrical and anesthetic data were collected for each case. Results : A hundred and four parturient women suffered from a neurological deficit (104/21804, 0.48%). Among these, we analyzed thirty-two patients. A majority of patients displayed radicular deficits (25/32). Radicular neurological dysfunctions were associated with the following risk factors: higher mother's age (p=0.01); late-term pregnancy (p=0.001); higher newborn's weight (p=0.006); longer lithotomy position (p=0.0004); instrumental vaginal delivery (p=0.03); episiotomy (p=0.006); time of epidural anesthesia (p=0.0005); and time between arrival in the delivery room and childbirth (p=0.008). Similar risk factors were also found in patients suffering from distal neurological dysfunctions: higher newborn's weight (p=0.006); longer lithotomy position (p=0.004); time of anesthesia consultation (p=0.001); and time between arrival in the delivery room and childbirth (p=0.005). Conclusion: Lower limb neurological deficits were identified in 0.48% of vaginal deliveries under epidural anesthesia. Among these, radicular impairments are more frequent, with obstetrical risk factors (excluding age and non-anesthetic factors). Similar risk factors are associated with distal impairments (excluding instrumental vaginal delivery and episiotomy)
Complications per anesthésie générale du POLIDOCANOL dans les malformations vasculaires à bas débit by Lauren Caro( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

INTRODUCTION: Polidocanol is a venous sclerosing agent used for the treatment of low-flow vascular malformations, of Off-Label use in France, both for adults and children. To our knowledge, no study reporting the safety profile of this drug used for this indication for children has been conducted. At Tours University hospital, children suffering from extensive and / or deep malformations benefit from general anesthesia, during sclerotherapy. Several incidents having occurred during these procedures, we wanted to know the systemic toxicity of polidocanol in this population. METHOD: We conducted a retrospective monocentric observational study to know the toxicity of polidocanol among children who had at least one sclerotherapy session under general anesthesia, from January 1, 2006 to December 31, 2019. The main outcome measure was the occurrence of at least a systemic event after the injection of polidocanol. The characteristics of the patients, their malformation and drugs received were noted. RESULTS: 101 sclerotherapy sessions were analyzed, involving 64 children. The incidence of occurrence of at least one systemic event is 37.5% [95% CI: 25.6; 49.4] including 17 hypotensions (26.6%), 8 bradycardias (12.5%), 2 desaturations (3.1%) and 1 cardio circulatory arrest (1.6%). Eight events (12.5%) required the administration of a vasopressor. CONCLUSION: Polidocanol sclerotherapy has an important role in the treatment of low-flow vascular malformations for children. However, under general anesthesia, the systemic toxicity of polidocanol justify a supervised and secure use
Évaluation de la perfusion cérébrale par Doppler Trans Crânien chez les traumatisés crâniens à la prise en charge initiale : quel apport pour améliorer la prédiction de la mortalité à J14 ? by Pierre-François Chalard( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction : Traumatic brain injury (TBI) is responsible for significant morbidity and mortality. Several mortality prediction models following TBI are available but none of them take into account initial brain perfusion. We aimed to investigate whether brain perfusion assessment with Trans Cranial Doppler on admission would provide additional independent information to these models. Method : Data was extracted from the Traumabase registry. We selected those patients with an initial GCS ≤ 12 and an available Pulsatility Index (PI) measurement on admission. The primary endpoint was mortality at day 14 (D14). The predictive value for death of PI was assessed in univariate analysis and in combination with IMPACT and CRASH scores to predict mortality at D14. The Integrated Discrimination Improvement (IDI) and the Net Reclassification Index (NRI) were calculated to estimate the reclassification capacity of the PI when added to these scores. Results : 2219 traumatic brain injury patients were analyzed; PI was significantly higher in patients who died at D14 compared to those alive at D14 (median at 1.5 (1.1-2.2) versus 1.1 (0.9-1.4) respectively, p<0.001), with an area under the ROC curve (AUC) to predict mortality at D14 of 0.69 (0,67-0,72).. The odds ratio of mortality for PI was always significant (p<0.001) with a value between 2.41 and 2.65 according to the models (CRASH and IMPACT). When adding PI to the pre-existing models, the AUC was in each case greater than the model without PI ranging from 0.883 to 0.904. The calculated NRI and IDI were significantly greater than 0. Conclusion The PI measured at hospital arrival is an independent factor associated with TBI mortality at D14. Adding it to the IMPACT and CRASH scores showed an improvement in the prediction of mortality in all models
Impact de la voie d'abord (transglutéale versus postérieure) sur les douleurs aigues et à 6 mois après arthroplastie totale de hanche by Ilham Aglime( Book )

2 editions published in 2015 in French and held by 3 WorldCat member libraries worldwide

Total hip arthroplasty (THA) can be inserted in several surgical approaches. The two most common approaches are the posterior one (considered as the reference approach) and the transgluteal one. Their influence on post-operative pain is poorly described. The purpose of this study is to compare the impact of these two approaches on pain early and 3 to 6 months after THA. Methods: Retrospective single-center matched study comparing patients operated on by transgluteal approach (treatment group) with patients operated on by posterior approach (control group). Patients were matched on sex, perioperative analgesics (ketoprofen, ketamine, pregabaline), surgeon's experience, and the type of acetabular and femoral implants (cemented or not). When several controls were possible, the patient with the closest age was selected. All patients received paracetamol, and were followed by phone at 1, 3 and 6 months. In the absence of follow up at 6 months, the 3 months follow up was taken into account. The main criteria of judgment were Day0 morphine consumption and the presence of pain with walking at 6 months. To detect a 30% decrease in the first criterion, and a 50% decrease of the second, respectively 107 and 157 patients per group were needed (alpha risk = 0.05% and beta = 0.20%, two-tailed test) .The secondary criteria were the occurrence of complications (sepsis, fractures, dislocation). Results: 161 patients were matched by group. Neither Day0 morphine consumption (15 ± 14 mg versus 14 ± 13 mg, p = 0.606), nor the incidence of hip pain at 6 months with walking (28 versus 23%, p = 0.336), nor the incidence of complications were different between the patients operated on by transgluteal way and the ones operated on by posterior approach. Discussion: for a THA, the transgluteal surgical approach or the posterior one do not affect postoperative pain during the first 6 postoperative months
La technique de pose du cathéter sciatique poplité (échographie versus neurostimulation) modifie-t-elle l'analgésie précoce et tardive après chirurgie du pied ? = The technique of popliteal sciatic catheter placement (ultrasound versus nerve stimulation) she changes early and late analgesia after foot surgery? by Jessica Rizk( Book )

2 editions published in 2014 in French and held by 3 WorldCat member libraries worldwide

Paranerveux catheters previously inserted under neurostimulation, are now mostly inserted under ultrasound. Analgesia issued by the two procedures was studied only during the first 48 postoperative hours, mainly after laying a popliteal catheter. The objective of this study was to compare bone after foot surgery, early and late analgesia provided by a continuous popliteal sciatic block inserted under neurostimulation or under ultrasound. Materiels and methods : Study retrospective single two periods. From October 2009 to April 2010, catheters were inserted under neurostimulation, and from January 2011 to September 2011, under ultrasound guidance (May-December 2010, the acquisition phase of ultrasound guidance in the service). After an initial bolus (ropivacaine 20 ml), all patients received 5 ml / h of 0.2% ropivacaine for minimum 48 hours, and a systemic analgesia (acetaminophen, ketoprofen and ketamine). The patients were monitored by phone a year after surgery. The primary endpoint was the incidence of DOMS (moderate to severe pain,> 3/10 on a simple numeric scale) walking to a year. To detect a halving of the incidence (43% in a previous study), 72 patients per group were required (alpha risk = 0.05% and beta = 0.20%, two-tailed test). Results: In the neurostimulation group, 113 patients (of 132 possible) were analyzed, and 75 patients (of 90 possible) in the ultrasound group. At 1 year, Doms walking existed in 44 patients in the neurostimulation group (39%) and 41 patients (55%) in the ultrasound group (p = 0.037). Discussion: ultrasound-guided catheters pose popliteal increase the incidence of chronic pain after foot surgery, possibly through more frequent accidental withdrawals
Incidence et facteurs de risque d'hypoxémie lors des endoscopies digestives sous sédation profonde : analyse post-hoc d'un essai randomisé contrôlé by Axelle Eugène( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction Deep sedation during upper or lower gastrointestinal endoscopy (GIE) improves the comfort and quality of the procedure, but is associated with a greater number of cardiopulmonary complications. Hypoxemia is the main complication and knowing the risk factors would allow the implementation of preventive measures. Few studies investigating the risk factors for hypoxemia in GIE have been conducted during deep sedation. Material and methods Post-hoc analysis of patients included in the standard oxygenation arm of the ODEPHI study (a randomized, controlled, multicenter study that compared high-flow nasal oxygen therapy to standard oxygenation during programmed deep sedation GIEs in patients predisposed to hypoxemia). Patients included already had hypoxemia-predisposing factors such as: cardiac or respiratory pathology, age ≥60 years, obstructive sleep apnea syndrome (OSA), obesity (defined by body mass index ≥30kg.m-²), or classified as class ≥2 on the American Society of Anesthesiologist physical status classification (ASA). The primary objective of our study was to identify the main risk factors for hypoxemia (defined as pulsed oxygen saturation SpO2≤ 92%.). Secondary objectives were to evaluate the incidence of cardiopulmonary complications and to analyze usual sedation practices during GIE. Results 202 patients were analyzed. The incidence of hypoxemia was 31%. Endoscopy had to be interrupted for 6 patients (3%) with need for intubation for 3 of them in 3 cases (2%). In univariate analysis, hypoxemia was more frequent in male patients (P=0.039), high blood pressure (P<0.01), with high body mass index (P=0.014), ASA score ≥2 (P=0.03), Mallampati score ≥3 (P<0.01) or obstructive sleep apnea syndrome (OSA) (P=0.01). Multivariate analysis recognizes high blood pressure and OSA as independent risk factors. Conclusion The independent risk factors for the occurrence of hypoxemia in deep sedation for GIEs are the presence of high blood pressure and/or obstructive sleep apnea syndrome
Travail préparatoire pour le dépôt d'un PHRC interrégional : évaluation du délai de contrôle de l'agitation par la voie intranasale et intraveineuse du midazolam dans la prise en charge aux urgences : essai contrôlé en cluster et cross-over by Lucas Reboul( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

L'agitation est une problématique récurrente de tous les services d'urgences nécessitant une prise en charge rapide humaine et médicamenteuse pour limiter les risques d'hétéro- et auto-agressivité du patient. D'après une étude de la banque de données en santé publique de 2003, cette population a une prévalence de 1.22% du total des admissions par an en France. 32.3% des SAU en France possédaient un protocole adapté à cette situation et 67% des prises en charge de cette population aboutissaient à une sédation. La prise en charge de l'agitation aux urgences se traduit par une mobilisation importante, la contention du patient et l'injection de neuroleptiques par voie intraveineuse ou voie intramusculaire, difficile d'accès, exposant à de multiples risques pour le personnel et le patient. Les neuroleptiques sont des molécules pourvoyeuses d'effets secondaires potentiellement graves et avec un délai d'action de 40 minutes pour la loxapine (neuroleptique le plus utilisé). Le midazolam est une molécule également recommandée pour la prise en charge des états d'agitations, possédant un délai d'action court, peu d'effets secondaires et ayant un antidote disponible. Des essais cliniques chez les enfants ont démontré une efficacité similaire entre l'intranasale et l'intraveineuse. Les demi-vies étaient identiques (2.2heures en IN, et 2.4 h heures pour la voie IV). Plusieurs études ont évalué les données de pharmacocinétique et de pharmacodynamie de l'administration intranasale de midazolam par rapport à la voie intraveineuse chez l'adulte sain (dose de 5 mg en intranasale) montrant qu'après administration du produit, l'assimilation était rapide, la biodisponibilité était de 48 % avec peu d'effets indésirables. Cette étude a pour but de démontrer la non-infériorité dans la rapidité de sédation de la voie intranasale et intraveineuse du midazolam pour la prise en charge de l'agitation aux urgences. Elle permettra également de comparer l'accessibilité des voies, les délais de prise en charge et d'étudier une population souvent écartée des essais cliniques à laquelle nous sommes de plus en plus confrontés aux urgences
Comparaison de la qualité d'image de différents échographes pour la réalisation des blocs axillaires et interscaléniques by Quentin Belot( )

2 editions published in 2017 in French and held by 3 WorldCat member libraries worldwide

Ultrasound machine are recommended to perform diagnostic or therapeutic procedures in ICU and anesthesia. Image quality is a cornerstone for accurate and safe procedures. There are no data to compare image quality among the available ultrasound machine. This study compared the image quality of 8 ultrasound machines in the field of axillary and interscalene nerves blocks. Method : Video loops of the axillary and interscalene regions of 2 healthy subjects were acquired with 8 different ultrasound machines. The video loops were anonymized and their order of analysis was randomized. The image quality of these video loops were analyzed by 15 anesthesiologists (juniors and seniors) according to a 10 point scale. Results : Five of 8 ultrasound machines images had higher image quality for axillary nerve block with mean scores of 6-7 (p <0.0001). Three of 8 ultrasound machines had higher imaging quality for an interscalene nerve block with mean scores of 6-7 (p <0.0001). Conclusion : Three ultrasound machine have higher image quality for axillary and interscalene nerve block construction than the remaining 5. This study is close to the dynamic use of ultrasound procedures to compare the image quality of different ultrasound machines. Ergonomics, maintenance, cost of purchase and use are other parameters to be taken into account to further analyze these 3 ultrasound system
Facteurs associés aux douleurs persistantes postopératoires après prothèse totale de hanche = factors related to persistent post surgical pain after total hip replacement by Valerie Lafon Gotay( Book )

2 editions published in 2014 in French and held by 3 WorldCat member libraries worldwide

After Total Hip Replacement (THR), the postoperative pain persists in 27-28% of patients. Its intensity is moderate to severe in 5-11% of patients. Their occurrence is associated with the presence of immediate pre and post-operative pain. Other factors associated with their occurrence are poorly identified, including those related to surgical procedures and analgesics used perioperatively. Objective: Examine factors associated with the presence of persistent postoperative pain 6 months after THR, especially surgical factors and analgesics protocols. Methods: A prospective single-center study including patients undergoing total hip replacement at the University Hospital of Tours from January 2006 to January 2012 was performed. Among the 851 patients includable, 718 patients (84%) responded to a telephone questionnaire. The four main criteria were the presence of pain at rest, walking, the presence of moderate to severe pain at rest, walking. Their association with demographic data, comorbidities, surgical data and analgesic protocols and pre and immediate post-operative pain was tested by univariate analysis and logistic regression. Results: After logistic regression, pre operative pain at rest other than the operated hip, intraoperative or postoperative fracture and no perioperative administration of ketamine were associated with three or four of the four main criteria. Preoperative chronic use of anxiolytics, old preoperative pain (> 2 years), a young surgeon, early postoperative occurrence of moderate to severe pain, septic complication of surgical site, were factors associated with 1 or 2 of the four main criteria. None of the tested surgical factors was independently associated with the main criteria. Conclusion: These factors should be taken into account in the preoperative patient information, as well as for the development of surgical and especially perioperative analgesic protocols
Efficacité et tolérance de la prégabaline dans l'analgésie multimodale post-opératoire : une méta-analyse by Jean-Baptiste Roques( )

2 editions published in 2018 in French and held by 3 WorldCat member libraries worldwide

Introduction: In many studies Pregabalin reduces postoperative pain, analgesics consumption, nausea and vomiting. However, it induced somnolence, as well as post-operative visual disturbance. Nevertheless, in most studies the analgesic protocol was exclusively opioid-based, contrary to recommendations and daily clinical use. The aim of this study was, therefore, to evaluate the effectiveness of and tolerance to Pregabalin for postoperative analgesia, when combined with a routine non-opioid analgesia. Methods: Randomized clinical trials published between 2000 and 2015 including at least one preoperative administration of pregabalin, combined with at least one post-operative non-opioids analgesics administration were included. The evaluation criteria were a pain score at H24, consumption of analgesics, and postoperative side-effects during the first 24 hours. The results were expressed in Standardized Mean Difference (SMD) or in relative risk (RR) with a confidence interval of 95% (IC95%).The analyses were carried out using the 3.2.5 version of R software. Results: 537 studies were referenced on The MedIine and Cochrane studies respectively. In total 31 studies were included in this meta-analysis: 2468 patients, 1229 received Pregabalin and 1239 placebo respectively. Combined with paracetamol and/or NSAIDs, Pregabalin reduced pain scores at H24 and the consumption of analgesics respectively -0.35 [-0.25; -0.45] and -1.04 [-1.16; -0.93]. Pregabalin did not reduce the incidence of postoperative nausea and vomiting (PONV), but increased risk of visual disturbances [RR = 2.60; IC 95% (1.36; 4.98)], dizziness [RR = 1.28; IC95% (1.06; 1.54)], and severe somnolence [RR = 1.22; IC95% (1.03; 1.44)]. Conclusion: When combined with Paracetamol and/or NSAIDs, Pregabalin improves postoperative analgesia, but does not reduce PONV, and retains several neurosensory side effects
Effet analgésique d'un bloc fémoral en complément d'une analgésie multimodale comprenant un bloc sciatique continu après prothèse de cheville by Edouard Lamarche( Book )

2 editions published in 2014 in French and held by 3 WorldCat member libraries worldwide

Le nerf saphène interne participerait à l'innervation osseuse de la face médiale de la cheville. L'objectif de cette étude était, après prothèse totale de cheville (PTC), d'évaluer l'effet d'un bloc fémoral sur l'analgésie fournie par l'association d'un bloc nerveux périphérique continu (BNPC) poplité et d'une analgésie multimodale systémique. MATERIEL ET METHODES : Etude rétrospective comparative monocentrique. La chirurgie se déroulait sous anesthésie générale après réalisation d'un BNPC poplité (20 ml de ropivacaïne 0,475% puis 5 ml/h de ropivacaïne 0,2%, groupe P). Une association de paracétamol, kétoprofène et kétamine était administrée durant 24-48H. Certains patients ont eu un bloc fémoral en préopératoire (ropivacaïne 0,475%, 20 ml, groupe PF). Le critère de jugement principal était la proportion de patients ayant eu recours à de la morphine en salle de surveillance post-interventionnelle (SSPI) et durant les 48 premières heures postopératoires. Douze patients par groupe étaient nécessaires pour ramener ce dernier critère de 96 à 52% (alpha 0.05 et beta 0.2). RESULTATS : 54 PTC ont été réalisées de janvier 2009 à juin 2013. Aucun patient du groupe PF n'a eu recours à la morphine en SSPI, versus 12 des 40 autres patients (0 versus 30%, p=0,016). Trois de ces patients (exclus de la suite de l'analyse) ont dû avoir un bloc fémoral antalgique en SSPI. Durant les 48 premières heures, 12 des 14 patients du groupe PF ont eu recours à de la morphine en SSPI, versus 29 des 37 autres patients (86% versus 78%, p=0,707). DISCUSSION : Après PTC, l'association d'un bloc fémoral à un BNPC poplité et une analgésie multimodale systémique permet d'améliorer nettement l'analgésie en SSPI. Néanmoins, un BNPC fémoral ou saphène interne semble indispensable pour prolonger ce bénéfice analgésique
Anesthésie locorégionale au canal huméral ou au poignet pour la chirurgie du canal carpien : efficacité et tolérance by Julie Caillaud( Book )

1 edition published in 2011 in French and held by 2 WorldCat member libraries worldwide

Douleurs chroniques à un an après chirurgie du canal carpien (étude de cohorte) : épidémiologie et recherche de facteurs associés by Olivier Belze( Book )

1 edition published in 2010 in French and held by 2 WorldCat member libraries worldwide

Etude de la sensibilisation centrale et périphérique dans le syndrome du canal carpien by Emilie Martin de Bellerive( )

1 edition published in 2017 in French and held by 2 WorldCat member libraries worldwide

Introduction : Des phénomènes de sensibilisation périphérique et centrale sont décrits après une agression nociceptive localisée, comme une incision chirurgicale. Ces phénomènes seraient associés à la survenue de douleurs chroniques postopératoires. Dans le syndrome du canal carpien (SCC), l'existence de cette sensibilisation est débattue. Aucune étude n'a portée sur des patients en préopératoire. Le but de cette étude était d'évaluer dans cette population la prévalence de différents aspects de sensibilisation. Matériels et Méthodes : Etude prospective monocentrique incluant des patients devant être opérés pour des manifestations cliniques et électrophysiologiques de SCC localisées exclusivement aux mains. Le seuil de douleur à la pression fine a été évalué bilatéralement dans les territoires médian et ulnaire de la main, ainsi qu'au niveau du manubrium sternal (série croissante de filaments de Von Frey). Le seuil de douleur à la pression large (hyperalgésie des tissus profonds) a été évalué avec un algomètre dans les même territoires. Le wind up ratio (allodynie) a été évalué sur les éminences thénar et hypothénar. Résultats : Parmi 44 patients explorés, cette étude ne met pas en évidence de signe de sensibilisation centrale, que ce soit dans le territoire du nerf médian, dans celui du nerf ulnaire ou à distance (en regard du manubrium sternal). Au contraire, on observe une hypoalgésie dans les territoires médian et ulnaire. Conclusion : Les patients devant être opérés d'un SCC ne présentent pas de signe d'hyperalgésie. Au contraire, ils ont un tableau d'hypoalgésie s'étendant bien au delà du territoire médian et du côté atteint. Ces résultats suggèrent un intérêt limité à l'usage d'antihyperalgésiques en périopératoire d'une chirurgie du SCC
 
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Alternative Names
Remérand, Francis

Languages
French (37)