Abstract Background The transport of postoperative patients to the postoperative anesthesia care unit (PACU) is a high-risk period for hypoxemia. The aim of this study was to determine risk factors ...for hypoxemia during transfers to the PACU. Methods An observational, prospective, monocentric, and noninterventional study was conducted in the University Hospital of Toulouse in 2015 during a 5-week period. All patients who were transferred to PACU were included. Twenty-eight variables related to patient, surgery, and anesthesia were recorded. Hypoxemia during transfer was defined as Sp o2 <90%. Results Five hundred five patients were included. The incidence of hypoxemia during transfer was 13%. After logistic regression analysis, 3 risk factors for desaturation were identified: sedation score >2, Sp o2 <96% before exiting the operating room (OR), and body mass index >30 kg/m2 . The 72% of patients were transferred without oxygen. Most of the hypoxemia appears in these patients. Conclusion The development of hypoxemia during transfer from the OR to the PACU was greater in patients who were obese, were more sedated, or had lower oxygen saturations upon leaving the OR. The rates of hypoxemia were greater among patients in whom supplemental oxygen was not administered. Supplemental oxygen should be considered in higher risk patients.
Abstract Purpose The purpose of the study is to determine if femoral artery blood flow Doppler parameters can assess cardiac response to a fluid challenge (FC). Materials and Methods We prospectively ...recorded in 52 critically ill ventilated patients' velocity time integral variation (%VTIf) and maximal systolic velocity variation (%Vfmax) derived from femoral Doppler analysis and aortic velocity time integral variation registered on transthoracic echocardiography before and after an FC of 500-mL saline. Results According to Pearson coefficient, %Vfmax and %VTIf were found to be positively correlated with aortic velocity time integral variation ( r2 = 0.46 and 0.51, respectively; P < .0001) and were significantly different between responder patients and nonresponders (11% ± 3.4% vs 5.9% ± 4.3% and 14.9% ± 4.2% vs 5.5% ± 5.5%, respectively; P < .0001). Increase of %VTIf 10% or higher and %Vfmax 7% or higher after an FC showed a sensitivity of 80% and 84%, a specificity of 85% and 73%, and an area under the curve of 0.905 and 0.851, respectively, for discriminating responder and nonresponder patients. Conclusion Variation of femoral Doppler parameters before and after FC mirrors cardiac response to fluid loading. This tool could be considered as an alternative to transthoracic echocardiography in case of poor thoracic insonation.
Abstract Study objective Hypotension frequently occurs during spinal anesthesia (SA), especially in the elderly. Phenylephrine is effective to prevent SA-induced hypotension during cesarean delivery. ...The objective of this study was to evaluate the efficacy and safety of prophylactic infusion of phenylephrine after SA for orthopedic surgery in the elderly. Design This prospective, randomized, double-blind, and placebo-controlled study included 54 patients older than 60 years undergoing elective lower limb surgery under SA (injection of 10 mg of isobaric bupivacaine with 5 μ g of sufentanyl). Intervention Patients were randomized to group P (100- μ g/mL solution of phenylephrine solution at 1 mL/min after placement of SA) or the control group C (0.9% isotonic sodium chloride solution). The flow of the infusion was stopped if the mean arterial blood pressure (MAP) was higher than the baseline MAP and maintained or restarted at 1 mL/min if MAP was equal to or lower than the baseline MAP. Heart rate and MAP were collected throughout the case. Measurements Hypotension was defined by a 20% decrease and hypertension as a 20% increase from baseline MAP. Bradycardia was defined as a heart rate lower than 50 beats per minute. Main results Twenty-eight patients were randomized to group P and 26 patients to group C. MAP was higher in group P than in group C (92 ± 2 vs 82 ± 2 mm Hg, mean ± SD, P < .001). The number of hypotensive episodes per patient was higher in group C compared with group P (9 0-39 vs 1 0-10, median extremes, P < .01), but the number of hypotensive patients was similar between groups (19 73% vs 20 71%, P = 1). The time to onset of the first hypotension was shorter in group C (3 1-13 vs 15 1-95 minutes, P = .004). The proportion of patients without hypotension (cumulative survival) was better in group P ( P = .04). The number of hypertensive episodes per patient and the number of bradycardic episodes per patient were similar between groups ( P = not significant). Conclusion Prophylactic phenylephrine infusion is an effective method of reducing SA-induced hypotension in the elderly. Compared with a control group, it delays the time to onset of hypotension and decreases the number of hypotensive episodes per patient. More data are needed to evaluate clinical outcomes of such a strategy.
Objective Maternal toxoplasmosis infection acquired during pregnancy carries significant risk of fetal damage. We aimed to assess the long-term outcome of children and young adults with congenital ...toxoplasmosis diagnosed and treated in utero. Study Design This was a 20 year prospective study (1985-2005). All mothers received spiramycin, alone or associated with pyrimethamine-sulfadoxine, and underwent amniocentesis and monthly ultrasound screening. Infected children were followed every 3-6 months. Results Of 666 liveborn children (676 mothers), 112 (17%) had congenital toxoplasmosis. Among these, 107 were followed up for 12-250 months: 79 were asymptomatic (74%) and 28 had chorioretinitis (26%). Only 1 child had a serious neurological involvement. Conclusion The percentage of chorioretinitis in treated children depends on length of follow-up, but this complication occurs mainly before the age of 5 years and almost always before the age of 10 years. Visual impairment was infrequently severe, and outcome appears consistently good. Long-term follow-up is recommended to monitor ocular and neurological prognosis, whatever the practical difficulties.
Abstract Background Intracardiac shunts are rare but very serious lesions after non-penetrating chest trauma. Their diagnosis is difficult. This pathology often goes unrecognized in the context of ...multiple trauma. Case Report We report the case of a 21-year-old man involved in a motor vehicle crash who presented with multiple injuries including myocardial contusion, severe brain injury, multiple pelvic fractures, closed femur fracture, bilateral lung contusion with a right pneumothorax, and intra-abdominal injuries. Three days after the initial event, a new cardiac murmur and complete heart block appeared. Transthoracic echocardiography (echo) followed by transesophageal echo revealed a high-velocity flow communication between the left ventricle and the right atrium. The patient underwent delayed cardiac surgery due to other unstable injuries. The hospital course was prolonged but favorable, and the patient left the hospital 1 month later without any neurologic or cardiologic after-effect. Conclusion This case highlights the potential for cardiac complications to occur in any patient with serious thoracic trauma. Transesophageal echo should be performed on any trauma patient with electrocardiographic abnormalities.
We report on a 62-year-old man referred to the cardiac intensive care unit less than 24 hours after anterior ST-segment elevated myocardial infarction. The patient developed cardiogenic shock ...requiring elective intubation, vasopressor, and inotropic support. Emergency coronary angiography, revascularization, and insertion of an intraaortic balloon pump were performed. Nevertheless, the hemodynamic situation remained unstable, and a left ventricular assist device (LVAD) was inserted. Severe hypoxemia occurred several minutes after initiating the Impella Recover LD/LP 5.0 (Abiomed, Danvers, MA). Transesophageal echocardiography allowed diagnosis of patent foramen ovale. The shunt resulted from abnormal left-to-right pressure gradient due to left ventricular unloading and increased right ventricular afterload induced by mechanical ventilation. Transesophageal echocardiography was used to regulate both LVAD output and positive end-expiratory pressure settings to optimize oxygen transport. Because patent foramen ovale is common in humans, transesophageal echocardiography should be performed systematically after LVAD insertion.
Abstract Study Objective To determine whether a new transdermal fentanyl patch (TFP) is a good choice for the postoperative pain management of patients undergoing primary total hip arthroplasty ...compared with patient-controlled analgesia (PCA). Design Randomized, prospective study. Setting University hospital. Patients 30 patients undergoing primary total hip arthoplasty. Interventions Patients received either a TFP (group T; Duragesic 50 μ g/h, matrix fentanyl patch, Janssen-Cilag) applied approximately 10 hours before induction of general anesthesia and PCA programmed in the postanesthesia care unit (PACU), or PCA programmed in the PACU (group P). Measurements Intraoperative sufentanil and additional postoperative morphine administration were recorded, as well as visual analog scores and routine vital signs at predetermined intervals during the first 48 hours. Main Results Morphine consumption on arrival in the PACU was 3.5 ± 3 mg in group T versus 13 ± 5 mg in group P ( P < 0.0001). Visual analog scores on arrival in the PACU were 37 ± 22 mm in group T versus 73 ± 13 mm in group P ( P < 0.0001). Cumulative morphine consumption at the 24th hour was 43 ± 16 mg in group P and 4 ± 3 mg in group T ( P < 0.0001). Cumulative morphine consumption at the 48th hour was 54 ± 26 mg in group P and 5 ± 4 mg in group T ( P < 0.0001). Intraoperative sufentanil consumption was 38 ± 15 μ g in group T versus 30 ± 5 μ g in group P (not significant). The sedation score was 0 in both groups during the first 48 postoperative hours. Conclusions Preoperative TFP application decreases pain scores and morphine consumption in the PACU and appears to have prolonged effects spanning the first 48 postoperative hours.
