Preoperative frailty assessment: a review.

Elderly surgical population is growing faster than the rate of population ageing. The risk of postoperative complication is higher in this population, the type of complication and the risk indicators are different from younger patients. There is also a huge heterogeneity in the elderly population. The concept of frailty-emerges to explain these specific aspects and to risk stratify older patients. The present work intends to help the anaesthesiologist to take into account the concept of frailty at the preoperative visit. We reviewed, in the light of surgical context, the physiopathology of ageing, the definitions of frailty concept,the current existing strategies for peri-operational optimisation and the different frailty assessment tools. Our conclusions are that preoperative frailty assessment is essential in modern perioperative medicine practice and that the Edmonton Frail Scale stands out from other tools even though it cannot yet be considered as a gold standard.

[Gastric foreign body. Rare complication of nasogastric tube placing]. / Corps étranger intragastrique. Une complication rare de la mise en place de sonde gastrique.

The use of an uncuffed endotracheal tube for the placement of nasogastric tubes during surgery is not a procedure free of any risk. We report a rare case of gastric foreign body secondary to this procedure. A 67-year-old patient who had underwent a coronary bypass for a three vessels disease two years before complained of postprandial epigastralgia lasting for a few months. The investigations reported a gastric ulcer associated with a tubular gastric foreign body. The endoscopic extraction found an endotracheal tube. It is a common habit in our institution to use this method when placing this tube through a nostril in order to ease the nasogastric tube insertion when it is difficult.

Adult liver transplantation at UCL: update 2002.

The authors present the results of a single centre study of 587 liver transplants performed in 522 adults during the period 1984-2002. Results have improved significantly over time due to better pre-, peri- and post-transplant care. One, five, ten and fifteen year actuarial survivals for the whole patient group are 81.2; 69.8; 58.9 and 51.2%. The high incidence of de novo tumors (12.3%), of cardiovascular diseases (7.5%) and of end-stage renal function (3.6%) should be further incentives to tailor the immunosuppression to the individual patient and to direct the attention of the transplant physician to the long-term quality of life of the liver recipient.

Reporting systems in healthcare from a case-by-case experience to a general framework: an example in anaesthesia.

Reporting systems are becoming more widespread in healthcare. Since they may become mandatory under the pressure of insurance companies and administrative organizations, it is important to begin to go beyond a case-by-case approach and to move to a system where there is a general reflection on the best conditions of development and setting up of such systems in medicine. In this paper, we review existing reporting systems, break down their components, examine how they are constructed and propose some ideas on how to articulate them in a dynamic process in order to improve the validity of the tool as mediator of safety, quality and well-being at work.

[Peroperative desaturation during gynaecological laparoscopy-hysteroscopy: an unknown aetiology, pleural extravasation]. / Désaturation peropératoire lors d'une laparoscopie-hystéroscopie gynécologique: une étiologie méconnue, l'épanchement pleural.

A 41-year-old patient presented several episodes of desaturation during a gynaecological laparoscopy. The major complication of this procedure is the venous air embolism. Several other side-effects have been reported: heart rate disorders, subcutaneous emphysema or pneumothorax. Pleural effusions during gynaecologic laparoscopy are apparently rare and the volume of effusion must be important to induce clinical symptoms. This fact can probably explain the frequent difficulty of diagnosis. The role of the diaphragmatic lymphatic network and other physiologic aspects are discussed in this article.

[Postoperative otorrhagia: an unknown complication of Trendelenburg position during laparoscopic surgery?]. / L'otorragie postopératoire: une complication méconnue de la position de Trendelenburg en chirurgie coelioscopique?

Two patients have presented postoperative otorrhagia following gynaecologic laparoscopic procedures. This occurred after uneventful anaesthesia and recovery for surgery performed in forced Trendelenburg position (35 degrees with horizontal position). Different responsible mechanisms are discussed including haemodynamic changes induced by both the Trendelenburg position and the pneumoperitoneum. Particularities of external ear blood supply directly submitted to arterial and venous pressure changes, may also have contributed to the appearance of otorrhagia.