RESUMEN
BACKGROUND: We studied 63 ASA I children (age 2-8 yr) to determine the sufentanil dose needed to facilitate intubation under excellent conditions after inhalation induction with various end-tidal concentrations of sevoflurane without neuromuscular block. METHODS: Subjects were allocated randomly to receive sevoflurane end-tidal concentrations (e'(sevo)) of 2.5%, 3%, or 3.5%. Anaesthesia was induced with sevoflurane 6% without nitrous oxide for 2 min, and then inspired sevoflurane concentration was adjusted to keep e'(sevo) at 2.5%, 3%, or 3.5% according to the group. Subjects received i.v. sufentanil according to an 'up and down' design. Tracheal intubation by direct laryngoscopy was performed 6 min after sufentanil injection. Intubation was considered successful, if intubation conditions were excellent as determined by the laryngoscopist. RESULTS: The ED(50) [effective dose for 50% of subjects; mean (sd)] of sufentanil required for excellent intubation conditions was 0.6 (0.12), 0.32 (0.10), or 0.11 (0.07) microg kg(-1) for e'(sevo) of 2.5%, 3%, or 3.5%, respectively. Using logistic analysis, the 95% effective dose (ED(95)) of sufentanil was 1.02 [95% confidence intervals (CI) 0.31-1.74] microg kg(-1), 0.58 (95% CI 0.17-0.99) microg kg(-1), or 0.28 (95% CI 0.04-0.52) microg kg(-1) for e'(sevo) of 2.5%, 3%, or 3.5%, respectively. CONCLUSIONS: Excellent intubation conditions could be obtained in children after inhalation induction with low sevoflurane concentrations and adjuvant sufentanil.
Asunto(s)
Analgésicos Opioides/administración & dosificación , Anestésicos por Inhalación , Intubación Intratraqueal/métodos , Éteres Metílicos , Sufentanilo/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Niño , Preescolar , Relación Dosis-Respuesta a Droga , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Laringoscopía , Masculino , Bloqueo Neuromuscular , SevofluranoRESUMEN
BACKGROUND AND OBJECTIVES: Conservative surgery for soft-tissue sarcoma (STS) within multimodality treatment attempts to reconcile two contradictory requirements: assuring a good oncological outcome through a wide resection and preserving the function. The aim of our study is to verify whether our conservative approach to STS met these objectives. METHODS: A retrospective database analysis was performed in adults with primary limb or trunk wall STS operated in a single center from 1989 to 2012. Predictive factors for postoperative complications and functional impairment were tested in a multivariate analysis. RESULTS: 728 patients were operated (resection R0: 68%). Neoadjuvant chemotherapy (NAC) was given to 28%, postoperative radiotherapy to 70% of patients. Median follow-up was 103 months. At five years, overall survival was 80% and local recurrences 11%. Major postoperative complications occurred in 8% and functional impairment in 13% of the patients. Independent predictive factors for postoperative complications were American Society of Anesthesiologist classes 2 and 3 (OR: 2.3, CI: 1.2-4.5 and 4.0 CI: 1.7-9.3), tumor size >80 mm (OR: 2.5, CI: 1.3-4.9), tumor site (trunk wall/lower limb, OR: 4.1, CI: 1.3-13.6) and multifocal/multicompartmental spread (OR: 2, CI: 1.1-3.6). Independent predictive factors for function impairment were postoperative complications (OR: 5.3, CI: 2.8-10.1), NAC (OR: 3.6, CI: 2.2-5.8), and bone or neurovascular involvement (OR 3.3, CI 2.0-5.3), whereas Early Rehabilitation after Surgery (ERAS) improved outcome (OR: 0.5, CI: 0.3-0.9). CONCLUSION: Postoperative complications induced functional impairment. They may be reduced by acting on comorbidity factors and careful tumor evaluation prior to surgery. Furthermore, ERAS measures improved function.
Asunto(s)
Actividades Cotidianas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia del Cáncer por Perfusión Regional/métodos , Extremidades/cirugía , Complicaciones Posoperatorias/epidemiología , Radioterapia Adyuvante/métodos , Sarcoma/terapia , Neoplasias de los Tejidos Blandos/terapia , Torso/cirugía , Pared Abdominal , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Dacarbazina/uso terapéutico , Doxorrubicina/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Ifosfamida/uso terapéutico , Masculino , Mesna/uso terapéutico , Persona de Mediana Edad , Análisis Multivariante , Terapia Neoadyuvante/métodos , Estudios Retrospectivos , Factores de Riesgo , Sarcoma/patología , Neoplasias de los Tejidos Blandos/patología , Tasa de Supervivencia , Pared Torácica , Carga Tumoral , Adulto JovenRESUMEN
Soft-tissue sarcoma of the limbs or the trunk wall determine a heterogeneous group of tumours that tends to receive a more individualized approach. The surgeon in charge with soft-tissue sarcoma has to be familiar with these tumours in order to deliver an adequate treatment. Most important is the initial diagnostic procedure, comprising imaging with MRI, a core needle biopsy, and in France, referral to a centre of expertise within the clinical network NETSARC. Prior to surgery, a multidisciplinary conference determines its moment and the extent of surgical resection within the frame of a multidisciplinary approach, and also plans reconstructive surgery, when needed. A standardized operative report summarizes items necessary to describe the resection quality (i.e. tumour seen, tumour infiltrated?). In multidisciplinary staff meetings, they are compared to margins measured by the pathologist on the operative specimen. Hence, resection quality is determined collegially and defined by resection type R (R0, R1, R2) as a qualitative result. The quality of resection directly determines the 5-year risk of local recurrence, estimated between 10 and 20% in specialized centres, with the objective to attain 10%. Early rehabilitation favours better functional outcome. The surgeon's experience with soft-tissue sarcoma, as part of a multidisciplinary treatment, is key in achieving the best adequacy between oncological resection and favourable functional outcome. In France, a specific university course for soft-tissue sarcoma will be set-up.
Asunto(s)
Extremidades/cirugía , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/cirugía , Torso/cirugía , Biopsia , Humanos , Imagen por Resonancia Magnética , Márgenes de Escisión , Cuidados Posoperatorios , Cuidados Preoperatorios , Sarcoma/diagnóstico por imagen , Sarcoma/patología , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/patologíaRESUMEN
OBJECTIVE: The aim of the study was to compare the rehospitalization rate in the first year of life between 2 groups of very preterm infants born on 1997 and 2002; then we compared the very preterm infants' rehospitalization rate between our retrospective 1997 group and literature (including French cohort Epipage). PATIENTS AND METHODS: Our retrospective study included all neonates bornAsunto(s)
Recien Nacido Prematuro
, Recién Nacido de muy Bajo Peso
, Readmisión del Paciente/estadística & datos numéricos
, Estudios de Cohortes
, Femenino
, Edad Gestacional
, Humanos
, Lactante
, Recién Nacido
, Masculino
RESUMEN
Postoperative analgesia at home induces necessarily pain assessment by self-report or observational measure. A special scale has been validated for day-case surgery: the PPMP. Nevertheless, children's and parents' information and education are essential.
Asunto(s)
Analgesia/métodos , Servicios de Atención de Salud a Domicilio , Dimensión del Dolor/métodos , Dolor Postoperatorio/tratamiento farmacológico , Padres , Procedimientos Quirúrgicos Ambulatorios , Niño , Humanos , Educación del Paciente como AsuntoRESUMEN
Oesophago-gastro-duodenoscopy for diagnostic is daily performed in adults and in children during sedation with propofol. This is administrated in France by anaesthesiologists. Pulmonary or cardiovascular complications are rare. We report a case of massive inhalation during an EGD with a teenager. The assessment has revealed an oesophageal achalasia, a condition rare in children and atypical development. This case highlights the importance of systematic screening for risk of a full stomach during the anaesthesia consultation, and the difficulty in evaluation in case of medical migrant patient.
Asunto(s)
Sedación Consciente , Endoscopía del Sistema Digestivo/efectos adversos , Acalasia del Esófago/diagnóstico , Hipnóticos y Sedantes , Propofol , Adolescente , Candidiasis/complicaciones , Candidiasis/tratamiento farmacológico , Constricción Patológica , Trastornos de Deglución/complicaciones , Acalasia del Esófago/complicaciones , Femenino , Tecnología de Fibra Óptica , Humanos , Pulmón/diagnóstico por imagen , Terapia por Inhalación de Oxígeno , Radiografía , Vómitos/etiología , Vómitos/terapiaRESUMEN
BACKGROUND: We aimed to evaluate the use of central catheters introduced by a peripheral vein (PICC) in children with CF. METHODS: A descriptive study in patients in whom a PICC (Beckton Dickinson) was inserted. RESULTS: 24 children aged (median (range) 10.2 years (0.3-17.3) undergoing 44 procedures were included. PICC was successfully inserted in 93.2% (41/44) of cases. Total procedure duration was (median (range)) 32.5 (10-105) minutes. The operators encountered few difficulties, median (range) 2 (1-10) (1 (absence) to 10 (maximal)); median (range) 1 (1 to 5) attempt per child). No major side effects or infections were observed. PICC obstruction in 5 (12%) cases was successfully unblocked in 4 cases (urokinase). The catheter was functional throughout the antibiotic course in 40/41 cases. A final Doppler scan (30 cases) showed total permeability of the central veins in all cases. Satisfaction index of the operators and the patients were high: median (range) 9.5 (1-10) and 8.0 (6-10) (scale: 1 (worse) to 10 (best)), respectively. CONCLUSION: PICCs are simple to use, and may be safely inserted in the ward. Such catheters are well tolerated, may increase the well-being of children with CF and prove an effective means by which to deliver IV therapy in this population.
Asunto(s)
Antibacterianos/administración & dosificación , Cateterismo Venoso Central/métodos , Fibrosis Quística/complicaciones , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/aislamiento & purificación , Adolescente , Cateterismo Periférico , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios Prospectivos , Infecciones por Pseudomonas/etiología , Infecciones por Pseudomonas/microbiologíaRESUMEN
The aim of this study was to determine if it was possible to decrease the number of boluses of indomethacin for the treatment of patent ductus arteriosus. This retrospective study included 46 preterm neonates (<34 weeks' GA) who had had an ultrasound diagnosis predictive of subsequent symptomatic patent ductus arteriosus. All patients had received a daily intravenous doses of indomethacin, 0.1 mg/kg. Mean age at initiation of treatment was 4.5 +/- 3.1 days. Patency of the ductus arteriosus was controlled echocardiographically each day and treatment was discontinued as soon as the ductus arteriosus was closed. The initial success rate was 84.7%, of which 6.5% reopened. The mean cumulative dose of indomethacin was 0.35 mg/kg. There was no correlation between gestational age or birth weight and total cumulative dose. Overall tolerance was satisfactory with only one case of transient acute renal failure. A weak correlation between the cumulative dose of indomethacin and natremia (r = -0.43) or weight gain (r = 0.35) was noted, and none with serum creatinine or blood urea nitrogen levels. We confirm that lower indomethacin treatment of patent ductus arteriosus in premature neonates are as effective as standard protocols.