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1.
Br J Anaesth ; 114(2): 297-306, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25431308

RESUMO

BACKGROUND: Intubation procedure in obese patients is a challenging issue both in the intensive care unit (ICU) and in the operating theatre (OT). The objectives of the study were (i) to compare the incidence of difficult intubation and (ii) its related complications in obese patients admitted to ICU and OT. METHODS: We conducted a multicentre prospective observational cohort study in ICU and OT in obese (BMI≥30 kg m(-2)) patients. The primary endpoint was the incidence of difficult intubation. Secondary endpoints were the risk factors for difficult intubation, the use of difficult airway management techniques, and severe life-threatening complications related to intubation (death, cardiac arrest, severe hypoxaemia, severe cardiovascular collapse). RESULTS: In cohorts of 1400 and 11 035 consecutive patients intubated in ICU and in the OT, 282 (20%) and 2103 (19%) were obese. In obese patients, the incidence of difficult intubation was twice more frequent in ICU than in the OT (16.3% vs 8.2%, P<0.01). In both cohorts, risk factors for difficult intubation were Mallampati score III/IV, obstructive sleep apnoea syndrome, and reduced mobility of cervical spine, while limited mouth opening, severe hypoxaemia, and coma appeared only in ICU. Specific difficult airway management techniques were used in 66 (36%) cases of difficult intubation in obese patients in the OT and in 10 (22%) cases in ICU (P=0.04). Severe life-threatening complications were significantly more frequent in ICU than in the OT (41.1% vs 1.9%, relative risk 21.6, 95% confidence interval 15.4-30.3, P<0.01). CONCLUSIONS: In obese patients, the incidence of difficult intubation was twice more frequent in ICU than in the OT and severe life-threatening complications related to intubation occurred 20-fold more often in ICU. CLINICAL TRIAL REGISTRATION: Current controlled trials. Identifier: NCT01532063.


Assuntos
Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Obesidade/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Arterial/fisiologia , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas/organização & administração , Oxigênio/sangue , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
2.
Rev Mal Respir ; 36(8): 985-1001, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31521434

RESUMO

The obese patient is at an increased risk of perioperative complications. Most importantly, these include difficult access to the airways (intubation, difficult or impossible ventilation), and post-extubation respiratory distress secondary to the development of atelectasis or obstruction of the airways, sometimes associated with the use of morphine derivatives. The association of obstructive sleep apnea syndrome (OSA) with obesity is very common, and induces a high risk of peri- and postoperative complications. Preoperative OSA screening is crucial in the obese patient, as well as its specific management: use of continuous positive pre, per and postoperative pressure. For any obese patient, the implementation of protocols for mask ventilation and/or difficult intubation and the use of protective ventilation, morphine-sparing strategies and a semi-seated positioning throughout the care, is recommended, combined with close monitoring postoperatively. The dosage of anesthetic drugs should be based on the theoretical ideal weight and then titrated, rather than dosed to the total weight. Monitoring of neuromuscular blocking should be used where appropriate, as well as monitoring of the depth of anesthesia. The occurrence of intraoperative recall is indeed more frequent in the obese patient than in the non-obese patient. Appropriate prophylaxis against venous thromboembolic disease and early mobilization are recommended, as thromboembolic disease is increased in the obese patient. The use of non-invasive ventilation to prevent the occurrence of acute post-operative respiratory failure and for its treatment is particularly effective in obese patients. In case of admission to ICU, an individualized ventilatory management based on pathophysiology and careful monitoring should be initiated.


Assuntos
Obesidade/complicações , Assistência Perioperatória , Analgésicos/uso terapêutico , Anestésicos/administração & dosagem , Antibioticoprofilaxia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/terapia , Relação Dose-Resposta a Droga , Humanos , Síndrome de Hipoventilação por Obesidade/etiologia , Síndrome de Hipoventilação por Obesidade/terapia , Oxigenoterapia , Complicações Pós-Operatórias/prevenção & controle , Respiração Artificial , Insuficiência Respiratória/prevenção & controle , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/terapia , Tromboembolia Venosa/prevenção & controle
3.
Ann Fr Anesth Reanim ; 33(7-8): 462-5, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25138358

RESUMO

During the past few years, many manufacturers have developed a new generation anesthesia ventilators or anesthesia workstations with innovative technology and introduced so-called new ventilatory modes in the operating room. The aim of this article is to briefly explain how an anesthesia ventilator works, to describe the main differences between the technologies used, to describe the main criteria for evaluating technical and pneumatic performances and to list key elements not to be forgotten during the process of acquiring an anesthesia ventilator.


Assuntos
Anestesia/métodos , Anestesiologia/instrumentação , Ventiladores Mecânicos , Humanos
4.
Ann Fr Anesth Reanim ; 33(1): 16-20, 2014 Jan.
Artigo em Francês | MEDLINE | ID: mdl-24439493

RESUMO

OBJECTIVE: To describe the evolution of perioperative anesthesia practices in for esophageal cancer surgery. PATIENTS AND METHODS: We conducted an observational retrospective study in a single center evaluating main perioperative practices during 16 years (1994-2009). Statistical analysis was done on 4 chronologic quartiles of same sample size. RESULTS: Two hundred and seven consecutive patients were included during the 4 periods 1994-1997 (n=52), 1997-1999 (n=52), 1999-2003 (n=52) and 2004-2009 (n=51). The main significant evolutions between the first and the fourth period were observed: (i) in ventilation: lower tidal volume (9.6[8.6-10.6] vs 7.6[7.0-8.3] mL/kg of ideal body weight (IBW), p<0.01), increased use of Positive End Expiratory Pressure (0 vs 83%, p<0.001) and increased use of post-operative non-invasive ventilation (0 vs 51%, p<0.001); (ii) in hemodynamic management: lower fluid replacement (20.6 [16.0-24.6] vs 12.6 [9.7-16.2] mL/h/kg of IBW, p<0.001); (iii) in analgesia: increased use of epidural thoracic anesthesia (31 vs 57%, p<0.001). Peroperative bleeding, type of fluid replacement, length of mechanical ventilation, length of stay in intensive care unit, ventilatory free days and mortality at day 28 didn't change. CONCLUSIONS: During these previous years, anesthesia practices in ventilation, hemodynamics and analgesia for esophageal cancer surgery have changed.


Assuntos
Neoplasias Esofágicas/cirurgia , Hemodinâmica/fisiologia , Manejo da Dor/tendências , Dor Pós-Operatória/tratamento farmacológico , Respiração Artificial/tendências , Adulto , Idoso , Analgesia Epidural/métodos , Volume Sanguíneo/fisiologia , Feminino , Hidratação/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Respiração com Pressão Positiva , Estudos Retrospectivos , Volume de Ventilação Pulmonar/fisiologia
5.
Ann Fr Anesth Reanim ; 30(12): 899-904, 2011 Dec.
Artigo em Francês | MEDLINE | ID: mdl-22035834

RESUMO

OBJECTIVE: To define the causes of mortality of patients who died within the first three months after a liver transplantation. TYPE OF STUDY: Retrospective, observational, and single centre study. PATIENTS AND METHODS: Between March 1989 and July 2010, all patients who died within three months after a liver transplantation were included. Demographic characteristics, preoperative and peroperative data, donor characteristics, postoperative complications and causes of mortality were collected. RESULTS: Among the 788 performed liver transplantations, 76 patients died in intensive care unit (11%). The main indications of liver transplantation were alcoholic cirrhosis (30%), hepatitis C (28%), hepatocarcinoma (15%), primitive or secondary biliary cirrhosis (10%). Fifty percent of the patients were categorized as Child C. The main causes of death were non-function or dysfunction with retransplantation contra-indication graft (18%), sepsis (18%), neurological complications (12%), hemorrhagic shock (13%), (9%), multiorgan failures (5%), cardiac complications (6%). CONCLUSION: In this study, the main causes of mortality were infectious, neurological and hemorrhagic. These results emphasize the necessity for better control of sepsis, haemorrhage and immunosupressors.


Assuntos
Transplante de Fígado/mortalidade , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
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