Safety of day surgery for patients with special needs.

BACKGROUND: The objective of this study was to assess the safety and quality of day care management for dental surgery under general anaesthesia in a population with special needs and to compare the results with a control population. METHODS: A retrospective observational cohort study was performed. The study population included all patients who had day care dental surgery under general anaesthesia for one year. The primary endpoint was the rate of unscheduled admission, which was defined as the unplanned need to maintain a hospital stay on the evening of the surgical procedure. Secondary endpoints included occurrence of complications during the perioperative period (either anaesthesia or surgery related) on the day of surgery (D0) and on day 1 and satisfaction of patients or their relatives. RESULTS: Data from 138 patients (70 with special needs and 68 controls) were analysed. In both groups, patients were young (mean age 33 years ± 14 in each group). Special needs were mainly related to autism (34%), cerebral palsy (19%), intellectual disability (19%) and Down syndrome (10 %). Surgical procedures were more extensive in the control group. There was 1 unscheduled admission in the special needs group and 3 in the control group (RR 0.32, 95% CI [0.03; 3.04]). There was no difference in the rate of complications. CONCLUSION: In our cohort, day care management for dental surgery under general anaesthesia is safe and effective for patients with special needs.

Bacterial colonization is decreased after tunneling femoral perineural catheters.

BACKGROUND: Infection of perineural catheter is rare, although bacterial colonization is frequent. An observational study reported that subcutaneous tunneling perineural catheter could decrease its colonization rate. We performed a comparative study to assess the incidence of catheter related bacterial colonization of tunnelized femoral perineural catheters. METHODS: This bicentric, randomized, single-blind, controlled and intention-to-treat study was conducted from December 2009 to December 2011. The catheter was secured with adhesive strips in the control group and was tunneled subcutaneously in the tunnelization group. Primary endpoint was catheter colonization rate assessed by by Brun-Buisson quantitative culture. Secondary endpoints included catheter-related infection, inadvertent catheter dislodgement rate, incidence of technical problems with subcutaneous tunneling and, risk factors for catheter-related colonization. RESULTS: Of the total 338 patients included, 2 patients were later excluded and 78 were lost to follow-up for primary endpoint. Inadvertent removal of femoral catheter accounted for 33 of these 78 patients (10 for the tunnelization group versus 23 for the control group, P=0.02). There was a lower colonization rate in the patient group with tunnelization compared to the control group without tunnelization (6% versus 13.5%, respectively; OR=2.4; 95% CI: 1.1-5.3; P=0.02). No infection was observed. Coagulase-negative staphylococci is present in 61%. The absence of tunnelization is the only risk factor of colonization. For 7 patients, accidental perforation of perineural catheter during procedure was observed. CONCLUSIONS: Tunneled subcutaneous perineural catheter decreased the incidence of colonization. Moreover, tunnelization is an effective technique for securing the perineural catheter.

Residents in tutored practice exchange groups have better medical reasoning as measured by the script concordance test: A pilot study.

BACKGROUND: This pilot study attempted to evaluate the impact of a practice exchange group (PEG) tutored by a senior anaesthesiologist on clinical reasoning performance of anaesthesiology residents for uncertain situations. Changes in clinical reasoning were measured by script concordance tests (SCT). METHODS: First, a curriculum, with educational objectives and assessment tools, was proposed to all residents at the beginning of their 6-month training. The first group (control) consisted of residents undergoing a 6-month rotation without PEG training. The second group (PEG group) consisted of the residents starting a new rotation 6 months later, who followed a weekly PEG session. In both groups, clinical reasoning was assessed in the same manner, with SCTs, multiple-choice questions (MCQs) and questions with short answers. The primary outcome measurement of this study was the SCT results in the group with PEG training (PEG group) in comparison with those without (control group). RESULTS: The performance in the SCT, expressed as the degree of concordance with the panel [95% confidence interval or CI], was better in the PEG group including 19 residents (72 [68 to 76] %) as compared to the control group including 17 residents (60 [57 to 63] % P<0.001). Performances (mean [95% CI]) in MCQs and short answers were better in the PEG group (64 [57 to 71] and 74 [68 to 72] %, respectively) when compared with the control group (32 [28 to 36]% [P<0.001] and 60 [52 to 68] % [P<0.01], respectively). CONCLUSION: Our pilot study suggested that a senior-directed, peer-conducted educational training might improve the clinical reasoning of anaesthesia residents as measured by the SCT.

Contribution of the anatomy laboratory to the practical training of residents in regional anesthesia.

INTRODUCTION: Dissection workshop has never been assessed in the initial training of resident medical students in anesthesia. This work aimed at assessing the impact of this educational tool on the rates of success of the main blocks the resident in anesthesia achieved during their training. MATERIALS AND METHODS: The primary outcome measure studied in this work was the self-assessment by the resident of the rate of success of every block before and after the complementary training in regional anesthesia included dissection workshop, determined by a questionnaire sent by post at least 6 months after the teaching. Besides, the seminar was estimated at once by a questionnaire evaluating the quality as well as the interest of the education on a scale ranging from 0 to 10. RESULTS: Forty-two anesthesia residents went through the training. Thirty-four (77%) handed back the questionnaire assessing the global interest an average of 8.9 (1.4). Theoretical training received an average score of 7.7 (1.4) and dissection workshop in anatomy laboratory, a score of 7.8 (1.6). The quality of teaching methods used was marked nine (0.8). Twenty-seven residents (61.36%) mailed the questionnaire. The rate of success concerning each block in their clinical practice before and after the training is not different, only concerning the humeral canal block. CONCLUSION: Although the educational quality of the training was acknowledged as responding to the expectancies of the anesthesia residents, the dissection workshop do not meet with the expected requirements of rates improval of the different blocks part from the humeral canal one's, within this medical sample in initial training.

The risk of pulmonary aspiration in patients after weight loss due to bariatric surgery.

BACKGROUND: We conducted a study including patients with gastric banding or gastroplasty who previously underwent plastic or functional surgery to assess the risk of pulmonary aspiration. METHODS: A retrospective case-control study was performed including all patients undergoing a plastic or functional surgery over a 5-yr period (2000-2005) at Rouen University Hospital. Two groups were defined: the postbariatric group included patients who previously had bariatric surgery (laparoscopic adjustable gastric banding or Mason's vertical gastroplasty) before undergoing the plastic surgery; all other patients were assigned to the control group. Data included all anesthetic management and were recorded in the hospital computer database. The incidence of pulmonary aspiration was the outcome variable. RESULTS: One hundred ninety-eight plastic and functional operations (66 cases and 132 controls) were performed. Pulmonary aspiration was significantly (P<0.006) higher in the postbariatric group (4 patients: 6%) than in the nonbariatric group (0 patient). For this complication, all patients had previously undergone gastric banding. One patient who did not receive prokinetic prophylaxis required intensive care for severe pulmonary alteration. CONCLUSION: The risk of perioperative pulmonary aspiration in a patient after weight loss due to gastric banding was considered significant.