Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study.

BACKGROUND: Propofol use during sedation for colonoscopy can result in cardiopulmonary complications. Intravenous lidocaine can alleviate visceral pain and decrease propofol requirements during surgery. We tested the hypothesis that i.v. lidocaine reduces propofol requirements during colonoscopy and improves post-colonoscopy recovery. METHODS: Forty patients undergoing colonoscopy were included in this randomised placebo-controlled study. After titration of propofol to produce unconsciousness, patients were given i.v. lidocaine (1.5 mg kg-1 then 4 mg kg-1 h-1) or the same volume of saline. Sedation was standardised and combined propofol and ketamine. The primary endpoint was propofol requirements. Secondary endpoints were: number of oxygen desaturation episodes, endoscopists' working conditions, discharge time to the recovery room, post-colonoscopy pain, fatigue. RESULTS: Lidocaine infusion resulted in a significant reduction in propofol requirements: 58 (47) vs 121 (109) mg (P=0.02). Doses of ketamine were similar in the two groups: 19 (2) vs 20 (3) mg in the lidocaine and saline groups, respectively. Number of episodes of oxygen desaturation, endoscopists' comfort, and times for discharge to the recovery room were similar in both groups. Post-colonoscopy pain (P<0.01) and fatigue (P=0.03) were significantly lower in the lidocaine group. CONCLUSIONS: Intravenous infusion of lidocaine resulted in a 50% reduction in propofol dose requirements during colonoscopy. Immediate post-colonoscopy pain and fatigue were also improved by lidocaine. CLINICAL TRIAL REGISTRATION: NCT 02784860.

Comparison between two intraoperative intravenous loading doses of paracetamol on pain after minor hand surgery: two grams versus one gram.

BACKGROUND: Paracetamol (acetaminophen) is widely used for postoperative analgesia at a recommended dose of 1 g every six hours in adult patients. Increasing the loading dose to 2 g was suggested to improve immediate postoperative analgesia without increased toxicity in healthy adult patients. We tested the hypothesis that a loading dose of 2 g of intravenous paracetamol results in better postoperative analgesia after surgery as compared with a dose of 1 g. METHODS: Sixty adult patients scheduled for minor hand surgery under intravenous regional anaesthesia were randomized into two groups. The first group received 1 g of intravenous paracetamol before surgery while the second group received 2 g. Verbal numeric pain score, analgesic consumption, first night sleep quality, and patient's satisfaction were recorded during the first 24 hours. RESULTS: Verbal numeric pain scores during the first 24 hours after surgery were significantly lower in the 2 g paracetamol group as compared to the 1 g paracetamol group. No differences were found between the two groups with regard to rescue analgesic consumption, sleep quality and patient's satisfaction. CONCLUSIONS: An intraoperative loading dose of 2 g paracetamol improves postoperative analgesia after minor hand surgery as compared to 1 g paracetamol.

[New developments in anesthesia-reanimation for ambulatory procedures]. / Actualités thérapeutiques en anesthésie-réanimation: cap sur l'hôpital de jour.

The one day clinic possesses its own structure and organisation; patient management is also specific. Preoperative visit and assessment are programmed at least 48 hours before anesthesia. Preoperative examinations and choice of anesthetic technique (sedation associated with local anesthesia or not, general anesthesia, locoregional anesthesia, or hypnosedation) are discussed and determined depending upon medical history, clinical examination, and type of procedure. General recommandations, instructions about fasting, interruption of some therapies, and introduction of new medication(s) are explained orally and also provided in a written document. New anesthetics and analgesics allow quick awakening and recovery of vital functions, and subsequently rapid hospital discharge. Prevention and aggressive treatment of postoperative nausea and vomiting are also a major concern in our anesthesic management of ambulatory patient.

[Postoperative pain management in ambulatory pediatric surgery]. / Prise en charge de la douleur en pédiatrie après chirurgie ambulatoire.

Over the last fifteen years, child's pain has become one of our major concerns. In spite of this evolution, it remains one of the most frequent complications after ambulatory surgery. It is thus essential to implement all the resources we have at our disposal in order to optimize pain management. This can be obtained by basing our strategy on the concept of multimode analgesia. It is consequently essential that each team can achieve its own quality program; the corollary will be the development of clear recommendations for the parents with a systematic analgesics regulation at home and the possibility to resort to the family doctor or to the ambulatory centre in the event of persistence of pain.

Cardiac tamponade and pulmonary compression due to volvulus of oesophageal coloplasty.

We describe an unusual case of cardiac tamponade and pulmonary compression due to acute volvulus of colon interposition occuring late after oesophagectomy. Clinical signs were suggestive of cardiac tamponade but there was no evidence of pericardial effusion by transthoracic echocardiography. Thoracic-CT provided the diagnostic clue in revealing the extrapericardial nature (a major dilatation of the colonic transplant) of the tamponade. This diagnosis should be considered in case of acute cardiopulmonary distress occuring early or late after oesophagectomy.

Fatal Prevotella oralis meningitis.

Prevotella oralis, an obligate Gram-negative anaerobe, was detected as the cause of acute meningitis in a four-year-old cocker spaniel. Clinical signs included acute onset collapse and severe depression. Despite treatment, the animal died. A post-mortem examination was performed which revealed a fibrinosuppurative meningitis with no significant inflammation of the brain or spinal parenchyma. The aetiological diagnosis was confirmed by anaerobic bacterial culture. This report discusses the nature and extent of the lesions and possible routes of infection of the causative organism.