Benefits of intraoperative analgesia guided by the Analgesia Nociception Index (ANI) in bariatric surgery: An unmatched case-control study.

INTRODUCTION: Analgesia Nociception Index (ANI) has been proposed for the evaluation of the nociception-antinociception balance in the perioperative period. In obese patients, where the management of analgesia may be rendered difficult by pharmacological changes, we hypothesised that the monitoring of analgesia with ANI would reduce intraoperative opioid consumption during bariatric surgery. METHODS: This monocentric, observational, unmatched case-control study aimed to compare perioperative data from obese subjects (body mass index ≥35kgm-2) during bariatric surgery with or without the use of ANI monitoring (ANI+ group versus ANI- group). Intraoperative analgesia was provided by injection of sufentanil, which was performed according to the clinician's assessment in the ANI- group or to the ANI value in the ANI+ group. The primary outcome was the mean hourly intraoperative sufentanil requirement. Secondary outcomes included the need for postoperative morphine titration, incidence of nausea and vomiting, respiratory distress and pain scores in the first 24hours. RESULTS: Between December 2013 and September 2016, 60 obese patients (i.e. 30 per group) were included. The mean hourly consumption of sufentanil was significantly lower in the ANI+ group (0.15±0.05µgkg-1h-1 versus 0.17±0.05µgkg-1h-1, P=0.038). We found no difference between groups regarding the incidence of nausea and vomiting, acute respiratory distress, the need for postoperative morphine titration, or pain scores in the first 24 postoperative hours. CONCLUSION: The use of ANI monitoring might reduce intraoperative consumption of sufentanil during bariatric surgery but does not appear to be accompanied by a reduction in its side effects.

Health related quality of life and predictive factors six months after intensive care unit discharge.

BACKGROUND: Advances in critical care medicine have improved patients' survival rate. However, physical and cognitive sequels after Intensive Care Unit (ICU) discharge remain substantial. Our objectives were to evaluate the Health-related Quality of Life (HRQL) at 6-month after ICU discharge and identify the risk factors of this outcomes. METHODS: We performed a single-centre prospective observational study. The components of Short Form 36 (SF-36) were analysed for assessing HRQL on preadmission and at 3- and 6-month after ICU discharge. RESULTS: During the study period, 438 patients were eligible for recruitment and 220 of them were included in the trial. During the follow-up period, bodily pain and role limitations relating to emotion were both improved in comparison to the preadmission status while physical role component was lower at 3- and 6- month after ICU discharge. There was no other significant change in the SF-36 domains. Mental as well as physical aggregates remained also unchanged. Most of preadmission SF-36 scores were lower in patients who died within the first 6 months of follow-up compared to those who are still alive. Factors independently associated with the 6-month HRQL were age, preadmission HRQL score, SAPS II, prolonged mechanical ventilation (>3 days) and the occurrence of acute respiratory distress syndrome. CONCLUSION: In our Cohort, ICU stay does not seem to alter globally neither the mental nor the physical component of the HRQL at 6-month after the discharge. However, some domains of the SF-36 are subject to significant changes.

Usefulness of the Airtraq DL™ videolaryngoscope for placing a double-lumen tube.

BACKGROUND: Endotracheal insertion of a double-lumen tube (DLT) may be difficult because of its size and shape. The Airtraq™ is a new videolaryngoscope that allows supraglottis exposure without needing to align the oro-pharyngo-laryngeal axis. A specific model (Airtraq DL™), with a large diameter, has been specifically designed to insert a DLT. We have tested the efficiency of this device on the quality of supraglottis exposure and the endotracheal position of the DLT. STUDY DESIGN: This was a prospective and observational study. METHODS: This study included 37 consecutive patients with no risk for difficult intubation and who required insertion of a DLT for one-lung ventilation. The main outcomes were the success rate of endotracheal intubation within 120 s, the quality of glottis exposure, the position of the tube within the trachea and the occurrence of any complications. RESULTS: All patients were safely intubated, but only 33 (89%) were successfully intubated within 120 s (mean time: 44±27 s). Using the Airtraq DL™ videolaryngoscope, significantly more patients were graded Cormack and Lehane I as compared to the Macintosh laryngoscope (97% vs. 73%, P<0.05). Overall, fiberoptic bronchoscopy detected 62% of incorrectly positioned DLTs. Blood was noted on the blade of the videolaryngoscope in seven patients, desaturation occurred in two patients and labial trauma in one patient. CONCLUSION: The use of the Airtraq DL™ improves exposure of the supraglottis during insertion of a DLT. However, previous removal of the stylet could increase the risk of incorrectly positioning the tube.