Emile Calenda

Sub-Tenon infiltration or classical analgesic drugs to relieve postoperative pain.

Background: In a prospective randomized double‐blind study, the analgesic effect produced by sub‐Tenon infiltration was compared with classic analgesic drugs in patients scheduled for posterior segment surgery under general anaesthesia.

Robot-Assisted Thoracoscopic Surgery versus Video-Assisted Thoracoscopic Surgery for Lung Lobectomy: Can a Robotic Approach Improve Short-Term Outcomes and Operative Safety?

Background Minimally invasive surgery has been recently recommended for treatment of early-stage non-small cell lung cancer. Despite the recent increase of robotic surgery, the place and potential advantages of the robot in thoracic surgery has not been well defined until now. Methods We reviewed our prospective database for retrospective comparison of our first 28 video-assisted thoracoscopic surgery lobectomies (V group) and our first 28 robotic lobectomies (R group). Results No significant difference was shown in median operative time between the two groups (185 vs. 190 minutes, p = 0.56). Median preincision time was significantly longer in the R group (80 vs. 60 minutes, P < 0.0001). The rate of emergency conversion for uncontrolled bleeding was lower in the R group (one vs. four). Median length of stay was comparable (6 days in the R group vs. 7 days in the V group, p = 0.4) with no significant difference in the rate of postoperative complications (eight Grade I in both groups, four Grade III or IV in the V group vs. six in the R group, according to the Clavien-Dindo classification, p = 0.93). No postoperative cardiac morbidity was observed in the R group. Median drainage time was similar (5 days, p = 0.78), with a rate of prolonged air leak slightly higher in the R group (25 vs. 17.8%, p = 0.74). Conclusion Perioperative outcomes are similar even in the learning period but robotic approach seems to offer more operative safety with fewer conversions for uncontrolled bleeding.

Peribulbar anaesthesia during keratoplasty: a prospective study of 100 cases

AIMS A prospective study was carried out in order to evaluate the efficacy and safety of peribulbar anaesthesia during keratoplasty and to describe surgical conditions. METHODS Of 137 consecutive keratoplasties, 100 (73%) were performed under peribulbar anaesthesia. Patients received a mean volume of 16.5 (SD 4) ml (range 9–22 ml) of a mixture of etidocaine, bupivacaine, and hyaluronidase. Ocular compression duration was at least 20 minutes and intraocular pressure (IOP) was measured with a Tonopen after injection, compression, and before trephination. Degree of akinesia, pain scoring, complications, and surgical conditions were studied. RESULTS Before trephination, IOP was 5.73 mm Hg below the preinjection value and was never above 21 mm Hg. Akinesia was complete in 80% of cases and 94% of patients found that surgery was painless. Two patients (2%) were very agitated during surgery. The last patient presented with an acute intraoperative suprachoroidal haemorrhage that did not result in a true expulsive haemorrhage despite an “open sky” situation. Surgical conditions were judged to be optimal by the patients in 92% of cases and by the surgeon in 98% of cases. CONCLUSION These results demonstrate that peribulbar anaesthesia offers excellent anaesthesia and akinesia during keratoplasty and may be recommended for this type of surgery.

Temporary quadriplegia following continuous thoracic paravertebral block

A case of temporary quadriplegia following a continuous thoracic paravertebral block in an adult patient scheduled for video-assisted thoracoscopy is presented. An 18-gauge Tuohy needle was inserted under direct vision by the surgeon but the tip of the catheter was not localized. Postoperatively, the patient developed temporary quadriplegia 90 minutes after the start of a continuous infusion of ropivacaine 0.2%. Imaging studies showed that the catheter was localized in the intrathecal space.

Peribulbar anesthesia in 750 patients treated with oral anticoagulants

AIM To check the safety of continuation of oral anticoagulants in ophthalmic procedures requiring a peribulbar anesthesia. METHOD A prospective case control study included 750 patients with oral anticoagulants in group A and 750 patients who had never been treated with oral anticoagulant in group B. Hemorrhages were graded as follows: 1) spot ecchymosis of eyelid and or subconjunctival hemorrhage; 2) eyelid ecchymosis involving half of the lid surface area; 3) eyelid ecchymosis all around the eye, no increase in intraocular pressure; 4) retrobulbar hemorrhage with increased intraocular pressure. RESULTS In group A, grade 1 was observed in 13 patients (1.74%) and grade 2 in 2 patients (0.26%). In group B, grade 1 was observed in 12 patients (1.6%) and grade 2 was absent. No 3 or 4 hemorrhage grade was encountered in both groups. There was not significant difference in grade 1 hemorrhage between both groups (P=0.21). CONCLUSION Oral anticoagulants were not associated with a significant increase in potentially sight-threatening local anesthetic complications.

Fiberoptic tracheal intubation through a Boussignac valve to maintain continuous oxygenation during intubation in severely obese patients: 11 cases

Tonsillar hypertrophy is seen most frequently in children aged 4 to 7 years. In addition, recurrent tonsillitis is often associated with unusually enlarged tonsils. The location of the laceration in our patient suggests that the injury was caused either by the right corner of the blade tip or by the edge of the guiding channel. The width of the tip of the pediatric Airtraq is 14 mm, while the width of the guiding channel of the device is 24 mm (Fig. 1). The pediatric Airtraq is relatively large compared with the oral cavity of young children. The anatomically shaped curvature of the Airtraq blade impedes visibility of the blade tip and the edge of the tube-guide in the oral cavity. The Airtraqs viewfinder also provides a narrower field of vision than does direct laryngoscopy, and we were unable to detect the bleeding site on withdrawal of the Airtraq. Manipulation of the Airtraq should be performed with care to avoid airway trauma in children, especially those with tonsillar hypertrophy.

Peribulbar block in 500 patients scheduled for eye procedures and treated with acetyl salicylic acid

OBJECTIVES No guidelines are available in France for peribulbar block for eye procedures. It is our hypothesis that continued use of acetyl salicylic acid for forestalling myocardial or cerebrovascular ischemic events does not increase the risk of hemorrhage, compared with discontinuation of its use in patients who undergo eye procedures under peribulbar block. METHODS For this prospective control study we enrolled two groups of 500 patients scheduled for intra-ocular eye surgery requiring a peribulbar block. Patients treated with acetyl salicylic acid were included in group A (500 patients). Patients who had never been treated with acetyl salicylic acid constituted the control group (group B: 500 patients). Hemorrhages were graded as follows: 1=spot ecchymosis; 2=lid ecchymosis involving half of the lid surface area or less; 3=lid ecchymosis all around the eye, without increase in intra-ocular pressure; 4=retrobulbar hemorrhage with increased intraocular pressure. RESULTS In group A, lid hemorrhages (grade 1) were observed in 30 patients (6.0%). No grade 2, 3 or 4 hemorrhages were encountered in this group. In group B, lid hemorrhage (grade 1) was observed in 20 patients (4.0%) and grade 2 in one patient (0.2 %), but no grade 3 or 4 hemorrhages were encountered. Statistical tests showed the absence of significance between both groups. CONCLUSION We conclude that between the groups with and without pre-operative acetyl salicylic acid the occurrence rate of lid hemorrhage was not significant in peribulbar block.

Toxic plasma concentration of ropivacaine after a paravertebral block in a patient suffering from severe hypoalbuminemia

A case of systemic ropivacaine toxicity from a continuous thoracic paravertebral block in an adult patient who received a lobectomy is presented. The catheter was placed by the surgeon. Eleven hours after the start of the infusion, the patient experienced an arrhythmia leading to death. The total venous plasma concentration of ropivacaine was high (3.2 μg/mL). Furthermore, the patient had severe hypoalbuminemia (albumin 24 g/L), which resulted in the increase of the unbound ropivacaine plasma concentration that was responsible for the toxic side effects.

Ultrasound comparison of diffusion of local anesthetic solution after a peribulbar and a sub-Tenon's block: a pilot study.

1Department of Anesthesiology, Rouen University Hospital, Institute for Biomedical Research, Rouen 76031, France Department of Opthalmology, Rouen University Hospital, Institute for Biomedical Research, Rouen 76031, France Correspondence to: Emile Calenda. Department of Anesthesiology, Rouen University Hospital, Institute for Biomedical Research, 1 rue de Germont, Rouen 76031, France. emile.calenda@chu-rouen.fr Received: 2014-07-22 Accepted: 2015-05-04

Effects of Unfractionated Heparin or Low-Molecular-Weight Heparin for Preventing Thrombosis after Infrainguinal Arterial Bypass Procedures

Unfractionated heparin or low-molecular-weight heparin for preventing thrombosis after infrainguinal arterial bypass procedures are commonly used without validation. We decided to assess both attitudes with the help of a retrospective study. We reported a non-inferiority between low-molecular-weight heparin and unfractionated heparin. It is possible to use unfractionated heparin in case of renal failure and a low molecular weight heparin when the clearance is normal because both therapies are equivalent.