G. Orliaguet

Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF).

Background:  The French‐Language Society of Paediatric Anaesthesiologists (ADARPEF) designed a 1‐year prospective, multicenter and anonymous study to update both epidemiology and morbidity of regional anesthesia in children.

A survey of practice of tracheal intubation without muscle relaxant in paediatric patients

Background: Because of the renewed interest in intubation in children without relaxants, over a period of 1 month, the anaesthesiologists of five paediatric universitary teaching hospitals were asked to complete a questionnaire each time they performed a tracheal intubation without muscle relaxant.

Management of critically ill children with traumatic brain injury

The management of critically ill children with traumatic brain injury (TBI) requires a precise assessment of the brain lesions but also of potentially associated extra‐cranial injuries. Children with severe TBI should be treated in a pediatric trauma center, if possible. Initial assessment relies mainly upon clinical examination, trans‐cranial Doppler ultrasonography and body CT scan. Neurosurgical operations are rarely necessary in these patients, except in the case of a compressive subdural or epidural hematoma. On the other hand, one of the major goals of resuscitation in these children is aimed at protecting against secondary brain insults (SBI). SBI are mainly because of systemic hypotension, hypoxia, hypercarbia, anemia and hyperglycemia. Cerebral perfusion pressure (CPP = mean arterial blood pressure – intracranial pressure: ICP) should be monitored and optimized as soon as possible, taking into account age‐related differences in optimal CPP goals. Different general maneuvers must be applied in these patients early during their treatment (control of fever, avoidance of jugular venous outflow obstruction, maintenance of adequate arterial oxygenation, normocarbia, sedation–analgesia and normovolemia). In the case of increased ICP and/or decreased CPP, first‐tier ICP‐specific treatments may be implemented, including cerebrospinal fluid drainage, if possible, osmotic therapy and moderate hyperventilation. In the case of refractory intracranial hypertension, second‐tier therapy (profound hyperventilation with PaCO2 < 35 mmHg, high‐dose barbiturates, moderate hypothermia, decompressive craniectomy) may be introduced, after a new cerebral CT scan.

A Case of Respiratory Depression in a Child With Ultrarapid CYP2D6 Metabolism After Tramadol

We discuss a case of severe respiratory depression in a child, with ultrarapid CYP2D6 genotype and obstructive sleep apnea syndrome, after taking tramadol for pain relief related to a day-case tonsillectomy.

Case scenario: perianesthetic management of laryngospasm in children

Once the diagnosis has been made,the main goals are identifying and removing the offendingstimulus,applyingairwaymaneuverstoopentheairway,andadministering anesthetic agents if the obstruction is not re-lieved. The purpose of this case scenario is to highlight keypoints essential for the prevention, diagnosis, and treatmentof laryngospasm occurring during anesthesia.

Sédation et analgésie en structure d’urgence. Réactualisation 2010 de la Conférence d’experts de la Sfar de 1999

Sedation and analgesia in emergency structure. Reactualization 2010 of the Conference of Experts of Sfar of 1999 B. Vivien *, F. Adnet , V. Bounes , G. Chéron , X. Combes , J.-S. David , J.-F. Diependaele , J.-J. Eledjam , B. Eon , J.-P. Fontaine , M. Freysz , P. Michelet , G. Orliaguet , A. Puidupin , A. Ricard-Hibon , B. Riou , E. Wiel , J.-E. de La Coussaye o,4,** a Samu de Paris, département d’anesthésie-réanimation, hôpital Necker–Enfants-Malades, université Paris Descartes–Paris-5, 149, rue de Sèvres, 75730 Paris cedex 15, France b EA 3409, Samu 93, hôpital Avicenne, université Paris-13, 125, rue de Stalingrad, 93009 Bobigny, France c Samu 31, pôle de médecine d’urgences, hôpitaux universitaires, université de Toulouse, 1, avenue Jean-Poulhès, place du Dr.Baylac, 31059 Toulouse cedex 9, France d Département des urgences pédiatriques, hôpital Necker–Enfants-Malades, université Paris Descartes–Paris-5, 149, rue de Sèvres, 75730 Paris cedex 15, France e Département d’anesthésie-réanimation-urgences, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69493 Pierre-Bénite, France f Smur pédiatrique régional de Lille, centre hospitalier régional universitaire de Lille, université Lille-2, Nord-de-France, 5, avenue Oscar-Lambret, 59037 Lille cedex, France g Structure des urgences, hôpital Lapeyronie, université 1, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France h Pôle réanimation urgence, service d’aide médicale urgente hyperbarie (RUSH), réanimation des urgences, CHU de SainteMarguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France i Service d’accueil des urgences, hôpital Saint-Louis, université Paris-7, 1, avenue Claude-Vellefaux, 75010 Paris, France j Samu 21, département d’anesthésie-réanimation, centre hospitalier universitaire de Dijon, faculté de médecine, 3, rue du Faubourg-Raines, BP 1519, 21033 Dijon cedex, France Annales Françaises d’Anesthésie et de Réanimation 31 (2012) 391–404

Anesthésie-réanimation des craniosténoses et dysmorphies craniofaciales de l'enfant

Craniosynostosis occurs in one out of 2,000 births. It results in primary skull deformations requiring surgical repair, in infants with a body weight of less than 10 kg. Pure craniosynostosis is the most frequent situation, where the risk for cerebral compression during brain development is the lowest. Therefore the aim of surgical correction in this case is mainly cosmetic. Conversely, in syndromic craniosynostosis, associated malformations are more common and cerebral, visual and respiratory consequences of complex facio-craniosynostosis are usually severe. Current surgical techniques consist of a total skull vault reconstruction which carry a high risk of sudden and major blood losses. Intraoperatively, whatever the type of craniosynostosis, mean blood losses corresponding to 90% of estimated red cell mass have to be anticipated. These blood losses vary according to the type of skull deformation and the type of surgery. Accurate evaluation is usually difficult and must be based more on calculation of red cell mass variations than on simple monitoring of surgical drainage. Invasive haemodynamic monitoring is always required. To reduce the amount of homologous blood transfusion, peroperative haemodilution seems to be the most suitable technique, due to unresolved technical difficulties in autotransfusion practice in infants. Severe facial deformities are associated with chronic hypoxaemia and cerebral compression representing major risk for these children in poor condition undergoing such major surgical procedures. With experienced teams, this high-risk surgery carries a low peroperative mortality (less than 1%) and morbidity rate. The latter includes essentially transient peroperative hypotension. The excellent final cosmetic and functional results justify the practice of this surgery in children with a bodyweight of less than 10 kg.

Les traumatismes crâniens du nourrisson et du petit enfant : prise en charge initiale

The initial management of severely head-injured patients, including infants and children, is aimed at preventing and treating secondary brain damage, which mainly result from systemic insults (hypoxaemia, hypercarbia, arterial hypotension). Orotracheal intubation, followed by continuous sedation-analgesia, is mandatory when the Glasgow Coma Scale score (GCS) is less than or equal to 8 (crush induction is recommended). The goal of mechanical ventilation is to maintain normoxaemia and normocarbia. Moreover, the maintenance of an optimal cerebral perfusion pressure, usually 50 mmHg in infants, requires volume loading (isotonic fluids and colloids), and catecholamines if arterial hypotension persists. Intravenous mannitol is used only in case of life threatening intracranial hypertension, keeping in mind the potential for aggravating an hypovolaemia. Cerebral tomodensitometry is the most relevant imaging procedure for diagnosing surgical brain lesion. However, it should be noted, that severe head trauma is frequently associated with extra-cranial traumatic injuries, which may be responsible for (avoidable) deaths if the diagnosis is not made or delayed. Therefore, infants and small children presenting with severe head trauma should be considered as multiple injured and treated accordingly. Adequate initial management of severely head-injured children may participate to improved neurological outcome.

A survey of blood transfusion practice in French-speaking pediatric anesthesiologists.

Background:  There are so far no existing consensus guidelines regarding red blood cell transfusion during pediatric surgery, and there is a little information regarding red blood cell transfusion policy among pediatric anesthesiologists.

Arrêt cardiocirculatoire chez l’enfant traumatisé : une cause rare, la luxation atlanto-occipitale

We report the case of a trauma child who developed a cardiac arrest due to atlanto-occipital luxation of the cervical spine. The occurrence of a rapidly reversible cardiac arrest in a trauma patient should alert physicians about cervical trauma. Adequate resuscitation of these patients require endotracheal intubation with concomitant full immobilisation of the cervical spine, plasma expansion to prevent arterial hypotension and immobilisation of the cervical spine during transport. Thorough application of these resuscitation techniques should increase the survival rate on admission to trauma centres of paediatric patients presenting with such a severe condition. Nevertheless, atlanto-occipital luxation is a major cause of paediatric cervical trauma mortality and our patient did not survive this condition.