Jean Fissette

Psychological approaches during conscious sedation. Hypnosis versus stress reducing strategies: a prospective randomized study

&NA; Stress reducing strategies are useful in patients undergoing surgery. Hypnosis is also known to alleviate acute and chronic pain. We therefore compared the effectiveness of these two psychological approaches for reducing perioperative discomfort during conscious sedation for plastic surgery. Sixty patients scheduled for elective plastic surgery under local anesthesia and intravenous sedation (midazolam and alfentanil upon request) were included in the study after providing informed consent. They were randomly allocated to either stress reducing strategies (control: CONT) or hypnosis (HYP) during the entire surgical procedure. Both techniques were performed by the same anesthesiologist (MEF). Patient behavior was noted during surgery by a psychologist, the patient noted anxiety, pain, perceived control before, during and after surgery, and postoperative nausea and vomiting (PONV). Patient satisfaction and surgical conditions were also recorded. Peri‐ and postoperative anxiety and pain were significantly lower in the HYP group. This reduction in anxiety and pain were achieved despite a significant reduction in intraoperative requirements for midazolam and alfentanil in the HYP group (alfentanil: 8.7±0.9 &mgr;g kg−1/h−1 vs. 19.4±2 &mgr;g kg−1/h−1, P<0.001; midazolam: 0.04±0.003 mg kg−1/h−1 vs. 0.09±0.01 mg kg−1/h−1, P<0.001). Patients in the HYP group reported an impression of more intraoperative control than those in the CONT group (P<0.01). PONV were significantly reduced in the HYP group (6.5% vs. 30.8%, P<0.001). Surgical conditions were better in the HYP group. Less signs of patient discomfort and pain were observed by the psychologist in the HYP group (P<0.001). Vital signs were significantly more stable in the HYP group. Patient satisfaction score was significantly higher in the HYP group (P<0.004). This study suggests that hypnosis provides better perioperative pain and anxiety relief, allows for significant reductions in alfentanil and midazolam requirements, and improves patient satisfaction and surgical conditions as compared with conventional stress reducing strategies support in patients receiving conscious sedation for plastic surgery.

Carpal and Guyon tunnel syndrome in burns at the wrist

A series of 22 patients with burns of the upper extremities have been evaluated by clinical and electromyographic (EMG) studies. As suggested by others, a significantly higher incidence of carpal tunnel syndrome and sensory involvement of the ulnar nerve was discovered. Those findings suggest that we pay more attention to the median and ulnar nerves at the wrist level in burns and treat them when compression is demonstrated by clinical and EMG evaluation.

Mechanical Properties of Skin and Liposuction

BACKGROUND Liposuction removes fat, setting the skin under tension, and could therefore alter the overall viscodastic properties of the teguments. OBJECTIVE To measure in vivo the mechanical properties of skin at the site of liposuction and to compare the viscoelastic values with those of the inner aspect of the forearms. METHODS The Cutometer SEM 474 equipped with a 8‐mm probe was used. RESULTS Data show that cutaneous laxity, which is characteristic for an aging aspect, is not higher at the liposuction sites than on the reference area. CONCLUSION Liposuction does not increase the clinical aspects of skin aging.

Invasive Tricholemmal Carcinoma of the Nose

Tricholemmal carcinoma is a rare entity. It must be distinguished from the benign proliferating variant of the tricholemmal cyst. We report a case of tricholemmal carcinoma massively invading the nose. The neoplasm was excised surgically with a satisfactory outcome.