Mustapha Bensghir

Faster double-lumen tube intubation with the videolaryngoscope than with a standard laryngoscope

Purpose This study was designed to compare videolaryngoscopy with direct laryngoscopy with respect to ease of intubation when inserting a double lumen tube (DLT).MethodsIn this prospective randomized study 68 patients American Society of Anesthesiologists (ASA) physical status I and II were included. Patients with criteria indicating possible difficult intubation were excluded. The patients were randomized into two groups, depending on the tool used to facilitate intubation: videolaryngoscope (VL group) or direct laryngoscopy (DL group). The time required for intubation was the primary endpoint. Cormack and Lehane glottic visualization (CL) scores, the need for external laryngeal maneuvers and the number of attempts were measured.ResultsGlottic visualization was better in the VL group than in the DL group. The CL scores were I, II and III in 24, eight and two patients, respectively, in the VL group compared with 13, 11 and eight in the DL group (Pxa0=xa00.025). Patients in the VL group required fewer attempts than the DL group (Pxa0=xa00.019). Intubation time was 39.9xa0±xa04.4 sec in the VL group and 47.9xa0±xa05.4 sec in the DL group (Pxa0<xa00.001). No intubation failure was noted in group VL compared with two in the DL group (not significant).ConclusionThe use of a videolaryngoscope reduces the time required for intubation with a DLT compared with the direct laryngoscopy in elective thoracic surgery.RésuméObjectifLe but de cette étude était de comparer le vidéolaryngoscope et le laryngoscope standard quant à la facilité d’intubation pour l’insertion d’un tube à double lumière (TDL).Méthode Il s’agit d’une étude prospective randomisée dans laquelle 68 patients classés I ou II selon le barème de l’American Society of Anesthesiologists (ASA) devant subir une chirurgie thoracique programmée ont été inclus. Étaient exclus les patients présentant des critères prédictifs d’intubation difficile. Les patients étaient randomisés en deux groupes selon l’outil servant à l’intubationxa0: le vidéolaryngoscopexa0(groupexa0VL) ou le laryngoscopexa0standard (groupe LS). Le temps d’intubation était le critère de jugement principal. Les scores de visualisation glottique selon l’échelle de Cormack et Lehane (CL), la nécessité des manœuvres laryngées externes et le nombre de tentatives ont été notés.RésultatsLa visualisation glottique était meilleure dans le groupexa0VL que dans le groupe LS. Des scores CL de I, II et III étaient notés chez 24, huit et deux malades, respectivement, dans le groupexa0VL contre 13, 11 et huit dans le groupe LS (Pxa0=xa00,025). Les patients du groupexa0VL ont nécessité moins de tentatives que ceux du groupexa0LS (Pxa0=xa00,019). Le temps d’intubation était de 39,9xa0±xa04,4 sec dans le groupe VL contre 47,9xa0±xa05,4 sec dans le groupexa0LS (Pxa0<xa00,001). Aucun échec d’intubation n’a été noté dans le groupexa0VL contre deux échecs dans le groupexa0LS (différence non significative).ConclusionLe vidéolaryngoscope permet de réduire le temps d’intubation par les TDL en chirurgie thoracique programmée par rapport au laryngoscope standard.PURPOSEnThis study was designed to compare videolaryngoscopy with direct laryngoscopy with respect to ease of intubation when inserting a double lumen tube (DLT).nnnMETHODSnIn this prospective randomized study 68 patients American Society of Anesthesiologists (ASA) physical status I and II were included. Patients with criteria indicating possible difficult intubation were excluded. The patients were randomized into two groups, depending on the tool used to facilitate intubation: videolaryngoscope (VL group) or direct laryngoscopy (DL group). The time required for intubation was the primary endpoint. Cormack and Lehane glottic visualization (CL) scores, the need for external laryngeal maneuvers and the number of attempts were measured.nnnRESULTSnGlottic visualization was better in the VL group than in the DL group. The CL scores were I, II and III in 24, eight and two patients, respectively, in the VL group compared with 13, 11 and eight in the DL group (Pxa0=xa00.025). Patients in the VL group required fewer attempts than the DL group (Pxa0=xa00.019). Intubation time was 39.9xa0±xa04.4 sec in the VL group and 47.9xa0±xa05.4 sec in the DL group (Pxa0<xa00.001). No intubation failure was noted in group VL compared with two in the DL group (not significant).nnnCONCLUSIONnThe use of a videolaryngoscope reduces the time required for intubation with a DLT compared with the direct laryngoscopy in elective thoracic surgery.

Accès veineux périphériques au bloc opératoire : caractéristiques et facteurs prédictifs de difficulté

PURPOSEnTo investigate of predictors factors of difficult venous access device in the operating room in elective surgery.nnnMETHODSnIn a prospective study in central operating room, were included all patients scheduled for a surgical or diagnostic intervention. Were excluded all patients admitted with functional venous access. For each, were recorded patients demographic characteristics (age, gender, ASA class, BMI), history (chemotherapy, prolonged ICU stay, hospitalization for more than five days), data from the clinical examination (presence of skin lesions, arteriovenous fistulas, burns, neurological deficits) and the type of operator (trainee, nurse, resident, senior). The difficulty was judged on the number of attempts required for successful venous access. Puncture was considered easier for a number of attempts to one to two and difficult if the number of attempts was greater than two. Predictors factors were identified after univariate and multivariate analysis.nnnRESULTSnDuring one year (March 2008 to February 2009), form returns in 1500 were met, 1325 were usable. Venous catheterization was successful in 50.9% at the first attempt in 24.2% of patients at the second attempt and after three attempts in 18% of patients. Only 6.8% of patients required more than three attempts. A central venous catheter was required in seven patients. In multivariate analysis, chemotherapy (OR=4.54, 95% CI [2.92 to 7.03]; P<0.001), a nurse in training (OR=2.27, 95% CI [1.40 to 3.63]; P=0.001), a resident in training (OR=2.14, 95% CI [1.29 to 3.58]; P=0.003) and the presence of burns (OR=3.59, 95% CI [2.44 to 5.27]; P<0.001) were identified as independent predictors of difficulty of peripheral venous access.nnnDISCUSSIONnThe optimization of venous access devices in the operating room through the search for predictors of difficulty.

Effet d’une infiltration sous-cutanée de ropivacaïne 0,75 % sur l’analgésie postopératoire après césarienne

OBJECTIVEnEvaluate the effects of skin infiltration with ropivacaine 0,75% on postoperative pain after caesarean section in the first 24h.nnnPATIENTS AND METHODSnA prospective randomized double blind study was realized during three months in Auxerre Hospital. All ASA 1-2 patients presenting for elective caesarean section under spinal anesthesia were enrolled in the study. Drug addicts and patients with chronic pain were excluded from the study. The patients were randomly divided into two groups to receive skin infiltration 20 ml of ropivacaine 0,75% (Gr R) or skin infiltration of 20 ml of 0,9% saline solution. All patients received systematically propacetamol 1g per six hours and ketoprofen 50mg per six hours. Intravenous morphine titration was delivered to patients with a simple numerical scale greater or equal to three (SNS> or =3). Postoperative pain (SNS), morphine consumption and adverse reactions were compared.nnnRESULTSnFrom July to September 2005, 42 patients were enrolled in the study. The SNS was lower in the Gr R. Total morphine consumption was reduced in the Gr R. The incidence of the adverse effects were higher in the Gr P. One case of parietal haematoma was detected in the Gr P, the evolution of which was favorable.nnnDISCUSSION AND CONCLUSIONnSkin infiltration of ropivacaine 0,75% is a simple technique able to reduce postoperative pain score and morphine consumption after caesarean section.

Anaphylactic shock during hydatid cyst surgery

Intraoperative anaphylactic shock is an unusual complication. Different causes can be involved. Surgery of hydatid cyst is rarely responsible. About a case report of anaphylactic shock due to hydatid cyst surgery, the authors discuss the mechanisms, principles of treatment, and prevention measures of this complication.

Efficacité de l’infiltration cicatricielle subfasciale par la bupivacaïne dans la réduction de la douleur postopératoire des hernies inguinales

INTRODUCTIONnThe reduction of postoperative pain after surgery of inguinal hernia is an objective of lot of studies. The subfasciale infiltration of the wound may be an efficient technique.nnnMETHODSnThis study was designed as a randomized, double blind, prospective study, comparing two treatment groups: a group infiltrated by bupivacaine (Gr B), and second one infiltrated by a placebo (Gr P). A part of demographic parameters and ASA class, the postoperative pain intensity at rest and at coughing, the morphine consumption and the secondary effects were compared. Patients satisfaction and postoperative chronic pain at 3 and 6 months were also analyzed.nnnRESULTSnConcerning demographic parameters, ASA class and secondary effects, we didnt find any meaningful difference between the two groups. However, there was a significant reduction of postoperative pain in the bupivacaine group as well at rest as coughing. Gr P patients have more morphine consumption and they were unsatisfied and accused more chronic pain.nnnDISCUSSIONnWound infiltration is still a simple and efficient technique in postoperative pain reduction. With this technique, hernia surgery may become ambulatory.

Postoperative neurological aggravation after anesthesia with sevoflurane in a patient with xeroderma pigmentosum: a case report

IntroductionXeroderma pigmentosum is a rare autosomal recessive disease that causes changes in skin pigmentation, precancerous lesions and neurological abnormalities. It is a defect in the nucleotide excision repair mechanism. It has been reported that volatile anesthetics has a possible genotoxic side effect and deranged nucleotide excision repair in cells obtained from a patient with xeroderma pigmentosum.We report an unusual case of postoperative neurological aggravation in a patient with xeroderma pigmentosum anesthetized with sevoflurane.Case presentationA 24-year-old African woman, who has had xeroderma pigmentosum since childhood, was admitted to our hospital for a femoral neck fracture. A preoperative physical examination revealed that she had a resting tremor with ataxia. She had cutaneous lesions such as keratosis and hyperpigmentation on her face and both hands. There was no major alteration of cognitive function, muscular strength was maintained and her osteotendinous reflexes were preserved. Surgical fixation was performed under general anesthesia after the failure of spinal anesthesia. All parameters were stable during surgery. When she woke up four hours later, the patient presented with confusion and psychomotor agitation, sharpened reflexes and the Babinski reflex was present. Her postoperative test results and a magnetic resonance imaging scan were unremarkable. It was suggested that sevoflurane had had a probable deleterious effect on the neurological status of this patient.ConclusionThe anesthetizing of a patient with xeroderma pigmentosum is associated with a risk of worsening neurological disorders. At present, there are no clear recommendations to avoid the use of volatile agents in the anesthetic management of patients with xeroderma pigmentosum. More clinical and experimental research is needed to confirm the sensitivity of patients with xeroderma pigmentosum to sevoflurane and other halogenated anesthetics.

Comparaison de l’Airtraq™ et du laryngoscope Macintosh pour l’intubation trachéale chez l’adulte avec stabilisation manuelle en ligne du rachis cervical

INTRODUCTIONnAirtraq laryngoscope is a new and single use device for endotracheal intubation. Few studies showed the superiority of the Airtraq comparing to Macintosh laryngoscope in the setting of difficult intubation.nnnSTUDY DESIGNnTo compare the performance of these two laryngoscopes by simulating a situation of reduced mobility of the cervical spine by applying the Manual in-line stablization (MILS) maneuver.nnnPATIENTS AND METHODSnAfter obtaining the approval of the ethic committee, we realized a prospective single blind randomized study. During a 6-month period, 120xa0consenting patients scheduled for ORL or ophthalmologic surgery were included. They all had general anesthesia and orotracheal intubation. These patients were randomly and equally divided in two groups (n=60), depending on the type of the laryngoscope used (Airtraq or Macintosh). Were excluded from the study the patients with history or criteria predicting difficult intubation. Each patient was intubated by one of the five experimented anesthetists selected for this work. The principle judgment criteria were: i) the time taken for the orotracheal intubation and ii) the intubation difficulty score (IDS). The secondary judgment criterion was the hemodynamic modifications after the endotracheal intubation.nnnRESULTSnDemographic and upper airway track variables were comparable between the two groups. There was no case of failure of intubation in this serie. Nonetheless, all the patients of the Airtaq group were intubated from the first attempt, whereas half of the patients of the Macintosh group were intubated after the third attempt. Comparing to the Macintosh, the Airtraq reduces the time taken for the orotracheal intubation (14±1s vs 19±3s, P=0.01), the necessity of additional maneuver to facilitate the intubation, and the intubation difficulty score (0.7±0.3xa0vs 3.8±1, P<0.001). Orotracheal intubation using the Airtraq laryngoscope caused less hemodynamic stimulation than using the Macintosh.nnnCONCLUSIONnOur study showed the usefulness of the Airtraq laryngoscope for endotracheal intubation for patients presenting conditions of difficult intubation such as reduced mobility of the cervical spine.

Utilisation d'un vidéolaryncoscope pour une intubation difficile en chirurgie thoracique

Enfin, l’administration d’épinéphrine par voie sous-cutanée a prévenu une éventuelle hypotension orthostatique consécutive à la sympathoplégie due à la péridurale et au fait que, dans les avions des compagnies low-cost, le voyageur est en position assise stricte sans possibilité d’inclinaison du fauteuil. En outre, les seules personnes qui accompagnaient la patiente, son conjoint et sa fille, n’avaient aucune connaissance médicale ou paramédicale.

Comparison between the Airtraq, X-Lite, and direct laryngoscopes for thyroid surgery: a randomized clinical trial

RésuméObjectifComparer la performance des laryngoscopes Airtraq, X-Lite et standard dans l’intubation trachéale en chirurgie programmée de la thyroïde.MéthodeDans cette étude prospective randomisée étaient inclus les patients classifiés I et II selon l’American Society of Anesthesiologists (ASA) et devant subir une chirurgie de la thryroïde. Les sujets présentant des critères d’intubation difficile étaient exclus. Après induction de l’anesthésie au fentanyl, propofol et cisatracurium, les patients étaient randomisés en trois groupes, selon le dispositif utilisé pour l’intubation: le laryngoscope Airtraq (Airtraq), le vidéolaryngoscope X-Lite (X-lite) et le laryngoscope standard avec lame Macintosh (standard). Le temps d’intubation trachéale a été le critère de jugement principal. Le score de difficulté d’intubation, la classification de Cormack et Lehane, et les effets hémodynamiques et respiratoires ont été les critères de jugement secondaires.RésultatsCent cinq patients ont été inclus. Le temps d’intubation a été de moyenne (écart type) 28,2 (2,1) sec dans le groupe Airtraq contre 36,6 (3,7) sec dans le groupe X-Lite (Pxa0<xa00,001) et 41,1 (4,4) sec dans le groupe standard (Pxa0<xa00,001). Par rapport au laryngoscope standard, l’Airtraq a permis une meilleure visualisation glottique (Pxa0=xa00,003) avec moins de tentatives (Pxa0<xa00,001) et de difficulté d’intubation (Pxa0<xa00,001). La difficulté d’intubation était moindre avec l’Airtraq que le X-Lite (Pxa0=xa00,003). Les patients dans les groupes X-Lite et standard ont présenté plus de variations hémodynamiques par rapport au groupe Airtraq. Un seul échec d’intubation a été noté; il se trouvait dans le groupe standard.ConclusionEn chirurgie de la thyroïde, l’Airtraq et le X-Lite permettent de réduire le temps d’intubation par rapport au laryngoscope standard.AbstractPurposeTo compare the performance of the Airtraq, X-Lite, and direct laryngoscopes for tracheal intubation for elective thyroid surgery.MethodsIn this randomized prospective study, Patients who were ASA (American Society of Anesthesiologists) I or II physical status I or II and patients undergoing thyroid surgery were included in this randomized prospective study. Patients with attributes for difficult intubation criteria were excluded. After induction of anesthesia with fentanyl, propofol, and cisatracurium, patients were randomized into three groups according to the intubating device used: Airtraq laryngoscope (Airtraq), X-Lite video laryngoscope (X-lLite), and direct laryngoscope with a Macintosh blade (Direct). The primary outcome measurement was the time needed for tracheal intubation. Secondary outcomes included intubation difficulty score (IDS), Cormack-Lehane classification, as well as hemodynamic and respiratory effects.ResultsOne hundred and five patients were included. Mean (standard deviation) time for intubation was 28.2 (2.1) sec in the Airtraq group vs 36.6 (3.7) sec in the X-Lite group (Pxa0<xa00.001), and 41.1 (4.4) sec in the Direct group (Pxa0<xa00.001). Compared with to the direct laryngoscope, the Airtraq provided better visualization of the glottis (Pxa0=xa00.003) with fewer attempts (Pxa0<xa00.001) and lower IDS (Pxa0<xa00.001). The intubation difficulty score was lower with the Airtraq than with the X-Lite (Pxa0=xa00.003). Patients in the X-Lite and Direct groups showed more hemodynamic variations than those in the Airtraq group. There was only one failed intubation, in the direct group.ConclusionIn thyroid surgery, the Airtraq and X-Lite laryngoscopes decrease time to intubation when compared with direct laryngoscopy.

Article originalComparaison de l’Airtraq™ et du laryngoscope Macintosh pour l’intubation trachéale chez l’adulte avec stabilisation manuelle en ligne du rachis cervicalA comparison of Airtraq™ laryngoscope and standard direct laryngoscopy in adult patients with immobilized cervical spine

INTRODUCTIONnAirtraq laryngoscope is a new and single use device for endotracheal intubation. Few studies showed the superiority of the Airtraq comparing to Macintosh laryngoscope in the setting of difficult intubation.nnnSTUDY DESIGNnTo compare the performance of these two laryngoscopes by simulating a situation of reduced mobility of the cervical spine by applying the Manual in-line stablization (MILS) maneuver.nnnPATIENTS AND METHODSnAfter obtaining the approval of the ethic committee, we realized a prospective single blind randomized study. During a 6-month period, 120xa0consenting patients scheduled for ORL or ophthalmologic surgery were included. They all had general anesthesia and orotracheal intubation. These patients were randomly and equally divided in two groups (n=60), depending on the type of the laryngoscope used (Airtraq or Macintosh). Were excluded from the study the patients with history or criteria predicting difficult intubation. Each patient was intubated by one of the five experimented anesthetists selected for this work. The principle judgment criteria were: i) the time taken for the orotracheal intubation and ii) the intubation difficulty score (IDS). The secondary judgment criterion was the hemodynamic modifications after the endotracheal intubation.nnnRESULTSnDemographic and upper airway track variables were comparable between the two groups. There was no case of failure of intubation in this serie. Nonetheless, all the patients of the Airtaq group were intubated from the first attempt, whereas half of the patients of the Macintosh group were intubated after the third attempt. Comparing to the Macintosh, the Airtraq reduces the time taken for the orotracheal intubation (14±1s vs 19±3s, P=0.01), the necessity of additional maneuver to facilitate the intubation, and the intubation difficulty score (0.7±0.3xa0vs 3.8±1, P<0.001). Orotracheal intubation using the Airtraq laryngoscope caused less hemodynamic stimulation than using the Macintosh.nnnCONCLUSIONnOur study showed the usefulness of the Airtraq laryngoscope for endotracheal intubation for patients presenting conditions of difficult intubation such as reduced mobility of the cervical spine.