Intravenous magnesium re-establishes neuromuscular block after spontaneous recovery from an intubating dose of rocuronium: a randomised controlled trial

in European Journal of Anaesthesiology (2012), 29(2), 95-99

Dispositif pédagogique en médecine palliative visant le développement de la réflexivité chez des étudiants. Utilisation d'un portfolio électronique

in Pédagogie Médicale (2012), 13(1), 51-64

The volume of blood for epidural blood patch in obstetrics: a randomized, blinded clinical trial

in Anesthesia and Analgesia (2011), 113(1), 126-33

Anesthésie et sécurité des procédures en dehors du bloc opératoire: "l'affaire de tous"

in Revue Médicale de Liège (2011), 66(1), 18-24

Due to important technological improvements, anesthesiological activity outside the operating theatre is increasing. Most of these procedures are performed for gastro- enterology procedures; other ... [more ▼]

Due to important technological improvements, anesthesiological activity outside the operating theatre is increasing. Most of these procedures are performed for gastro- enterology procedures; other procedures include medical ima- ging, electroconvulsive therapy or cardioversion. The practice of anesthesia at alternative sites is associated with logistical dif- ficulties with many constraints. Anesthesia will be requested if the procedure is likely to be unpleasant or painful, if the patient is not cooperative, or if the patient’s hemodynamic condition is unstable. The pre-anesthesia assessment, an adequate monito- ring and an appropriate choice of the anesthetic technique and drugs will be helpful in managing an anesthetic procedure too frequently neglected despite it is associated with risks similar to procedures performed in the operating theatre. [less ▲]

Comparison of the Surgical Pleth Index (TM) with haemodynamic variables to assess nociception-anti-nociception balance during general anaesthesia

in British Journal of Anaesthesia (2011), 106(1), 101-11

BACKGROUND: The Surgical Pleth Index (SPI) is proposed as a means to assess the balance between noxious stimulation and the anti-nociceptive effects of anaesthesia. In this study, we compared SPI, mean ... [more ▼]

BACKGROUND: The Surgical Pleth Index (SPI) is proposed as a means to assess the balance between noxious stimulation and the anti-nociceptive effects of anaesthesia. In this study, we compared SPI, mean arterial pressure (MAP), and heart rate (HR) as a means of assessing this balance. METHODS: We studied a standard stimulus [head-holder insertion (HHI)] and varying remifentanil concentrations (CeREMI) in a group of patients undergoing neurosurgery. Patients receiving target-controlled infusions were randomly assigned to one of the three CeREMI (2, 4, or 6 ng m(1)), whereas propofol target was fixed at 3 microg ml(1). Steady state for both targets was achieved before HHI. Intravascular volume status (IVS) was evaluated using respiratory variations in arterial pressure. Prediction probability (Pk) and ordinal regression were used to assess SPI, MAP, and HR performance at indicating CeREMI, and the influence of IVS and chronic treatment for high arterial pressure, as possible confounding factors. RESULTS: The maximum SPI, MAP, or HR observed after HHI correctly indicated CeREMI in one of the two patients [accurate prediction rate (APR)=0.5]. When IVS and chronic treatment for high arterial pressure were taken into account, the APR was 0.6 for each individual variable and 0.8 when all of them predicted the same CeREMI. That increase in APR paralleled an increase in Pk from 0.63 to 0.89. CONCLUSIONS: SPI, HR, and MAP are of comparable value at gauging noxious stimulation-CeREMI balance. Their interpretation is improved by taking account of IVS, treatment for chronic high arterial pressure, and concordance between their predictions. [less ▲]

Analgésie épidurale obstétricale et pseudoxanthome élastique : à propos d’un cas

in Annales Françaises d'Anesthésie et de Réanimation (2011), 30(9), 685-7

Pseudoxanthoma elasticum is a rare inherited disorder of the elastic tissue characterised by multisystem manifestations. Skin, eyes, gastro-intestinal system and cardiovascular system are the major ... [more ▼]

Pseudoxanthoma elasticum is a rare inherited disorder of the elastic tissue characterised by multisystem manifestations. Skin, eyes, gastro-intestinal system and cardiovascular system are the major affected systems. We describe the anaesthetic management of a parturient affected by this disease. [less ▲]

Influence of anesthesia on cerebral blood flow, cerebral metabolic rate, and brain functional connectivity.

in Current Opinion in Anaesthesiology (2011), 24(5), 474-9

PURPOSE OF REVIEW: To describe recent studies exploring brain function under the influence of hypnotic anesthetic agents, and their implications on the understanding of consciousness physiology and ... [more ▼]

PURPOSE OF REVIEW: To describe recent studies exploring brain function under the influence of hypnotic anesthetic agents, and their implications on the understanding of consciousness physiology and anesthesia-induced alteration of consciousness. RECENT FINDINGS: Cerebral cortex is the primary target of the hypnotic effect of anesthetic agents, and higher-order association areas are more sensitive to this effect than lower-order processing regions. Increasing concentration of anesthetic agents progressively attenuates connectivity in the consciousness networks, while connectivity in lower-order sensory and motor networks is preserved. Alteration of thalamic sub-cortical regulation could compromise the cortical integration of information despite preserved thalamic activation by external stimuli. At concentrations producing unresponsiveness, the activity of consciousness networks becomes anticorrelated with thalamic activity, while connectivity in lower-order sensory networks persists, although with cross-modal interaction alterations. SUMMARY: Accumulating evidence suggests that hypnotic anesthetic agents disrupt large-scale cerebral connectivity. This would result in an inability of the brain to generate and integrate information, while external sensory information is still processed at a lower order of complexity. [less ▲]

EVALUATION SANCTIONNANTE D’ÉTUDIANTS DANS UN DISPOSITIF SUSCITANT LA RÉFLEXIVITÉ EN 2E CYCLE D’ÉTUDES MÉDICALES DANS UN COURS DE « MÉDECINE PALLIATIVE ET DE FIN DE VIE » DONT LES MOYENS UTILISÉS SONT LE PORTFOLIO ÉLECTRONIQUE, LE TUTORAT ET DES COURS THÉORIQUES

in Bulletin de l'ADMEE 2001/1 (2011)

Le cours de Médecine Palliative est dispensé aux étudiants en avant-dernière année des études médicales de 2e cycle par deux enseignants, Médecin Généraliste et Médecin Hospitalier. Ce cours est dispensé ... [more ▼]

Le cours de Médecine Palliative est dispensé aux étudiants en avant-dernière année des études médicales de 2e cycle par deux enseignants, Médecin Généraliste et Médecin Hospitalier. Ce cours est dispensé depuis 10 ans selon un format traditionnel ex cathedra. De nouveaux objectifs et de nouvelles modalités pédagogiques ont été introduits en 2010-2011. L’objectif principal est l’apprentissage réflexif des étudiants. Les outils pédagogiques sont le portfolio électronique, une vignette clinique évolutive, l’accompagnement à distance de chaque étudiant par un tuteur, des cours en présentiel. La pratique réflexive de chaque étudiant est évaluée au terme du dispositif selon des critères et des indicateurs préalablement communiqués. Des perspectives ont émergé sur base des analyses des forces et faiblesses. [less ▲]

Effets respiratoires de l'anesthésie locorégionale

Conference (2010, September 07)

Norepinephrine and ephedrine do not counteract the increase in cutaneous microcirculation induced by spinal anaesthesia.

in British Journal of Anaesthesia (2010), 105(2), 214-9

BACKGROUND: /st> Neuraxial anaesthesia improves tissue perfusion and tissue oxygen tension. Vasodilation induced by this technique may result in hypotension requiring the administration of vasoactive ... [more ▼]

BACKGROUND: /st> Neuraxial anaesthesia improves tissue perfusion and tissue oxygen tension. Vasodilation induced by this technique may result in hypotension requiring the administration of vasoactive drugs. The use of peripheral vasoconstrictors might counteract the improved tissue perfusion and its potentially beneficial effects. We therefore investigated the effect of i.v. norepinephrine and ephedrine on skin perfusion using laser-Doppler flowmetry (LDF) in patients during spinal anaesthesia. METHODS: /st> Skin blood flow expressed in perfusion units (PU) provided by LDF was measured simultaneously at the foot and the manubrium levels in 44 patients during spinal anaesthesia with a sensory level below T5. Norepinephrine infusion was then titrated to normalize mean arterial pressure (MAP) in 23 patients (Group NOR). Ephedrine (max. 10 mg) was administered in 21 patients (Group EPH). Changes in relative PU were compared between the two sites of measurements in each group during drug administration. The same doses of norepinephrine were assessed in 11 normal volunteers to assure comparable vasoreactivity at the foot and manubrium levels. RESULTS: /st> Spinal anaesthesia resulted in a 10% decrease in MAP (P<0.001), an increase in relative PU values at the foot level (P<0.001), and a decrease at the sternum level (P<0.05). Norepinephrine and ephedrine produced a significant increase in relative PU values at the foot level when compared with the sternum level (NOR: P=0.02; EPH: P=0.0035). In volunteers, norepinephrine decreased cutaneous perfusion similarly at the manubrium and foot levels. CONCLUSIONS: /st> Improved skin perfusion induced by spinal anaesthesia was not counteracted by the use of norepinephrine or ephedrine. [less ▲]