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  • 1
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    Online Resource
    Pupillometry-guided Intraoperative Remifentanil Administration versus Standard Practice Influences Opioid Use
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Anesthesiology Vol. 127, No. 2 ( 2017-08-01), p. 284-292
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 127, No. 2 ( 2017-08-01), p. 284-292
    Abstract: Pupillometry has shown promising results for assessing nociception in anesthetized patients. However, its benefits in clinical practice are not demonstrated. The aim of this prospective randomized study was to evaluate the impact of intraoperative pupillometry monitoring on perioperative opioid consumption in major gynecologic surgery. Methods After receiving ethics committee approval and written consent of patients, American Society of Anesthesiologists status I to II women undergoing gynecologic surgery were included in this single-blinded, prospective, parallel-arm randomized study. General anesthesia was standardized with propofol–remifentanil target-controlled infusion. Patients were randomly assigned into two groups. In the pupillometry group, remifentanil administration was guided by pupillary diameter changes. In the standard group, remifentanil administration was left to the discretion of the anesthesiologist. The primary outcome was intraoperative remifentanil consumption. Results Fifty-five patients were analyzed. Remifentanil consumption was markedly decreased in the pupillometry group (3.8 [3.4 to 4.8 µg · kg–1 · h–1] vs. 7.9 µg · kg–1 · h–1 [6.5 to 9.0 µg · kg–1 · h–1] in the standard group; difference = 4.2 µg · kg–1 · h–1 [95% CI, 3.0 to 5.3 µg · kg–1 · h–1]; P & lt; 0.001). Cumulative 0- to 12-h morphine consumption was reduced in the pupillometry group (two-way repeated measures ANOVA 0.3 ± 0.1 vs. 0.4 ± 0.2 mg/kg; P = 0.048). A telephone survey 3 months after surgery revealed that 15 of 29 patients in the standard group still experienced procedure-related pain versus 3 of 23 in the pupillometry group (chi-square P = 0.037). No adverse events associated with pupillometry were observed during the study. Conclusions The use of pupillometry to guide intraoperative analgesia reduced intraoperative remifentanil consumption and postoperative morphine requirements. The possible consequences of decreasing intraoperative remifentanil in terms of chronic pain require further investigation.
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/ALN.0000000000001705
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2016092-6
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  • 2
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    Monitoring of analgesia level during general anesthesia in children
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Current Opinion in Anaesthesiology Vol. 35, No. 3 ( 2022-06), p. 367-373
    Details
    In: Current Opinion in Anaesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 3 ( 2022-06), p. 367-373
    Abstract: Monitoring of intraoperative nociception has made substantial progress in adult anesthesia during the last 10 years. Several monitors have been validated and their use has been associated with intraoperative or postoperative benefits in the adult population. In pediatric anesthesia, less data are available. However, several recent publications have assessed the performance of nociception monitors in children, and investigated their potential benefits in this context. This review will describe the main validated intraoperative nociception monitors, summarize adult findings and describe the available pediatric data. Recent findings Six intraoperative nociception indices were included in this review. Among them, four have shown promising results in children: Surgical Pleth Index (GE-Healthcare, Helsinki, Finland), Analgesia-Nociception Index (Mdoloris Medical Systems, Loos, France), Newborn-Infant Parasympathetic Evaluation (Mdoloris Medical Systems), and Pupillometry (IDMED, Marseille, France). The relevance of Skin Conductance (MedStorm innovations, AS, Oslo, Norway) under general anesthesia could not be established. Finally, the Nociception Level (Medasense, Ramat Gan, Israel) still requires to be investigated in children. Summary To date, four monitors may provide a relevant assessment of intraoperative nociception in children. However, the potential clinical benefits associated with their use to guide analgesia remain to be demonstrated.
    Type of Medium: Online Resource
    ISSN: 0952-7907 , 1473-6500
    URL: Article
    DOI: 10.1097/ACO.0000000000001141
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2027005-7
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  • 3
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    Admission Base Deficit as a Long-Term Prognostic Factor in Severe Pediatric Trauma Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Journal of Trauma: Injury, Infection & Critical Care Vol. 67, No. 6 ( 2009-12), p. 1272-1277
    Details
    In: Journal of Trauma: Injury, Infection & Critical Care, Ovid Technologies (Wolters Kluwer Health), Vol. 67, No. 6 ( 2009-12), p. 1272-1277
    Type of Medium: Online Resource
    ISSN: 0022-5282
    URL: Article
    DOI: 10.1097/TA.0b013e31819db828
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
    detail.hit.zdb_id: 2001856-3
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  • 4
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    Influence de la profondeur d’hypnose sur le réflexe de dilatation pupillaire sous anesthésie générale
    Elsevier BV ; 2015
    In:  Anesthésie & Réanimation Vol. 1 ( 2015-09), p. A154-A155
    Details
    In: Anesthésie & Réanimation, Elsevier BV, Vol. 1 ( 2015-09), p. A154-A155
    Type of Medium: Online Resource
    ISSN: 2352-5800
    URL: Article
    DOI: 10.1016/j.anrea.2015.07.238
    Language: French
    Publisher: Elsevier BV
    Publication Date: 2015
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  • 5
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    Epidemiology and complications of anaesthesia in the French centres that participated to NECTARINE: A secondary analysis
    Elsevier BV ; 2022
    In:  Anaesthesia Critical Care & Pain Medicine Vol. 41, No. 2 ( 2022-04), p. 101036-
    Details
    In: Anaesthesia Critical Care & Pain Medicine, Elsevier BV, Vol. 41, No. 2 ( 2022-04), p. 101036-
    Type of Medium: Online Resource
    ISSN: 2352-5568
    URL: Article
    DOI: 10.1016/j.accpm.2022.101036
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2814747-9
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  • 6
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    Management of the child's airway under anaesthesia: The French guidelines
    Elsevier BV ; 2019
    In:  Anaesthesia Critical Care & Pain Medicine Vol. 38, No. 6 ( 2019-12), p. 681-693
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    In: Anaesthesia Critical Care & Pain Medicine, Elsevier BV, Vol. 38, No. 6 ( 2019-12), p. 681-693
    Type of Medium: Online Resource
    ISSN: 2352-5568
    URL: Article
    DOI: 10.1016/j.accpm.2019.02.004
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
    detail.hit.zdb_id: 2814747-9
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  • 7
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    Bispectral index under propofol anesthesia in children: a comparative randomized study between TIVA and TCI
    Wiley ; 2016
    In:  Pediatric Anesthesia Vol. 26, No. 9 ( 2016-09), p. 899-908
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 26, No. 9 ( 2016-09), p. 899-908
    Abstract: In children, only a few studies have compared different modes of propofol infusion during a total intravenous anesthesia ( TIVA ) with propofol and remifentanil. The aim of this study was to compare Bispectral Index ( BIS ) profiles (percentage of time spent at adequate BIS values) between four modes of propofol infusion: titration of the infusion rate on clinical signs ( TIVA 0 ), titration of the infusion rate on the BIS (TIVA BIS ), target controlled infusion ( TCI ) guided by the BIS either with the Kataria model ( TCI K BIS ) or the Schnider model ( TCI S BIS ). Methods Sixty‐six children (aged from 4 to 14 years) were prospectively randomized into one of the four groups. In the TIVA 0 group, the anesthesiologist was blinded to the BIS . In each group, the percentage of time with adequate BIS values (45–55), the bias, and imprecision were calculated. Results The propofol consumption was similar in the four groups. During the maintenance phase, the percentage of time spent in the targeted BIS range was significantly lower in the TIVA 0 group compared to the three other groups ( TIVA 0 : 31% ± 22, TIVA BIS : 59% ± 17, TCI K BIS : 53% ± 12, TCI S BIS : 56% ± 17). The bias was not statistically different between the four groups, but the imprecision was larger for the TIVA 0 group. Compared to the Kataria model, the Schnider model was associated with shorter time delay to reach the desired BIS , to eyes opening, and to tracheal extubation. Conclusions Propofol administration using manual infusion guided by clinical signs was associated with higher risks of over‐ or underdosage when compared to BIS ‐guided administrations. When propofol infusion was guided by the BIS , no major difference was found between TIVA and TCI (either with the Kataria or the Schnider model). This study highlights the need of a pharmacodynamic feedback during propofol anesthesia in children.
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.2016.26.issue-9
    DOI: 10.1111/pan.12957
    Language: English
    Publisher: Wiley
    Publication Date: 2016
    detail.hit.zdb_id: 2008564-3
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  • 8
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    Relationship between pre‐incision Pupillary Pain Index and post‐incision heart rate and pupillary diameter variation in children
    Wiley ; 2021
    In:  Pediatric Anesthesia Vol. 31, No. 10 ( 2021-10), p. 1121-1128
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 31, No. 10 ( 2021-10), p. 1121-1128
    Abstract: The Pupillary Pain Index is a recent pupillometric index designed to assess the level of analgesia under general anesthesia in children and adults. If analgesia is inadequate, acute nociceptive stimuli such as skin incision may induce significant hemodynamic disturbances. Aims Our aim was to investigate the potential relationship between pre‐incision Pupillary Pain Index and heart rate increase following skin incision in children. Methods This was a prospective, non‐randomized, registered pilot study. We included children undergoing surgery under general anesthesia. Pupillary Pain Index was assessed 2 min before skin incision. Then, heart rate maximal variation (Δ HR ) and pupillary diameter maximal variation (Δ PD ) in the minute following incision were recorded. Spearman coefficient was calculated to characterize the relationship between Pupillary Pain Index and Δ HR or Δ PD . Using receiver operating characteristic curve analysis, we also studied the predictive value of pre‐incision Pupillary Pain Index for heart rate and pupillary diameter reactivity. Results 53 patients were included (10 ± 4 years, 40 ± 19 kg). There was a modest correlation between pre‐incision Pupillary Pain Index and Δ HR (Spearman rs = 0.35 [0.05–0.57], p  = .011), and between pre‐incision Pupillary Pain Index and Δ PD (Spearman rs = 0.54 [0.33–0.71], p   〈  .001). Regarding the predictive value of Pupillary Pain Index for heart rate or pupillary diameter reactivity, the corresponding areas under the receiver operating characteristic curves were 0.90 [0.82–0.99] and 0.78 [0.65–0.93], respectively. A threshold of Pupillary Pain Index 〈 3 predicted the absence of heart rate reactivity at incision with a good performance (negative predictive value = 1). Conclusions In children, pre‐incision Pupillary Pain Index was moderately correlated with post‐incision nociception. Pre‐incision Pupillary Pain Index had good predictive performances for heart rate or pupillary diameter reactivity to skin incision. Pre‐incision Pupillary Pain Index 〈 3 might predict the absence of heart rate reaction to incision.
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.v31.10
    DOI: 10.1111/pan.14253
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2008564-3
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  • 9
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    Pupillary Pain Index Changes After a Standardized Bolus of Alfentanil Under Sevoflurane Anesthesia: First Evaluation of a New Pupillometric Index to Assess the Level of Analgesia During General Anesthesia
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Anesthesia & Analgesia Vol. 128, No. 3 ( 2019-03), p. 467-474
    Details
    In: Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 128, No. 3 ( 2019-03), p. 467-474
    Abstract: The pupillary pain index (PPI) is a novel pupillometric index, designed to assess intraoperative analgesia. It is based on the evaluation of the pupillary response to electrical stimuli of increasing intensity. It ranges from 1 (low level of pupillary reactivity, high level of analgesia) to 10 (high level of pupillary reactivity, low level of analgesia). In this first evaluation of the PPI, our objective was to investigate the PPI changes after a bolus of 10 µg·kg −1 of alfentanil in children under sevoflurane general anesthesia. METHODS: After ethics committee approval and informed consent, 20 healthy children (9 ± 5 years) undergoing elective surgery under general anesthesia were included in this prospective, open, registered pilot study (NCT02646592). Anesthetic induction was standardized with sevoflurane 6% and propofol 1 mg·kg −1 . After tracheal intubation, sevoflurane concentration was maintained at 2% for 10 minutes. A first PPI measurement was performed (PPI-1), and a bolus of 10 µg·kg −1 was administered. Two minutes after this bolus, a second PPI measurement was performed (PPI-2). Heart rate, blood pressure, and bispectral index were recorded before and after each PPI measurement. Resting pupillary diameter was recorded before each PPI measurement. PPI scores before and after the bolus of alfentanil were compared using a Wilcoxon signed rank test. RESULTS: PPI scores decreased after administration of a bolus of alfentanil (median difference: −3 [95% confidence interval, −4 to −2]). The median (quartiles) of PPI-1 (baseline, before alfentanil) was 6 (4, 7), and the median (quartiles) of PPI-2 (after alfentanil) was 2 (2, 3) ( P 〈 .001). No difference was found in resting pupillary diameter before PPI-1 and PPI-2 (2.2 ± 0.2 and 2.2 ± 0.3 mm, respectively; P = .86). There were no significant changes in heart rate or blood pressure after PPI measurements ( P = .46 and .49, respectively). Bispectral index was slightly increased after PPI measurements ( P = .01; mean bispectral index increase 〈 5%). No withdrawal movements occurred during PPI measurements. CONCLUSIONS: There was a significant decrease in PPI after alfentanil administration. The results of this pilot study suggest that PPI score decreases when the level of analgesia increases. PPI measurement was not associated with a clinical or hemodynamic nociceptive response. This new index might provide useful information to individually adapt opioid administration before nociceptive stimuli under general anesthesia.
    Type of Medium: Online Resource
    ISSN: 0003-2999
    URL: Article
    DOI: 10.1213/ANE.0000000000003681
    RVK:
    XA 22250
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2018275-2
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  • 10
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    Online Resource
    Assessment of Coagulation by Thromboelastography During Ongoing Postpartum Hemorrhage: A Retrospective Cohort Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Anesthesia & Analgesia Vol. 130, No. 2 ( 2020-02), p. 416-425
    Details
    In: Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 130, No. 2 ( 2020-02), p. 416-425
    Abstract: Rapid assessment of hemostasis during postpartum hemorrhage (PPH) is essential to allow characterization of coagulopathy, to estimate bleeding severity, and to improve outcome. Point of care (POC) coagulation monitors could be of great interest for early diagnosis and treatment of coagulation disorders in PPH. METHODS: Women with ongoing PPH 〉 500 mL who clinically required an assessment of coagulation with thromboelastography (TEG) were included. The primary aim of this retrospective observational cohort study was to assess the predictive accuracy of TEG parameters for the diagnosis of coagulation disorders (hypofibrinogenemia ≤2 g/L, thrombocytopenia ≤80,000/mm 3 , prothrombin ratio ≤50%, or activated partial thromboplastin time ratio ≥1.5) during PPH. The analyzed TEG parameters were Kaolin-maximum amplitude (K-MA), Kaolin-maximum rate of thrombus generation using G (K-MRTGG), functional fibrinogen-maximum amplitude (FF-MA), and functional fibrinogen-maximum rate of thrombus generation using G (FF-MRTGG). Secondary aims of this study were (1) comparison of the time delay between classical parameters and velocity curve–derived parameters (K-MA versus K-MRTGG and FF-MA versus FF-MRTGG) and (2) evaluation of the accuracy of TEG parameters to predict severe hemorrhage estimated by calculated blood losses. RESULTS: Ninety-eight patients were included with 98 simultaneous TEG analyses and laboratory assays. All parameters had an excellent predictive performance. For the Kaolin assay, no significant difference was evidenced between K-MA and K-MRTGG for the predictive performance for hypofibrinogenemia ≤2 g/L and/or thrombocytopenia ≤80,000/mm 3 (respective area under the curve [AUC], 0.970 vs 0.981 ). For the functional fibrinogen assay, no significant difference was evidenced between FF-MA and FF-MRTGG for the predictive performance for hypofibrinogenemia ≤2 g/L (respective AUC, 0.988 vs 0.974 ). For both assays, the time to obtain results was shorter for the velocity parameters (K-MRTGG: 7.7 minutes [2.4 minutes] versus K-MA: 24.7 minutes [4.2 minutes] , P 〈 .001; FF-MRTGG: 2.7 minutes [2.7 minutes] versus FF-MA: 14.0 minutes [4.3 minutes] , P 〈 .001). All TEG parameters derived from the Kaolin and functional fibrinogen assays and Clauss fibrinogen were significantly predictive of severe PPH 〉 2500 mL. CONCLUSIONS: During PPH, when coagulation assessment is indicated, TEG provides a rapid and reliable detection of hypofibrinogenemia ≤2 g/L and/or thrombocytopenia ≤80,000/mm 3 . No difference in performance was evidenced between the velocity-derived parameters (K-MRTGG and FF-MRTGG) and the classical parameters (K-MA and FF-MA). However, velocity-derived parameters offer the advantage of a shorter time to obtain results: FF-MRTGG parameter is available within ≤5 minutes. POC assessment of hemostasis during PPH management may help physicians to diagnose clotting disorders and to provide appropriate hemostatic support.
    Type of Medium: Online Resource
    ISSN: 0003-2999
    URL: Article
    DOI: 10.1213/ANE.0000000000004422
    RVK:
    XA 22250
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2018275-2
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