McGrath® versus Macintosh laryngoscopes on hemodynamic response to intubation in elderly patients: a randomized clinical trial.

Introduction: laryngoscopy and tracheal intubation induce catecholaminergic release. Our study aimed to evaluate the hemodynamic impact of orotracheal intubation by McGrath® compared to the Macintosh laryngoscope in the elderly. Methods: we conducted a prospective randomized clinical trial that included elderly patients proposed for a scheduled surgery under general anesthesia with orotracheal intubation and divided into 2 groups: patients who were intubated using the McGrath® (group V) and patients who were intubated using the Macintosh direct laryngoscope (group M). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP), were recorded before induction of anesthesia (baseline), and at 1 min, 3 min, and 5 min after intubation. Our outcomes were the increase of SBP (∆ SBP), MAP (∆ MAP), and HR (∆ HR) between the two groups, during the 5 minutes following the start of the orotracheal intubation, intubation time and the incidence of its related complications. Results: sixty patients were included and randomized into 2 groups of 30. The average age of our sample was 70±6 years with a sex ratio of 1.22. Most of the patients were operated on for orthopedic, urologic, or abdominal surgery. There were no statistically significant differences between the two groups in terms of demographic characteristics and the duration of anesthesia (p> 0.05). The intubation time was significantly increased in group M (p≤0.001). There was a significant difference in SBP, MAP, and HR values at 1 min after orotracheal intubation compared with the baseline values in Group V(P<0,05) and Group M (p < 0.05). There was a significant increase in the first minute after tracheal intubation in terms of SBP (151±42 vs 134.5±26 mmHg, p=0.012), MAP (114±4 vs 102±17 mmHg, p=0.015), DBP (89±32 vs 84±16 mmHg, p=0.01), and HR (99.5±10 vs 94.5±2 b/min, p=0.008) when group M was compared to group V. The ∆SBP was significantly different between group M (∆SBP = 36.2±23.5mmHg) and group V (∆SBP= 30.77±21.6mmHg) (p = 0.005). There were 4 ventricular arrhythmias in group M versus zero in group V (p <0.0001). The postoperative sore throat was significantly decreased in group M vs V (p=0.036). Conclusion: the McGrath® videolaryngoscope decreased the hemodynamic fluctuations due to endotracheal intubation in elderly patients.

[The effect of intraperitoneal administration of dexamethasone on postoperative analgesia after laparoscopic cholecystectomy: a prospective randomized controlled double-blind study]. / Intérêt de la déxaméthasone en intrapéritonéale dans l'analgésie post cholécystectomie laparoscopique: étude prospective contrôlée randomisée en double aveugle.

Introduction: the effect of intravenous corticosteroids on postoperative pain has been well demonstrated; however, few studies have focused on the efficacy of intraperitoneal corticosteroid use after laparoscopic surgery. The purpose of this study was to evaluate the effect of intraperitoneal administration of dexamethasone on postoperative analgesia after laparoscopic cholecystectomy. Methods: we conducted a prospective, randomised, double-blind, controlled study, including patients scheduled for laparoscopic cholecystectomy and randomised into two groups: the group D (receiving 16 ml: 12 ml saline and 4 ml solution containing 16mg dexamethasone) and the group T (receiving 16 ml saline). The primary endpoint was: Visual Analogue Scale (VAS) for abdominal pain during the first 24 hours after surgery. The secondary endpoints were the incidence of shoulder pain, time to first request for analgesia, the consumption of morphine in the post-intervention surveillance room (PACU), the consumption of non-opioid analgesics and the incidence of nausea and vomiting during the first 24 hours after surgery as well as the presence of complications. Results: sixty patients were included in the study and divided into two groups of 30. Demographic parameters, duration of surgical and anesthesia procedures, as well as intraoperative fentanyl consumption were comparable between the two groups. Abdominal pain VAS values (p≤0.001), the incidence of shoulder pain (p<0.001), opioid and analgesic consumption (p<0.001) and the incidence of nausea (p=0.002) and vomiting (p=0.012) during the first 24 hours after surgery were significantly lower in group D. No complications related to dexamethasone administration were noted. Conclusion: intraperitoneal dexamethasone reduces postoperative pain after laparoscopic cholecystectomy.

Pericapsular nerve group block versus fascia iliaca block for perioperative analgesia in hip fracture surgery: a prospective randomized trial.

The aim of our study was to evaluate the efficacy of the pericapsular nerve group block (PENG) versus the supra-inguinal fascia iliaca compartment block (SI-FICB) to improve analgesia during positioning for spinal anesthesia (SA) for hip fracture surgery. We conducted a prospective randomized clinical trial involving patients who will undergo hip fracture surgery under SA and randomized into two groups: the PENG group: patients who received PENG block with 10 ml of 0.25% bupivacaine and 10 ml of 2% lidocaine and the SI-FICB group: patients who received SI-FICB block with the same solution. Our primary outcome was the Visual Analogue Scale (VAS) score at positioning for SA. Secondary outcomes were VAS after the block, the ease of spinal positioning (EOSP), the time to perform the block, the postoperative morphine consumption, and the VAS score at the 3rd, 6th, 12th, and 24th postoperative hours. Eighty-nine patients were enrolled and randomized into two groups: 44 in the PENG group and 45 in the SI-FICB group. The time of block performance was comparable in both groups (p = 0.195). There was a significant decrease in pain scores in the 2 groups, 20 min after the blocks at rest and while positioning for SA. PENG block provided better analgesia than SI-FICB block at positioning (P=0.046) with no significant difference in the ease of positioning (p=0.328). The morphine consumption was comparable in the 2 groups (p = 0.842). There was no significant difference in VAS scores at the 3rd, 6th, 12th, and 24th postoperative hours with p respectively 0.061, 0.767, 0.198, and 0.130. Both PENG and SI-FICB blocks provided adequate perioperative analgesia with the superiority of the PENG block in the sitting position for SA.

[Implication of early extubation after cardiac surgery for postoperative rehabilitation]. / L'effet de l'extubation precoce apres chirurgie cardiaque pour la rehabilitation post opératoire.

INTRODUCTION: Postoperative rehabilitation after cardiac surgery is based on medical-surgical management in order to reduce the lenght of stay in hospital and the costs of this high risk surgery. Early tracheal extubation (within the first 6 hours) is the cornerstone of fast-track surgery. Our study aimed to evaluate fast-track practice and early tracheal extubation in scheduled cardiac surgery for adult patients in our Institution. METHODS: We conducted a descriptive study including all patients aged over 18 years who consecutively had undergone scheduled cardiac surgery and postoperative treatment in the post-operative intensive care unit in the Department of Thoracic and Cardiovascular Surgery at the Habib Bourguiba University Hospital, Sfax. Inclusion criteria were: patients aged 18 years and older who had undergone scheduled cardiac surgery and postoperative treatment in the post-operative intensive care unit in the Department of Thoracic and Cardiovascular Surgery. Standardized anaesthetic protocol was used in all cases: propofol, remifentanil, cisatracrium. We recorded the mean postoperative extubation time and the factors affecting extubation time. RESULTS: We collected data from 200 patients who consecutively had undergone scheduled cardiac surgery. Among these patients, 115 underwent coronary artery bypass surgery, 79 valvular surgery and 6 combined surgery or another surgical procedure. Patients' demographic characteristics were comparable. 152 patients (76%) underwent postoperative extubation within the first 6 hours. 48 patients couldn't be extubated within the FIrst 6 hours. The main causes of early extubation failure were: catecholamines in high doses, bleeding, arrhythmia and neurological disorders. CONCLUSION: Our study demonstrates that postoperative rehabilitation can be performed in our Institution and that all patients undergoing scheduled cardiac surgery should be candidates for early extubation.

[Acute acalculous gangrenous cholecystitis in postoperative period after orthopedic surgery: about a case]. / Cholécystite aigue gangréneuse alithiasique en postopératoire d'une chirurgie orthopédique: à propos d'un cas.

Postoperative acalculous gangrenous cholecystitis is a serious and severe complication, especially in patients hospitalized in the Department of Reanimation. It occurs most often during vascular surgery or major digestive surgery, a polytrauma, in a context septic or in a context of shock. We report the case of a 74 year man who underwent surgery for femoral neck fracture. On the sixth postoperative day, he developed acute cholecystitis. Radiological examinations confirmed acalculous cholecystitis. After emergency cholecystectomy, anatomo-pathologic study confirmed the diagnosis of acalculous gangrenous cholecystitis.