[Feedback on the evaluation of clinical pharmacy activities developed in surgery]. / Retour d'expérience sur l'évaluation des activités de pharmacie clinique développées en chirurgie.

INTRODUCTION: Our current development strategy integrates clinical pharmacy activities prioritized in surgical services. Patients in these services are typically risk patients: transfers, multiple prescribers, frequent medication change, pharmacotherapeutic risk classes. PATIENTS AND METHODS: Three clinical pharmacy activities (admission reconciliation, pharmaceutical analysis, participation doctors round) have been developed in orthopaedic surgery and neurosurgery. Pharmacists prospectively recorded data describing their activities: number of reconciliations and analyzed requirements and time required to achieve them. Data on pharmaceutical interventions were recorded on the basis ActIP®. The clinical significance of interventions was retrospectively rated by a team of two pharmacists and two physicians on the scale adapted Hatoum et al. RESULTS: Four thousand five hundred pharmaceutical analysis and 248 reconciliations were conducted. One hundred and fifty-six pharmaceutical interventions were issued. The average acceptance rate was 80%. A total of 5.8% of pharmaceutical interventions have been listed with a very significant clinical importance and 48.1% with at least significant clinical importance. The activities and documentation required pharmaceutical average daily time (senior pharmacist, resident and external pharmacist) about 6 hours. DISCUSSION AND CONCLUSION: Other studies, including comparative and medico-economic, must be conducted to support these results. Nevertheless, the indicators obtained attend a better readability of the clinical importance of the activities performed by clinical pharmacists and this particularly in surgical services, both by prescribers and authorities.

[Clinical pharmacy and surgery: Review]. / Pharmacie clinique et chirurgie : revue de la littérature.

Clinical pharmacy has been developed and evaluated in various medical hospital activities. Reviews conducted in this area reported a higher value of this discipline. In surgical services, evenly adverse drug events may occur, so clinical pharmacy activities must also help to optimize the management of drug's patient. The objectives of this literature review is to determine the profile of clinical pharmacy activities developed in surgical services and identify indicators. The research was conducted on Pubmed(®) database with the following keywords (2000-2013), "surgery", "pharmacy", "pharmacist", "pharmaceutical care", "impact" and limited to French or English papers. Studies dealing on simultaneously medical and surgical areas were excluded. Twenty-one papers were selected. The most frequently developed clinical pharmacy activities were history and therapeutic drug monitoring (antibiotics or anticoagulants). Two types of indicators were identified: activity indicators with the number of pharmaceutical interventions, their description and clinical signification, the acceptance rate and workload. Impact indicators were mostly clinical and economic impacts. The development of clinical pharmacy related to surgical patients is documented and appears to have, as for medical patients, a clinical and economical value.

[Prophylactic antibiotic use in gastro-intestinal surgery: an audit of current practice]. / L'antibioprophylaxie en chirurgie digestive: audit de pratiques.

OBJECTIVE: To evaluate compliance with clinical guidelines on prophylactic antibiotic usage in gastro-intestinal surgery. MATERIAL AND METHODS: The medical charts of one hundred consecutive patients undergoing surgery in the last 6 months of 2006 were analysed as to determine whether the use of prophylactic antibiotics was indicated. Compliance with the prophylactic antibiotic guidelines of the Toulouse teaching hospitals and the Société Française d'Anesthésie et de Réanimation (SFAR) was examined; cases were analyzed by the criteria of the Haute Autorité en Santé for indication, type of antibiotic, time of administration, and duration of treatment. RESULTS: Antibiotic prophylaxis was prescribed in 58% of patients; there was an 85% compliance rate with the indication. Of those receiving antibiotic prophylaxis, the choice of antibiotic was appropriate in 82.8%, but the timing of administration was in compliance in only 39.7%. Duration of antibiotic administration was excessive in 5 cases. The overall rate of compliance with guidelines was 42%. CONCLUSION: Prophylactic antibiotic guidelines were inadequately applied, especially regarding the timing of administration. Further systemic progress is needed to achieve compliance with guidelines and documentation of administration; such evaluations must be repeated on regular basis.

Early morbidity of endoscopic ultrasound: 13 years' experience at a referral center.

BACKGROUND AND STUDY AIM: Endoscopic ultrasonography (EUS) now has an important place in the diagnosis of gastroenteropancreatic diseases. However, prospective data on the morbidity and mortality related to its use are sparse and often retrospective. We attempted to assess the acute and immediate complications of both diagnostic and interventional EUS. PATIENTS AND METHODS: At our university-affiliated tertiary care referral center, immediate (occurring during the procedure) and acute (occurring within 24 hours) complications of EUS were prospectively investigated. Over a first period, spanning 10 years, complications of diagnostic EUS involving 3207 consecutive patients were assessed. During the second period of 3 years, complications observed after EUS-guided fine-needle aspiration (FNA) biopsy were evaluated from 224 procedures. EUS was mostly done with the patient under sedation with intravenous propofol and spontaneous ventilation, and complications were evaluated by both the operator and the anesthesiologist. RESULTS: There were no deaths, and no surgery was required over the two periods of assessment. Three mild complications occurred among patients who underwent standard diagnostic EUS: two immediate complications were related to anesthesia and one to the procedure. There were five complications associated with interventional EUS; all were related to the procedure (acute pancreatitis, duodenal perforation, upper digestive bleeding, cyst, and mediastinal infection), with a mean delay of occurrence of 30 hours, and mean duration of hospitalization of 7 days. CONCLUSION: In our experience, which is the longest reported in Europe, the morbidity rates of diagnostic EUS and EUS-guided FNA biopsy were 0.093% and 2.2%, respectively, with no mortality.

[Prolonged neuromuscular block induced by mivacurium in a patient treated with cyclophosphamide]. / Curarisation prolongée après mivacurium chez une patiente traitée par cyclophosphamide.

A case is reported of prolonged neuromuscular block after mivacurium chloride for laparoscopic cholecystectomy, in a 45 years old patient, treated with cyclophosphamide for a Wegener's granulomatosis. The neuromuscular function monitoring by train-of-four showed a duration of action of 75 min after an intubation dose of 0.20 mg.kg-1. Additional bolus of 1 mg, corresponding to 25% of usual doses, every 10 or 15 min, were sufficient for maintaining muscle relaxation. Spontaneous recovery, without any antagonization, lasted 40 min for a TOF ratio (T4/T1) > or = 70%. Recovery index from 25 to 75% were 13 min. Plasma butyrilcholinesterases activity were reduced to a level of 50%. With reference to literature about succinylcholine, the responsibility of cyclophosphamide is likely, and discussed. This observation shows the value of monitoring the neuromuscular transmission.

[Double transplantation of the liver and kidney. A study of curarization using continuously perfused atracurium]. / Double transplantation hépatique et rénale. Etude de la curarisation par atracurium en perfusion continue.

We report the use of atracurium besylate with monitoring of neuromuscular function in a young women with primary hyperoxaluria and no renal function. She underwent orthotopic liver transplantation and also a kidney graft during the same operation. The bolus dose (0.5 mg.kg-1) and the mean infusion rate (0.405 mg.kg-1.h-1) were similar to those reported in references. The infusion rate decreased during anhepatic period. Spontaneous recovery time from TR 25 to 75% was 36 mn and TR 90% was 127 mn, after the end of atracurium infusion. The depression of neuromuscular function was potentiated with isoflurane use, acidemia, hypocalcemia, hypothermia but without cumulative effect. It was concluded that the administration of atracurium by infusion is suitable for long surgical procedures despite impaired hepatic and renal function.