[Safety and efficacy of intravenous tranexamic acid in endoscopic transurethral resections in urology: Prospective randomized trial]. / Intérêt de l'acide tranexamique dans les résections endoscopiques urologiques : étude prospective randomisée.

BACKGROUND: Endoscopic urological procedures (transurethral resection of the prostate TURP/transurethral resection of bladder tumor TURBT) are not without risk of significant bleeding. This risk is due to the vascular nature of the tissues and their high levels of fibrinolytic enzymes in the tissues and urine. This study was conducted to evaluate the safety and efficacy of the antifibrinolytic agent tranexamic acid (TXA) in reducing blood loss in patients undergoing TURP/TURBT and transfusion requirement. METHODS: This study was a prospective, randomized, double-blind, placebo controlled clinical trial. One hundred and thirty-one patients of ASA physical status I or II, undergoing TURP (60 patients) or TURBT (71 patients) were randomly allocated to receive IV TXA: bolus of 10mg/kg at the induction of anesthesia followed by infusion of 1mg/kg/h intraoperatively and for 24h postoperatively or an equal volume of saline (control group). Blood loss was evaluated in terms of reduction in the serum hemoglobin level (delta Hb=Hb H24-Hb H0). RESULTS: There was no difference between two groups in terms of transfusion requirements and episodes of retention. TXA did not significantly reduce mean blood loss compared with placebo during TURP (1.37±0.69 vs. 1.72±1.23g/dL respectively, P=0.256) or TURBT (1.15±0.95 vs. 1.07±0.88g/dL; P=0.532). No thrombotic complications were noted in any patient. CONCLUSION: Tranexamic acid did not reduce transfusion requirements or perioperative blood loss in transurethral resection of the prostate or bladder tumor. LEVEL OF EVIDENCE: 4.

[Target-controlled intravenous anesthesia during laparoscopic surgery for obesity]. / Anesthesie intraveineuse a Objectif de Concentration durant la Chirurgie Laparoscopique de L'obesite.

BACKGROUND: The TCI is a mode of administration that provides greater security by allowing more accurate titration of the anesthetic agent. It leads to a better adaptation to the desired effects, and provide a great interest for the realization of anesthetic induction and the prediction of waking for a well- determined population. OBJECTIVE: The aim of our prospective study was to evaluate the feasibility of TCI in patients with morbid obesity undergoing laparoscopic surgery for obesity. METHODS: Thirty patients were included in this study. Age and BMI means were 32 years and 49.31 kg / m2. Our protocol was proposed to associate an hypnotic agent (propofol) to an opioid one (remifentanil) using the technique of the TCI, with respectively Schnider and Minto models. RESULTS: The induction protocol has brought good conditions for laryngoscopy with no hypertensive peak or desaturation episode. The period of unconsciousness was 89 seconds with an average target concentration of propofol of 5.1 mg / ml. We also noted hemodynamic stability in 79% of patients at induction. During both preparation phase and final installation of the patients, a low ERC to 2 hg / ml was consistent with a suitable hemodynami profile. We obtained hemodynamic stability by adapting target concentration of remifentanil at different operating times (Surgical incision: 3.64 hg / ml, insufflation of the peritoneum: 5.37 hg / ml, jejuno-jejunal resection anastomosis: 9 hg / ml, gastric resection and gastrojejunal anastomosis: 14.2 hg / ml). During this period, no episodes of bradycardia or hypotension were noticed. During the recovery phase and while doing the distribution of CEP and CER according to the BMI of patients, we identified two groups: Group 1 (BMI <49 kg / m2): fast time extubation (11 min) and target concentrations of propofol and remifentanil respectively at 1.3 mg / ml and 1.25 hg / ml which is similar to most publications on this subject and Group 2 (BMI> 49 kg / m2): time-delayed extubation (23 min) with very low values of CEP and CER inconsistent with the literature data.