[Assessment of Teleconsultation for planned orthopaedic surgery]. / Faisabilité d'une téléconsultation d'anesthésie en chirurgie orthopédique programmée.

The COVID-19 pandemic has motivated the development of teleconsultation in anaesthesia. We have conducted a single centre prospective study in patients scheduled for planned orthopaedic surgery during 9 weeks between may and july 2020 to assess its practicability. The quality of the consultation and patients' satisfaction, were evaluated during this period. The teleconsultation was successful in 90% of the patients without the need of attendance to the hospital for assessment before anaesthesia. The process was satisfactory for 97% of these patients. The mean duration was 15 minutes. The support of a third party was required in 46% of patients older than 65 years. The main cause of failure was the poor quality of the connection. Only two patients were cancelled for surgery because they did not understand fasting rule. The teleconsultation is now an integral part of preoperative assessment of patients for anaesthesia with good practicability and reliability.

Effects of peritoneal ropivacaine nebulization for pain control after laparoscopic gynecologic surgery.

STUDY OBJECTIVE: To evaluate the effects of peritoneal cold nebulization of ropivacaine on pain control after gynecologic laparoscopy. DESIGN: Evidence obtained from a properly designed, randomized, double-blind, placebo-controlled trial (Canadian Task Force classification I). SETTING: Tertiary care center. PATIENTS: One hundred thirty-five women with American Society of Anesthesiologists disease classified as ASA I-III who were scheduled to undergo operative laparoscopy. INTERVENTION: Patients were randomized to receive either nebulization of 30 mg ropivacaine before surgery (preoperative group), nebulization of 30 mg ropivacaine after surgery (postoperative group), instillation of 100 mg ropivacaine before surgery (instillation group), or instillation of saline solution (control group). Nebulization was performed using the Aeroneb Pro device. MEASUREMENT AND MAIN RESULTS: Pain scores, morphine consumption, and ambulation time were collected in the post-anesthesia care unit and at 4, 6, and 24 hours postoperatively. One hundred eighteen patients completed the study. Patients in the preoperative group reported lower pain Numeric Ranking Scale values compared with those in the control group (net difference 2 points; 95% confidence interval [CI], 0.3-3.1 at 4 hours, 1-3 at 6 hours, and 0.7-3 at 24 hours; p = .01) Patients in the preoperative group consumed significantly less morphine than did those in the control group (net difference 7 mg; 95% CI, 0.7-13; p = .02). More patients who received nebulization walked without assistance within 12 hours after awakening than did those in the instillation and control groups (net difference 15%; 95% CI, 6%-24%; p = .001). CONCLUSIONS: Cold nebulization of ropivacaine before surgery reduced postoperative pain and morphine consumption and was associated with earlier walking without assistance.

Intraperitoneal ropivacaine nebulization for pain management after laparoscopic cholecystectomy: a comparison with intraperitoneal instillation.

BACKGROUND: Studies evaluating intraperitoneal local anesthetic instillation for pain relief after laparoscopic procedures have reported conflicting results. In this randomized, double-blind study we assessed the effects of intraperitoneal local anesthetic nebulization on pain relief after laparoscopic cholecystectomy. METHODS: Patients undergoing elective laparoscopic cholecystectomy were randomly assigned to receive either instillation of ropivacaine 0.5%, 20 mL after induction of the pneumoperitoneum, or nebulization of ropivacaine 1%, 3 mL before and after surgery. Anesthetic and surgical techniques were standardized. Degree of pain at rest and on deep breathing, incidence of shoulder pain, morphine consumption, unassisted walking time, and postoperative nausea and vomiting were evaluated at 6, 24, and 48 hours after surgery. RESULTS: Of the 60 patients included, 3 exclusions occurred for conversion to open surgery. There were no differences between groups in pain scores or in morphine consumption. No patients in the nebulization group presented significant shoulder pain in comparison with 83% of patients in the instillation group (absolute risk reduction -83, 95% CI -97 to -70, P<0.001). Nineteen (70%) patients receiving nebulization walked without assistance within 12 hours after surgery in comparison with 14 (47%) patients receiving instillation (absolute risk reduction -24, 95% CI -48 to 1, P=0.04). One (3%) patient in the instillation group vomited in comparison with 6 (22%) patients in the nebulization group (absolute risk reduction -19%, 95% CI -36 to -2, P=0.03). CONCLUSIONS: Intraperitoneal ropivacaine nebulization was associated with reduced shoulder pain and unassisted walking time but with an increased incidence of postoperative vomiting after laparoscopic cholecystectomy.

Xenon anaesthesia produces better early postoperative cognitive recovery than sevoflurane anaesthesia.

BACKGROUND AND OBJECTIVE: Xenon anaesthesia may have the potential to reduce postoperative cognitive impairment after general anaesthesia. This randomized double-blind controlled trial was designed to compare the early postoperative cognitive recovery after xenon and sevoflurane anaesthesia. METHODS: After institutional ethics approval, we obtained informed written consent from 60 adults, with American Society of Anesthesiologists I or II status, scheduled for elective surgery with an estimated surgery time between 60 and 360 min. Patients were randomized to receive xenon or sevoflurane anaesthesia. Both groups received a remifentanil infusion adjusted to clinical needs based on patients' haemodynamic and state entropy of less than 60. In cases of state entropy of at least 60 during the first 15 min after induction, patients in the xenon group received a propofol infusion targeted to state entropy of less than 60. The primary end-point of the study was the early postoperative cognitive recovery evaluated by the Short Orientation Memory Concentration Test. RESULTS: There was no significant difference in the mean preoperative Short Orientation Memory Concentration Test values between groups (sevoflurane 2.7 +/- 3.2 and xenon 3.2 +/- 2.6; P, 0.53). Awakening was significantly faster in the xenon group (sevoflurane 8 +/- 4 min and xenon 3 +/- 1 min; P < 0.001). Patients receiving xenon presented significantly lower Short Orientation Memory Concentration Test scores at 30 min (sevoflurane 6.7 +/- 5.9 and xenon 3.3 +/- 3.1; P 0.003) and 60 min (xenon 2.1 +/- 3 and sevoflurane 5 +/- 4.1; P 0.003) after extubation. CONCLUSION: Xenon anaesthesia was associated with faster emergence and with better early postoperative cognitive recovery than sevoflurane anaesthesia.