Prediction of post-induction hypotension by point-of-care echocardiography: A prospective observational study.

BACKGROUND: Post-induction hypotension (PIH) is a common side effect of general anaesthesia and is associated with poor perioperative outcomes. We assessed the ability of two point-of-care echocardiographic variables to predict the occurrence of PIH: the passive leg raising-induced changes in the velocity-time integral of the left ventricular outflow tract (ΔVTI-PLR) and the inferior vena cava collapsibility index (IVC-CI). METHODS: We studied 64 patients > 50 years scheduled for elective abdominal surgery. ΔVTI-PLR and IVC-CI were prospectively obtained before general anaesthesia induction. PIH was defined by a systolic arterial pressure < 90 mmHg or a mean arterial pressure < 65 mmHg or by a decrease in systolic or mean arterial pressure > 30% from pre-induction level. Intraclass correlation coefficients (ICCs) were calculated to assess the reproducibility of echocardiographic measurements. Receiver operating characteristic (ROC) curves with 95% confidence intervals (CIs) were generated to test the ability of ΔVTI-PLR and IVC-CI to predict the occurrence of PIH. RESULTS: PIH occurred in 33 (51%) patients. The ICCs for VTI and IVC measurements showed excellent reproducibility. The occurrence of PIH was accurately predicted by ΔVTI-PLR with an area under the ROC curve (AUROC) of 0.89 (95% CI: 0.80-0.97), a threshold value of 18% with a sensitivity of 88% (95% CI: 71-97%) and a specificity of 84% (95% CI: 66-94%). The occurrence of PIH was poorly predicted by IVC-CI with an AUROC of 0.68 (95% CI: 0.54-0.80) and a threshold value of 42%. CONCLUSIONS: ΔVTI-PLR, unlike IVC-CI, could reliably predict the occurrence of PIH. The use of ΔVTI-PLR could help individualise anaesthesia management to prevent PIH.

[Staphylococcal toxic shock syndrome at a chronic hemodialysis]. / Syndrome de choc toxique staphylococcique chez un hémodialysé chronique.

Staphylococcal toxic shock syndrome is an acute and systemic infectious syndrome associated with the super-antigenic activity of staphylococcal toxins. It is a pathology that is rather rare but remains burdened with a considerable mortality despite the therapeutic management. The gateway is usually cutaneous with secondary bacteremic spread could be subject to preventive measures. We report the case of a rapidly fatal staphylococcal toxic shock, developed in a chronic hemodialysis whose entry from the arteriovenous fistula was suspected.

The parasacral sciatic nerve block does not induce anesthesia of the obturator nerve.

PURPOSE: The ability of the parasacral sciatic nerve block (PSNB) to induce anesthesia of the obturator nerve remains controversial. Our objective was to evaluate the anesthesia of the obturator nerve after a PSNB. METHODS: Forty patients scheduled to undergo knee surgery (anterior cruciate ligament reconstruction) were included in this prospective, randomized, controlled study. Patients were randomized to receive PSNB alone (control group, n = 20) or PSNB in combination with an obturator nerve block (obturator group, n = 20). After evaluation for 30 min, the two groups received a femoral nerve block, and patients were taken to surgery. The obturator nerve blockade was assessed by measurement of adductor strength at baseline (T0) and every 10 min during the 30-min evaluation (T10, T20, and T30). Pain scores after tourniquet inflation and during surgery were compared between the two groups. The requirement for additional intravenous analgesia and/or sedation was also recorded. RESULTS: The two groups had comparable demographic and surgical characteristics. Four patients were excluded from the study because of PSNB or femoral nerve block failure. The adductor strength values were similar between groups at T0 but were significantly lower in the obturator group at T10, T20, and T30 (p < 0.0001). Patients in the obturator group reported less pain than those in the control group (p < 0.05). They also required less additional intravenous sedation and/or analgesia (p < 0.05). CONCLUSION: This clinical study demonstrated that the PSNB is an unreliable means of inducing anesthesia of the obturator nerve and emphasizes the need to block this nerve separately to induce adequate analgesia during knee surgery.