Effects of opioid-free anesthesia on postoperative morphine consumption after bariatric surgery.

Study Objectives: The objective of this study was to determine whether postoperative morphine requirement in obese patients undergoing laparoscopic bariatric surgery was reduced by opioid-free anesthesia (OFA), as compared to an anesthetic strategy using opioids (opioid balanced anesthesia (OBA)) and to investigate the differences that may exist between the use of clonidine and dexmedetomidine in the context of OFA.

Design: Retrospective cohort study.

Setting: Academic medical center in Lyon, France.

Digestive perforations related to endoscopy procedures: a local management charter based on local evidence and experts' opinion.

Perforations are a known adverse event of endoscopy procedures; a proposal for appropriate management should be available in each center as recommended by the European Society of Gastrointestinal Endoscopy. The objective of this study was to establish a charter for the management of endoscopic perforations, based on local evidence. Patients were included if they experienced partial or complete perforation during an endoscopic procedure between 2008 and 2018 (retrospectively until 2016, then prospectively).

Immune Profiling Demonstrates a Common Immune Signature of Delayed Acquired Immunodeficiency in Patients With Various Etiologies of Severe Injury.

Objectives: The host response plays a central role in the pathophysiology of sepsis and severe injuries. So far, no study has comprehensively described the overtime changes of the injury-induced immune profile in a large cohort of critically ill patients with different etiologies.

Design: Prospective observational cohort study.

Impact of Enhanced Recovery Program after Surgery in Patients Undergoing Pancreatectomy on Postoperative Outcomes: A Controlled before and after Study.

Background: Implementation of enhanced recovery after surgery (ERAS) program after pancreatic surgery was associated with decreased length of stay (LOS). However, there were only retrospective uncontrolled before-after study, and care protocols were heterogeneous. We aimed to evaluate the impact of ERAS program on postoperative outcomes after pancreatectomy through a prospective controlled study.

Serum Concentrations of Lidocaine During Bariatric Surgery.

Lidocaine has been shown to be clinically beneficial during bariatric surgery. However, information about lidocaine serum concentrations in this setting is scarce. This prospective clinical trial included 42 obese patients undergoing laparoscopic bariatric surgery.

Intraoperative carcinoid syndrome during small-bowel neuroendocrine tumour surgery.

Only few descriptions of intraoperative carcinoid syndrome (ioCS) have been reported. The primary objective of this study was to describe ioCS. A second aim was to identify risk factors of ioCS.

Cardiovascular risk 10 years after liver transplant.

Objectives: We sought to evaluate the frequency of cardiovascular risk factors in a cohort of patients 10 years after a liver transplant, and to assess their 10-year risk of fatal cardiovascular disease using Systematic COronary Risk Evaluation (SCORE) charts.

Materials And Methods: Between January 1990 and June 1996, one hundred eighty-nine adults underwent a first liver transplant in our center. Fifty-nine patients (31%) died before reaching their tenth year, and 115 patients were available with complete clinical data at 10 years.

"First look" unsedated transnasal esogastroduodenoscopy in patients with upper gastrointestinal bleeding? A prospective evaluation.

Background And Aims: With small diameter endoscopes, transnasal esophagogastroduodenoscopy (t-EGD) is routinely performed. The aim of this prospective observational study was to evaluate the role of t-EGD for upper gastrointestinal bleeding (UGIB).

Patients And Methods: One hundred and forty-five consecutive patients (mean age, 66±18.

Thymoglobulin induction in liver transplant recipients with a tacrolimus, mycophenolate mofetil, and steroid immunosuppressive regimen: a five-year randomized prospective study.

This randomized, comparative study assessed the long-term efficacy and tolerability of thymoglobulin (TMG) induction in 93 liver transplant patients with an initial regimen of tacrolimus (Tac), mycophenolate mofetil (MMF), and steroids. Forty-four patients were randomly allocated to the TMG+ group, and 49 patients were randomly allocated to the TMG- group. In both groups, Tac was given orally at the initial daily dose of 0.

Transoesophageal echo-Doppler vs. thermodilution cardiac output measurement during hepatic vascular exclusion in liver transplantation.

Background And Objective: Continuous monitoring of cardiac output during liver transplantation is essential to evaluate the patient's haemodynamic tolerance to acute volume variations. The aim of this study was to compare the cardiac output values obtained with a transoesophageal echo-Doppler and those obtained with a continuous thermodilution cardiac output pulmonary artery catheter.

Methods: Twenty adult patients were prospectively studied during a 5 min hepatic vascular exclusion test performed at the end of the dissection phase.

Paradoxical symptomatic air embolism after saline contrast transesophageal echocardiography.

We describe one case of paradoxical air embolism after contrast transesophageal echocardiography realized to detect a patent foramen ovale. At the end of this procedure, the patient presented a left lateral homonymous hemianopsia attributed to air embolism. Total recovery was obtained after one therapeutic recompression.

Severe portal hypertension secondary to arterio-portal fistula: salvage surgical treatment.

Background: Arterio-portal fistulas (APFs) are rare vascular disorders of various origins that can lead to severe portal hypertension. Even if surgery was initially the treatment of choice, more recently, interventional radiological procedures have been considered as the first line therapeutic option.

Case Report: A man with no history of liver disease was admitted for abdominal pain and distension.

Negative impact of de novo malignancies rather than alcohol relapse on survival after liver transplantation for alcoholic cirrhosis: a retrospective analysis of 305 patients in a single center.

Objectives: Alcoholic liver disease is a leading indication for liver transplantation (LT). The aim of this study was to evaluate long-term results and survival prognostic factors of LT in this indication from a large cohort of patients.

Methods: From October 1990 to October 2005, 305 consecutive patients with alcoholic cirrhosis (from 594 patients presenting with cirrhosis, i.

Impact of adult-to-adult living donor liver transplantation on access to transplantation and patients' survival: an 8-year single-center experience.

While the number of candidates for liver transplantation has increased in the recent years, the pool of cadaveric donor organs has remained constant and the waiting time progressively increases. These facts led us to start a program of adult-to-adult living-donor liver transplantation in 1998. The aim of this study was to compare the outcome of all patients put on the waiting list since 1998.

Conversion from tacrolimus to cyclosporine in liver transplanted patients with diabetes mellitus.

Adverse effects associated with calcineurin inhibitors may impact their clinical utility in some patients. This study characterizes the clinical outcomes of liver transplanted (LT) patients who experienced diabetes mellitus (DM) on tacrolimus-based regimen and were converted to cyclosporine-based therapy. Since January 2002, all patients with DM on a tacrolimus-based regimen were recruited and converted to cyclosporine-based therapy, after a 6-month minimal follow-up after LT.

Peritoneovenous shunt as a bridge to liver transplantation.

Intractable ascites carries great morbidity. The aim of this study was to determine the efficacy of peritoneovenous shunt (PVS) in patients listed for liver transplantation (LT). Between January 1999 and January 2004, PVS was inserted in 36 (30 males and 6 females) cirrhotic patients, 50.

Half the family members of intensive care unit patients do not want to share in the decision-making process: a study in 78 French intensive care units.

Objective: To evaluate the opinions of intensive care unit staff and family members about family participation in decisions about patients in intensive care units in France, a country where the approach of physicians to patients and families has been described as paternalistic.

Design: Prospective multiple-center survey of intensive care unit staff and family members.

Setting: Seventy-eight intensive care units in university-affiliated hospitals in France.

Compliance with triage to intensive care recommendations.

Design: Recommendations for triage to intensive care units (ICUs) have been issued but not evaluated.

Setting: In this prospective, multicenter study, all patients granted or refused admission to 26 ICUs affiliated with the French Society for Critical Care were included during a 1-month period. Characteristics of participating ICUs and patients, circumstances of triage, and description of the triage decision with particular attention to compliance with published recommendations were recorded.

Long- and medium-chain triglycerides during parenteral nutrition in critically ill patients.

Due to their special metabolic pathway, medium-chain triglycerides (MCT) have been claimed to be oxidized more extensively, compared with long-chain triglycerides (LCT), when administered as a parenteral nutritional support. This enhanced lipid oxidation rate of MCT emulsions could be particularly disclosed in hyperglycemic and hyperinsulinemic conditions. In an attempt to further elucidate this question, we measured substrate oxidation rates in critically ill patients liable to experience such metabolic conditions, that is to say postoperative patients after esophageal resection receiving 1.

Clinical validation of the Deltatrac monitoring system in mechanically ventilated patients.

Objective: To evaluate a monitor of pulmonary gas exchange (Deltatrac, Datex) in a clinical setting.

Design: After in vitro evaluation, comparison over 2 min between VO2 and VCO2 values measured by the Deltatrac and the Douglas bag technique. Comparisons were also achieved over 8 h periods between the Deltatrac and a system using a mass-spectrometer.

Effects of glucose-to-lipid ratio and type of lipid on substrate oxidation rate in patients.

This study is an investigation into the effects of different carbohydrate-to-lipid ratios on CO2 production in postoperative patients and the determination of the substrate oxidation rates induced by long-chain triglycerides (LCT) or a mixture of long- and medium-chain triglycerides (MCT/LCT) at various carbohydrate-to-lipid ratios. Two groups of eight patients randomly received either LCT or MCT/LCT emulsions. Total caloric intake was set at the measured energy expenditure provided at three different glucose-to-lipid ratios (70:30, 50:50, 30:70).