Changes in Intrinsic Connectivity Networks Topology Across Levels of Dexmedetomidine-Induced Alteration of Consciousness.

Background: Human consciousness is generally thought to emerge from the activity of intrinsic connectivity networks (resting-state networks [RSNs]) of the brain, which have topological characteristics including, among others, graph strength and efficiency. So far, most functional brain imaging studies in anesthetized subjects have compared wakefulness and unresponsiveness, a state considered as corresponding to unconsciousness. Sedation and general anesthesia not only produce unconsciousness but also phenomenological states of preserved mental content and perception of the environment (connected consciousness), and preserved mental content but no perception of the environment (disconnected consciousness).

The effects of intrathecal morphine on urinary bladder function and recovery in patients having a cesarean delivery - A randomized clinical trial.

Introduction: Spinal anesthesia with intrathecal morphine (ITM) is a common anesthesia technique for cesarean delivery. The hypothesis was that the addition of ITM will delay micturition in women undergoing cesarean delivery.

Methods: Fifty-six ASA physical status I and II women scheduled to undergo elective cesarean delivery under spinal anesthesia were randomized to the PSM group (50 mg prilocaine + 2.

Driving performance of outpatients achieving discharge criteria after deep sedation is worse than these of their escort-driver: a prospective observational study on simulator.

Background: Achieving post-anesthesia discharge criteria after surgery or outpatient procedures does not mean that the patient has regained all his or her faculties, such as driving. Although mandated by many clinical guidelines, there is no evidence that escort-drivers reduce the risk of traffic accidents after deep sedation. The purpose of this study was to evaluate that hypothesis that driving performance as measured using a driving simulation would not differ between patients who had undergone deep sedation for gastrointestinal endoscopy meeting discharge criteria and their escorts.

In situ simulation improves perceived self-efficacy of OR nurses and anaesthesiologists during COVID-19 pandemic.

Introduction: Self-efficacy is defined as people's internal beliefs about their ability to have an impact on events that affect their lives. As part of the COVID-19 pandemic, we carried out in situ simulation for anaesthesiologists and operating room (OR) nurses. Simulation was focused on the recommendations on the use of specific personal protective equipment (PPE) as well as on airway management and intubation.

[Interscalene block and shoulder surgery. Literature review and new method of infiltration].

Nowadays, interscalene block is the gold standard for intra- and post-operative analgesia for shoulder surgery. It consists of distributing a sufficient volume of local anesthetics, within the interscalenic space which contains the C5 to C7 nerve roots. Due to its proximity to the area where the anesthetic is injected, the phrenic nerve can be transiently blocked causing a kind of paralysis of an hemidiaphragm.

[Treatment of post-total knee replacement gonalgy by radiofrequency ablation of the genicular nerves].

Neurotomy of genicular nerves by radiofrequency is a technique efficient to reduce mecanic knee pain and pain after total knee replacement. In this article, we describe the case of a patient that has suffered from chronic knee pain after total knee replacement. The patient has successfully benefited of a neurotomy of genicular nerves by radiofrequency in the inferior right limb.

Cardiac Biomarkers and Prediction of Early Outcome After Heart Valve Surgery: A Prospective Observational Study.

Objectives: Circulating cardiac biomarkers may improve the prediction of long-term outcomes after cardiac surgery. The authors sought to assess if cardiac biomarkers also help better predict short-term morbidity.

Design: Prospective observational study.

[Predictive scores used during the anesthetic preoperative visit. Part 2. Assessment of perioperative risk].

Anesthesia remains a high-risk specialty, even though the discipline has evolved considerably over the last few decades. Independently of postoperative complications, some risks are inherent to the perioperative period itself. In this narrative review of the literature, we describe these risks and the predictive scores, allowing an assessment of these complications.

[Predictive scores used during the anesthetic preoperative visit. Part 1. Assessment of postoperative complications].

Anesthesia is changing, moving from an intraoperative medicine to a transversal perioperative medicine. The evolution of the preoperative anesthetic consultation is part of this evolution. Recently, anesthesiologists attempt to categorize their patients to detect as early as possible those at risk of short, medium, and long-term complications.

Teaching humanitarian surgery: Filling the gap between NGO needs and subspecialized surgery through a novel inter-university certificate.

Access to surgical care is a global health burden. A broad spectrum of surgical competences is required in the humanitarian context whereas current occidental surgical training is oriented towards subspecialties. We proposed to design a course addressing the specificities of surgery in the humanitarian setting and austere environment.

Quadratus lumborum block: an imaging study of three approaches.

Background And Objectives: Different injection techniques for the quadratus lumborum (QL) block have been described. Data in human cadavers suggest that the transverse oblique paramedian (TOP) QL3 may reach the thoracic paravertebral space more consistently than the QL1 and QL2. However, the distribution of injectate in cadavers may differ from that in patients.

Short message service as a tool to improve perioperative follow-up of surgical outpatients: A before-after study.

Background: In outpatient surgery, the patients may be called by phone for detecting and managing perioperative problems. However, phone calls consume time and can waste caregiver's time when the patient is not available. Information and communication technologies could bridge the gap between available resources and need to contact patients.

[Autonomic hyperreflexia after spinal cord injury : perioperative management].

Spinal cord injury can have widespread consequences beyond the disruption of sensory and motor functions. Injury at or above the sixth thoracic spinal cord segment frequently leads to dysregulation of the autonomic nervous system, which results in a syndrome called autonomic hyperreflexia or dysreflexia. It is a hypertensive crisis triggered by visceral or somatic stimuli below the level of the injury and caused by sympathetic spinal reflexes not modulated by regulatory centers in the brain.

[Preoperative fasting : state of the art].

Inhalation of gastric content is a significant risk factor for perioperative complications. Preoperative fasting reduces this risk. The preanesthesia fasting time is variable and is subject to recommendations from different scientific societies.

[An unexpected discovery of laryngeal neurofibroma during intubation for elective surgery].

We report the unexpected discovery of a large laryngeal neurofibroma during a direct laryngoscopy for intubation in a 18-year old female with a medical history of neurofibromatosis type 1. The most striking feature of this case report is the discrepancy between the absence of clinical manifestations and the size and location of the neurofibroma. This case highlights the importance of a careful preoperative assessment, especially in the context of multisystemic disease.

[Anesthetist facing ethylic patient : management and precaution].

The anesthetic management of the patient with unhealthy alcohol use is challenging. Chronic alcohol intake results in numerous co-morbid diseases, physiologic changes and pharmacologic alterations leading to increased perioperative morbidity and mortality. Hence anesthesiologists should search for chronic and acute effects of alcohol abuse when managing such patients.

A fast and general method to empirically estimate the complexity of brain responses to transcranial and intracranial stimulations.

Background: The Perturbational Complexity Index (PCI) was recently introduced to assess the capacity of thalamocortical circuits to engage in complex patterns of causal interactions. While showing high accuracy in detecting consciousness in brain-injured patients, PCI depends on elaborate experimental setups and offline processing, and has restricted applicability to other types of brain signals beyond transcranial magnetic stimulation and high-density EEG (TMS/hd-EEG) recordings.

Objective: We aim to address these limitations by introducing PCI, a fast method for estimating perturbational complexity of any given brain response signal.

The spectral exponent of the resting EEG indexes the presence of consciousness during unresponsiveness induced by propofol, xenon, and ketamine.

Despite the absence of responsiveness during anesthesia, conscious experience may persist. However, reliable, easily acquirable and interpretable neurophysiological markers of the presence of consciousness in unresponsive states are still missing. A promising marker is based on the decay-rate of the power spectral density (PSD) of the resting EEG.

Evoked Alpha Power is Reduced in Disconnected Consciousness During Sleep and Anesthesia.

Sleep and anesthesia entail alterations in conscious experience. Conscious experience may be absent (unconsciousness) or take the form of dreaming, a state in which sensory stimuli are not incorporated into conscious experience (disconnected consciousness). Recent work has identified features of cortical activity that distinguish conscious from unconscious states; however, less is known about how cortical activity differs between disconnected states and normal wakefulness.

Propofol-induced unresponsiveness is associated with impaired feedforward connectivity in cortical hierarchy.

Background: Impaired consciousness has been associated with impaired cortical signal propagation after transcranial magnetic stimulation (TMS). We hypothesised that the reduced current propagation under propofol-induced unresponsiveness is associated with changes in both feedforward and feedback connectivity across the cortical hierarchy.

Methods: Eight subjects underwent left occipital TMS coupled with high-density EEG recordings during wakefulness and propofol-induced unconsciousness.

Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study.

Background: Propofol use during sedation for colonoscopy can result in cardiopulmonary complications. Intravenous lidocaine can alleviate visceral pain and decrease propofol requirements during surgery. We tested the hypothesis that i.

The effect of force applied to the left paratracheal oesophagus on air entry into the gastric antrum during positive-pressure ventilation using a facemask.

Cricoid force is widely applied to decrease the risk of pulmonary aspiration and gastric antral insufflation of air during positive-pressure ventilation, yet its efficacy remains controversial. We compared manual oesophageal compression at the low left paratracheal and cricoid levels for the prevention of gastric antral air insufflation during positive-pressure ventilation by facemask in patients scheduled for elective surgery under general anaesthesia. After gaining written consent, participants were randomly allocated by sealed envelope to one of three groups: oesophageal compression by 30 N paratracheal force (paratracheal group); oesophageal compression by 30 N cricoid force (cricoid group); or no oesophageal compression (control group).