Detection of Motor Cerebral Activity After Median Nerve Stimulation During General Anesthesia (STIM-MOTANA): Protocol for a Prospective Interventional Study.

Background: Accidental awareness during general anesthesia (AAGA) is defined as an unexpected awareness of the patient during general anesthesia. This phenomenon occurs in 1%-2% of high-risk practice patients and can cause physical suffering and psychological after-effects, called posttraumatic stress disorder. In fact, no monitoring techniques are satisfactory enough to effectively prevent AAGA; therefore, new alternatives are needed.

Protocol of DEXPED trial: efficacy of intravenous dexamethasone, administered at the time of analgesic blocking of the lower limb, on postoperative pain in children: a randomised, placebo-controlled, double-blind trial.

Introduction: Dexamethasone is a drug used to prolong the postoperative analgesia in children after peripheral nerve blockade, although the dose usually used (0.2 mg/kg) has not been studied yet. This study is a monocentric, prospective, randomised, placebo-controlled, double-blinded study in a university hospital in France.

How to optimize neuromuscular blockade in ambulatory setting?

Purpose Of Review: The purpose of this review is to discuss the optimal use of neuromuscular blocking agents (NMBA) during ambulatory surgery, and to provide an update on the routine use of neuromuscular monitoring and the prevention of residual paralysis.

Recent Findings: The number of major surgical procedures performed in ambulatory patients is likely to increase in the coming years, following the development of laparoscopic and thoracoscopic procedures. To successfully complete these procedures, the proper use of NMBA is mandatory.

Use of a train-of-four ratio of 0.95 versus 0.9 for tracheal extubation: an exploratory analysis of POPULAR data.

Background: The prospective observational European multicentre cohort study (POPULAR) of postoperative pulmonary complications (NCT01865513) did not demonstrate that adherence to the recommended train-of-four ratio (TOFR) of 0.9 before extubation was associated with better pulmonary outcomes from the first postoperative day up to hospital discharge. We re-analysed the POPULAR data as to whether there existed a better threshold for TOFR recovery before extubation to reduce postoperative pulmonary complications in patients who had quantitative neuromuscular monitoring (87% acceleromyography).

Antibiotic prophylaxis with high-dose cefoxitin in bariatric surgery: an observational prospective single center study.

Background: The optimal dose of cefoxitin for antibiotic prophylaxis in obese patients remains uncertain. We evaluated the adequacy of a 4-gram dosing regimen of cefoxitin against the most frequent pathogens that infect patients undergoing bariatric surgery.

Methods: This observational prospective study included obese patients who required bariatric surgery and a 4-gram dose of cefoxitin as an antibiotic prophylaxis.

MOTANA: study protocol to investigate motor cerebral activity during a propofol sedation.

Background: Accidental Accidental awareness during general anesthesia (AAGA) occurs in 1-2% of high-risk practice patients and is a cause of severe psychological trauma, termed post-traumatic stress disorder (PTSD). However, no monitoring techniques can accurately predict or detect AAGA. Since the first reflex for a patient during AAGA is to move, a passive brain-computer interface (BCI) based on the detection of an intention of movement would be conceivable to alert the anesthetist.

Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial.

Purpose: Shortening the duration of antibiotic therapy (ABT) is a key measure in antimicrobial stewardship. The optimal duration of ABT for treatment of postoperative intra-abdominal infections (PIAI) in critically ill patients is unknown.

Methods: A multicentre prospective randomised trial conducted in 21 French intensive care units (ICU) between May 2011 and February 2015 compared the efficacy and safety of 8-day versus 15-day antibiotic therapy in critically ill patients with PIAI.

Do we really need sugammadex as an antagonist of muscle relaxants in anesthesia?

Purpose Of Review: Sugammadex is a selective relaxant-binding agent that is designed to encapsulate rocuronium and chemically similar steroidal muscle relaxants such as vecuronium. This review summarizes recent information on the use of sugammadex in clinical practice.

Recent Findings: The main advantages of sugammadex when compared with conventional anticholinesterase agents are a much faster recovery time and its unique ability to reverse rapidly and efficiently, for the first time, deep levels of neuromuscular blockade.

Biological evaluation of the effect of sugammadex on hemostasis and bleeding.

Background: Notification of sugammadex has been supplemented with a section on hemostasis, including a longer clotting time in the first minutes following injection, without any documented clinical consequences. The objective of this observational study was to analyze the effects of sugammadex administration on routine coagulation tests and bleeding in the clinical setting.

Methods: After Institutional Review Board approval, a prospective observational study was conducted between January and December 2011.

Sugammadex: A Scientific Review Including Safety and Efficacy, Update on Regulatory Issues, and Clinical Use in Europe.

Muscle relaxants are used in the perioperative period to aid in endotracheal intubation, facilitate surgical exposure, and in the critical care setting for prolonged relaxation. Until now, the only mechanism to reverse their effect is acetylcholinesterase inhibitors that result in excess parasympathetic activity and require the second drug to prevent this side effect. Additionally, the onset and degree of neuromuscular antagonism are often unpredictable and unreliable.

Impact of fluid resuscitation with hypertonic-hydroxyethyl starch versus lactated ringer on hemorheology and microcirculation in hemorrhagic shock.

The choice of volume expander for fluid resuscitation in hemorrhagic shock is still debated. Changes in plasma viscosity (PV) are barely investigated while PV modulates functional capillary density, microcirculation and organ function. The present study evaluated the impact of 2 strategies of fluid resuscitation in hemorrhagic shock in pigs.

Sugammadex: clinical development and practical use.

the selective relaxant binding agents. Sugammadex can reverse residual paralysis by encapsulating free circulating non depolarizing muscle relaxants. The mains advantages of sugammadex when compared with conventional anticholinesterase agents are a much faster recovery time and the unique ability, for the first time, to reverse rapidly and efficiently deep levels of neuromuscular blockade.

Low-dose neostigmine to antagonise shallow atracurium neuromuscular block during inhalational anaesthesia: A randomised controlled trial.

Background: Even shallow residual neuromuscular block [i.e. train-of-four (TOF) ratio around 0.

Motion sickness in rally car co-drivers.

Background: Car sickness is a frequent and potentially disabling problem, commonly related to a theory of sensory conflict, in particular visuo-vestibular, and between actual and anticipated sensory signals. This study aimed to evaluate predictors of motion sickness (MS) in rally car co-drivers exposed to various accelerations.

Methods: The subjects were 85 rally co-drivers (21 women) who filled in a questionnaire investigating MS symptoms in 4 situations: 1) special stages (competition itself); 2) special stages reconnaissance; 3) reading a book in the car; and 4) rear-seat passenger.

Is sugammadex economically viable for routine use.

Purpose Of Review: Sugammadex belongs to a new class of drugs termed selective relaxant binding agents and is now available for clinical use in over 50 countries. Because of its innovative mechanism of action, reversal of rocuronium or vecuronium becomes independent of the degree of residual neuromuscular blockade. Deep or intense neuromuscular blockade now can rapidly and predictably be reversed.

Antagonism of low degrees of atracurium-induced neuromuscular blockade: dose-effect relationship for neostigmine.

Background: Low degrees of residual paralysis (i.e., a train-of-four [TOF] ratio > 0.

Single acceleromyographic train-of-four, 100-Hertz tetanus or double-burst stimulation: which test performs better to detect residual paralysis?

Background: Acceleromyography is regularly used as an isolated test to detect residual paralysis. The performance of acceleromyography, however, has not been investigated for the setting where calibration is impossible. This study first evaluated the reliability of a single acceleromyographic train-of-four (TOF) ratio (T4/T1) to detect residual paralysis and compared it with tactile estimation of fade after double-burst stimulation and 100-Hz, 5-s tetanus.