[For a more humane hospital: experience of medical mediators].

The legislation on patient's rights has considerably evolved during these last ten years. Its appropriation by users and its perception by care providers occur progressively. An important gap appears between the progresses of the medical sciences and techniques and the humane approach of the patient.

[From continuing medical education to anesthesia skill assessment].

The global approach to continuing medical education is needed not only to maintain the adequate level of knowledge, but also to adjust an anesthesiological practice to the emergence of new technologies. In addition to technological progress, the future of anesthesiology is seen to assure the maximum quality of performed therapy by the most cost-effective manner.

Anaesthesia workforce in Europe.

Background And Objective: The European anaesthesia workforce is facing increased demand and expansion of the labour market, which may likely exceed supply. This survey assesses the numbers and practice patterns of anaesthesiologists and studies migration and shortage of the anaesthesia workforce in Europe.

Methods: A questionnaire was sent to all national European anaesthesia societies.

Continuous professional development for anaesthetists.

Anaesthesia, as well as the whole of medicine, is involved in a revolution not only technical but also economic, because of the need for cost-containment in healthcare delivery. Continuing medical education, primarily devoted to updating knowledge and skills, is moving rapidly towards continuous professional development. A permanent evolution of practitioners is mandatory in order that they are able to adapt their practice to technical, ethical and economic changes, integrated in a team-working and multidisciplinary approach to patient care.

[Interest of mannequin based simulator to evaluate anaesthesia residents].

Objective: The aim of this study was to test simulator validity to evaluate the ability of anaesthesia residents to solve two simulated scenarios.

Study Design: Monocentre, prospective, randomized study.

Population: Anaesthesia residents.

Demography of French anaesthesiologists. Results of a national survey by the French College of Anaesthesiologists (CFAR) and the French National Society of Anaesthesia and Intensive Care (SFAR), supported by the National Institute for Demographic Studies (INED).

Background And Objective: The perception of a looming manpower shortage led the French College of Anaesthesiologists (CFAR) and the French Society of Anaesthesia and Intensive Care (SFAR), with assistance from the National Institute for Demographic Studies (INED), to conduct a national survey of French anaesthesiologists in order to determine precise physician characteristics data, analyse professional practices and project future service provision.

Methods: The survey was based on self-administered individual questionnaires, approved by the National Committee on Informatics and Freedom (CNIL). The survey was carried out at the end of 1998 among 1484 hospitals (590 public and 894 private), under the supervision of local referees and regional co-ordinators.

Inflammation increases sufentanil requirements during surgery for inflammatory bowel diseases.

Background And Objective: Inflammation promotes hyperalgesia and increases opioid binding protein (alpha1-acid glycoprotein) inducing increased opioid requirement. To investigate the influence of an acute episode of inflammatory bowel disease in opioid requirement during major abdominal surgery, 17 patients with Crohn's disease, 12 patients with ulcerative colitis and seven patients without any inflammatory process (control group) were prospectively studied. Sufentanil requirements were assessed during surgery.

[Delayed evaluation of continuous medical education].

Objectives: To analyse the results of delayed evaluation of European teaching sessions using a questionnaire provided by the French College of Anaesthesiologists.

Study Design: Open evaluation.

Material: Questionnaires were completed 3-6 months after European courses provided in November-December 1999.

[Anesthesiologists in France. First results of the national survey conducted in 1999 by the French College of Anesthesiologist, The French National Society of Anesthesia and Intensive Care with the scientific support of the National Institute for Demographic Studies].

Objectives: Fears related to the future of anaesthesia manpower in France have led the French College of Anaesthesiologists (Cfar) and the French Society of Anaesthesia and Intensive Care (Sfar), in scientific partnership with the National Institute for Demographic Studies (Ined), to set-up a national survey among French anaesthetists (MAR) practicing in France, to describe their demographic evolution and to analyse their professional activities.

Methods: The survey was based on a personal questionnaire, filled by each individual, approved by the National Commission on Informatics and Freedoms (CNIL). The survey was conducted in November 1998, in the 1484 hospitals, public (590) and private (894) where anaesthetics are performed, under the control of local and regional referents.

Multicenter randomized comparison of the efficacy and safety of xenon and isoflurane in patients undergoing elective surgery.

Background: All general anesthetics used are known to have a negative inotropic side effect. Since xenon does not have a negative inotropic effect, it could be an interesting future general anesthetic. The aim of this clinical multicenter trial was to test the hypothesis of whether recovery after xenon anesthesia is faster compared with an accepted, standardized anesthetic regimen and that it is as effective and safe.

The evolution of human resource needs in Europe.

The distribution of anaesthesia-related staff in Europe is characterized by a wide disparity between countries--and also within countries, between the rural regions and between large and small cities. The density of anaesthesiologists varies in different European areas--for example, 4.4 per 100,000 inhabitants in Ireland compared to 15.

The cardiovascular effects of mivacurium in hypertensive patients.

Unlabelled: Hypotension is common after mivacurium injection in healthy patients. This hemodynamic event had not been investigated in hypertensive patients characterized by more intense hemodynamic instability. In this open-label, multicenter, randomized, and controlled study, we sought to determine whether mean arterial blood pressure (MAP) and heart rate variations were larger in hypertensive versus normotensive patients after a bolus dose of mivacurium injected over 10 or 30 s.

Perioperative care of diabetic patient.

Diabetes mellitus is a common endocrinopathy. Diabetic patients undergoing surgery have to be carefully evaluated in order to lower the risk of perioperative complications. The author reviews the possible pathological involvement of target organs, focusing on cardiovascular pathology, neuropathy, nephropathy, respiratory impairment and joint abnormalities.

Perioperative care of diabetic patients.

Diabetes mellitus is the most common metabolic disease and its incidence is increasing. New classifications have been recently proposed based upon a better knowledge of pathogenesis, mechanisms of glucose transport and insulin resistance. The perioperative care of diabetic patients is less dependent on blood-glucose control, which needs to be exceptionally tight, and is usually easily obtained thanks to pharmacological improvements, human insulins and analogues, technical progress with blood-glucose monitoring at the bedside and infusion with constant flow rates.

[Xenon anesthesia: from myth to reality].

Objective: To analyze the current knowledge concerning xenon anaesthesia.

Data Sources: References were obtained from computerized bibliographic research (Medline), recent review articles, the library of the service and personal files.

Study Selection: All categories of articles on this topic have been selected.

The efficacy of intravenous 0.15 versus 0.25 mg/kg intraoperative morphine for immediate postoperative analgesia after remifentanil-based anesthesia for major surgery.

Unlabelled: We evaluated the effect of perioperative administration of two doses of morphine for postoperative analgesia after remifentanil-based anesthesia. The prospective, randomized study included 245 patients from 33 centers. All patients were scheduled for abdominal or urological surgery lasting more than 1 h.

[Anesthesia simulators: benefits and limits of experience gained at several European university hospitals].

Simulation has become essential in all situations where reality was too risky, too expensive, difficult to manage or inaccessible. In anaesthesia, the low rate of accidents and incidents, as well as the necessity to assure patient's safety, limit education and training in crisis management. The progress in data processing allowed the development of realistic anaesthesia simulators, associating the usual environment of an operating room, and made possible the simulation of a wide range of events.

Recovery after anaesthesia for pulmonary surgery: desflurane, sevoflurane and isoflurane.

We have studied maintenance and recovery profiles after general anaesthesia with sevoflurane, desflurane and isoflurane in 100 patients undergoing pulmonary surgery. End-tidal concentrations of anaesthetic required to maintain mean arterial pressure and heart rate within 20% of baseline values were 1.4 +/- 0.

Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension.

Background: Monitoring left ventricular preload is critical to achieve adequate fluid resuscitation in patients with hypotension and sepsis. This prospective study tested the correlation of the pulmonary artery occlusion pressure, the left ventricular end-diastolic area index measured by transesophageal echocardiography, the arterial systolic pressure variation (the difference between maximal and minimal systolic blood pressure values during one mechanical breath), and its delta down (dDown) component (= apneic - minimum systolic blood pressure) with the response of cardiac output to volume expansion during sepsis.

Methods: Preload parameters were measured at baseline and during graded volume expansion (increments of 500 ml) in 15 patients with sepsis-induced hypotension who required mechanical ventilation.

[Exclusive use of calcium channel blockers and cardioselective beta-blockers in the pre- and per-operative management of pheochromocytomas. 70 cases].

The pre and intraoperative use of calcium channel blockers (CCB) has been suggested for the management of either eutopic or ectopic pheochromocytomas. We report our experience of 70 pheochromocytomas, operated between 1988 and 1996 and managed with CCB, especially nicardipine. 59 were hypertensive (84.

Chondronecrosis of the cricoid cartilage after intubation. Two case reports.

Chondronecrosis of the cricoid cartilage is a rare complication of intubation. The records of two children were reviewed. An 8-month-old girl with myelomonocytic leukaemia developed chondronecrosis 10 days after a 2-day period of ventilation.

Can prolonged expiration manoeuvres improve the prediction of arterial PCO2 from end-tidal PCO2?

We have studied, in 16 patients undergoing thoracoabdominal oesophagectomy, if two prolonged expiration manoeuvres improve prediction of arterial PCO2 (PaCO2) from end-tidal PCO2 (PE' CO2). PE' CO2, PCO2 at the end of a simple prolonged expiration (PE1 CO2), and PCO2 at the end of a prolonged expiration preceded by sustained hyperinflation of the lungs (PE2 CO2), were measured during laparotomy, in the lateral thoracotomy position during two-lung ventilation, and after transition to one-lung ventilation. (PaCO2-PE' CO2) was 1.