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See detailBelgian standards for patient safety in anesthesia (Revision 2019)
BONHOMME, Vincent ULiege; Wouters, Patrick; BRICHANT, Jean-François ULiege et al

in Acta Anaesthesiologica Belgica (2020), 71(1), 5-14

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See detailThe spectral exponent of the resting EEG indexes the presence of consciousness during unresponsiveness induced by propofol, xenon, and ketamine
Colombo, M. A.; Napolitani, Martino; Boly, Mélanie et al

in NeuroImage (2019), 189

Despite the absence of responsiveness during anesthesia, conscious experience may persist. However, reliable, easily acquirable and interpretable neurophysiological markers of the presence of ... [more ▼]

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. We acquired resting electroencephalogram (EEG) in three groups of healthy participants (n = 5 each), before and during anesthesia induced by either xenon, propofol or ketamine. Dosage of each anesthetic agent was tailored to yield unresponsiveness (Ramsay score = 6). Delayed subjective reports assessed whether conscious experience was present (‘Conscious report’) or absent/inaccessible to recall (‘No Report’). We estimated the decay of the PSD of the resting EEG—after removing oscillatory peaks—via the spectral exponent β, for a broad band (1–40 Hz) and narrower sub-bands (1–20 Hz, 20–40 Hz). Within-subject anesthetic changes in β were assessed. Furthermore, based on β, ‘Conscious report’ states were discriminated against ‘no report’ states. Finally, we evaluated the correlation of the resting spectral exponent with a recently proposed index of consciousness, the Perturbational Complexity Index (PCI), derived from a previous TMS-EEG study. The spectral exponent of the resting EEG discriminated states in which consciousness was present (wakefulness, ketamine) from states where consciousness was reduced or abolished (xenon, propofol). Loss of consciousness substantially decreased the (negative) broad-band spectral exponent in each subject undergoing xenon or propofol anesthesia—indexing an overall steeper PSD decay. Conversely, ketamine displayed an overall PSD decay similar to that of wakefulness—consistent with the preservation of consciousness—yet it showed a flattening of the decay in the high-frequencies (20–40 Hz)—consistent with its specific mechanism of action. The spectral exponent was highly correlated to PCI, corroborating its interpretation as a marker of the presence of consciousness. A steeper PSD of the resting EEG reliably indexed unconsciousness in anesthesia, beyond sheer unresponsiveness. © 2019 The Authors [less ▲]

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See detailA fast and general method to empirically estimate the complexity of brain responses to transcranial and intracranial stimulations.
Comolatti, Renzo; Pigorini, Andrea; Casarotto, Silvia et al

in Brain Stimulation (2019), 12(5), 1280-1289

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 ... [more ▼]

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(ST), a fast method for estimating perturbational complexity of any given brain response signal. METHODS: PCI(ST) is based on dimensionality reduction and state transitions (ST) quantification of evoked potentials. The index was validated on a large dataset of TMS/hd-EEG recordings obtained from 108 healthy subjects and 108 brain-injured patients, and tested on sparse intracranial recordings (SEEG) of 9 patients undergoing intracranial single-pulse electrical stimulation (SPES) during wakefulness and sleep. RESULTS: When calculated on TMS/hd-EEG potentials, PCI(ST) performed with the same accuracy as the original PCI, while improving on the previous method by being computed in less than a second and requiring a simpler set-up. In SPES/SEEG signals, the index was able to quantify a systematic reduction of intracranial complexity during sleep, confirming the occurrence of state-dependent changes in the effective connectivity of thalamocortical circuits, as originally assessed through TMS/hd-EEG. CONCLUSIONS: PCI(ST) represents a fundamental advancement towards the implementation of a reliable and fast clinical tool for the bedside assessment of consciousness as well as a general measure to explore the neuronal mechanisms of loss/recovery of brain complexity across scales and models. [less ▲]

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See detailPropofol-induced unresponsiveness is associated with impaired feedforward connectivity in cortical hierarchy
Sanders, R. D.; Banks, M. I.; Darracq, M. et al

in British Journal of Anaesthesia (2018), 121(5), 1084-1096

Background: Impaired consciousness has been associated with impaired cortical signal propagation after transcranial magnetic stimulation (TMS). We hypothesised that the reduced current propagation under ... [more ▼]

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. Spectral analysis was applied to responses recorded from sensors overlying six hierarchical cortical sources involved in visual processing. Dynamic causal modelling (DCM) of induced time–frequency responses and evoked response potentials were used to investigate propofol's effects on connectivity between regions. Results: Sensor space analysis demonstrated that propofol reduced both induced and evoked power after TMS in occipital, parietal, and frontal electrodes. Bayesian model selection supported a DCM with hierarchical feedforward and feedback connections. DCM of induced EEG responses revealed that the primary effect of propofol was impaired feedforward responses in cross-frequency theta/alpha–gamma coupling and within frequency theta coupling (F contrast, family-wise error corrected P<0.05). An exploratory analysis (thresholded at uncorrected P<0.001) also suggested that propofol impaired feedforward and feedback beta band coupling. Post hoc analyses showed impairments in all feedforward connections and one feedback connection from parietal to occipital cortex. DCM of the evoked response potential showed impaired feedforward connectivity between left-sided occipital and parietal cortex (T contrast P=0.004, Bonferroni corrected). Conclusions: Propofol-induced loss of consciousness is associated with impaired hierarchical feedforward connectivity assessed by EEG after occipital TMS. © 2018 British Journal of Anaesthesia [less ▲]

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See detailEvoked Alpha Power is Reduced in Disconnected Consciousness During Sleep and Anesthesia
Darracq, M.; Funk, C. M.; Polyakov, D. et al

in Scientific Reports (2018), 8(1),

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 ... [more ▼]

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. We employed transcranial magnetic stimulation–electroencephalography (TMS–EEG) over parietal regions across states of anesthesia and sleep to assess whether evoked oscillatory activity differed in disconnected states. We hypothesized that alpha activity, which may regulate perception of sensory stimuli, is altered in the disconnected states of rapid eye movement (REM) sleep and ketamine anesthesia. Compared to wakefulness, evoked alpha power (8–12 Hz) was decreased during disconnected consciousness. In contrast, in unconscious states of propofol anesthesia and non-REM (NREM) sleep, evoked low-gamma power (30–40 Hz) was decreased compared to wakefulness or states of disconnected consciousness. These findings were confirmed in subjects in which dream reports were obtained following serial awakenings from NREM sleep. By examining signatures of evoked cortical activity across conscious states, we identified novel evidence that suppression of evoked alpha activity may represent a promising marker of sensory disconnection. © 2018, The Author(s). [less ▲]

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See detailDeep neural networks for automatic classification of anesthetic-induced unconsciousness
Patlatzoglou, K.; Chennu, S.; Boly, Mélanie et al

in Lecture Notes in Computer Science (2018), 11309 LNAI

Despite the common use of anesthetics to modulate consciousness in the clinic, brain-based monitoring of consciousness is uncommon. We combined electroencephalographic measurement of brain activity with ... [more ▼]

Despite the common use of anesthetics to modulate consciousness in the clinic, brain-based monitoring of consciousness is uncommon. We combined electroencephalographic measurement of brain activity with deep neural networks to automatically discriminate anesthetic states induced by propofol. Our results with leave-one-participant-out-cross-validation show that convolutional neural networks significantly outperform multilayer perceptrons in discrimination accuracy when working with raw time series. Perceptrons achieved comparable accuracy when provided with power spectral densities. These findings highlight the potential of deep convolutional networks for completely automatic extraction of useful spatio-temporo-spectral features from human EEG. © 2018, Springer Nature Switzerland AG. [less ▲]

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See detailIntravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study
Forster, C.; VANHAUDENHUYSE, Audrey ULiege; GAST, Pierrette ULiege et al

in British Journal of Anaesthesia (2018), 121(5), 1059-1064

Background: Propofol use during sedation for colonoscopy can result in cardiopulmonary complications. Intravenous lidocaine can alleviate visceral pain and decrease propofol requirements during surgery ... [more ▼]

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.v. lidocaine reduces propofol requirements during colonoscopy and improves post-colonoscopy recovery. Methods: Forty patients undergoing colonoscopy were included in this randomised placebo-controlled study. After titration of propofol to produce unconsciousness, patients were given i.v. lidocaine (1.5 mg kg−1 then 4 mg kg−1 h−1) or the same volume of saline. Sedation was standardised and combined propofol and ketamine. The primary endpoint was propofol requirements. Secondary endpoints were: number of oxygen desaturation episodes, endoscopists’ working conditions, discharge time to the recovery room, post-colonoscopy pain, fatigue. Results: Lidocaine infusion resulted in a significant reduction in propofol requirements: 58 (47) vs 121 (109) mg (P=0.02). Doses of ketamine were similar in the two groups: 19 (2) vs 20 (3) mg in the lidocaine and saline groups, respectively. Number of episodes of oxygen desaturation, endoscopists’ comfort, and times for discharge to the recovery room were similar in both groups. Post-colonoscopy pain (P<0.01) and fatigue (P=0.03) were significantly lower in the lidocaine group. Conclusions: Intravenous infusion of lidocaine resulted in a 50% reduction in propofol dose requirements during colonoscopy. Immediate post-colonoscopy pain and fatigue were also improved by lidocaine. Clinical trial registration: NCT 02784860. © 2018 British Journal of Anaesthesia [less ▲]

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See detailInhaled sevoflurane sedation in the intensive care unit. A case report and narrative literature review
Hubert, Julien ULiege; PIRET, Sonia ULiege; SERPE, Philippe ULiege et al

in Acta Anaesthesiologica Belgica (2018), 69(1), 55-59

This article aims at reviewing, in recent literature, the interest and good practice of using volatile sedation with sevoflurane in an intensive care setting. Although rarely used in the intensive care ... [more ▼]

This article aims at reviewing, in recent literature, the interest and good practice of using volatile sedation with sevoflurane in an intensive care setting. Although rarely used in the intensive care unit (ICU) compared to intravenous sedation, inhaled sedation may be a good alternative to insure comfort to ICU patients. Current literature demonstrates that sevoflurane, administrated through a specifically designed device, the AnaConDa, provides safe and good quality sedation to those patients. Long-term inhaled sevoflurane sedation (ISS) (>96 hours) would be associated to lower agitation, improved pain control, and lower mortality than intravenous sedation. The properties of sevoflurane may be of further advantage in specific intensive care situations such as bronchospasm, postoperative sedation after cardiothoracic surgery, or in agitated patients due to alcohol or other drugs withdrawal. Other studies suggest superiority of ISS in case of pulmonary arterial hypertension, chronic obstructive pulmonary disease, and acute respiratory distress syndrome. We here illustrate our literature review with a case of severe bronchospasm successfully managed using ISS. © Acta Ancesthesiologica Belgica, 2018. [less ▲]

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See detailLow Cardiac Output Syndrome After Adult Cardiac Surgery: Predictive Value of Peak Systolic Global Longitudinal Strain.
AMABILI, Philippe ULiege; Benbouchta, Sabeha ULiege; ROEDIGER, Laurence ULiege et al

in Anesthesia and Analgesia (2018)

BACKGROUND: Peak systolic global longitudinal strain (GLS) is increasingly used to quantify left ventricular systolic function. The primary objective of this study was to assess whether GLS obtained ... [more ▼]

BACKGROUND: Peak systolic global longitudinal strain (GLS) is increasingly used to quantify left ventricular systolic function. The primary objective of this study was to assess whether GLS obtained during intraoperative transesophageal echocardiogram, performed before cardiopulmonary bypass, improves the prediction of postoperative low cardiac output syndrome (LCOS) after adult cardiac surgery. METHODS: GLS from 275 patients undergoing on-pump cardiac surgery was calculated retrospectively using two-dimensional- speckle tracking echocardiography (aCMQ module from Qlab software version 10.5, Philips Medical, Brussels, Belgium). LCOS was defined as the need for inotropic or mechanical circulatory support for >24 hours postoperatively. Patient and procedure characteristics associated with LCOS at the univariable level (P </= .05) were entered into a forward stepwise logistic regression to create a first predictive model. A second model was created by adding GLS. The 2 models were compared using the likelihood-ratio test, the area under the receiver operating characteristic (ROC) curve, and the integrated discrimination index. The optimal cutoff value of GLS associated with LCOS was determined by maximizing the Youden index of the ROC curve. Secondary outcomes included time until complete weaning from inotropes, discharge from the intensive care unit and from the hospital, and 30-day mortality. RESULTS: GLS was significantly associated with LCOS (P < .001) at the univariable level. Predictors of LCOS retained in the first model were cardiopulmonary bypass duration, decreased left ventricular ejection fraction, mitral valve surgery, and New York Heart Association functional class III or IV. Adding the GLS value improved the prediction of LCOS (P = .02). However, the area under the ROC curve did not differ between the 2 models (0.83; 95% confidence interval [CI], 0.77-0.99 vs 0.84; 95% CI, 0.79-0.90; P = .15). The integrated discrimination index associated with addition of GLS was 0.02 (P = .046), meaning that the difference in predicted risk between patients with and without LCOS increased by 2% after adding GLS. A GLS cutoff value of -17% (95% CI, -18.8% to -15.3%) was found to best identify LCOS. After adjusting for covariates included in model 1, a lower GLS value was significantly associated with a lower cumulative probability of weaning from inotropes postoperatively (hazard ratio, 0.90; 95% CI, 0.82-0.97; P = .01). No association was found between GLS and other secondary outcome measures. CONCLUSIONS: GLS is an independent predictor of LCOS after on-pump cardiac surgery. Its incremental value over other established risk factors for postoperative LCOS is, however, limited. [less ▲]

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See detailEffect of hydroxy ethyl starch (HES) 130/0.4 on renal function and mortality one year after adult cardiac surgery : A single center retrospective study
AMABILI, Philippe ULiege; Servais, E.; Senard, Marc ULiege et al

in Acta Anaesthesiologica Belgica (2017), 68(2), 73-79

Hydroxyethyl starch (HES) adversely affect short-term survival and renal function of intensive care unit and possibly of surgical patients. We retrospectively investigated whether using HES as a pump ... [more ▼]

Hydroxyethyl starch (HES) adversely affect short-term survival and renal function of intensive care unit and possibly of surgical patients. We retrospectively investigated whether using HES as a pump prime and for intraoperative fluid therapy is associated with mortality and end-stage renal failure one year after adult cardiac surgery. Multivariable logistic regression was used to adjust for imbalanced characteristics between the two study groups. The primary outcome, a composite of end-stage renal failure or mortality during the first postoperative year was observed in 9.7% of patients who received HES and in 6.2% of patients treated with crystalloids only (Adjusted OR 1.05; 95%CI, 0.5-2; P = 0.9). These results suggest that using HES or balanced crystalloids as a pump prime and for intraoperative fluid therapy results in similar one-year outcomes but must be considered as preliminary given the limited statistical power of the study. [less ▲]

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See detailBrain functional connectivity differentiates dexmedetomidine from propofol and natural sleep
Guldenmund, Pieter; VANHAUDENHUYSE, Audrey ULiege; Sanders, R. D. et al

in British Journal of Anaesthesia (2017), 119(4), 674-684

Background We used functional connectivity measures from brain resting state functional magnetic resonance imaging to identify human neural correlates of sedation with dexmedetomidine or propofol and ... [more ▼]

Background We used functional connectivity measures from brain resting state functional magnetic resonance imaging to identify human neural correlates of sedation with dexmedetomidine or propofol and their similarities with natural sleep. Methods Connectivity within the resting state networks that are proposed to sustain consciousness generation was compared between deep non-rapid-eye-movement (N3) sleep, dexmedetomidine sedation, and propofol sedation in volunteers who became unresponsive to verbal command. A newly acquired dexmedetomidine dataset was compared with our previously published propofol and N3 sleep datasets. Results In all three unresponsive states (dexmedetomidine sedation, propofol sedation, and N3 sleep), within-network functional connectivity, including thalamic functional connectivity in the higher-order (default mode, executive control, and salience) networks, was significantly reduced as compared with the wake state. Thalamic functional connectivity was not reduced for unresponsive states within lower-order (auditory, sensorimotor, and visual) networks. Voxel-wise statistical comparisons between the different unresponsive states revealed that thalamic functional connectivity with the medial prefrontal/anterior cingulate cortex and with the mesopontine area was reduced least during dexmedetomidine-induced unresponsiveness and most during propofol-induced unresponsiveness. The reduction seen during N3 sleep was intermediate between those of dexmedetomidine and propofol. Conclusions Thalamic connectivity with key nodes of arousal and saliency detection networks was relatively preserved during N3 sleep and dexmedetomidine-induced unresponsiveness as compared to propofol. These network effects may explain the rapid recovery of oriented responsiveness to external stimulation seen under dexmedetomidine sedation. Trial registry number Committee number: 'Comité d'Ethique Hospitalo-Facultaire Universitaire de Liège' (707); EudraCT number: 2012-003562-40; internal reference: 20121/135; accepted on August 31, 2012; Chair: Prof G. Rorive. As it was considered a phase I clinical trial, this protocol does not appear on the EudraCT public website. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. [less ▲]

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See detailThe role of the oxytocinergic system in pain physiology : new data and possible therapeutic strategies
Saveri, Maximilien ULiege; Stefenatto, Nicolas ULiege; BONHOMME, Vincent ULiege et al

in Acta Anaesthesiologica Belgica (2017), 68(4), 157-166

Pain is an essential subjective warning symptom that can transform into a disease when it becomes chronic and affects the patients’ quality of life. The oxytocinergic system has long been known to play a ... [more ▼]

Pain is an essential subjective warning symptom that can transform into a disease when it becomes chronic and affects the patients’ quality of life. The oxytocinergic system has long been known to play a physiological role in pain perception and its psychological aspects. Despite potential implications for pain treatment, the oxytocinergic system has not yet been therapeutically targeted in clinical practice. This narrative review explores the latest scientific findings on the subject, and discusses some of the unexplored leads for the clinical use of oxytocin in the domain of pain treatment. [less ▲]

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See detailSedation of Patients With Disorders of Consciousness During Neuroimaging: Effects on Resting State Functional Brain Connectivity.
KIRSCH, Murielle ULiege; Guldenmund, Pieter; Bahri, Mohamed Ali ULiege et al

in Anesthesia and Analgesia (2017), 124(2),

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See detailResting-state Network-specific Breakdown of Functional Connectivity during Ketamine Alteration of Consciousness in Volunteers
BONHOMME, Vincent ULiege; VANHAUDENHUYSE, Audrey ULiege; Demertzi, Athina ULiege et al

in Anesthesiology (2016), 125(5), 873-878

Background: Consciousness-altering anesthetic agents disturb connectivity between brain regions composing the resting-state consciousness networks (RSNs). The default mode network (DMn), executive control ... [more ▼]

Background: Consciousness-altering anesthetic agents disturb connectivity between brain regions composing the resting-state consciousness networks (RSNs). The default mode network (DMn), executive control network, salience network (SALn), auditory network, sensorimotor network (SMn), and visual network sustain mentation. Ketamine modifies consciousness differently from other agents, producing psychedelic dreaming and no apparent interaction with the environment. The authors used functional magnetic resonance imaging to explore ketamine-induced changes in RSNs connectivity. Methods: Fourteen healthy volunteers received stepwise intravenous infusions of ketamine up to loss of responsiveness. Because of agitation, data from six subjects were excluded from analysis. RSNs connectivity was compared between absence of ketamine (wake state [W1]), light ketamine sedation, and ketamine-induced unresponsiveness (deep sedation [S2]). Results: Increasing the depth of ketamine sedation from W1 to S2 altered DMn and SALn connectivity and suppressed the anticorrelated activity between DMn and other brain regions. During S2, DMn connectivity, particularly between the medial prefrontal cortex and the remaining network (effect size β [95% CI]: W1 = 0.20 [0.18 to 0.22]; S2 = 0.07 [0.04 to 0.09]), and DMn anticorrelated activity (e.g., right sensory cortex: W1 = −0.07 [−0.09 to −0.04]; S2 = 0.04 [0.01 to 0.06]) were broken down. SALn connectivity was nonuniformly suppressed (e.g., left parietal operculum: W1 = 0.08 [0.06 to 0.09]; S2 = 0.05 [0.02 to 0.07]). Executive control networks, auditory network, SMn, and visual network were minimally affected. Conclusions: Ketamine induces specific changes in connectivity within and between RSNs. Breakdown of frontoparietal DMn connectivity and DMn anticorrelation and sensory and SMn connectivity preservation are common to ketamine and propofol-induced alterations of consciousness. [less ▲]

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See detailInterfascial spread of injectate after adductor canal injection in fresh human cadavers
GOFFIN, Pierre ULiege; LECOQ, Jean-Pierre ULiege; NINANE, Vincent ULiege et al

in Anesthesia and Analgesia (2016), 123(2), 501-503

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See detailThe new Sfar journals are in place
Plaud, B; Lefrant, JY; BRICHANT, Jean-François ULiege

in Current Anaesthesia and Critical Care (2016)

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See detailTransversus abdominis plane block or intravenous lignocaine in open prostate surgery: a randomized controlled trial.
Maquoi, I.; JORIS, Jean ULiege; Dresse, C. et al

in Acta Anaesthesiologica Scandinavica (2016), 60(10), 1453-1460

BACKGROUND AND OBJECTIVES: Transversus abdominis plane block (TAP) and intravenous lignocaine are two analgesic techniques frequently used after abdominal surgery. We hypothesized that these two ... [more ▼]

BACKGROUND AND OBJECTIVES: Transversus abdominis plane block (TAP) and intravenous lignocaine are two analgesic techniques frequently used after abdominal surgery. We hypothesized that these two techniques improve post-operative analgesia after open prostate surgery and sought to compare their efficacy on immediate post-operative outcome after open prostate surgery. METHODS: After ethics committee approval, 101 patients were enrolled in this prospective study and randomly allocated to receive bilateral ultrasound-guided TAP (n = 34), intravenous lignocaine (n = 33) or placebo (n = 34). In addition, intravenous paracetamol was given every 6 h. The primary endpoint was the cumulative opioid consumption during the first 48 post-operative hours (median[IQR]). Secondary endpoints included pain scores at rest and upon coughing, need for rescue tramadol, incidence of post-operative nausea and vomiting (PONV), recovery of bowel function and incidence of bladder catheter-related discomfort. RESULTS: Cumulative piritramide consumption after 48 h was 28 [23] mg in the control group, 21 [29] mg in the TAP group and 21 [31] mg in the lignocaine group (P = 0.065). There was no significant difference in post-operative pain scores between groups. The proportions of patients requiring rescue tramadol, experiencing PONV or bladder catheter-related discomfort were similar in each group. Recovery of bowel function was also similar in the three groups. CONCLUSIONS: Our study suggests that TAP block and intravenous lignocaine do not improve the post-operative analgesia provided by systematic administration of paracetamol after open prostatectomy. [less ▲]

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See detailPositron Emission Tomography: Basic Principles, New Applications, and Studies Under Anesthesia
KIRSCH, Murielle ULiege; Wannez, Sarah ULiege; Thibaut, Aurore ULiege et al

in International Anesthesiology Clinics (2016)

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See detailDevelopment and validation of a morphologic obstructive sleep apnea prediction score: The DES-OSA score
Deflandre, E.; Degey, S.; Brichant, Jean-Francois ULiege et al

in Anesthesia and Analgesia (2016), 122(2), 363-372

BACKGROUND: Obstructive sleep apnea (OSA) is a common and underdiagnosed entity that favors perioperative morbidity. Several anatomical characteristics predispose to OSA. We developed a new clinical score ... [more ▼]

BACKGROUND: Obstructive sleep apnea (OSA) is a common and underdiagnosed entity that favors perioperative morbidity. Several anatomical characteristics predispose to OSA. We developed a new clinical score that would detect OSA based on the patient's morphologic characteristics only. METHODS: Patients (n = 149) scheduled for an overnight polysomnography were included. Their morphologic metrics were compared, and combinations of them were tested for their ability to predict at least mild, moderate-to-severe, or severe OSA, as defined by an apnea-hypopnea index (AHI) >5, >15, or >30 events/h. This ability was calculated using Cohen κ coefficient and prediction probability. RESULTS: The score with best prediction abilities (DES-OSA score) considered 5 variables: Mallampati score, distance between the thyroid and the chin, body mass index, neck circumference, and sex. Those variables were weighted by 1, 2, or 3 points. DES-OSA score >5, 6, and 7 were associated with increased probability of an AHI >5, >15, or >30 events/h, respectively, and those thresholds had the best Cohen κ coefficient, sensitivities, and specificities. Receiver operating characteristic curve analysis revealed that the area under the curve was 0.832 (95% confidence interval [CI], 0.762-0.902), 0.805 (95% CI, 0.734-0.876), and 0.834 (95% CI, 0.757-0.911) for DES-OSA at predicting an AHI >5, >15, and >30 events/h, respectively. With the aforementioned thresholds, corresponding sensitivities (95% CI) were 82.7% (74.5-88.7), 77.1% (66.9-84.9), and 75% (61.0-85.1), and specificities (95% CI) were 72.4% (54.0-85.4), 73.2% (60.3-83.1), and 76.9% (67.2-84.4). Validation of DES-OSA performance in an independent sample yielded highly similar results. CONCLUSIONS: DES-OSA is a simple score for detecting OSA patients. Its originality relies on its morphologic nature. Derived from a European population, it may prove useful in a preoperative setting, but it has still to be compared with other screening tools in a general surgical population and in other ethnic groups. © 2016 International Anesthesia Research Society. [less ▲]

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