Œsophagectomie carcinologique : 16 ans d’évolution des pratiques anesthésiques ventilatoires, hémodynamiques et analgésiques
Annales Françaises d'Anesthésie et de Réanimation, ISSN: 0750-7658, Vol: 33, Issue: 1, Page: 16-20
2014
- 1Citations
- 26Captures
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Example: if you select the 1-year option for an article published in 2019 and a metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019. If you select the 3-year option for the same article published in 2019 and the metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019, 2018 and 2017.
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Article Description
L’objectif de cette étude était de décrire l’évolution des pratiques anesthésiques péri-opératoires au cours de la chirurgie pour œsophagectomie carcinologique. Étude descriptive, observationnelle, rétrospective, monocentrique évaluant les principales pratiques en médecine périopératoire de l’œsophagectomie sur une période de 16 ans (1994–2009). Les analyses statistiques étaient réalisées après regroupement chronologique des données en 4 quartiles d’effectifs identiques. Deux cent sept patients consécutifs au cours des 4 périodes (1994–1997 ( n = 52), 1997–1999 ( n = 52), 1999–2003 ( n = 52) et 2004–2009 ( n = 51)) ont été inclus. Les principales évolutions significatives entre la première et la quatrième période étaient : (1) la prise en charge ventilatoire : diminution du volume courant (9,6[8,8–10] vs 7,6[7,0–8,3] mL/kg de poids idéal théorique (PIT), p < 0,01), application d’une pression expiratoire positive (0 vs 83 %, p < 0,001), et mise en place plus fréquente d’une ventilation non invasive en postopératoire (0 vs 51 %, p < 0,001) ; (2) la prise en charge hémodynamique : diminution des volumes perfusés en peropératoire (20,6 [16,0–24,6] vs 12,6 [2,7–9,9–16] mL/h/kg de PIT, p < 0,001) ; 3) la prise en charge analgésique : utilisation plus fréquente d’analgésie péridurale thoracique (31 vs 57 %, p < 0,001). Le saignement peropératoire, les types de solutés de remplissage, les durées de ventilation mécanique, les durées de séjour en réanimation, le nombre de jours sans ventilation et la mortalité à j28 (8 vs 4 %) ne changeaient pas de façon significative. Au cours de ces dernières années, la prise en charge ventilatoire, hémodynamique et analgésique a beaucoup évolué au cours de l’œsophagectomie. To describe the evolution of perioperative anesthesia practices in for esophageal cancer surgery. We conducted an observational retrospective study in a single center evaluating main perioperative practices during 16 years (1994–2009). Statistical analysis was done on 4 chronologic quartiles of same sample size. Two hundred and seven consecutive patients were included during the 4 periods 1994–1997 ( n = 52), 1997–1999 ( n = 52), 1999–2003 ( n = 52) and 2004–2009 ( n = 51). The main significant evolutions between the first and the fourth period were observed: (i) in ventilation: lower tidal volume (9.6[8.6–10.6] vs 7.6[7.0–8.3] mL/kg of ideal body weight (IBW), p < 0.01), increased use of Positive End Expiratory Pressure (0 vs 83 %, p < 0.001) and increased use of post-operative non-invasive ventilation (0 vs 51 %, p < 0.001); (ii) in hemodynamic management: lower fluid replacement (20.6 [16.0–24.6] vs 12.6 [9.7–16.2] mL/h/kg of IBW, p < 0.001); (iii) in analgesia: increased use of epidural thoracic anesthesia (31 vs 57 %, p < 0.001). Peroperative bleeding, type of fluid replacement, length of mechanical ventilation, length of stay in intensive care unit, ventilatory free days and mortality at day 28 didn’t change. During these previous years, anesthesia practices in ventilation, hemodynamics and analgesia for esophageal cancer surgery have changed.
Bibliographic Details
http://www.sciencedirect.com/science/article/pii/S075076581301263X; http://dx.doi.org/10.1016/j.annfar.2013.12.004; http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=84894243245&origin=inward; http://www.ncbi.nlm.nih.gov/pubmed/24439493; https://linkinghub.elsevier.com/retrieve/pii/S075076581301263X; https://dx.doi.org/10.1016/j.annfar.2013.12.004
Elsevier BV
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