Anaesthesia In France Research Articles

Facteurs associés à la stratégie transfusionnelle au cours des anesthésies programmées pour arthroplastie de hanche ou de genou en France

Goal of the study: To determine over a whole country what are the factors associated with an intraoperative homologous blood transfusion and with the use of autologous techniques (preoperative autologous blood donation : PABD; acute normovolemic hemodilution: ANVH; intraoperative red cell salvage: IRCS). Study design: National enquiry using a large representative sample (3 days of anaesthesia in France). Methods: Univariate followed by multivariate analyses of data gathered in 1996 during the survey leaded by the French society of anaesthesia and intensive care (Sfar) and corresponding to 884 scheduled hip and knee prosthesis surgical procedures. Results: Factors associated with a decreased use of PABD programme were: 1- old age and high ASA physical status; 2- procedures of short duration. By contrast, an increased use of PABD was associated with anaesthetics in which a closed circuit had been used. Except for a significant association with increasing age and with absence of PABD used, no additional factor was found to be linked with ANVH. No factor among those studied was found related to the use of IRCS. Homologous blood transfusion was more frequently used in ASA ≥ 3 patients, in long duration surgeries while its use was decreased in patients with PABD (odds ratio for reduction by PABD : 4.4 〚95 % confidence interval : 2.2-8.8〛). Homologous blood transfusion was not related to the use of ANVH or IRCS. Conclusion: These data obtained from a large national survey confirm previously published studies and meta-analyses and are in agreement with current recommendations. An unexpected relation between PABD and closed circuit anaesthesia has been found.

Anaphylaxis during anaesthesia. Results of a two‐year survey in France

Between January 1, 1997 and December 31, 1998, 467 patients were referred to one of the allergo-anaesthesia centres of the French GERAP (Groupe d'Etudes des Réactions Anaphylactoïdes Peranesthésiques) network and were diagnosed as having anaphylaxis during anaesthesia. Diagnosis was established on the basis of clinical history, skin tests and/or a specific IgE assay. The most frequent cause of anaphylaxis was a neuromuscular blocking agent (69.2%). Latex was less frequently incriminated (12.1%) than in previous reports. A significant difference was observed between the incidence of anaphylactic reactions observed with each neuromuscular blocking agent and the number of patients who received each drug during anaesthesia in France throughout the study period (P<0.0001). Succinylcholine and rocuronium were most frequently incriminated. Clinical reactions to neuromuscular blocking drugs were more severe than to latex. The diagnostic value of specific IgE assays was confirmed. These results are consistent with changes in the epidemiology of anaphylaxis related to anaesthesia and are an incentive for the further development of allergo-anaesthesia clinical networks.

The Introduction of Ether Anesthesia in France

The Introduction of Ether Anesthesia in France

Adverse reactions to intravenous agents in anaesthesia in France.

One hundred severe peranesthetic accidents occurring in hospitals in the eastern part of France were tested between 1975 and 1980 at the Immunological Unit of the University Hospital in Nancy. Tests were carried out "a posteriori"; mean time: three weeks after the accident (extremes: one week to one year). A second battery of tests was carried out in 35%, and a third one in 8% of the patients. Anaphylaxis was differentiated from anaphylactoid reactions be means of the tests. Responsible drugs were determined by intradermal testing, by the human basophil degranulation test and P.K. tests. Predisposing factors were studied: atopy (IgE dosage), increase of histamine release (intradermal testing with 48/80), abnormal receptivity to histamine (intradermal histamine), spasmophilia (electromyography recordings). The results show that 42 accidents were due to true anaphylaxis (one of them due to IgG); 48% of the reported accidents were due to succinylcholine. Some of the predisposing factors, in the tested population, are found in a higher proportion than in the French population as a whole; atopy, hypersensitivity to histamine, previous drug allergy, spasmophilia.

Anaesthesia in France

Anaesthesia in France

Anaesthesia in France

Anaesthesia in France

The Introduction of Surgical Anesthesia in France

The Introduction of Surgical Anesthesia in France

The Introduction of Surgical Anesthesia in France

The Introduction of Surgical Anesthesia in France