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T Pottecher

Publications and source records attributed to T Pottecher.

At least 19 recordsLinked to original sources
PubMed2006

[Assessment of patient satisfaction after regional anaesthesia in two institutions].

OBJECTIVES: This study was designed to assess patient satisfaction after regional anaesthesia for limb surgery. METHODS: An anaesthesia satisfaction questionnaire was developed, validated (Kappa coefficient) and submitted to 314 patients operated in two institutions (one university hospital with anaesthesiology residents and one specialised in orthopaedics with experienced anaesthesiologists). Items explored were information modalities, pain and anxiety during procedure and global satisfaction rated with four levels (very satisfied [VS], satisfied [S], partially satisfied [PS], non-satisfied [NS]). Patients were interviewed by telephone at postoperative D1 and D8 by a pharmacist student not involved in the patient's care. RESULTS: Inspite of a high level of patient satisfaction at D8 (VS: 50%, S: 44%), some interesting aspects should be emphasised: a) sedation given before nerve block was not efficient to reduce anxiety and pain during procedure; b) VS levels decreased from D1 (56%) to D8 (50%) mainly because of late postoperative pain (after discharge) and discomforts; c) willingness to undergo the same nerve block again (294/314) was not correlated with patient's satisfaction since among PS and NS patients, a majority (9/15) wished for a block in case of renewed limb surgery; d) multivariate analysis showed that VS level was highly correlated with the quality of communication by the anaesthesiologist mainly for informations about pre and postoperative periods. No correlation was found with pain level during procedure; e) satisfaction levels were not different in the two institutions. CONCLUSION: This study has emphasised some important factors of patient satisfaction which were not sufficiently taken into account in our daily practice.

Adolescent↗
PubMed2005

[Should we use catheter replacement with the aid of wire introducer?].

Two types of catheter replacement with the help of wire introducer are reported: systematic scheduled replacement and replacement in case of suspicion of catheter related infection. Guidelines do not recommend systematic scheduled replacement of the catheters. In case of suspicion of catheter infection, French consensus guidelines allow the use of wire introducer in the absence of local risk and of signs of severity. The American guidelines do not recommend the catheter change over guidewire in this setting.

Catheterization↗
PubMed2005

[Ringer solution: osmolarity and composition revisited].

The composition of Ringer solution, a crystalloid fluid that is often used in anaesthesia and intensive care, varies depending on the manufacturer. The knowledge of the actual content in electrolytes and of the characteristics of this fluid is necessary before it is used. We call attention to a certain Ringer solution (Ringer Maco Pharma, Maco Pharma), for which the manufacturer's information about the tonicity and the osmolarity was incorrect. Contrary to what is written on the bag and in the product description (isotonicity, osmolarity of 276.8 mOsm/l), the theoretical osmolarity was 221.4 mOsm/l and the measured osmolality was about 208 mmol/kg, exposing the hypotonic characteristics of this fluid. The use of this product is potentially dangerous in patients with pathologies where the infusion of free water is especially badly supported.

Anesthesia↗
PubMed2005

[Role of MRI in the diagnostic of Gayet Wernicke's encephalopathy (GWE) after gastrectomy and parenteral nutrition].

GWE is rarely described after gastric surgery following parenteral nutrition. The case of a 33 years old female with no previous alcohol addiction, who presented severe neurological disorders after reoperation for postoperative peritonitis and total parenteral nutrition is reported. She was operated 8 days before for gastric leiomyoma and underwent partial gastrectomy. The management has consisted of a tracheal intubation and welfare ventilation. The brain CT scan was normal and the brain MRI made the diagnostic of Gayet Wernicke's encephalopathy with typical signs. An inner, bilateral and symetrical on both sides of the 3rd ventricle, thalamic hypersignal. After treatment in ICU including mechanical ventilatory support and thiamine infusion, she recovered with minor neurological sequelae concicting in amnesia and false recognition. The control of MRI after 5 weeks returned to normal. Mandatory of thiamine to parenteral nutrition is recommended.

Adult↗
PubMed2003

[Lung contusion: relevance of initial injured pulmonary volume measurement by computed tomography].

OBJECTIVE: To evaluate computed tomography quantification of injured pulmonary volume after thoracic trauma and its relevance for severity grade of patients with lung contusion. STUDY DESIGN: Retrospective study in a major French Level I university trauma center. PATIENTS AND METHODS: Clinical and biological data including oxygenation index (PaO2/FIO2) and therapeutics modalities during the first 5 days: positive end expiratory pressure (Peep) and nitric oxide (NO), were collected on 49 patients with lung contusion resulting from thoracic trauma. Injured pulmonary volume was evaluated on initial thoracic tomodensitometry by 2 senior radiologists. The correlation between oxygenation index, therapeutics modalities and initial injured pulmonary volume was assessed for signification. RESULTS: Injured pulmonary volume larger than 37.75% of total lung volume is associated with both hypoxemia at the twenty-fourth hour (PaO2/FIO2 <300), and need for Peep >6 cm H2O and /or ongoing NO administration on day 5. CONCLUSION: Injured parenchymal pulmonary volume evaluation on initial tomodensitometry seems to be an important indicator of lung contusion severity. Thoracic computed tomography provides additional prognostic information in the initial evaluation of thoracic trauma with parenchymal injury.

Adolescent↗
PubMed2002

[Gas embolism and flexible Ecoflac type bag].

Gas embolism at the end of infusion is a well known hazard, that should have disappeared with the use of flexible bags. However, some cases have been reported after pressure infusion. This experimental study evaluates the risk for gas embolism with Ecoflac type flexible bags. These bags are safe under normal pressure infusion conditions with a pneumatic sleeve, because of their texture and pliability; indeed, only minimal air volumes could be expelled, without any risk even in children. However, to be on the safe side, the manufacturer recommends to expel any residual air before pressure administration. This recommendation applies to any bag containing residual air, and since many people are not aware of this, it is rarely put into practice.

Child↗
PubMed2002

[Severe hypophosphatemia and grave head trauma].

The authors report the case of an 18-year-old man with polytrauma, who died at the third day of its accident from brain death and who presented during his stay in the intensive care unit, a deep hypophosphatemia. Two physiopathologic mechanisms were presumed: increase of renal losses and intracellular transfer of phosphorus. Consequences, as well as the indications and the therapeutic modalities of hypophosphatemia are discussed.

Adolescent↗
PubMed2002

[Evaluation of the demand for access to peridural obstetrical anesthesia in maternity units].

OBJECTIVES: This prospective study was initiated by a multicentric work. Each participating hospital, was asked to give data about 20 patients. Because of the importance of these informations for our practice, we decided to continue the evaluation, using the same inquiry, until 200 patients were enrolled. PATIENTS AND METHODS: An independent student (resident pharmacist), using a preprinted inquiry from interviewed two hundred consecutive in the, 48 hours after delivery in order to evaluate the following aspects: reasons to wish an epidural analgesia (EA) or not, modalities of achievement of EA. Statistical study: Chi-square and logistic regression. RESULTS: Among 199 analyzable files, 137 women wished for an EA (68.5%) but in only 90 the procedure was performed. Reasons for non-achievement of EA were the following: labour too advanced (43/47), obstetrical contraindication (2/47), anaesthesiologist non available (2/47). Delay between arrival at hospital and EA performance was 5 h 30 during daytime and 4 h 40 during nighttime. Delay and rate of EA achievement were not different between day and night time. Logistic regression analysis found following criteria related to: Wish for an EA analgesia: anaesthesiology consultation (OR = 193, p < 0.001), nulliparity (OR = 4, p < 0.002) and satisfactory information about EA (OR 35, p = 0.051). Achievement of EA: nulliparity (OR 38, p < 0.002), length of labour (OR = 1.01/min, p < 0.001). CONCLUSION: This study underlined the fact that one third of parturients do not wish for an epidural analgesia, mainly out of fear for neurological complications. When the obstetrician indicated an EA, our organisation allowed its achievement in 98% of cases. The latency between arrival and EA should be shortened.

Adult↗
PubMed2001

[Abdominal compartment syndrome].

French physicians dealing with abdominal emergencies are not very familiar with the abdominal compartment syndrome (ACS). Increased abdominal pressure has deleterious consequences on local (intestine, liver, kidney) circulation, leading to death in the absence of correct treatment. Abdominal trauma and ruptured aortic aneurism are the main causes of ACS. Clinical presentation may be misleading: respiratory failure, oliguria or circulatory symptoms are often predominant. Abdominal palpation is inefficient for evaluating intra-abdominal pressure (IAP); only measurement of cystic pressure allows precise evaluation of IAP. Abdominal decompression is the treatment of choice. It must be performed as soon as IAP exceeds 25 mmHg. The procedure may be risky with a high incidence of severe complications when ischaemic territories are reperfused. Recent data underline the importance of compensation of hypovolemia before decompression. Abdominal closure may necessitate various techniques (aponevrotomy, Bogota bags, etc.). At any rate, IAP must remain low at the end of the procedure. In case of suspicion of ACS, early measurement of IAP is mandatory. If pressure is over 25 mmHg, a decompressive procedure must be initiated.

Abdominal Injuries↗
PubMed2001

[Liver transplantation in a patient with hemophilia A and end stage liver failure].

We report the case of a 50 year-old man factor VIII deficient haemophiliac and hepatitis C cirrhosis. The patient underwent orthotopic liver transplantation because of episodes of variceal bleeding and encephalopathy. He received factor VIII replacement therapy perioperatively. Factor VIII returned to normal within 24 hours postoperatively and factor VIII replacement was stopped. Liver transplantation can be considered as definitive therapy for haemophilia.

Hemophilia A↗
PubMed2001

[Resuscitation in severe forms of pre-eclampsia (short text)].

An expert's conference about Intensive Care in preeclampsia was organized by the French Society of Anesthesiology and Intensive Care (SFAR) associated with the societies of Pediatrics (SFP) and Obstetricians (SFMP and CNGOF). Each expert wrote a chapter according to instructions previously defined by the Referential Committee of Sfar. The coordinator was in charge of a short text which was presented to each society. The main issue was the intensive care management, but chapters about epidemiology, pathology and physiopathology were also included. Principles of care in less severe cases were also added as well as prognosis in mothers and babies. Finally, mandatory anesthetic requirements of were also presented. The aim of this work was to take stock of the state of art in severe preeclampsia. Due to improved knowledge, intensive care strategies for severe pre-eclampsia will have to be updated in the near future.

Anticoagulants↗
PubMed1999

[Nosocomial meningitis in the adult].

Cerebrospinal fluid (CSF) has anti-infectious defense abilities similar to those of the serum of a neutropenic patient. A septic inoculation as in case of nosocomial meningitis (NM), results rapidly in microbial proliferation with major alterations to the blood brain barrier, cerebral oedema and loss of autoregulation of the cerebral blood flow. Arterial hypotension during NM may induce focal or global cerebral ischaemia. The incidence of NM is increasing, staphylococci and Gram negative bacilli being the most frequent pathological agents. Clinical symptoms are not specific in this postoperative and post-traumatic context. In this context, the analysis of pleocytosis and the increased protein content of CSF is disturbing. Numerous clinical conditions may cause NM. Among them, NM from spinal puncture is an important issue for anaesthetists, while combined epidural and spinal anaesthesia carry the highest risks. Cutaneous contamination plays a major role. Half of the post-operative infections after neurosurgery are due to NM, and CSF leakage, iterative operations and surgery in contaminated conditions are the main risk factors. Antibioprophylaxis for postoperative NM is validated for clean and clean-contaminated surgery. Some consider that only procedures of more than two hours require this prophylaxis. Prophylaxis is targeted on staphylococci. Other preventive measures (drainage of less than 24 h, head shaving and prevention of CSF leakage) are of major importance. Antibiotherapy should be guided by the same considerations as for community acquired meningitis, associated with specific issues in the surgical context (presence of foreign material and CSF blockage).

Animals↗
PubMed1999

Improvement of pulmonary hypertension after liver transplantation.

Pulmonary hypertension at the end stage of chronic liver disease is not an uncommon situation. This association termed portopulmonary hypertension raises the question of the feasibility of performing orthotopic liver transplantation (OLT). In the case reported herein, there was a favorable outcome after OLT, even though the mean pulmonary artery pressure (MPAP) before transplantation was increased to 45 mm Hg. Before OLT, the cardiac index (CI) was considerably elevated (7.69 L/min/m2), giving evidence of a marked hyperdynamic circulatory state. The CI decreased significantly after OLT (3.38 L/min/m2), and this produced a significant decrease in the MPAP. Our observation suggests that portopulmonary hypertension due to a marked increase in the CI can be managed successfully by OLT.

Adult↗
PubMed1998

[Tracheal injuries during percutaneous tracheotomy].

Subcutaneous emphysema associated with impossible tracheobronchial aspiration occurred in a patient several hours after percutaneous tracheostomy. Misplacement of tracheal cannula was diagnosed and a tube exchanger was used to replace the cannula in a normal position. Twenty hours later a tracheal tear was recognized. This paper considers the pathophysiology and prevention of such a complication.

Aged↗