Publications (4)

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    [Show abstract] [Hide abstract] ABSTRACT: Background: Intra-operative use of oesophageal Doppler (OD) was associated with improved postoperative outcomes through the optimization of perioperative fluid management. We studied the effect on haemodynamics of a goal-directed fluid management approach guided by OD during elective spine surgery in the prone position. Methods: Intra-operative fluid and vasopressor administration were directed according to one of two randomly chosen decision-making algorithms driven by either OD (OD group; n=33 patients) or standard parameters (Standard group; n=34 patients). Both groups were monitored by OD, however haemodynamics management in the Standard group was blinded to OD information. OD algorithm used corrected flow time as the primary variable to guide haemodynamics management. Mean arterial blood pressure (MAP) was maintained within 75% of the pre-operative value for both groups. The primary outcome was the duration of intra-operative hypotensive episodes during prone position. Results: The proportion of procedure duration with MAP below the predefined threshold was greater in the Standard group than in the OD group: 34%(15-62) (median, interquartile range) versus 17%(5-35) of the observation period, respectively (p=0.01). They were also more frequent in the Standard group: 7(3-11) per patient versus 3(1-7) per patient (p<0.001). The requirement and dosing of ephedrine and infused colloids over the observation period did not significantly differ between the two groups. The OD parameters were comparable between the two groups during prone position. Conclusion: OD monitoring during spine surgery in prone position is feasible and may help physicians to reduce the duration of hypotensive episodes during this surgical procedure.
    Full-text Article · Apr 2016
  • [Show abstract] [Hide abstract] ABSTRACT: After elective craniotomy for brain surgery, patients are usually admitted to an intensive care unit (ICU). We sought to identify predictors of postoperative complications to define perioperative conditions that would safely allow ICU bypass. This observational cohort study enrolled 358 patients admitted to neuro-ICU after elective intracranial procedures. Postoperative complications were defined as unexpected events occurring within 24 hours of surgery that required imaging or treatment for neurologic deterioration. Fifty-two patients were transferred postoperatively to neuro-ICU with sedation and mechanical ventilation. Of the remaining 306 patients subjected to an attempt to awake and extubate in the operating room, 26 (8%) developed 1 postoperative complication, primarily a new motor deficit, unexpected awakening delay, or subsequent deterioration in consciousness. Four intracerebral hematomas required surgical evacuation and each of these was detected within 2 hours after surgery. Predictors of postoperative complications included failure to extubate the trachea in operating room [odds ratio 61.8; 95% confidence interval (CI) 12.2-312.5], and, to a lesser extent, a duration of surgery of more than 4 hours (odds ratio 3.3; 95% CI 1.4-7.8), and lateral positioning of the patient during the procedure (odds ratio 2.8, 95% CI 1.2-6.4). Our results encourage prospectively testing the hypothesis that patients with immediate, successful tracheal extubation after elective craniotomy for brain surgery, with a surgical duration of less than 4 hours in a nonlateral position could be monitored safely in the postanesthesia care unit before being discharged to a neurosurgical ward.
    Article · Apr 2011 · Journal of neurosurgical anesthesiology
  • C Ollinet · D Bedague · J Carcey · [...] · J-F Payen
    [Show abstract] [Hide abstract] ABSTRACT: Functional surgery for movement disorders is a recent stereotactic neurosurgical operation, restricted yet to patients with advanced Parkinson's disease or with generalized primary dystonia. One or two electrodes are implanted in the basal ganglia, namely in the globus pallidus pars interna or in the subthalamic nucleus, to realize a deep brain stimulation at high frequency. While this approach needs additional data to demonstrate clinical benefits, first results observed after short and long-term follow up are encouraging. Perioperative problems in patients with Parkinson's disease are possible respiratory disorders, a postoperative miss in medication doses and potential drug interactions with anaesthesia. The objectives of anaesthesia will be to allow stereotactic neurosurgical procedure, to maintain the upper airway patency and to be quickly reversible.
    Article · May 2004 · Annales Françaises d Anesthésie et de Réanimation
  • C Ollinet · D Bedague · J Carcey · [...] · J.-F Payen
    [Show abstract] [Hide abstract] ABSTRACT: Functional surgery for movement disorders is a recent stereotactic neurosurgical operation, restricted yet to patients with advanced Parkinson’s disease or with generalized primary dystonia. One or two electrodes are implanted in the basal ganglia, namely in the globus pallidus pars interna or in the subthalamic nucleus, to realize a deep brain stimulation at high frequency. While this approach needs additional data to demonstrate clinical benefits, first results observed after short and long-term follow up are encouraging. Perioperative problems in patients with Parkinson’s disease are possible respiratory disorders, a postoperative miss in medication doses and potential drug interactions with anaesthesia. The objectives of anaesthesia will be to allow stereotactic neurosurgical procedure, to maintain the upper airway patency and to be quickly reversible.
    Article · Apr 2004 · Annales francaises d'anesthesie et de reanimation