Purpose: The aim of this study was to assess the incidence and causes of cardiac arrests related to anesthesia.Methods: All patients undergoing anesthesia over a six year period were included in a prospective study. The cardiac arrests encountered during anesthesia and the first twelve postoperative hours in the PACU or ICU were analysed. For each arrest, partially or totally related to anesthesia, the sequence of events leading to the accident was evaluated.Results: Eleven cardiac arrests related to anesthesia were identified among the 101,769 anesthetic procedures (frequency : 1.1/10,000 [0.44-1.72]). Mortality related to anesthesia was 0.6/10,000 [0.12-1.06]. Age over 84 yr and an ASA physical status > 2 were found to be risk factors of cardiac arrest related to anesthesia. The main causes of anesthesia related cardiac arrest were anesthetic overdose (four cases), hypovolemia (two cases) and hypoxemia due to difficult tracheal intubation (two cases). No cardiac arrests due to alveolar hypoventilation were noted during the postoperative periods in either PACU or ICU. At least one human error was noted in ten of the eleven cardiac arrests cases, due to poor preoperative evaluation in seven. All cardiac arrests totally related to anesthesia were classified as avoidable.Conclusion: Efforts must be directed towards improving preoperative patient evaluation. Anesthetic induction doses should be titrated in all ASA 3 and 4 patients. The prediction of difficult tracheal intubation, and if required, the use of awake tracheal intubation techniques, should remain a priority when performing general anesthesia. Objectif : Le but de cette étude était d'évaluer la fréquence et les causes des arrêts cardiaques liés à l'anesthésie (ACA).

PCA is an efficient and safe analgesia technique. FNB and PCB should not be used routinely after total-hip arthroplasty.

The FRANCE-2 registry represents the largest database available on late results of TAVR. Late mortality is largely related to noncardiac causes. Incidence rates of severe events are low after the first month. Valve performance remains stable over time.

To assess the effect of field strength on magnetic resonance (MR) images, the same healthy subject was imaged at three field strengths: 0.5, 1.0, and 1.5 T. Imaging was performed with three similarly equipped MR imagers of the same generation and from the same manufacturer. The same imaging sequences were used with identical parameters and without repetition time correction for field strength. Imaging was performed in four anatomic locations: the brain, lumbar spine, knee, and abdomen. Quantitative image analysis involved calculation of signal-to-noise ratio, contrast-to-noise ratio, and relative contrast; qualitative image analysis was performed by four readers blinded to field strength. The results of all of the examinations were considered to be of diagnostic value. In general, signal-to-noise ratio and contrast-to-noise ratio were lowest at 0.5 T and highest at 1.5 T; relative contrast was not related to field strength. At qualitative analysis, images obtained at 1.0 and 1.5 T were superior to images obtained at 0.5 T; qualitative differences were less important in locations where there is motion or high magnetic susceptibility differences between tissues (e.g., the spine and abdomen). However, excellent image quality was obtained with all three field strengths.

Inspired gases must be warmed and humidified during mechanical ventilation. In a prospective randomized study we compared the performance of a heated humidifier (HH) (Draegger Aquaport) and a heat and moisture exchanger (HME) (Pall Filter BB 2215). A total of 116 patients requiring mechanical ventilation (Servo 900 C Siemens) were enrolled into the study and were randomly assigned to 2 groups. Patients in group I were ventilated with a traditional breathing circuit with HH and patients in group II using a simplified circuit with HME. Pre-existing and hospital acquired atelectasis and pneumonia, occurrence of endotracheal tube (ET) occlusion and ventilatory parameters (respiratory rate, tidal volume) were studied. No statistical difference was found between groups for each parameter except the greater frequency of ET occlusions in the II group (0/61 vs 9/55) (p = 0.0008). Pall Filter (PF), a hydrophobic filter, humidifies the dry gases from the condensed water which is put down on the HME surfaces during cooling of saturated expired gases. This purely physical property is linked to the magnitude of the thermic gradient between the expired gases and the ambiant temperature. Performance impairment of PF in our study might be due to high ambiant temperature in the intensive care unit (usually around 28 degrees C) which reduces thermic gradient and water exchanges. We conclude that efficiency of PF may be weak in some conditions of ambiant temperature.