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Reviews of Macaire Resorts
Post operative pain after open heart surgery is still a main concern; current multimodal analgesia modalities have shown good efficacy for postoperative pain at rest, without reaching full pain relief. The primary goal of this study is to evaluate the effectiveness of peri-operative analgesia, measured by consumption of opioids during the first 48h hours after the surgery, using bilateral erector spinae catheters for 48h, compared to single shot erector spinae block in pediatric patients undergoing open heart surgeries.
Fast track to extubation after pediatric cardiothoracic surgery is becoming more common after a number of reports showing it is safe and effective [1]. However, it has introduced new challenges to pain control. Intubated patients require larger doses of opioids and benzodiazepines for comfort [2].
In patients who are awake and spontaneously breathing, pain and agitation cannot be treated with lower doses. Some centers still administer continuous infusions of opioid and benzodiazepines to extubated patients. These infusions may not be necessary and may even be harmful. In a pilot study of adult patients undergoing open heart surgery at VinMec hospitals, peri-operative regional analgesia by continuous bilateral erector spinae plane ESP block, Investigators showed that the pain relief was efficient and the requirement for opioids in the first 48 hours post-surgery was zero [3].
It confirmed that the impact of regional anesthesia techniques on main procedure-specific postoperative outcomes is very important in decreasing opioid use in the context of fast-track recovery programs that are recommended after cardiac surgery [4]. Since April Investigators are performing bilateral ESP single shot block in cardiac surgery on infants and children. Since December Investigators are performing these surgeries with bilateral ESP catheters with an Intermittent infusion of very low doses of local anesthetic according to the guidelines [7] in regional anesthesia analgesia in pediatric to improve the post-operative analgesia and avoid any opioids.
The ESP block is an inter-fascial block described as a quite simple technique, far from risky anatomical structures. Since the first publication in November only one study on children has been published [8], in thoracic surgery. This technique has been presented at the World Congress on Regional Anesthesia and Pain Medicine as a opioid free pain free for open heart surgery in adult [9]. Researchers from Stanford University reported also one case in open heart surgery announcing a new era in cardiac anesthesia in adult [10].
A study in press shows the interest of a similar thoracic block named Serratus plane block in thoracic aortic surgery in newborn and infants [11]. The study will be a double-blind randomized controlled trial. After informed consent from guardians or parents, infants and children will be randomized via a random number generator into one of two treatment groups.
Catheter Performance The anesthesia team will check that the catheter is inserted in the inter-fascial space rather than intra-vascular. This procedure will be bilateral. After this control an induction dose is injected according to the pediatric regional anesthesia analgesia guidelines. After 7h the ESP catheter has been placed, one of the clinical research nurses will proceed to the randomization of the patient according to the randomization table, and prepare the solution mL in the pump as per protocol.
They will put the ID number of patient on the pump. The nurse will receive instruction to keep strictly confidential the content of the pumps. They will deliver the prepared pumps to the anesthesiologist and anesthesia nurse in charge of the patient. They will connect the pumps to the patient and start the infusion 8 hours after regional anesthesia induction as per protocol. A Bi Daily inspection of the catheters insertion points will be done. If redness around puncture point the catheters will be removed and shift to classical IV analgesia to prevent any infection.
It will be declared as a minor incident in the study. When patient will be intubated Investigators will use scale Comfort-B.
After extubation and still drains will remain Investigators will use FLACC scale at rest and at Mob sitting in bed rotation of the thorax analysis of the Localization of the pain.
One month after the surgery a pain assessment will be done during the 1st one month follow up with a FLACC scale rest and Mobilisation and also analyze if the patient is playing normally according to his parents or guardians. Based on our prior institutional unpublished retrospective data of morphine consumption in the first 48H after the surgery End of surgery to 48h after end of surgery in patients who received Single shot ESP bl0cks who underwent open heart surgeries control group mean 0.
Latest version submitted February 20, on ClinicalTrials. A study version is represented by a row in the table. Select two study versions to compare. One each from columns A and B. Choose either the "Merged" or "Side-by-Side" comparison format to specify how the two study versions are to be displayed. The Side-by-Side format only applies to the Protocol section of the study. Click "Compare" to do the comparison and show the differences. Select a version's Submitted Date link to see a rendering of the study for that version.
A yellow table row indicates the study version currently being viewed. Hover over the " Recruitment Status " to see how the study's recruitment status changed. Study edits or deletions are displayed in red. Study additions are displayed in green. Scroll up to access the controls. Oversight U. Study Description Brief Summary: Post operative pain after open heart surgery is still a main concern; current multimodal analgesia modalities have shown good efficacy for postoperative pain at rest, without reaching full pain relief.
Detailed Description: Fast track to extubation after pediatric cardiothoracic surgery is becoming more common after a number of reports showing it is safe and effective [1]. Group 1 control will receive a single shot dose of local anesthestic ropivacaine through ESP catheters and 6 hours later continuous infusion of Iso saline with a rescue analgesia in case of pain.
Group 2 treatment will received a single shot dose of local anesthestic ropivacaine through ESP catheters and 6 hours later a continuous infusion of ropivacaine with a rescue analgesia in case of pain.
The infusion regimen will be Intermittent automatic bolus IAB every 8 hours of 0. The bolus on the second catheter will be delayed by 2 hours. Group 2 Continuous regional analgesia group will receive an automatic infusion of Ropivacaine see above for concentration according to age through the 2 ESP catheters. The infusion regimen will be IAB every 8 hours 0.
The bolus on the second catheter will be delayed by 2 hours to reduce the maximal plasmatic concentration as much as possible. Management of the pain If pain appears before next IAB the delay between 2 IAB will be reduced to 6 hr without adding any medication This is a common practice in peripheral nerve management.
This increase in volume will be limited to one increase. ESP catheters will be removed 2 hours after drain removal maximum 46h after insertion.
After extubation and still drains will remain Investigators will use FLACC scale at rest and at Mob sitting in bed rotation of the thorax analysis of the Localization of the pain Sternum Back pain Drains o After drains removal Investigators will use FLACC Scale rest and Mob sitting in bed rotation of the thorax and pain localization One month after the surgery a pain assessment will be done during the 1st one month follow up with a FLACC scale rest and Mobilisation and also analyze if the patient is playing normally according to his parents or guardians Statistical analysis Based on our prior institutional unpublished retrospective data of morphine consumption in the first 48H after the surgery End of surgery to 48h after end of surgery in patients who received Single shot ESP bl0cks who underwent open heart surgeries control group mean 0.
Arms and Interventions Arms Assigned Interventions Placebo Comparator: Control Group Erector spinae bilateral catheters with continuous infusion iso saline during 48h after surgery Day 0 to day 2. Erector spinae bilateral catheters with continuous infusion Ropivacaine 0. Outcome Measures Primary Outcome Measures: 1. Persistent pain at 1 month [ Time Frame: Consultation 1 month after the surgery ] Flacc Scale to evaluate pain in Infants from 0 no pain to 10 maximal pain Mobilisation and rest.
Extubation in the operating room after cardiac surgery in children: a prospective observational study with multidisciplinary coordinated approach. J Cardiothorac Vasc Anesth. Epub Apr Early extubation after cardiac operations in neonates and young infants. J Thorac Cardiovasc Surg. Factors affecting the decision to defer endotracheal extubation after surgery for congenital heart disease: a prospective observational study.
Anesth Analg. Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways. Reg Anesth Pain Med. Erector spinae plane block for postoperative analgesia in pediatric oncological thoracic surgery. Can J Anaesth. Bilateral automatized intermittent bolus erector spinae plane analgesic blocks for sternotomy in a cardiac patient who underwent cardiopulmonary bypass: A new era of Cardiac Regional Anesthesia.
J Clin Anesth. Epub May Early extubation after pediatric cardiac surgery: systematic review, meta-analysis, and evidence-based recommendations. J Card Surg. Scroll up to access the controls Scroll to the Study top. National Library of Medicine U.
National Institutes of Health U. July 9, None earliest Version on record 2. July 19, February 20, Study Status Record Verification:. FDA-regulated Drug:. Study Description Brief Summary:. Conditions Conditions:. Study Design Study Type:. Experimental: Regional analgesia group Erector spinae bilateral catheters with continuous infusion Ropivacaine 0. Drug: Continuous infusion of ropivacain in ESP catheter administration of ropivacaine in ESP catheter to provide regional analgesia after surgery.
Outcome Measures Primary Outcome Measures:. Eligibility Minimum Age:. Inclusion Criteria: Elective open heart surgery Exclusion Criteria: Consent refusal Urgent surgery unstable hemodynamic patient after anesthesia induction. References Citations:.
Quiroga Takes Solid Advantage in to Stage 3 of the 52nd La Solitaire du Figaro
Brown, Anthony G. Geomorphology , , This paper reviews the traditional approach to sediment budget studies in geomorphology, new approaches and more specifically the potential impact of new methodological advances. Each component of the budget is discussed including the spatial and volumetric estimations of erosion, deposition and storage and the precision and accuracy of flux rate estimation.
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Like last year, Xavier Macaire offered himself the timpani. This time, without striking a blow with a very cozy eiderdown in advance. His pursuers on the podium, Pierre Quiroga Skipper Macif and Tom Laperche Bretagne CMB Performance being relegated to 47 minutes and 1h28 respectively after spending three days at sea to complete a course of nautical miles kilometers. Read also Solitaire of Figaro : Lorient sets sail. With a little overflow of joy. My minutes in advance are not to be managed.
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He said Tehran was at a crossroads, with the prospect of continuing political and economic isolation unless it engages diplomatically with the west. His arrest came as a wave of anti-government demonstrations broke out across the country following the admission Iranian forces had accidentally brought down a Ukrainian airliner killing all people on board. It is understood that the ambassador had been attending what had been billed as a vigil for the victims of the crash at the Amir Kabir University. However the event quickly turned into an anti-government protest at which point he was said to have left. It is unclear who he was arrested by. It can continue its march towards pariah status with all the political and economic isolation that entails, or take steps to de-escalate tensions and engage in a diplomatic path forwards. The incident threatened to reignite tensions in the region just as they appeared to be easing.
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Information sources and search strategies for identification of studies. Review authors have planned in advance the relevant data to be collected in this meta-analysis and systematic review. A data collection form was created which included the citation details, study design, total study duration, type and number of participants, study location, study inclusion and exclusion criteria, baseline patient characteristics, description of the intervention and control, relevant outcome of interest, and results. This data collection form guaranteed some consistency in the process of data abstraction, and deemed necessary in comparing data. My bio page Edit user profile Reset the password.
Both of them lead teams within the Climate Change Group and gave us some fantastic insight into the work they do as part of the project. I am currently in my third seat, in the Property Cyber Liability team, and have had the opportunity to work on some chargeable climate change work which was exciting. I currently lead the Energy Team. Helena : I am a second-year trainee currently on secondment with one of our key clients. I took a module in Environmental Law in my final year of study so was delighted to be asked to join the CCG group and proud to be one of the founding members, and the leader of the Climate Equality team, originally set up as Pro Bono Broker team.
With the prevailing winds still from the east this third stage of four does look like another speed stage, reaching and downwind running whilst fully observing the strong tides in the English Channel and then the Bristol Channel. It is a miles reach during Tuesday morning and afternoon to the Welsh mark which is the first time the Figaro fleet has turned here. The return reach under Code Zero or J2 headsail is open with no marks of the course other than the Scillies observing only the TSS zones. But there is then a gap of nearly one hour to the fourth placed veteran Gildas Mahe Breizh Cola.
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