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ABSTRACTBackground Recent studies have shown that preoperative education can positively impact postoperative recovery, improving postoperative pain management and patient satisfaction. Gaps in preoperative education regarding postoperative pain and opioid use may lead to increased patient anxiety and persistent postoperative opioid use.Objectives The objective of this narrative review was to identify, examine, and summarize the available evidence on the use and effectiveness of preoperative educational interventions with respect to postoperative outcomes.Method The current narrative review focused on studies that assessed the impact of preoperative educational interventions on postoperative pain, opioid use, and psychological outcomes. The search strategy used concept blocks including “preoperative” AND “patient education” AND “elective surgery,” limited to the English language, humans, and adults, using the MEDLINE ALL database. Studies reporting on preoperative educational interventions that included postoperative outcomes were included. Studies reporting on enhanced recovery after surgery protocols were excluded.Results From a total of 761 retrieved articles, 721 were screened in full and 34 met criteria for inclusion. Of 12 studies that assessed the impact of preoperative educational interventions on postoperative pain, 5 reported a benefit for pain reduction. Eight studies examined postoperative opioid use, and all found a significant reduction in opioid consumption after preoperative education. Twenty-four studies reported on postoperative psychological outcomes, and 20 of these showed benefits of preoperative education, especially on postoperative anxiety.Conclusion Preoperative patient education interventions demonstrate promise for improving postoperative outcomes. Preoperative education programs should become a prerequisite and an available resource for all patients undergoing elective surgery.

Résumé: Objectif: Évaluer rétrospectivement l’impact de l’âge sur la morbidité et les résultats oncologiques de la radiothérapie néoadjuvante du cancer rectal chez des patients de 70ans ou plus. Patients et méthodes: Quatre-vingt-onze patients consécutifs ont été divisés en trois terciles : groupe 1, 70 à 75ans (n =31), groupe 2, 76 à 79ans (n =31) et groupe 3, 80ans ou plus (n =29). La radiothérapie a été délivrée selon deux schémas : 25Gy en cinq fractions (schéma court) ou 45–50Gy en fractionnement classique (schéma long) avec une chimiothérapie concomitante par 5-fluoro-uracile seule ou associée à de l’oxaliplatine. Résultats: Les trois groupes étaient comparables en termes d’indice de performance, de score de Charlson et de stade T. Le schéma long a été utilisé dans 77,5, 74,5, et 48,3 % des groupes 1, 2 et 3 (p = 0,03) et une chimiothérapie était associée dans respectivement 77,4, 71 et 41,4 %, (p = 0,006). Tous les patients traités avec le schéma court ont reçu le traitement prévu sans toxicité aiguë. Dans le groupe traité avec le schéma long, l’observance du traitement a été de 65 % et le taux de toxicité aiguë de grade 3 ou plus de 12 % sans oxaliplatine et 48 % avec oxaliplatine. Les probabilités de survie globale à trois et cinq ans étaient respectivement de 66,9 % et 60,8 % dans le groupe 1, 90,5 % et 75,9 % dans le groupe 2 et 80,5 % et 73,8 % dans le groupe 3 (p = 0,15). Conclusion: Chez les patients de 70ans ou plus, un traitement néoadjuvant doit être privilégié et le schéma court semble être une bonne option. [ABSTRACT FROM AUTHOR]

EPILEPSY'S SURGERY NOW BECAME AN OPTION IN THE TREATMENT OF PHARMACO-RESISTANT EPILEPSY. IT IMPROVES THE QUALITY OF LIFE OF THE EPILEPTIC PATIENT BUT ALSO DECREASES ITS MAJOR CONSEQUENCES AND AMONG THEM THE PSYCHIATRIC COMORBIDITY. LINKS BETWEEN PSYCHIATRY AND EPILEPSY ARE WIDELY KNOWN AND THESE LINKS ARE LIKELY TO ENDURE AFTER THE SURGERY. THIS PAPER IS MEANT TO DESCRIBE STAKES AND SUBSTANCE OF THIS PREOPERATIVE PSYCHIATRIC ASSESSMENT THROUGH A REVIEW OF THE RELATED LITERATURE. FINALLY, ITS CONTENT WILL BE HIGHLIGHTED IN A CLINICAL CASE REPORT. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Because of the lack of controlled studies, there is no consensus regarding the practice of routine haemostasis tests before neuraxial blockade in children. The purpose of this study was to describe the French surgical practice about the preoperative evaluation of coagulation in children who were scheduled for paediatric neuraxial anaesthesia. Study design: Descriptive analysis of the practice. Methods: A telephone survey for coagulation screening was conducted in French surgical paediatric units, known to perform paediatric neuraxial anaesthesia on a routine basis. The aim of the standardized questionnaire was to evaluate the expertise in performance of neuraxial block, the modalities of the preoperative haemostasis screening, and the indications of biological tests and to assess whether a standardized team procedure was used. Results: Forty-two hospitals (27 universities, 10 general hospitals and five private institutions) were contacted; 61 anaesthesiologists with an expertise with central block answered the survey. Thirty-five institutions used a standardized procedure and 57,1% of them undertook routines tests only in children who are not walking. In the remaining 42,9%, the strategy was to screen systematically all patients whatever their age, familial and personal history as well as physical examination. However, only 54% of the anaesthesiologists performed an extensive physical examination in order to detect symptoms in favour of signs of haemostatic disorders. Conclusion: While numerous data suggest that routine testing does not to provide much extra information in the absence of a positive history, a systematic strategy is still widely applied in children. Guidelines need to be developed to insure the safety of oriented tests. [Copyright &y& Elsevier]

Abstract: A 3-year-old boy of North African decent was seen in the anaesthetic preoperative clinic prior to a scheduled adenoidectomy. His history revealed that his older brother suffered from an unknown form of muscular dystrophy. On clinical exam, no signs of muscular dystrophy were present. However in light of the patient''s family history a blood sample for CPK was taken. This was found to be elevated and a neurological consultation was obtained. The patient was diagnosed with a deltasarcoglycanopathy, a rare form of limb girdle muscular dystrophy. A non triggering anaesthetic technique was used, avoiding halogenated anaesthetics and succinylcholine. The preoperative evaluation for a child with a suspected myopathy and the implications for its anaesthetic management are reviewed in this article. [Copyright &y& Elsevier]

For more than 10 years now, post-operative adjuvant chemotherapy has been standard treatment for early stage breast cancer. Neoadjuvant preoperative treatment (primary chemotherapy or induction chemotherapy) is still the standard treatment for inflammatory tumours and local inoperable advanced tumors. This approach has spread to operable breast tumours, for which the mastectomy was the only treatment option, the goal being mammary conservation. This neoadjuvant chemotherapy model has become the most appropriate in vivo model for assessing therapeutic response. This approach is all the more interesting due to recent developments in molecular biology, notably in genomics and proteomics. This strategy is interesting for assessing new treatments, as most of the patients have adjuvant chemotherapy. It is important to assess histologic response. However, future therapeutic trials, or those already in process, should also allow for the identification of new intermediary response markers that can predict therapeutic response. This therapeutic approach is logical considering that 4 trials have shown that neither chemotherapy before nor after surgery modified survival without relapse or overall survival. This article first reviews neo-adjuvant chemotherapy in operable breast cancer and then overviews the methodological problems linked to phase II trials (impossible to compare 2 treatments, difficulties in comparing studies due to different anatomapathological classifications) and the difficulties in running phase III neoadjuvant trials, due to the number of protocols associated with the drugs that have proven effective in treating breast cancer. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les complications respiratoires sont un facteur de morbi-mortalité postopératoire. La chirurgie et l’anesthésie ont des répercussions sur la fonction respiratoire. L’évaluation préopératoire de la fonction respiratoire représente donc un enjeu majeur. Se pose dès lors la question de l’intérêt de réaliser des explorations fonctionnelles respiratoires (EFR) préopératoires afin de juger de l’état respiratoire des patients devant bénéficier d’une chirurgie. Matériel et méthodes Revue de la littérature (Medline) et sélection des articles portant sur les EFR en préopératoire selon leur pertinence évaluée par l’auteur en fonction de son expérience. Résultats Les EFR seules ne permettent pas de prédire le risque de complications respiratoires postopératoires. Elles restent recommandées avant une chirurgie de résection pulmonaire. Il peut être intéressant de réaliser, de façon ciblée, des EFR préopératoires chez un patient ayant des antécédents respiratoires. Le but étant de déterminer si une préparation respiratoire pourrait être utile dans le cadre d’un programme de réhabilitation périopératoire. Conclusion Les EFR ne doivent pas être réalisées de façon systématique avant une chirurgie en dehors de la chirurgie de résection pulmonaire. Summary Introduction As postoperative respiratory complications are an important issue for patients’ outcome, it is useful to assess the respiratory function in the preoperative period. Surgery and anaesthesia have many consequences on the respiratory function, so can respiratory function tests (RFT) be useful in this assessment? Material and methods This article is based on many articles to determine if RFT are useful before surgery. Results Lots of studies have shown that respiratory function tests are not useful to predict the risk of postoperative respiratory complications. They are still recommended before lung resection. Preoperative respiratory function tests can be useful in patients with respiratory issues to know if whether or not a respiratory rehabilitation program is appropriate before surgery. Conclusion Systematic RFT shall not be performed before surgery. [ABSTRACT FROM AUTHOR]

The goal of anesthesia preoperative consultation is to better document comorbid patient's disease, selectively order investigations, optimize pre-existing medical conditions, to prepare the most adequate plan of anesthesia.