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Hypotension during surgery is frequent in the elderly population and is associated with acute kidney and myocardial injury, which are, themselves, associated with increased 30-day mortality. The present study compared the hemodynamic effects of hypobaric unilateral spinal anesthesia (HUSA) to general anesthesia (GA) in patients ≥70 years of age undergoing hip fracture surgery.We conducted a single-center, prospective, randomized study. In the HUSA group, patients were positioned with the operated hip above, and the hypobaric anesthetic solution was composed of 9 mg ropivacaine, 5 µg sufentanil, and 1 mL of sterile water. Anesthesia was adjusted for the GA group. Mean arterial pressure (MAP) was measured with a noninvasive blood pressure upper arm cuff every 3 minutes. Hypotension was treated with a bolus of ephedrine and then a continuous intravenous of norepinephrine to obtain a MAP ≥65 mm Hg. Primary outcome was the occurrence of severe hypotension, defined as a MAP65 mm Hg for12 consecutive minutes.A total of 154 patients were included. Severe hypotension was more frequent in the GA group compared to the HUSA group (odds ratio, 5.6; 95% confidence interval, 2.7-11.7; P.001). There was no significant difference regarding the short-term outcomes between the HUSA and GA groups: acute kidney injury (respectively, 5.1% vs 11.3%; P = .22), myocardial injury (18.0% vs 14.0%; P = .63), and 30-day mortality (2.4% vs 4.7%; P = .65).HUSA leads to fewer episodes of severe intraoperative hypotension compared to GA in an elderly population undergoing hip fracture surgery.

Background Non-elective caesarean sections may be classified using a three-colour coding system, from code-green caesarean section corresponding to non-urgent delivery (no maternal of foetal compromise) to code-red caesarean section corresponding to emergency caesarean section due to immediate life-threatening maternal or foetal situations. Decision-to-delivery interval ≤ 15 min has been advocated in France for code-red caesarean section. This retrospective cohort study aimed to assess the decision-to-delivery interval and the neonatal outcomes according to the anaesthetic technique performed for code red caesarean section in a French tertiary care obstetric unit. Methods All women undergoing code-red caesarean section between January 2013 and December 2015 were included. Demographic characteristics and anaesthetic, obstetrical and neonatal outcomes were collected from the patient's electronic medical records. Results Among 194 code-red caesarean sections analysed, 127 (65%) were performed under epidural anaesthesia and 67 (35%) under primary general anaesthesia. The median decision-to-delivery interval was 10 [8–12.5] min, and the interval was ≤ 15 min in 174 (90%) women. Effective epidural top-up and epidural top-up requiring supplemental sedation were associated with the shortest decision-to-delivery interval. Primary general anaesthesia was independently associated with depressed 5 minutes Apgar score. Conclusion The decision-to-delivery interval was ≤ 15 min in most women, suggesting that optimised organisation ensures short decision-to-delivery interval independently of the anaesthetic technique performed. As general anaesthesia was associated with worse neonatal outcomes, our results support the early insertion of an epidural catheter whenever there is any potential concern that an emergency caesarean section may be required.

Introduction Les programmes de rehabilitation precoce ont permis de diminuer la duree d’hospitalisation et les complications postoperatoires, notamment dans la chirurgie colorectale [1] . La chirurgie pancreatique a fait l’objet de recommandations recentes de la societe ERAS ® [2] . L’objectif de cette etude etait d’evaluer l’impact de la mise en place de ces recommandations dans notre institution. Materiel et methodes Il s’agit d’une etude interventionnelle monocentrique de type avant/apres. Nous avons compare une cohorte retrospective pre-implementation de septembre 2012 a aout 2013 (groupe controle) avec une cohorte prospective post-implementation de janvier 2014 a decembre 2014 (groupe ERAS). Tous les patients ayant beneficie d’une chirurgie pancreatique ont ete inclus. Les patients n’ayant pas eu de geste curatif ont ete exclus. Le critere de jugement principal etait la duree moyenne de sejour postoperatoire (DMS). Les criteres secondaires etaient la prise de boissons carbohydratees preoperatoires, l’utilisation d’une analgesie peridurale thoracique (APD), le remplissage vasculaire peroperatoire, la fonction renale a j1 et j3, le delai de reprise de transit, le taux de complications et le taux de readmission. Les analyses statistiques ont ete realisees avec le logiciel R. Resultats Le groupe ERAS a comporte 47 patients contre 48 dans le groupe controle. Les groupes etaient comparables en termes d’âge, de comorbidites et de diagnostic carcinologique. Dans le groupe ERAS, 41 patients (87 %) ont recu des boissons carbohydratees en preoperatoire. Une chirurgie de type duodenopancreatectomie cephalique a ete realisee chez 23 patients (49 %) dans le groupe ERAS contre 29 patients (60 %) dans le groupe controle ( p = 0,89). Les durees operatoires moyennes etaient similaires ( p = 0,15). Les resultats sont presentes dans le Tableau 1 . Discussion L’implementation du programme ERAS ® en chirurgie pancreatique a permis de diminuer la DMS sans augmentation des complications precoces ni du taux de readmission. La restriction des apports parenteraux peroperatoires n’a pas de consequences a court terme sur la fonction renale.