D. Evaluation et préparation du patient
V. Les limites de l’étude
remifentanil en mode AIVOC et groupe anesthésie générale avec le sévoflurane. Dans cette étude l’incidence de l’hypotension artérielle et les besoins en éphédrine étaient plus faibles dans le groupe rachianesthésie continue par rapport aux autres groupes avec une différence significative [109].
Dans notre travail la stabilité hémodynamique était en faveur de la RAC par rapport à la RAU avec un recours moins fréquent aux drogues vasoactives. Ceci rejoint les données des différentes séries cliniques sus cités.
V. Les limites de l’étude
Le nombre limité des patients, la durée courte de suivi après l’hospitalisation constituent les limites de notre étude. Cependant on a noté durant cette étude que la rachianesthésie continue permet une bonne stabilité hémodynamique per opératoire par rapport à la rachianesthésie standard.
Ce travail illustre l’intérêt de la rachianesthésie continue comme alternative à la rachianesthésie conventionnelle chez les sujets âgés souffrant d’une fracture du col de fémur. Cette technique procure une bonne stabilité hémodynamique per opératoire, un moins recours aux vasoconstricteurs, permettant une réduction des complications cardiaques postopératoire à court et à long terme.
Titre : Anesthésie pour fracture du col du fémur chez le sujet âgé : Comparaison
entre rachianesthésie standard et rachianesthésie continue. Auteur: EL BOUTI Anass
Mots clés : Fracture du col de fémur ; Sujet âgé; Rachianesthésie standard ;
Rachianesthésie continue.
Introduction : La fracture du col du fémur représente un véritable tournent dans la vie
des patients. La prise en charge anesthésique représente un véritable défi vu le risque péri opératoire majeur. L’objectif de notre étude était de comparer entre la rachianesthésie en injection unique et la rachianesthésie continue pour chirurgie de la fracture du col du fémur.
Matériel et méthodes : Il s’agissait d’une étude prospective observationnelle
randomisée réalisée au service d’anesthésiologie de l’HMI Med V de Rabat sur une période de 2 ans intéressant 51 patients. Les patients étaient randomisés en deux groupes : Groupe rachianesthésie avec une injection unique (RAU) et groupe rachianesthésie continue (RAC).
Résultats : Durant la période d’étude, 51 patients étaient éligibles, 9 patients étaient
exclus et 42 patients ont été colligés dont 21 dans chaque groupe. L’incidence de l’hypotension artérielle était plus élevée dans le groupe RAU par rapport à celle du groupe RAC avec une différence significative (P=0,025). Les besoins en vasoconstricteurs étaient plus élevés dans le groupe RAU par rapport au groupe RAC avec une différence significative (P<0,001). Il n’y avait pas de différence concernant l’espace abordé ainsi que le type d’abord. Les modifications du segment ST étaient plus importantes dans le groupe RAC (P=0,047). La satisfaction des patients et des chirurgiens ainsi que les mouvements de la troponine étaient comparables entre les deux groupes. Aucun échec n’a été noté chez les deux groupes.
Conclusion : La RAC procure une bonne stabilité hémodynamique per opératoire avec
moins recours aux vasoconstricteurs, permettant une réduction des complications cardiaques péri opératoire.
Title : Anesthesia for fracture of the femoral neck in the elderly: Comparison of
standard spinal anesthesia and continuous spinal anesthesia. Author : EL BOUTI Anass
Keywords : Femoral neck fracture; Elderly; Standard spinal anesthesia ; Continuous
spinal anesthesia
Introduction : The femoral neck fracture is a real turn in the lives of patients. The
anesthetic management is a challenge given the major peri operative risk. The aim of our study was to compare between spinal anesthesia as a single injection and continuous spinal anesthesia for surgery fracture of the femoral neck.
Materials and methods : This was a randomized, prospective observational study in
anaesthesiology department of the HMI med V in Rabat over 2 years worth 51 patients. Patients were randomized into two groups: group with a single spinal injection (SSI) and continuous spinal anesthesia group (CSA).
Results : During the study period, 51 patients were eligible, 9 patients were excluded
and 42 patients were collected with 21 in each group. The incidence of hypotension was higher in the SSI group compared to that of the CSA group with a significant difference (P=0.025). The need for vasoconstrictor were higher in the SSI group compared with the CSA group with a significant difference (P <0.001). There was no difference regarding the area covered and the type first. Changes in the ST segment were higher in the CSA group (P=0.047). The satisfaction of patients and surgeons as well as movements of troponin was comparable between the two groups. No failures were noted in both groups.
Conclusion : The CSA provides good hemodynamic stability with less intraoperative
ناونعلا
قلا يكوشلا ريدختلا نيب ةنراقم : نينسملا دنع ذخفلا قنع رسكل ريدختلا :
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لمعلا ءانثأ يومدلا طغضلل اديج ارارقتسا رمتسملا يكوشلا ريدختلا رفوي :
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.ةحارجلاب ةطيحملا ةرتفلا يف ةيبلقلا تافعاضملا حيتيو ةيعولأا تاقيضم لا
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