Background Ischemic myocardial damage accompanying coronary artery bypass graft surgery remains a clinical challenge. We investigated whether xenon anesthesia could limit myocardial damage in coronary artery bypass graft surgery patients, as has been reported for animal ischemia models. Methods In 17 university hospitals in France, Germany, Italy, and The Netherlands, low-risk elective, on-pump coronary artery bypass graft surgery patients were randomized to receive xenon, sevoflurane, or propofol-based total intravenous anesthesia for anesthesia maintenance. The primary outcome was the cardiac troponin I concentration in the blood 24 h postsurgery. The noninferiority margin for the mean difference in cardiac troponin I release between the xenon and sevoflurane groups was less than 0.15 ng/ml. Secondary outcomes were the safety and feasibility of xenon anesthesia. Results The first patient included at each center received xenon anesthesia for practical reasons. For all other patients, anesthesia maintenance was randomized (intention-to-treat: n = 492; per-protocol/without major protocol deviation: n = 446). Median 24-h postoperative cardiac troponin I concentrations (ng/ml [interquartile range]) were 1.14 [0.76 to 2.10] with xenon, 1.30 [0.78 to 2.67] with sevoflurane, and 1.48 [0.94 to 2.78] with total intravenous anesthesia [per-protocol]). The mean difference in cardiac troponin I release between xenon and sevoflurane was −0.09 ng/ml (95% CI, −0.30 to 0.11; per-protocol: P = 0.02). Postoperative cardiac troponin I release was significantly less with xenon than with total intravenous anesthesia (intention-to-treat: P = 0.05; per-protocol: P = 0.02). Perioperative variables and postoperative outcomes were comparable across all groups, with no safety concerns. Conclusions In postoperative cardiac troponin I release, xenon was noninferior to sevoflurane in low-risk, on-pump coronary artery bypass graft surgery patients. Only with xenon was cardiac troponin I release less than with total intravenous anesthesia. Xenon anesthesia appeared safe and feasible.

No abstract

Le contexte social et médiatique actuel est marqué par l’omniprésence de la sexualité et une disqualification relativement courante du vieillissement. A ce titre, la sexualité des sujets vieillissants demeure une thématique peu explorée même dans les institutions spécialisées. Pourtant, il nous paraît essentiel de réfléchir sur la liberté pour chacun d’exprimer et d’assumer son désir jusqu’à un âge avancé. La démarche de recherche, entreprise dans le cadre du mémoire ponctuant notre cursus universitaire en psychologie, permet d’appréhender cette dimension du sujet vieillissant à travers les représentations que s’en font les soignants en maison de retraite et en service hospitalier. Par l’effleurement d’une réalité clinique parfois difficile à saisir, les propos recueillis lors des entretiens sont l’occasion d’esquisser des représentations générales. A l’origine d’attitudes et de réactions émotionnelles variées, ces représentations ne cessent d’influer sur les pratiques professionnelles quotidiennes.

No abstract

No abstract