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Krebs H, Perrin Bayard R, Bares A, Dahmani S, Story T, Claret PG, Bobbia X, de La Coussaye J. Délégation de l’évaluation et du traitement de la douleur à l’infirmier de Service mobile d’urgence et de réanimation : étude avant–après monocentrique. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : La prise en charge de la douleur en médecine d’urgence préhospitalière est encore insuffisante. Cette étude a pour objectif d’évaluer les effets d’une délégation de l’évaluation et du traitement de la douleur à l’infirmier diplômé d’État (IDE) en Service mobile d’urgence et de réanimation (Smur) sur le suivi des recommandations de la Société française de médecine d’urgence (SFMU).
Méthode : Étude rétrospective de type avant–après réalisée au Smur du centre hospitalier universitaire (CHU) de Nîmes de janvier à mai 2017. Les IDE ont été formés, entre les deux phases, à un protocole de délégation de l’évaluation et du traitement de la douleur fondé sur les dernières recommandations.
Résultats : Cent quatre-vingt-un patients ont été inclus dans chaque groupe, 74 (40 %) femmes (âge moyen de 60 ± 18 ans). Les groupes étaient comparables à l’exception de la proportion d’interventions traumatologiques (11 % dans le groupe « avant » vs 20 % dans le groupe « après » ; p = 0,02). Les recommandations ont été respectées pour 12 (7 %) patients dans le groupe « avant », 21 (12 %) dans le groupe « après » (p = 0,10). Le seul facteur indépendant de respect des recommandations est le type d’intervention traumatologique (odds ratio = 9,7 ; intervalle de confiance à 95 % : [2,3–53,3] ; p < 0,01). Le nombre de patients ayant bénéficié d’une administration d’antalgique était respectivement de 55 (30 %) dans le groupe « avant » et de 73 (40 %) dans le groupe « après » (p = 0,05). La réévaluation de l’intensité douloureuse en fin de prise en charge a été consignée dans 11 (6 %) cas de la phase avant vs 38 (21 %) dans la phase après (p < 0,01). Dans le sous-groupe des patients n’ayant pas bénéficié de trinitrine, les recommandations ont été respectées respectivement pendant les phases « avant » et « après » chez 7 (6 %) patients vs 17 (14 % ; p = 0,03).
Conclusion : Malgré une augmentation du taux de prescription d’antalgiques et de réévaluation de la douleur, le protocole de délégation IDE n’a pas permis un meilleur respect des recommandations. L’établissement de protocoles spécifiques en fonction du type d’intervention, notamment traumatologique, pourrait être une piste de réflexion.
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Julien-Marsollier F, Rachdi K, Caballero MJ, Ayanmanesh F, Vacher T, Horlin AL, Skhiri A, Brasher C, Michelet D, Dahmani S. Evaluation of the analgesia nociception index for monitoring intraoperative analgesia in children. Br J Anaesth 2018; 121:462-468. [PMID: 30032886 DOI: 10.1016/j.bja.2018.03.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/27/2018] [Accepted: 04/26/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Intraoperative analgesia is still administered without guidance. Anaesthetists decide upon dosing on the basis of mean population opioid pharmacological studies and in response to variations in haemodynamic status. However, those techniques have been shown to be imprecise. We assessed the diagnostic value of monitoring the analgesia nociception index (ANI) to detect surgical stimulation in children. METHODS This was an observational study of 2- to 12-yr-old patients 5 min before and after surgical incision. Hypnosis was maintained with sevoflurane and guided by bispectral index. Intraoperative analgesia was administered as a remifentanil infusion titrated to variations in haemodynamic parameters, and ANI monitor values were recorded. ANI parameters assessed included instantaneous ANI (ANIi), mean ANI (ANIm), and the relative change of ANIi to ANIm (DeltaANI=ANIi-ANIm/ANIm). Statistical analyses were performed using receiver-operating-characteristic analysis with determination of the area under the receiver operating characteristic (AUROC) curve and the grey zone. RESULTS Overall, 49 subjects were included in this study. The AUROC was 0.755 (0.738-0.772), 0.771 (0.755-0.787), and 0.756 (0.738-0.774) for ANIi, ANIm, and DeltaANI, respectively. The threshold of ANI parameters indicating the presence of noxious surgical stimuli was ≤53%, ≤56%, and ≤-13.3% for ANIi, ANIm, and DeltaANI, respectively. The percentage of subjects in the inconclusive zone was 41%, 51%, and 33% for ANIi, ANIm, and DeltaANI, respectively. CONCLUSIONS ANI has diagnostic value for detecting surgical stimuli in children.
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Affiliation(s)
- F Julien-Marsollier
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France
| | - K Rachdi
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France
| | - M-J Caballero
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France
| | - F Ayanmanesh
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France
| | - T Vacher
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France
| | - A-L Horlin
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France
| | - A Skhiri
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France
| | - C Brasher
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Australia; Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - D Michelet
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Paris Descartes University, Paris, France
| | - S Dahmani
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris, France; Denis Diderot University, Paris, France; DHU Protect INSERM U 1141, Robert Debré University Hospital, Paris, France.
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Michelet D, Brasher C, Horlin AL, Bellon M, Julien-Marsollier F, Vacher T, Pontone S, Dahmani S. Ketamine for chronic non-cancer pain: A meta-analysis and trial sequential analysis of randomized controlled trials. Eur J Pain 2017; 22:632-646. [DOI: 10.1002/ejp.1153] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2017] [Indexed: 01/17/2023]
Affiliation(s)
- D. Michelet
- Department of Anaesthesia and Intensive Care; Robert Debre University Hospital; Paris France
- Paris Diderot University; France
| | - C. Brasher
- Department of Anaesthesia and Pain Management; Royal Children's Hospital; Melbourne Australia
| | - A.-L. Horlin
- Department of Anaesthesia and Intensive Care; Robert Debre University Hospital; Paris France
- Paris Diderot University; France
| | - M. Bellon
- Department of Anaesthesia and Intensive Care; Robert Debre University Hospital; Paris France
- Paris Diderot University; France
| | - F. Julien-Marsollier
- Department of Anaesthesia and Intensive Care; Robert Debre University Hospital; Paris France
- Paris Diderot University; France
| | - T. Vacher
- Department of Anaesthesia and Intensive Care; Robert Debre University Hospital; Paris France
- Paris Diderot University; France
| | - S. Pontone
- Paris Diderot University; France
- Department of Palliative Care and Pain Management; Robert Debre University Hospital; Paris France
| | - S. Dahmani
- Department of Anaesthesia and Intensive Care; Robert Debre University Hospital; Paris France
- Paris Diderot University; France
- DHU PROTECT; INSERM U1141; Robert Debre University Hospital; Paris France
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Michelet D, Skhiri A, Greff B, Luce V, Dahmani S. Management of perioperative laryngospasm by French paediatric anaesthetists. Br J Anaesth 2017; 119:342-343. [DOI: 10.1093/bja/aex200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bellon M, Taillardat E, Hörlin AL, Delivet H, Brasher C, Hilly J, Dahmani S. Validation of a simple tool for anxiety trait screening in children presenting for surgery. Br J Anaesth 2017; 118:910-917. [PMID: 28520894 DOI: 10.1093/bja/aex120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 11/14/2022] Open
Abstract
Background. Screening for preoperative anxiety is an important challenge during the preoperative period. The aim of our study was to validate the faces scale used to detect anxiety trait in children. Methods. Children aged 8-18 yr were asked to quantify their anxiety trait using the readily available faces scale and to respond to the trait component of the State-Trait Anxiety Inventory (STAI) for children (C) or adults (A) before the anaesthesia consultation. Using receiver operating characteristics analysis, we determined the faces scale optimal value on a construct cohort. A validation cohort was recruited to assess the accuracy of the results. Results. The construction cohort comprised 207 patients and the validation cohort 91 patients. The receiver operating characteristics analysis found an area under the curve of 0.75 [95% confidence interval (CI) 0.67, 0.83]. The optimal value for faces scale score was 4, with a sensitivity of 0.61 [95% CI 0.59, 0.62] and a specificity of 0.82 [95% CI 0.81, 0.83]. When this threshold was applied to the construction and validation cohorts, 61.3 and 44.4% of positives were true positives in the construction and validation cohorts, respectively; and 82.1 and 81.3% of negatives were true negatives, respectively. Conclusions. Our study determined the performance of a simple faces scale to measure the preoperative anxiety trait in children aged 8-18 yr. This tool is potentially helpful for clinicians aiming to identify patients at risk of preoperative anxiety and to assign them to targeted management.
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Affiliation(s)
- M Bellon
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Denis Diderot University, Paris VII, 10 avenue de Verdun, Paris, France
| | - E Taillardat
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France
| | - A-L Hörlin
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Denis Diderot University, Paris VII, 10 avenue de Verdun, Paris, France
| | - H Delivet
- Department of Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,René Descarte University, Paris V, 71 avenue Edouard Vaillant, 92774 Boulogne-Billancourt Cedex, France
| | - C Brasher
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - J Hilly
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Denis Diderot University, Paris VII, 10 avenue de Verdun, Paris, France
| | - S Dahmani
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Denis Diderot University, Paris VII, 10 avenue de Verdun, Paris, France.,Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia
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Zidane S, Maiza A, Bouleghlem H, Herizi W, Dahmani S. Investigation of Cyclodextrin Inclusion Compounds Using FT-IR, SEM and X-Ray Diffraction. ACTA ACUST UNITED AC 2016. [DOI: 10.7763/ijcea.2016.v7.568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Maesani M, Pares F, Michelet D, Abdat R, Hilly J, Diallo T, Greff B, Malbezin S, Bonnard A, Dahmani S. Haemodynamic and cerebral oxygenation during paediatric laparoscopy in fluid optimized patients. Br J Anaesth 2016; 116:564-6. [PMID: 26994241 DOI: 10.1093/bja/aew041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Melboucy-Belkhir S, Dahmani S, Brigant F, Paupière S, Ferrand J, Khentache R, Brihaye B. Une ascite à éosinophiles. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Le Bot A, Michelet D, Hilly J, Maesani M, Dilly MP, Brasher C, Mantz J, Dahmani S. Efficacy of intraoperative dexmedetomidine compared with placebo for surgery in adults: a meta-analysis of published studies. Minerva Anestesiol 2015; 81:1105-1117. [PMID: 26005187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Dexmedetomidine (Dex) demonstrates sedative and analgesic effects. We investigated the intraoperative and postoperative effects of intraoperative Dex administration during surgery in adult patients. A search for randomized placebo-controlled trials was conducted in Pubmed and Embase databases to identify randomized controlled clinical trials using intraoperative Dex for surgery in adult population. Outcome assessed were: intraoperative and postoperative opioid consumption, time of recovery from anesthesia, postoperative pain, and postoperative nausea or vomiting (PONV) in the first 24 hours. Data from each trial were combined to calculate pooled odds ratios (OR), mean difference (MD) or standardized mean difference (SMD) and 95% confidence interval (95 % CI). Heterogeneity was measured using I² statistics. Eighteen randomized controlled trials were analyzed. Dex was administered to 815 patients and 410 received placebo. Overall, Dex significantly decreased intraoperative opioid consumption (SMD=-1.58 [-2.98, -0.19], I²=95 %, P<0.00001), but did not decrease time of recovery from anesthesia (SMD=-0.13 [-1.60, 1.34] minutes, I²=95 %, P<0.00001). Dex significantly reduced postoperative opioid consumption (SMD=-1.58 [-2.98, -0.19], I²=95 %, P<0.00001), postoperative pain intensity (SMD=-0.73 [-1.19, -0.27], I²=62 %, P=0.03), and the prevalence of PONV (OR=0.43 [0.27, 0.69], I²=0 %, P=0.46). This meta-analysis shows that intraoperative Dex administration in adult patients reduces intra and postoperative opioid consumption, postoperative pain and PONV. Time of recovery is not affected.
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Affiliation(s)
- A Le Bot
- Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France -
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Yahiaoui R, Mecabih F, Belguendouz H, Messaoudène D, Djami N, Benbetka Y, Dahmani S, Bouaddou E, Alet A, Bandoui M, Atlaoui N, Amrane R, Babahmed R, Fissah A. Place du Quantiféron TB Gold In Tube dans un pays à prévalence intermédiaire de tuberculose. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.10.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yahiaoui R, Debache D, Bouadou E, Dahmani S, Atlaoui N, Djami N, Amrane R, Babahmed R, Fissah A. Étiologies des pleurésies lymphocytaires dans un pays d’endémie de tuberculose. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.10.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Diallo T, Amiel I, Lira E, Borie C, Skhiri A, Hilly J, Dahmani S. [Sub-capsular renal hematoma during severe preeclampsia: clinical case and review of the literature]. ACTA ACUST UNITED AC 2014; 33:536-9. [PMID: 25148716 DOI: 10.1016/j.annfar.2014.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/12/2014] [Indexed: 11/29/2022]
Abstract
Renal haematoma during severe preeclampsia is a rare uneventful event. It is usually associated with other organ injury such as cerebral or liver haematoma. Imaging (ultrasound or tomodensitometry examination) plays an important role in detecting this complication and following its evolution. In the current case report, we describe an isolated renal haematoma during a severe preeclampsia complicated by a HELLP syndrome. This patient was managed with a conservative treatment (control of arterial pressure and induction of delivery) and an imaging follow-up.
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Affiliation(s)
- T Diallo
- Département d'anesthésie et de réanimation, DHU PROTECT, faculté de médecine Denis-Diderot Paris VII, hôpital Robert-Debré, 48, boulevard Serurier, 75019 Paris, France
| | - I Amiel
- Département d'anesthésie et de réanimation, DHU PROTECT, faculté de médecine Denis-Diderot Paris VII, hôpital Robert-Debré, 48, boulevard Serurier, 75019 Paris, France
| | - E Lira
- Département d'anesthésie et de réanimation, DHU PROTECT, faculté de médecine Denis-Diderot Paris VII, hôpital Robert-Debré, 48, boulevard Serurier, 75019 Paris, France
| | - C Borie
- Département d'anesthésie et de réanimation, DHU PROTECT, faculté de médecine Denis-Diderot Paris VII, hôpital Robert-Debré, 48, boulevard Serurier, 75019 Paris, France; Service de gynécologie et obstétrique, hôpital Robert-Debré, 48, boulevard Serurier, 75019 Paris, France
| | - A Skhiri
- Département d'anesthésie et de réanimation, DHU PROTECT, faculté de médecine Denis-Diderot Paris VII, hôpital Robert-Debré, 48, boulevard Serurier, 75019 Paris, France
| | - J Hilly
- Département d'anesthésie et de réanimation, DHU PROTECT, faculté de médecine Denis-Diderot Paris VII, hôpital Robert-Debré, 48, boulevard Serurier, 75019 Paris, France
| | - S Dahmani
- Département d'anesthésie et de réanimation, DHU PROTECT, faculté de médecine Denis-Diderot Paris VII, hôpital Robert-Debré, 48, boulevard Serurier, 75019 Paris, France.
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Yahiaoui R, Messaoudene D, Khakha S, Khanouf K, Djami N, Dahmani S, Bouadou E, Atlaoui N, Babahmed R, Mansouri B, Fissah A, Amrane R. Apport de l’adénosine déaminase (ADA) dans le diagnostic de la tuberculose pleurale. Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2013.10.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gauss T, Hamada S, Jurcisin I, Dahmani S, Boudaoud L, Mantz J, Paugam-Burtz C. Limits of agreement between measures obtained from standard laboratory and the point-of-care device Hemochron Signature Elite(R) during acute haemorrhage. Br J Anaesth 2013; 112:514-20. [PMID: 24335551 DOI: 10.1093/bja/aet384] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Rapid diagnosis of coagulopathy in the bleeding patient using point-of-care (POC) devices would be ideal. The Hemochron Signature Elite(®) (HC(®)) is a POC device that determines international normalized ratio (INR) and activated partial thromboplastin time (aPTT). The aim of the study was to evaluate the agreement for INR and aPTT between the HC(®) and standard laboratory values in acute haemorrhage. METHODS This was a single-centre observational prospective study including patients with acute haemorrhage. Laboratory INR and aPTT were compared with simultaneous measurements performed with the HC(®). The diagnostic performance of HC(®) was determined; bias and limits of agreement were calculated according to the method of Bland and Altman. RESULTS Seventy-two pairs of measurements from 39 patients were analysed. The bias between the INR-HC(®) and aPTT-HC(®) measurements and the central laboratory were 0.02 and -1.13, respectively. The Spearman's correlation coefficients for the INR-HC(®)/INR-lab and the aPTT-HC(®)/aPTT-lab were 0.68 and -0.29, respectively. Twenty-seven per cent of INR-HC(®) values and 89% of the aPTT-HC(®) values exceeded the predefined limits of agreement. The INR-HC(®) measurement identified patients with a central laboratory INR >1.5 with a sensitivity, specificity, and positive and negative predictive values of 83%, 70%, 76%, and 77%, respectively. CONCLUSIONS The results showed a lack of agreement between the INR-HC(®) and the aPTT-HC(®) measurements and the standard laboratory in the context of acute haemorrhage. The INR-HC(®) showed moderate performance as a decision-making tool to detect coagulopathy in the context of acute haemorrhage.
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Affiliation(s)
- T Gauss
- Department of Anaesthesia and Critical Care and
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Edjo Nkilly G, Michelet D, Hilly J, Diallo T, Greff B, Mangalsuren N, Lira E, Bounadja I, Brasher C, Bonnard A, Malbezin S, Nivoche Y, Dahmani S. Postoperative decrease in plasma sodium concentration after infusion of hypotonic intravenous solutions in neonatal surgery. Br J Anaesth 2013; 112:540-5. [PMID: 24193323 DOI: 10.1093/bja/aet374] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hypotonic i.v. solutions can cause hyponatraemia in the context of paediatric surgery. However, this has not been demonstrated in neonatal surgery. The goal of this study was to define the relationship between infused perioperative free water and plasma sodium in neonates. METHODS Newborns up to 7 days old undergoing abdominal or thoracic surgery were included in this prospective, observational study. Collected data included type and duration of surgery, calculated i.v. free water intake, and pre- and postoperative plasma sodium. Statistical analyses were performed using the Pearson correlation, Mann-Whitney test, and receiver operating characteristic analysis with a 1000 time bootstrap procedure. RESULTS Thirty-four subjects were included. Postoperative hyponatraemia occurred in four subjects (11.9%). The difference between preoperative and postoperative plasma sodium measurements (ΔNaP) correlated with calculated free water intake during surgery (r=0.37, P=0.03), but not with preoperative free water intake. Calculated operative free water intake exceeding 6.5 ml kg(-1) h(-1) was associated with ΔNaP≥4 mM with a sensitivity and specificity [median (95% confidence interval)] of 0.7 (0.9-1) and 0.5 (0.3-0.7), respectively. CONCLUSIONS Hypotonic solutions and i.v. free water intake of more than 6.5 ml kg(-1) h(-1) are associated with reductions in postoperative plasma sodium measurements ≥4 mM. In the context of neonatal surgery, close monitoring of plasma sodium is mandatory. Routine use of hypotonic i.v. solutions during neonatal surgery should be questioned as they are likely to reduce plasma sodium.
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Affiliation(s)
- G Edjo Nkilly
- Department of Anaesthesia, Intensive Care and Pain Management
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Chhor V, Canini F, De Rudnicki S, Dahmani S, Gressens P, Constantin P. [Hyperbaric oxygen therapy and inert gases in cerebral ischemia and traumatic brain injury]. ACTA ACUST UNITED AC 2013; 32:863-71. [PMID: 24169200 DOI: 10.1016/j.annfar.2013.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022]
Abstract
Cerebral ischemia is a common thread of acute cerebral lesions, whether vascular or traumatic origin. Hyperbaric oxygen (HBO) improves tissue oxygenation and may prevent impairment of reversible lesions. In experimental models of cerebral ischemia or traumatic brain injury, HBO has neuroprotective effects which are related to various mechanisms such as modulation of oxidative stress, neuro-inflammation or cerebral and mitochondrial metabolism. However, results of clinical trials failed to prove any neuroprotective effects for cerebral ischemia and remained to be confirmed for traumatic brain injury despite preliminary encouraging results. The addition of inert gases to HBO sessions, especially argon or xenon which show neuroprotective experimental effects, may provide an additional improvement of cerebral lesions. Further multicentric studies with a strict methodology and a better targeted definition are required before drawing definitive conclusions about the efficiency of combined therapy with HBO and inert gases in acute cerebral lesions.
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Affiliation(s)
- V Chhor
- Fédération d'anesthésiologie-réanimation et de médecine hyperbare, hôpital d'instruction des armées du Val-de-Grâce, 75005 Paris, France; Inserm U676, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UMRS 676, 75013 Paris, France; Centre for the Developing Brain, Department of Perinatal Imaging and Health, King's College London, London, Royaume-Uni.
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Abback PS, Ben Sallah T, Hilly J, Skhiri A, Silins V, Brasher C, François M, Van Den Abeele T, Wood C, Nivoche Y, Dahmani S. [Opioid-sparing effect of ketamine during tonsillectomy in children]. ACTA ACUST UNITED AC 2013; 32:387-91. [PMID: 23623534 DOI: 10.1016/j.annfar.2013.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/18/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In the adult population, Ketamine is currently used as an antihyperalgesic and opioid-sparing agent during the perioperative period. However, for doses of ketamine up to 0.5mg/kg, these effects have not been found in pediatric population. The aim of the present study was to evaluate the efficacy of a preoperative bolus of 1mg/kg of ketamine on postoperative pain intensity and morphine consumption in children undergoing tonsillectomy. METHODS We have undertaken a retrospective comparison of 60 consecutive children operated for tonsillectomy in our institution before (first 30 patients) and after (last 30 patients) the introduction of a preoperative bolus of 1mg/kg of ketamine. Data collected were: age, ASA score, dose of intraoperative sufentanil, OPS score during PACU stay and the first postoperative day, morphine consumption during PACU stay and the first postoperative day, psychodysleptic manifestations, pain at first solid oral intake and postoperative respiratory complications or haemorrhage. RESULTS No difference was found between the two groups in terms of demographic characteristics. Perioperative doses of sufentanil, postoperative opioid consumption or pain score in PACU or during 24hours were similar between the two groups. The two groups did not differ in terms of pain at first oral intake, or other adverse effects. CONCLUSION These results suggest that 1mg/kg of ketamine administered right after anaesthesia induction in children undergoing tonsillectomy did not result in an opioid sparing effect.
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Affiliation(s)
- P-S Abback
- Département d'anesthésie et réanimation, faculté de médecine Denis-Diderot-Paris-VII, PRES Paris-Sorbonne, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy-la-Garenne, France.
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Nivoche Y, Bruneau B, Dahmani S. [Anesthetic malignant hyperthermia: what's new in 2012?]. Ann Fr Anesth Reanim 2013; 32:e43-e47. [PMID: 23290613 DOI: 10.1016/j.annfar.2012.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Malignant hyperthermia (MH) is a pharmacogenetic disorder of anesthesia. Recent advances dealing with epidemiology of MH and the safe anesthetic course of MH susceptible patients are shortly presented here with a special insight into the preparation of modern anesthesia workstations, which they will share in operating room.
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Affiliation(s)
- Y Nivoche
- Département d'anesthésiologie et réanimation, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France.
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Allary J, Soubirou JF, Michel J, Amiel I, Silins V, Brasher C, Oury JF, Nivoche Y, Dahmani S. An individual scoring system for the prediction of postpartum anaemia. ACTA ACUST UNITED AC 2013; 32:e1-7. [DOI: 10.1016/j.annfar.2012.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
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Yahiaoui R, Hakem D, Dahmani S, Amrane R, Berrah A. Hypertension artérielle pulmonaire post embolique d’origine hydatique. Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yahiaoui R, Dahmani S, Bouadou A, Fissah A, Djami N, Mahi R, Amrane R. Profil clinique et étiologique des pleurésies sérofibrineuse. Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nouette-Gaulain K, Dahmani S. [Paediatric anaesthesia: what are we really doing?]. Ann Fr Anesth Reanim 2012; 31:833-834. [PMID: 23103183 DOI: 10.1016/j.annfar.2012.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Nivoche Y, Bruneau B, Dahmani S. [Suxamethonium and myotonic dystrophy type 1]. Ann Fr Anesth Reanim 2012; 31:571. [PMID: 22677059 DOI: 10.1016/j.annfar.2012.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Nivoche Y, Léculée R, Dahmani S, Lucas MM, Wodey E, Courrèges P. Les anesthésistes face à l’enfant ambulatoire : une enquête de l’Association des anesthésistes réanimateurs pédiatriques d’expression française (Adarpef). ACTA ACUST UNITED AC 2010; 29:554-6. [DOI: 10.1016/j.annfar.2010.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dahmani S, Brasher C, Stany I, Golmard J, Skhiri A, Bruneau B, Nivoche Y, Constant I, Murat I. Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies. Acta Anaesthesiol Scand 2010; 54:397-402. [PMID: 20085541 DOI: 10.1111/j.1399-6576.2009.02207.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Premedication is considered important in pediatric anesthesia. Benzodiazepines are the most commonly used premedication agents. Clonidine, an alpha2 adrenoceptor agonist, is gaining popularity among anesthesiologists. The goal of the present study was to perform a meta-analysis of studies comparing premedication with clonidine to Benzodiazepines. METHODS A comprehensive literature search was conducted to identify clinical trials focusing on the comparison of clonidine and Benzodiazepines for premedication in children. Six reviewers independently assessed each study to meet the inclusion criteria and extracted data. Original data from each trial were combined to calculate the pooled odds ratio (OR) or the mean differences (MD), 95% confidence intervals [95% CI] and statistical heterogeneity were accessed. RESULTS Ten publications fulfilling the inclusion criteria were found. Premedication with clonidine, in comparison with midazolam, exhibited a superior effect on sedation at induction (OR=0.49 [0.27, 0.89]), decreased the incidence of emergence agitation (OR=0.25 [0.11, 0.58]) and produced a more effective early post-operative analgesia (OR=0.33 [0.21, 0.58]). Compared with diazepam, clonidine was superior in preventing post-operative nausea and vomiting (PONV). DISCUSSION Premedication with clonidine is superior to midazolam in producing sedation, decreasing post-operative pain and emergence agitation. However, the superiority of clonidine for PONV prevention remains unclear while other factors such as nausea prevention might interfere with this result.
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Affiliation(s)
- S Dahmani
- Department of Anesthesiology, Robert Debre University Hospital, Paris, France.
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Dahmani S, Kandri Rodi Y, Capet F, Essassi EM, Ng SW. 1,3-Dibenzyl-6-bromo-1H-imidazo[4,5-b]pyridin-2(3H)-one. Acta Crystallogr Sect E Struct Rep Online 2010; 66:o754. [PMID: 21580599 PMCID: PMC2983860 DOI: 10.1107/s1600536810007713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 03/01/2010] [Indexed: 11/14/2022]
Abstract
The imidazopyridine fused-ring in the title compound, C(20)H(16)BrN(3)O, is planar (r.m.s. deviation = 0.011 Å). The phenyl rings of the benzyl substitutents twist away from the central five-membered ring in opposite directions; the rings are aligned at 61.3 (1) and 71.2 (1)° with respect to this ring.
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Affiliation(s)
- S. Dahmani
- Laboratoire de Chimie Organique Appliquée, Faculté des Sciences et Techniques, Université Sidi Mohamed Ben Abdallah, Fés, Morocco
| | - Y. Kandri Rodi
- Laboratoire de Chimie Organique Appliquée, Faculté des Sciences et Techniques, Université Sidi Mohamed Ben Abdallah, Fés, Morocco
| | - F. Capet
- Unité de Catalyse et de Chimie du Solide, Ecole Nationale Supérieure de Chimie de Lille, Lille, France
| | - El Mokhtar Essassi
- Laboratoire de Chimie Organique Hétérocyclique, Pôle de Compétences Pharmacochimie, Université Mohammed V-Agdal, BP 1014 Avenue Ibn Batout, Rabat, Morocco
| | - Seik Weng Ng
- Department of Chemistry, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Dahmani S, Haoudi A, Capet F, Essassi EM, Ng SW. 6-Bromo-1-(1,2-propadien-yl)-3-(2-propyn-yl)-1H-imidazo[4,5-b]pyridin-2(3H)-one. Acta Crystallogr Sect E Struct Rep Online 2010; 66:o755. [PMID: 21580600 PMCID: PMC2983773 DOI: 10.1107/s1600536810007695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 03/01/2010] [Indexed: 11/17/2022]
Abstract
The reaction of propargyl bromide and 6-bromo-1,3-dihydroimidazo[4,5-b]pyridin-2-one in refluxing dimethylformamide yields the title compound, C12H8BrN3O, which features nitrogen-bound propadienyl and propynyl substituents. The imidazolopyridine fused ring is planar (r.m.s. deviation = 0.012 Å); the propadienyl chain is coplanar with the fused ring as it is conjugated with it, whereas the propynyl chain is not as the nitrogen-bound C atom is a methylene linkage. The acetylenic H atom is hydrogen bonded to the carbonyl O atom of an adjacent molecule, forming a helical chain runnning along the b axis.
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Dahmani S, Haoudi A, Capet F, Essassi EM, Ng SW. 6-Bromo-1,3-di-2-propynyl-1H-imidazo[4,5-b]pyridin-2(3H)-one. Acta Crystallogr Sect E Struct Rep Online 2010; 66:o756. [PMID: 21580601 PMCID: PMC2983980 DOI: 10.1107/s1600536810007701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 03/01/2010] [Indexed: 11/10/2022]
Abstract
The room-temperature reaction of propargyl bromide and 6-bromo-1,3-dihydroimidazo[4,5-b]pyridin-2-one in dimethylformamide yields the title compound, C12H8BrN3O, which features nitrogen-bound propynyl substituents. The imidazopyridine fused ring is almost planar (r.m.s. deviation = 0.011 Å); the propynyl chains point in opposite directions relative to the fused ring. One acetylenic H atom is hydrogen bonded to the carbonyl O atom of an inversion-related molecule, forming a dimer; adjacent dimers are linked by a second acetylene–pyridine C—H⋯N interaction, forming a layer motif.
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Dahmani S, Stany I, Brasher C, Lejeune C, Bruneau B, Wood C, Nivoche Y, Constant I, Murat I. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth 2010; 104:216-23. [PMID: 20047899 DOI: 10.1093/bja/aep376] [Citation(s) in RCA: 223] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Emergence agitation (EA) in children is increased after sevoflurane anaesthesia. The efficacy of prophylactic treatment is controversial. The aim of this study was to provide a meta-analysis of the studies of the pharmacological prevention of EA in children. METHODS A comprehensive literature search was conducted to identify clinical trials that focused on the prevention of EA in children anaesthetized with sevoflurane, desflurane, or both. The data from each trial were combined using the Mantel-Haenszel model to calculate the pooled odds ratio (OR) and 95% confidence interval. I(2) statistics were used to assess statistics heterogeneity and the funnel plot and the Begg-Mazumdar test to assess bias. RESULTS Thirty-seven articles were found which included a total of 1695 patients in the intervention groups and 1477 in the control ones. Midazolam and 5HT(3) inhibitors were not found to have a protective effect against EA [OR=0.88 (0.44, 1.76); OR=0.39 (0.12, 1.31), respectively], whereas propofol [OR=0.21 (0.16, 0.28)], ketamine [OR=0.28 (0.13, 0.60)], alpha(2)-adrenoceptors [OR=0.23 (0.17, 0.33)], fentanyl [OR=0.31 (0.18, 0.56)], and peroperative analgesia [OR=0.15 (0.07, 0.34)] were all found to have a preventive effect. Subgroup analysis according to the peroperative analgesia given does not affect the results. CONCLUSIONS This meta-analysis found that propofol, ketamine, fentanyl, and preoperative analgesia had a prophylactic effect in preventing EA. The analgesic properties of these drugs do not seem to have a role in this effect.
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Affiliation(s)
- S Dahmani
- Department of Anesthesiology, Robert Debre University Hospital, Assistance Publique des Hôpitaux de Paris, 48 Bd Serurier, 75019 Paris, France.
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Tremelot L, Restoux A, Paugam-Burtz C, Dahmani S, Massias L, Peuch C, Belghiti J, Mantz J. Interest of BIS monitoring to guide propofol infusion during the anhepatic phase of orthotopic liver transplantation. ACTA ACUST UNITED AC 2008; 27:975-8. [PMID: 19028068 DOI: 10.1016/j.annfar.2008.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Accepted: 10/01/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The anhepatic phase of orthotopic liver transplantation (OLT) is associated with significant changes in pharmacokinetics. The aim of this study was to compare the influence of this phase on propofol target concentrations during BIS guided target controlled infusion (TCI). STUDY DESIGN Prospective study. PATIENTS AND METHODS Eight patients aged 25 to 65 years, Child-Pugh status A-B scheduled for OLT were prospectively included. Anesthesia was performed using TCI of propofol (Diprifusor, Marsh pharmacokinetic model), sufentanil and cisatracurium. Propofol target concentration was adjusted to maintain BIS values between 40 and 50. RESULTS To maintain stable BIS values, propofol target concentrations should be decreased during the anhepatic phase versus the dissection one (2.0 microg/ml+/-0.8 versus 3.0 microg/ml+/-0.9, p<0.0001). CONCLUSION BIS could be useful to titrate propofol infusion during the anhepatic phase of OLT.
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Affiliation(s)
- L Tremelot
- Department of Anesthesia and Critical Care Service, Beaujon University Hospital, 100, boulevard du Général-Leclerc, 92100 Clichy, France
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Mantz J, Dahmani S. Exploring the mechanisms of general anesthesia. Acta Anaesthesiol Belg 2008; 59:167-171. [PMID: 19051448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- J Mantz
- Department of Anesthesia and Critical Care, Beaujon University Hospital, 100 Boulevard du Général Leclerc, F-92110 Clichy.
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Dahmani S, Tesnière A, Rouelle D, Desmonts JM, Mantz J. Thiopental and isoflurane attenuate the decrease in hippocampal phosphorylated Focal Adhesion Kinase (pp125FAK) content induced by oxygen-glucose deprivation. Br J Anaesth 2004; 93:270-4. [PMID: 15194624 DOI: 10.1093/bja/aeh188] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Thiopental and isoflurane exhibit neuroprotective effects against cerebral ischaemia. Here, we hypothesized that oxygen-glucose deprivation decreases the ATP-dependent phosphorylation process of Focal Adhesion Kinase (pp125FAK, a functionally important non-receptor tyrosine kinase), and that this phenomenon is attenuated by thiopental and isoflurane. METHODS Rathippocampal slices were subjected to an anoxic-aglycaemic (or physiologic, control) challenge followed by 3-h reperfusion, and treated with various concentrations of thiopental and isoflurane. PP125FAK phosphorylation was measured by immunoblotting. Neuronal death was assessed by immunostaining with bis-benzimide. RESULTS Significant neuronal death was detected after 30 min (but not 10) of anoxia-aglycaemia (40 (4) vs 14 (5)% of control, P<0.05). At 30 min, phosphorylated pp125FAK content was significantly decreased by anoxic glucose-free conditions (55 (27)% of control, P<0.05). This effect was markedly attenuated by thiopental (10 and 100 microM) and isoflurane (1 and 2%). Under control conditions, thiopental (1, 10, and 100 microM) and isoflurane (0.5, 1, and 2%) increased pp125FAK phosphorylation in a concentration-related fashion. This effect was blocked by chelerythrin and bisindolylmaleimide I and IX (10 microM, three structurally distinct inhibitors of protein kinase C, PKC) but not the N-methyl-D-aspartate (NMDA) receptor antagonist MK801 (10 microM). CONCLUSION Phosphorylated pp125FAK content was markedly decreased in hippocampal slices subjected to oxygen-glucose deprivation. Thiopental and isoflurane significantly attenuated this phenomenon, possibly via PKC activation.
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Affiliation(s)
- S Dahmani
- Department of Anaesthesia, Bichat University Hospital, 46 rue Henri Huchard, F-75018 Paris, France
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Keïta H, Geachan N, Dahmani S, Couderc E, Armand C, Quazza M, Mantz J, Desmonts JM. Comparison between patient-controlled analgesia and subcutaneous morphine in elderly patients after total hip replacement. Br J Anaesth 2003; 90:53-7. [PMID: 12488379 DOI: 10.1093/bja/aeg019] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The goal of this study was to evaluate the effectiveness on postoperative pain, and cognitive impact, of patient-controlled analgesia (PCA) compared with subcutaneous (s.c.) injections of morphine in elderly patients undergoing total hip replacement (THR). METHODS Forty patients older than 70 yr were randomly assigned to two different postoperative analgesic techniques for 48 h: i.v. PCA morphine (dose, 1 mg; lockout interval, 8 min; PCA group) or regular s.c. morphine injections (SC group). Postoperative pain was assessed at rest and when moving, using a visual analogue scale (VAS) every 4 h. A Mini Mental Status (MMS) examination was used to assess cognitive functions before surgery, at 2 h, 24 h and 48 h after surgery, and at hospital discharge. Side-effects were also recorded systematically during the first 48 h after surgery. RESULTS The PCA group showed significantly lower pain scores than the SC group both at rest and during mobilization. However, the clinical significance of pain scores was weak. There was no intergroup difference in postoperative MMS scores. The incidence of side-effects was similar in both groups. CONCLUSIONS We conclude that in healthy elderly subjects undergoing THR, the flexibility of the analgesic regimen is more important than the route of administration with regard to efficacy, adverse effects and recovery of cognitive function.
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MESH Headings
- Administration, Cutaneous
- Aged
- Aged, 80 and over
- Analgesia, Patient-Controlled/adverse effects
- Analgesia, Patient-Controlled/methods
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Arthroplasty, Replacement, Hip
- Cognition
- Female
- Humans
- Injections, Intradermal
- Male
- Morphine/administration & dosage
- Morphine/adverse effects
- Pain, Postoperative/prevention & control
- Pain, Postoperative/psychology
- Postoperative Care/methods
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Affiliation(s)
- H Keïta
- Department of Anaesthesiology and Intensive Care, Hospital Bichat, 46 Rue Henri Huchard, F-75018 Paris, France.
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Dahmani S, Dupont H, Mantz J, Desmonts JM, Keita H. Predictive factors of early morphine requirements in the post-anaesthesia care unit (PACU). Br J Anaesth 2001; 87:385-9. [PMID: 11517121 DOI: 10.1093/bja/87.3.385] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Use of morphine by titration in the post-anaesthesia care unit (PACU) is often the first step in postoperative pain management. This approach provides rapid analgesia but shows a wide inter-individual variability in morphine requirements and may prolong patient stay in the PACU. The aim of this study was to identify the patient characteristics, surgical, anaesthetic, and postoperative factors predictive of early morphine requirements. The study included 149 patients undergoing various non-cardiac surgical procedures under general anaesthesia. In the multiple regression analysis of nine variables, only ethnicity (Caucasian), emergency surgery, major surgery, surgery exceeding 100 min, and pain score on arrival in PACU were predictive factors of morphine requirements. This observational study identifies for the first time independent predictive factors of morphine requirements in the early postoperative period. Future studies are warranted to evaluate the impact of intervention on these factors and any resulting improvement in postoperative pain treatment.
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Affiliation(s)
- S Dahmani
- Department of Anaesthesia and Intensive Care, Hospital Bichat, 46 rue Henri Huchard, F-75018 Paris, France
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Orliaguet G, Dahmani S, Meyer P, Blanot S, Carli P. [Acute hemolysis following perioperative blood salvage in chldren operated for the surgical correction of craniosynostosis]. Ann Fr Anesth Reanim 2001; 20:28-31. [PMID: 11234574 DOI: 10.1016/s0750-7658(00)00323-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report the case of a 6-month-old child, who suffered from acute haemolysis following transfusion of salvaged blood. This complication, of favourable outcome, was related to the accidental aspiration of benzalkonium chloride into the cell saver. This case emphasizes that any adjunction of antiseptic solution is contraindicated during blood saving. The use of a cell saver must be associated with written protocols, describing clearly the contraindications, precautions of use, and the different steps of use of this method of autologous blood transfusion.
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Affiliation(s)
- G Orliaguet
- Département d'anesthésie-réanimation chirurgicale, hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75743 Paris, France.
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Dahmani S, Orliaguet GA, Meyer PG, Blanot S, Renier D, Carli PA. Perioperative blood salvage during surgical correction of craniosynostosis in infants. Br J Anaesth 2000; 85:550-5. [PMID: 11064613 DOI: 10.1093/bja/85.4.550] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Surgical correction of craniosynostosis in infants is a very haemorrhagic procedure. The aim of this study was to determine whether the perioperative use of the continuous autotransfusion system (CATS) would reduce homologous transfusion during repair of craniosynostosis. Two groups of patients were studied according to the availability of the CATS in our hospital. The control group had surgery before the system was introduced and the study group had operations subsequently. Use of CATS was associated with a significant decrease in the median (95% confidence interval) volume of homologous blood transfused [413 (250-540) ml in the control group versus 317 (150-410) ml in the CATS group, P = 0.02] and in the median (95% confidence interval) number of packed red cell units transfused [2 (1-2) in the control group versus 1 (1-2) in the CATS group, P = 0.04] in the perioperative period. Use of CATS is associated with a reduction in homologous transfusion during the surgical correction of craniosynostosis in infants.
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Affiliation(s)
- S Dahmani
- Département d'Anesthésie-Réanimation, Groupe hospitalier Necker-Enfants Malades, Paris, France
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