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Adjunctive remifentanil infusion in deeply sedated and paralyzed ICU patients during fiberoptic bronchoscopy procedure: a prospective, randomized, controlled study
Hervé Quintard, Isabelle Pavlakovic, Jean Mantz, Carole Ichai
Annals of Intensive Care , 2012, DOI: 10.1186/2110-5820-2-29
Abstract: A prospective, randomized, blinded, placebo-controlled study was conducted in 18-bed ICU. Patients needing a tracheal fibroscopy under deep sedation (midazolam (0.1?mg/kg per hour) fentanyl (4?μg/kg per hour)) and neuromuscular blocking (atracurium 0.5?mg/kg) were included in the study. A continuous monitoring of BIS, arterial pressure, and heart rate were realized before, during, and after the fiberoptic exam. An adjunctive continuous placebo or Remifentanil infusion was started just before the fiberoptic exam with a target effect-site concentration of 4?ng/ml using a Base Primea pump.Mean arterial pressure and heart rates were comparable between the placebo and Remifentanil groups at all times of the procedure. We did not observe differences in the variation of BIS values between the two groups during procedure. We described no change in BIS values relative to the placebo group in this population.In deeply sedated and paralyzed patients, receiving analgesic support based on a scale score an additional administration of short-acting analgesic drug, such as Remifentanil, seems not to be necessary for acute pain control.NCT00162591.
Une observation de suicide d’un vétérinaire par pentobarbital et dexmédétomidine A case report of a veterinary surgeon’s suicide with pentobarbital and dexmedetomidine
Zanifé David,Schmitt Corinne,Balzani Céline,Ichai Carole
Annales de Toxicologie Analytique , 2012, DOI: 10.1051/ata/2012018
Abstract: Introduction : Il existe dans la littérature médicale peu de références rapportant des observations d’intoxication volontaire humaine par euthanasiants pour animaux. Les auteurs présentent le cas d’un vétérinaire de 38 ans qui s’est injecté, pour se suicider, deux euthanasiants pour animaux utilisés dans sa pratique courante. Méthode : Il s’agit d’une observation du centre antipoison de Marseille qui a été consulté pour une aide à la prise en charge de cette intoxication inhabituelle. Résultat : Le patient s’est administré du pentobarbital, barbiturique qui n’est plus utilisé en médecine humaine en France et de la dexmédétomidine, un agoniste sélectif des récepteurs α2-adrénergiques aux propriétés hypnotiques et analgésiques. Lorsqu’elle l’a découvert, la famille, travaillant également dans le domaine vétérinaire, lui a aussit t administré l’antidote de la dexmédétomidine et contacté les urgences. L’équipe médicale arrivée sur place a trouvé le patient en arrêt cardio-respiratoire, avec un score de Glasgow à 3. Malgré une prise en charge en service spécialisé, le patient décédera au bout de 13 jours des complications anoxiques de son arrêt respiratoire. Discussion : Le r le du pentobarbital et de la dexmédétomidine dans la symptomatologie du patient, ainsi que l’influence de l’administration de l’antidote sont discutés dans cet article. Conclusion : Il para t important que les professionnels de santé soient informés de l’existence de ces produits vétérinaires et de leurs propriétés pharmacologiques afin de prendre en charge au mieux les patients potentiellement intoxiqués avec ces molécules. Introduction: Suicide poisonings with drugs used for animal euthanasia are rare in the medical literature. The authors describe the case of a 38-year-old veterinary surgeon who killed himself in his office with intravenous injection of two molecules: dexmedetomidine and pentobarbital. Method: Description of a clinical observation of the Marseille Poison Control Centre. Results: The two veterinary drugs used by the patient were high quantities of pentobarbital, which is a barbiturate no longer used in France as a human medicine, and dexmedetomidine, which is an α2 agonist used in veterinary medicine for its hypnotic and analgesic properties. As soon as the family (also working as veterinary practitioners) discovered the poisoned patient, the antidote of dexmedetomidine was injected, and the emergency medical team that arrived found the patient to have respiratory arrest with a Glasgow coma scale of 3. Despite being taken to an intensive care unit he died from complic
The Practice of Therapeutic Hypothermia after Cardiac Arrest in France: A National Survey
Jean-Christophe Orban, Florian Cattet, Jean-Yves Lefrant, Marc Leone, Samir Jaber, Jean-Michel Constantin, Bernard Allaouchiche, Carole Ichai, for the AzuRéa group
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0045284
Abstract: Aims Cardiac arrest is a major health concern worldwide accounting for 375,000 cases per year in Europe with a survival rate of <10%. Therapeutic hypothermia has been shown to improve patients’ neurological outcome and is recommended by scientific societies. Despite these guidelines, different surveys report a heterogeneous application of this treatment. The aim of the present study was to evaluate the clinical practice of therapeutic hypothermia in cardiac arrest patients. Methods This self-declarative web based survey was proposed to all registered French adult intensive care units (ICUs) (n = 357). Paediatrics and neurosurgery ICUs were excluded. The different questions addressed the structure, the practical modalities of therapeutic hypothermia and the use of prognostic factors in patients admitted after cardiac arrest. Results One hundred and thirty-two out of 357 ICUs (37%) answered the questionnaire. Adherence to recommendations regarding the targeted temperature and hypothermia duration were 98% and 94% respectively. Both guidelines were followed in 92% ICUs. During therapeutic hypothermia, sedative drugs were given in 99% ICUs, mostly midazolam (77%) and sufentanil (59%). Neuromuscular blocking agents (NMBA) were used in 97% ICUs, mainly cisatracurium (77%). Numerous prognostic factors were used after cardiac arrest such as clinical factors (95%), biomarkers (53%), electroencephalography (78%) and evoked potentials (35%). Conclusions In France, adherence to recommendations for therapeutic hypothermia after cardiac arrest is higher than those previously reported in other countries. Numerous prognostic factors are widely used even if their reliability remains controversial.
International recommendations for glucose control in adult non diabetic critically ill patients
Carole Ichai, Jean-Charles Preiser, for the Société Fran?aise d'Anesthésie-Réanimation (SFAR), Société de Réanimation de langue Fran?aise (SRLF) and the Experts group
Critical Care , 2010, DOI: 10.1186/cc9258
Abstract: Twenty-one experts issued recommendations related to one of the five pre-defined categories (glucose target, hypoglycemia, carbohydrate intake, monitoring of glycemia, algorithms and protocols), that were scored on a scale to obtain a strong or weak agreement. The GRADE (Grade of Recommendation, Assessment, Development and Evaluation) system was used, with a strong recommendation indicating a clear advantage for an intervention and a weak recommendation indicating that the balance between desirable and undesirable effects of an intervention is not clearly defined.A glucose target of less than 10 mmol/L is strongly suggested, using intravenous insulin following a standard protocol, when spontaneous food intake is not possible. Definition of the severe hypoglycemia threshold of 2.2 mmol/L is recommended, regardless of the clinical signs. A general, unique amount of glucose (enteral/parenteral) to administer for any patient cannot be suggested. Glucose measurements should be performed on arterial rather than venous or capillary samples, using central lab or blood gas analysers rather than point-of-care glucose readers.Thirty recommendations were obtained with a strong (21) and a weak (9) agreement. Among them, only 15 were graded with a high level of quality of evidence, underlying the necessity to continue clinical studies in order to improve the risk-to-benefit ratio of glucose control.Critically ill patients in intensive care units (ICUs) develop insulin resistance that is responsible for so-called "stress diabetes" [1-3]. For a long time this was accepted insofar as stress diabetes was seen as an adaptive metabolic response. However, over the last 10 years, there have been changes in clinical practice resulting from a better knowledge of glucose toxicity and from observations on the benefits of glucose control in clinical trials [4]. Since the first trial in Leuven in 2001 [4], a plethora of articles has been published on the subject but these have triggered much c
Life Satisfaction between Chinese-Immigrant Adolescents and Their Counterparts in the United States and China  [PDF]
Jessica J. Lee, Carole Kimberlin
Open Journal of Social Sciences (JSS) , 2015, DOI: 10.4236/jss.2015.34014
Abstract: The objective of this study was to compare the life satisfaction (LS) of Chinese-immigrant children in the United States (US) with their counterparts in America and China by using the Students’ Life Satisfaction Scale (SLSS). The mean scores of SLSS were examined and compared among three groups. Multivariate linear regression analysis was conducted to identify the differences of LS among comparison groups after adjusting for other potential risk factors. Out of 161 children who completed the surveys, 47 (29%) were Chinese-immigrant children, 81 (50%) were native Chinese children, and 33 (20%) were non-immigrant US children. The results showed that Chinese- immigrant children had higher overall LS than native Chinese children (4.39 ± 0.83 vs 3.79 ± 0.81; p = 0.0001), but lower overall LS than non-immigrant children in the US (4.39 ± 0.83 vs 4.81 ± 0.69; p = 0.0207). Systematic investigation on larger populations will be necessary to identify the potential contributing factors.
The Low Down on e-Science and Grids for Biology
Carole Goble
Comparative and Functional Genomics , 2001, DOI: 10.1002/cfg.115
Abstract: The Grid is touted as a next generation Internet/Web, designed primarily to support e-Science. I hope to shed some light on what the Grid is, its purpose, and its potential impact on scientific practice in biology. The key message is that biologists are already primarily working in a manner that the Grid is intended to support. However, to ensure that the Grid’s good intentions are appropriate and fulfilled in practice, biologists must become engaged in the process of its development.
Criterios de transferibilidad del enfoque concurrente en los procesos de dise?o y desarrollo de productos de las peque?as y medianas empresas chilenas
Ingeniare. Revista chilena de ingeniería , 2011, DOI: 10.4067/S0718-33052011000100014
Abstract: the results of the first stage of a study aimed at generating a model for the evaluation and improvement of product design and development processes (pddp) of chilean small and middle size enterprises (smes) based on the concurrent approach with the aim of inserting them in current competitive markets are presented. many authors have shown that in our globalized society the ability of a company to provide good guidance and development of the product design stages determines largely its industrial efficiency. in particular, models based on concurrent engineering (ce) seem to be the most appropriate to respond rapidly and adequately to ever more demanding markets. however, there are few studies showing the applicability of these models to smes. therefore this first stage is aimed at establishing transferability criteria of the concurrent approach in small and middle size companies, analyzing the technical and experimental corpus related to ce and its application in smes, contrasting these analyses with the first results of an exploratory and qualitative investigation of three chilean manufacturing smes. these transferability criteria are based on the one hand on an interpretation of the concurrent approach from the existing literature and the performance pattern of the smes in order to highlight the particular critical sizes, and on the other hand on an analysis of the type of intervention model that will allow its implementation in these kinds of companies.
Chungará (Arica) , 2004, DOI: 10.4067/S0717-73562004000400008
Abstract: the systematization on chronology, rock art, landscape, and settlement pattern carried out at the upper salado river in the loa superior basin have produced important advance in the understanding of the regional prehistory. this is particularly true for the formative and early intermediate periods as multiple archaeological settlements have been identified, supported by more than forty archaeometric from 1.400 bc to ad 900. these results have permitted to go ahead in the comprehension of the subsistence and settlement systems of the local populations, and to understand their entailment with the complex formative processes that are developing in the circumpunean. in this paper, a specifically cultural/historical period frame for the formative period is proposed throughout a systematization of settlement and chronology's new information in this sub-region, updating previous chronological data and integrating the whole archaeological information
Les tours de la machine et les détours du langage : Le Marchand de Venise mis en scène par Luca Ronconi The Turns of the Machine and the Twists of Language: The Merchant of Venice directed by Luca Ronconi
Carole Guidicelli
Revue LISA / LISA e-journal , 2009, DOI: 10.4000/lisa.413
Abstract: In his 1987 staging of Shakespeare’s Merchant of Venice at the Théatre National de l’Odéon in Paris, Luca Ronconi adopted structuralist principles and thus highlighted the shifts of meaning between love and money, thanks to an original choice and direction of the actors on the one hand, and to the use of implements and machines (winch, hoist, counterweight, scales, glass kiln, weaving loom) linked to the trade and industry of Venice, on the other. Within the spirit of the Renaissance these machines were a meaningful addition to the operation of the Italian stage: by cutting and segmenting the scenic image thanks to the positioning of the curtains and frames, Luca Ronconi thus constructs the spectators’ point of focus on the play.
Bloomsbury People
Carole Reeves
Opticon1826 , 2009, DOI: 10.5334/opt.060912
Abstract: The Bloomsbury Project, funded by the Leverhulme Trust, aims to create an archive illustrating nineteenth-century Bloomsbury’s development from swampy rubbish dump to centre of intellectual life. Whilst my academic colleagues focus on the elite reformers, my role, as the Outreach Historian in the Wellcome Trust Centre for the History of Medicine, is to gather information about the ordinary professional and working people of Bloomsbury who contributed to this increasingly vibrant and unique area of London. The objective is to gain an insight into the contemporary social scene on all levels.
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