In France, the carbon monoxide is one of the first causes of the accidental poisonings with
approximately 8000 cases a year, among which 500 deaths.
The severe forms are translated by neurological disorders even a coma or the death straight
away. The more insidious forms with a little carboxyhémoglobine level give rise to frustrate
clinical pictures, mimicking flu or intestinal syndromes. The syndrome post–intervallaire
corresponds to the appearance of remote neuropsychiatric disorders of the poisoning. Its
appearance and its gravity are not correlated in the gravity of the initial poisoning,
however the precocity of the treatment tends to decrease its frequency.
Carbon monoxide elimination is made under unchanged form in the expired air. In a spontaneous
way, the half-life in ambient air is of the order of 4 hours. In ventilation in isobaric pure
oxygen, the half-life is shortened at 80 minutes and in hyperbaric oxygen at 23 minutes.
This imposes a fast diagnosis for two reasons:
– For poisonings with low level, the more the investigators wait to measure the
carboxyhémoglobine (HBCO), the more they risk not to detect it.
– The oxygen therapy decreases the duration of the poisoning and thus the tissular
suffering.
Actually the risk is important to pass next to the diagnosis and to let leave a patient
without adapted care and without technical intervention to eliminate the source of the
poisoning.
Presently, to make the diagnosis, the investigators possess the analysis of the blood HbCO by
realization of gas of the venous blood, which are taken in emergencies, but very often a few
hours after the end of the exposure at the source of poisoning, what is translated by a
disappearance of the symptoms and an underestimate of the initial blood HbCO. Since 2005,
MASIMO laboratory commercialize a pulse carboxymètre, the RAD 57, which allows to estimate
the carboxyhémoglobinémie in a not invasive way.
Lot of studies showed the interest of its use in the early screening of carbon monoxide
poisonings, allowing a faster dosage of the blood HbCO, and thus an also faster adapted care.
Purpose: This prospective, randomised, controlled, single-blind, multicentre study was
designed to investigate the effects of peripheral nerve block methods (applied using
unilateral spinal anaesthesia [USA] on elderly patients scheduled to undergo total knee
arthroplasty) on perioperative haemodynamic parameters and the postoperative analgesia
period.
Materials and Methods: Sixty patients in the American Society of Anesthesiologists (ASA)
Physical Status II-III group were randomly divided into two groups. Spinal anaesthesia was
performed in the USA group, in the lateral position through the intervertebral space, with 2
ml of hyperbaric bupivacaine (L4-L5 or L3-L4); 0.5% bupivacaine hydrochloride and 2%
lidocaine were combined for the psoas compartment-sciatic (PCS) group, and the mixture was
used for psoas compartment block (PCB) and sciatic nerve block. The haemodynamic parameters
were recorded every 5 minutes until the end of the preoperative and perioperative operation
periods and postoperative first analgesic application time.
This is a pilot study to evaluate the efficacy of hyperbaric oxygen therapy (HBO2) for
mobilizing hematopoietic progenitor cells from bone marrow to blood. These cells are needed
for patients to undergo bone marrow transplantation and some patients fail to respond to
current best chemotherapy. HBO2 has been shown to trigger stem cell mobilization in other
patient populations and we plan to investigate whether this intervention can act in concert
with chemotherapeutic agents to allow poor mobilizer patients to achieve successful bone
marrow transplantation. Twenty patients will be identified by participating hematologists who
have failed to respond adequately to chemotherapy. When it is deemed appropriate to attempt
an additional stem cell mobilization protocol, these patients will be administered
chemotherapy as determined by their primary treating hematologist and additionally receive
daily HBO2 (2.5 atmospheres absolute [ATA] for 90 minutes) for 3-8 days. At intervals, blood
samples will be obtained as is the normal transplantation protocol practice to assess whether
adequate stem cells are present in blood for the patient to proceed with transplantation. The
project is anticipated to take one year to complete.
This is a prospective, single centre, two-part, three doses study. Part 1 is a Phase I, three
cohorts, dose-ascending, open-label, safety study. Part 2 is a Phase II, randomised,
parallel-group, double-blind, placebo-controlled, exploratory efficacy and safety study The
objective of the study is to investigate the efficacy and safety of a single intrathecal
injection of paracetamol, administered at 3 doses to 3 active treatment groups, as compared
to placebo solution, for post-operative analgesia of hip replacement surgery performed under
spinal anaesthesia. Patients scheduled for hip replacement surgery will be randomised into 4
treatment groups (15 patients per group) to receive either one of the 3 single doses of
paracetamol 3% (D1: 60 mg, D2: 90 mg, D3: 120 mg) or placebo solution (P: saline solution) by
intrathecal (IT) injection. Immediately after paracetamol or placebo IT administration, all
patients will receive a single IT dose of Hyperbaric Bupivacaine HCl 0.5% (12.5 mg for ≤ 160
cm-tall patients and 15 mg for > 160 cm-tall patients). The time interval between paracetamol
IT and bupivacaine IT administrations should not exceed 2 min.
The study will include a screening phase (Visit 1, Days -21/1), a treatment phase
(paracetamol IT administration, anaesthesia and surgical procedure: Visit 2, Day 1) and a
follow-up phase including an observation period (Visit 3, from Day 1 after surgery until
discharge, a final visit (at discharge) and a follow-up (day 6±1). Pain at rest will be
assessed at screening and on visit 2 at baseline (0 h), 1, 2, 3, 6, 9, 12, 15, 18, 21, 24,
27, 30, 33, 36, 39, 42, 45 and 48 h after anaesthetic IT injection and at discharge, using a
0-100 mm VAS.
The combined spinal-epidural analgesia during the labor has been associated with changes in
fetal heart rate, which the opinions in literature are not fully consolidated and some
studies have failed to show an increase significant fetal bradycardia following the
combination lock. In addition, it’s not clear that these changes found may modify the
perinatal outcome in pregnancies who attend with intrauterine growth restriction (IUGR),
since there are no studies comparing the techniques in this population.
At our centre a conventional dose of 12 mg of hyperbaric bupivacaine in combination with a
short acting opioid fentanyl (to increase block density) and a long acting opioid morphine
(to provide post-operative pain relief ) is used for spinal anesthesia for cesarean
section.However, larger doses of local anesthetic drug when used in caesarean section
commonly cause low blood pressure and requires drugs (vasopressors) to treat it. In our study
the investigators will standardize the doses of both opioids (fentanyl/morphine) and adjust
the dose of local anesthetic (bupivacaine) based on the patients height and weight .One of
the obvious challenges anesthesiologists face is providing adequate anesthesia to the patient
whilst minimizing harmful side effects. Our primary concern is the low blood pressure as an
effect of the spinal anesthetic as it is harmful to both mother and the baby. The
investigators propose that the extent of surgical anesthetic block, which is dependent on
height and weight in our adjusted dose group, will provide adequate anesthesia for surgery
and minimise maternal low blood pressure.
The use of spinal anesthesia in pre-eclamptic pregnant woman is of considerable benefit, as
these patients present particular hazards with general anaesthesia, such as concerns for
rapid airway control and cerebral blood flow alterations during induction of general
anaesthesia and intubation However, the incidence of hypotension is high during spinal
anesthesia for Cesarean section and it may approach values up to 95 %.
Maternal hypotension is the most frequent complication of a spinal Anesthesia. The prevention
of spinal hypotension appears more likely to decrease the frequency and severity of
associated adverse maternal symptoms than the treatment of established hypotension.
Intravenous fluid administration prior to spinal anesthesia for caesarean section is accepted
standard practice. The choice of fluid depends on individual and institutional habit,
material cost (crystalloid is considerably cheaper) and the perceived relative benefits and
risks. Uncommon but potentially serious adverse effect of colloids is impaired coagulation.
Although pregnancy is associated with hypercoagulability, little is known about the effects
of colloid preloading on coagulation in pregnant patients.
Stroke is one of the leading causes of disability and death in North America and Europe. Up
to 30% of stroke survivors never recuperate completely and suffer from loss of function and
poor quality of life. To improve recovery after stroke, innovative interventions should be a
priority.
Hyperbaric oxygen therapy (HBOT) is an intermittent inhalation of 100% oxygen in a hyperbaric
chamber at a pressure higher than 1 absolute atmosphere (ATA). There is a growing body of
evidence that HBOT can enhance ability of brain to changes its structure (neuroplasticity) in
order to recover. Exercise program during HBOT can augment the effect. Although, recent
randomized controlled trials in patients with chronic brain injury showed promising results,
there are no studies demonstrating combine effect HBOT and exercise rehabilitation program on
stroke recovery.
The proposed study investigates feasibility, safety and efficacy of using a combination of
HBOT and exercise program to improve arm function recovery in chronic stroke patients. In
this pilot randomized control trial, investigators will compare the combination of HBOT and
the focused rehabilitation exercise program versus exercise program alone on recovery of arm
function in patients with chronic stroke.
Kidney injury is a serious complication of cardiac surgery that occurs in up to 30% of
patients and increases the risk of adverse outcomes. Kidney injury initiates when oxygen
supply to the kidney drops below levels that are needed for normal cellular function, causing
tissue oxygen deficiency (hypoxia), activation of the inflammatory cascade, and oxidative
stress. Together, these events further impair tissue oxygenation, culminating in impaired
kidney function due to cellular injury and death.
There are no effective therapies for kidney injury after cardiac surgery, but there is
evidence that recovery is possible if the processes of injury – i.e., impaired oxygen
delivery, increased inflammatory response, and oxidative stress – are ameliorated soon after
the onset of injury. Hyperbaric oxygen therapy (HBOT) – which entails the intermittent
inhalation of 100% oxygen in a hyperbaric chamber at a pressure higher than one absolute
atmosphere (> 760 mmHg) – has been shown to positively affect all of these processes (i.e.,
to improve tissue oxygenation, reduce inflammation, and reduce oxidative stress). Thus, we
hypothesized that HBOT will reduce the severity of kidney injury after cardiac surgery if it
is initiated soon after onset of injury. This hypothesis has not been tested in humans, but
is supported by animal studies.
In this first-in-human, unblinded, controlled pilot trial, 20 adult patients who develop
severe kidney injury soon after cardiac surgery will be randomized (after obtaining informed
consent from the patient or surrogate) to standard-of-care or early HBOT. Severe kidney
injury will be defined as a ≥30% drop in kidney function within 6 hours of surgery (as
determined by change in creatinine from before surgery to Intensive Care Unit (ICU)
admission). This degree of injury occurs in ~ 2% of patients and is associated with a 12-fold
increase in the risk of complete kidney failure (requiring dialysis) or death. Patients will
be excluded if they have any relative or absolute contraindications to HBOT (e.g., severe
ventricular dysfunction, ventricular assist device, severe respiratory dysfunction,
pneumothorax, bronchospasm).
