Détermination et optimisation du contenu gastrique en anesthésie

Pulmonary aspiration of gastric content is one of the main causes of mortality related to anesthesia in France. The pathophysiology of this complication involves, among others, the presence of gastric content causing an increase in intragastric pressure leading to regurgitation and pulmonary inhalation during general anesthesia. Prevention of this complication is based on both identifying patients at risk and developing strategies to reduce the gastric contents. Following these two objectives, we conducted four studies. We have described and assessed the contribution of the ultrasound measurement of the antral cross-sectional area for estimating the preoperative volume of gastric content, in order to identify patients at risk of pulmonary aspiration. We have shown in healthy volunteers that the infusion of erythromycin 250 mg was effective in accelerating gastric emptying of solids during gastroparesis related to acute painful stress. Finally, we determined the level of inspiratory pressure that minimizes the risk of gastric insufflation while providing adequate ventilation during facemask ventilation performed prior to tracheal intubation. This result should contribute to the revision of the current recommendations, in order to improve the patient safety during facemask ventilation. In the future, ultrasound measurement of antral area can be used in clinical studies in order to clarify the risk of pulmonary aspiration of gastric content in emergency surgical patients, and to assess the effectiveness of preventive measuresL'inhalation pulmonaire du contenu gastrique représente l'une des principales causes de mortalité liée à l'anesthésie en France. La physiopathologie de cette complication fait intervenir, entre autres, la présence d'un contenu gastrique à l'origine d'une augmentation de la pression intragastrique favorisant la survenue de régurgitations et d'inhalations pulmonaires lors de l'anesthésie générale. La prévention de cette complication repose sur l'identification des patients à risque, ainsi que sur l'établissement de stratégies permettant de réduire le contenu gastrique. Suivant ces deux objectifs, nous avons conduit quatre études. Nous avons décrit et évalué l'apport de la mesure échographique de l'aire de section antrale pour l'estimation du volume du contenu gastrique en période préopératoire afin d'identifier les patients à risque d'inhalation pulmonaire. Nous avons montré chez des volontaires sains que la perfusion de 250 mg d'érythromycine est efficace pour accélérer la vidange gastrique des aliments solides lors de la gastroparésie induite par un stress douloureux. Enfin, nous avons déterminé le niveau de pression inspiratoire minimisant l'insufflation d'air dans l'estomac tout en assurant une ventilation satisfaisante lors de la ventilation au masque facial précédant l'intubation trachéale. Ce dernier résultat doit contribuer à modifier les recommandations afin d'améliorer la sécurité des patients lors de la ventilation au masque facial en anesthésie. En perspective d'avenir, l'échographie antrale permettra la réalisation d'études cliniques visant à préciser chez les patients opérés en urgence le risque d'inhalation pulmonaire et évaluant l'efficacité des mesures de préventio

Point-of-Care Gastric Ultrasound Confirms the Inaccuracy of Gastric Residual Volume Measurement by Aspiration in Critically Ill Children:GastriPed Study

Introduction: No consensus exists on how to define enteral nutrition tolerance in critically ill children, and the relevance of gastric residual volume (GRV) is currently debated. The use of point-of-care ultrasound (POCUS) is increasing among pediatric intensivists, and gastric POCUS may offer a new bedside tool to assess feeding tolerance and pre-procedural status of the stomach content. Materials and Methods: A prospective observational study was conducted in a tertiary pediatric intensive care unit. Children on mechanical ventilation and enteral nutrition were included. Gastric POCUS was performed to assess gastric contents (empty, full of liquids or solids), and gastric volume was calculated as per the Spencer formula. Then, GRV was aspirated and measured. The second set of gastric POCUS measurements was performed, similarly to the first one performed prior to GRV measurement. The ability of GRV measurement to empty the stomach was compared to POCUS findings. Both GRV and POCUS gastric volumes were compared with any clinical signs of enteral feeding intolerance (vomiting). Results: Data from 64 children were analyzed. Gastric volumes were decreased between the POCUS measurements performed pre- and post-GRV aspiration [full stomach, n = 59 (92.2%) decreased to n = 46 (71.9%), p =0.001; gastric volume: 3.18 (2.40–4.60) ml/kg decreased to 2.65 (1.57–3.57), p < 0.001]. However, the stomach was not empty after GRV aspiration in 46/64 (71.9%) of the children. There was no association between signs of enteral feeding intolerance and the GRV obtained, nor with gastric volume measured with POCUS. Discussion: Gastric residual volume aspiration failed to empty the stomach and appeared unreliable as a measure of gastric emptiness. Gastric POCUS needs further evaluation to confirm its role

Improvement in real time detection and selectivity of phthalocyanine gas sensors dedicated to oxidizing pollutants evaluation

International audienceA sensor microsystem prototype, using copper phthalocyanine thin film as sensitive layer, and dedicated to ozone evaluation, was developed. The methodology implemented is based on cyclic sensor recalibrations by thermal cleaning of the sensitive membrane, and on pollutant concentration quantification according to the kinetics of sensor response. Results of laboratory experiments for various NO2 and O3 concentrations, in the range of 10–200 ppb, illustrate the selectivity of CuPc sensors towards ozone, obtained by our methodology. We have shown that ozone selectivity is especially improved for short time of exposure (few minutes) and for phthalocyanine layer maintained at low temperature (80 °C). For optimal conditions, our microsystem exhibits a threshold lower than 10 ppb, a resolution lower than 10 ppb, and good reproducibility of measurements. Performances obtained in real urban atmosphere are satisfying to ensure real time evaluation of ozone during several days. Long-term stability and the detection of NO2 by associating chemical filters to our microsystem will be also discussed

Molecular dissection of mRNA poly(A) tail length control in yeast

In eukaryotic cells, newly synthesized mRNAs acquire a poly(A) tail that plays several fundamental roles in export, translation and mRNA decay. In mammals, PABPN1 controls the processivity of polyadenylation and the length of poly(A) tails during de novo synthesis. This regulation is less well-detailed in yeast. We have recently demonstrated that Nab2p is necessary and sufficient for the regulation of polyadenylation and that the Pab1p/PAN complex may act at a later stage in mRNA metabolism. Here, we show that the presence of both Pab1p and Nab2p in reconstituted pre-mRNA 3′-end processing reactions has no stimulating nor inhibitory effect on poly(A) tail regulation. Importantly, the poly(A)-binding proteins are essential to protect the mature mRNA from being subjected to a second round of processing. We have determined which domains of Nab2p are important to control polyadenylation and found that the RGG-box work in conjunction with the two last essential CCCH-type zinc finger domains. Finally, we have tried to delineate the mechanism by which Nab2p performs its regulation function during polyadenylation: it likely forms a complex with poly(A) tails different from a simple linear deposit of proteins as it has been observed with Pab1p

Assessment and optimization of gastric contents in anesthesia

L'inhalation pulmonaire du contenu gastrique représente l'une des principales causes de mortalité liée à l'anesthésie en France. La physiopathologie de cette complication fait intervenir, entre autres, la présence d'un contenu gastrique à l'origine d'une augmentation de la pression intragastrique favorisant la survenue de régurgitations et d'inhalations pulmonaires lors de l'anesthésie générale. La prévention de cette complication repose sur l'identification des patients à risque, ainsi que sur l'établissement de stratégies permettant de réduire le contenu gastrique. Suivant ces deux objectifs, nous avons conduit quatre études. Nous avons décrit et évalué l'apport de la mesure échographique de l'aire de section antrale pour l'estimation du volume du contenu gastrique en période préopératoire afin d'identifier les patients à risque d'inhalation pulmonaire. Nous avons montré chez des volontaires sains que la perfusion de 250 mg d'érythromycine est efficace pour accélérer la vidange gastrique des aliments solides lors de la gastroparésie induite par un stress douloureux. Enfin, nous avons déterminé le niveau de pression inspiratoire minimisant l'insufflation d'air dans l'estomac tout en assurant une ventilation satisfaisante lors de la ventilation au masque facial précédant l'intubation trachéale. Ce dernier résultat doit contribuer à modifier les recommandations afin d'améliorer la sécurité des patients lors de la ventilation au masque facial en anesthésie. En perspective d'avenir, l'échographie antrale permettra la réalisation d'études cliniques visant à préciser chez les patients opérés en urgence le risque d'inhalation pulmonaire et évaluant l'efficacité des mesures de préventionPulmonary aspiration of gastric content is one of the main causes of mortality related to anesthesia in France. The pathophysiology of this complication involves, among others, the presence of gastric content causing an increase in intragastric pressure leading to regurgitation and pulmonary inhalation during general anesthesia. Prevention of this complication is based on both identifying patients at risk and developing strategies to reduce the gastric contents. Following these two objectives, we conducted four studies. We have described and assessed the contribution of the ultrasound measurement of the antral cross-sectional area for estimating the preoperative volume of gastric content, in order to identify patients at risk of pulmonary aspiration. We have shown in healthy volunteers that the infusion of erythromycin 250 mg was effective in accelerating gastric emptying of solids during gastroparesis related to acute painful stress. Finally, we determined the level of inspiratory pressure that minimizes the risk of gastric insufflation while providing adequate ventilation during facemask ventilation performed prior to tracheal intubation. This result should contribute to the revision of the current recommendations, in order to improve the patient safety during facemask ventilation. In the future, ultrasound measurement of antral area can be used in clinical studies in order to clarify the risk of pulmonary aspiration of gastric content in emergency surgical patients, and to assess the effectiveness of preventive measure

Le Lean manufacturing et l'amélioration continue (intérêt en production pharmaceutique)

L industrie pharmaceutique doit aujourd hui affronter de nombreux challenges rencontrés par l ensemble des industriels, mais également des challenges plus spécifiques à son secteur d activité. Après une présentation des principes du Lean Manufacturing, la concordance des objectifs du Lean avec le secteur de l industrie pharmaceutique sera exposée ainsi que les domaines spécifiques de ce secteur auxquels les principes du Lean sont applicables. Par la suite, les outils majeurs du Lean seront relatés, notamment : la cartographie de processus, le SMED (Single Minute Exchange of Die), le TPM (Totale Productive Maintenance), et le 5S. Une seconde partie de cette étude résumera des activités d amélioration continue mises en place au sein d un site de production des laboratoires Galderma sur la base d objectifs d amélioration : de la productivité, de la qualité et de la sécurité d un atelier de fabrication de formes pâteuses.TOURS-BU Sciences Pharmacie (372612104) / SudocSudocFranceF

La Vidange gastrique en situation de stress (étude des effets prokinétiques de l'érythromycine chez des volontaires soumis à un stress aigu douloureux)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Détection échographique de l'insufflation gastrique selon le mode de ventilation d'apnée en anesthésie (étude prospective randomisée en double aveugle)

LYON1-BU Santé (693882101) / SudocSudocFranceF