[MEOPA use practices in a university hospital: Which conformity?] / Pratiques d'utilisation du MEOPA dans un CHU : quelle conformité ?

INTRODUCTION: MEOPA (equimolar mixture of oxygen and nitrous oxide) is used for its analgesic and anxiolytic properties in order to obtain conscious sedation of the patient when performing painful care. It is subject to an enhanced pharmacovigilance and addictovigilance monitoring. In this context, it is important to dispose of hospital utilization data. This work aims to assess the compliance of the use of nitrous oxide regarding the recommendations of the summary of product characteristics, in a French university hospital (Nantes) and consider possible improvements. MATERIALS AND METHODS: Transversal descriptive study, conducted in 2014 with all health professionals using MEOPA. RESULTS: Two thousand thirty-four health professionals answered the questionnaire ; durations of administrations are in conformity and the premises are generally appropriate but almost 60% of professionals have the feeling of inhaling the drug. The systematization of the prescription (always or almost always prescribed for 67% of professionals) and traceability of use (always or almost always in the patient's file for 71% of professionals) are potential source of improvement, particularly since 18% of professional health reported "abuse demands" from patients. CONCLUSION: The formation and information of health professionals are major issues of good use of nitrous oxide.

[Renal denervation for resistant hypertension without general anesthesia: advantage of a MEOPA morphine protocol. Preliminary experience]. / Dénervation rénale pour HTA réfractaire sans anesthésie générale : intérêt d'un protocole MEOPA Morphine. Expérience préliminaire.

UNLABELLED: Renal denervation using the technique of radiofrequency is used only recently for the treatment of resistant hypertension. Normally, it is done under general anesthesia because the ablation point technique is painful. We suggest an alternative to general anesthesia comprising an association of morphin 0.1mg/kg IV to MEOPA (gas combining oxygen and azot protoxyd) delivered through an oxygen mask. Our series includes 12 consecutive patients treated between October 2011 and June 2013, the first five patients (group 1) have received only an hydroxizin and morphin sedation. Every five have felt the ablation painful, in two cases bearable pain (EVA<5), in three cases intense (EVA>5) pain leading to increasing doses of morphin, (total dose of 0.25mg/kg in two cases, 0.17mg in one case). For the seven following patients, a protocol including hydroxyzin, morphin and MEOPA given through a mask has been set up. Only one patient has felt a mild pain (EVA 5) leading to an increasing dose of morphin (total dose 0.17mg/kg). None of the six other patients has felt any pain during the procedure. The average dose of morphin is 0.17mg/kg in group 1, 0.11mg/kg in group 2. This is a preliminary study; if confirmed, it will allow a lot of hospitals without on-site possibilities of general anesthesia, to realize such procedures. CONCLUSION: regarding pain, the procedure of renal ablation was well tolerated for six among seven patients receiving the association MEOPA and IV morphin. In contrast, in the five patients treated only with IV morphin, we observed a less good tolerance to pain and the need to increase the doses of IV morphin.

[Use of MEOPA during nasolacrimal duct probing in children]. / Utilisation du mélange protoxyde d'azote-oxygène lors du sondage des voies lacrymales chez l'enfant.

BACKGROUND: Congenital nasolacrimal duct obstruction affects more than 6% of newborns. Whereas some recommend nasolacrimal probing under general anesthesia from 1 year of age when the condition does not spontaneously resolve, some decide in favor of early probing from 4 to 6 months of age with topical anesthesia. We present nasolacrimal probing with inhalation of MEOPA, an equimolar mixture of nitrous oxide and oxygen, as a therapeutic alternative. PATIENTS AND METHODS: We conducted a descriptive, prospective study including 63 children (75 eyes) who had nasolacrimal duct probing with inhalation of MEOPA between March 2005 and March 2006, in consultation. Efficacy was estimated by the observation of medical staff and parents and by the feasibility of the probing procedure. RESULTS: Children were 4-28 months old (mean age, 11.5 months). Symptoms resolved spontaneously in 79% of cases after only one probing. No incident was observed. In case of failure, probing with nasolacrimal intubation with nasal endoscopy and general anesthesia was done (21% of cases, mean age, 17.5 months). DISCUSSION: Administration of MEOPA, by inhalation with a facial mask, is already used for minor pediatric surgical procedures. It is simple to use, fast, low-risk, inexpensive, and effective. CONCLUSION: Use of MEOPA in nasolacrimal duct probing in children could be a good alternative, making it possible to alleviate pain in the youngest children and general anesthesia in the oldest.

Civilian uses of hemoglobin-based oxygen carriers.

This article briefly discusses a few key issues related to transfusion, the concept of hemoglobin-based red blood cell substitutes (HBOCs), and some parameters useful in evaluating the current properties of solutions. Potential uses of HBOCs in civilian applications are identified and listed. Use of HBOCs as a hemodiluent for intraoperative autologous blood donation (IAD) is a particular application that has relevance in many surgical settings and this is discussed in some detail. Data from a Phase III clinical trial is presented to show the potential for avoiding the use of allogeneic blood and blood products in a clinical model of large volume red cell use. Extrapolation to a general use model, primarily based in the potential for surgery, will be noted. Some general parametric values of HBOCs are presented. These values are by no means considered optimal for all HBOCs and are subject to exploration, fine tuning, correction, or even rejection.

[Use of MEOPA (nitrogen monoxide-oxygen mixture) as analgesic for prostate biopsies]. / Utilisation du MEOPA (mélange protoxyde d'azote-oxygène) comme méthode analgésique des biopsies de prostate.

OBJECTIVE: To determine the tolerance of prostate biopsies in the case of co-administration of an analgesic gas composed of a ready for use mixture of nitrogen monoxide and oxygen (MEOPA) (marketed under the trade name of Kalinox), and intrarectal instillation of xylocaine gel by comparing the results with those obtained in a control group only receiving intrarectal xylocaine instillation. MATERIAL AND METHODS: Non-randomized, prospective study conducted on 100 cases, with a control group composed of the first 22 patients (before availability of MEOPA in the department), followed by 78 patients treated with MEOPA. A questionnaire was completed by the patient and by the outpatient nurse caring for the patient. RESULTS: A very significant reduction (p=0.003) of the VAS pain score (from 3.86 to 2.38) and a highly significant improvement (p<0.001) of global tolerance of the procedure based on the nurse's estimation of pain (VAS scale) were observed. The MEOPA group also presented a significant improvement of pain in patients who had previously undergone a series of prostate biopsies (p=0.043). The satisfaction rate was higher in patients receiving MEOPA, although 28.2% of patients experienced adverse effects, all minor and bothersome in only 3.81% of cases. CONCLUSION: The MEOPA analgesic method as a complement to intrarectal xylocaine instillation considerably improved tolerance of the procedure with no major adverse effects and without prolonging the procedure or the surveillance. It is simple to use, safe and effective.

Resistencia a la exposición al oxígeno de lodos anaerobios suspendidos / Oxygen exposure resistance in suspended anaerobic sludge

La tolerancia al oxígeno de una biomasa anaerobia suspendida en presencia o ausencia de un sustrato primario (sacarosa) se evaluó en términos de la recuperación de la actividad metanogénica aceticlástica especial (AME) de la biomasa anaerobia y un índice de inhibición 50 por ciento (II50) asociado a la AME. Incubada en presencia de sacarosa. La biomasa anaerobia suspendida mostró resistencia a la exposición al oxígeno; la recuperación de la AME fue >45 por ciento para [O²] iniciales <20 por ciento en el espacio gaseoso, y de 10 a 12 por ciento para [O²] iniciales >20 por ciento en el espacio gaseoso. Cuando fue incubada son fuente, la biomasa suspendida fue mucho más inhibida después de la exposición al oxígeno para [O²] iniciales >20 por ciento. El efecto inhibitorio fue descrito por un II50 elevado /28,6) en contraste con un bajo II50 (5,9) cuando se incubó en presencia de sacarosa. La tolerancia de la biomasa suspendida en este trabajo parece ser del mismo orden de la biomasa anaerobia inmovilizada (gránulos anaerobios) en condiciones de incubación en presencia de sustrato: los II50 fueron 5,9 para todos anaerobios suspendidos (sacarosa) y 5,3 y 2,4 para todos granulares incubados con acetato etanol, respectivamente. La respiración aerobia heterótrofa de los lodos anaerobio floculentos incubados con sacarosa fue cerca de 4 veces mayor que la respiración basal, y la inhibición de la AME descrita por el II50 parece seguir una relación inversa con la respiración aerobia heterótrofa. La relación inversa entre II50 y respiración aerobia heterótrofa se ajustó para datos de todos granulares en la literatura y todos floculentos de este trabajo, y sigue un modelo semi-empírico general, con un coeficiente de correlación de 0,82. Esta relación parece reforzar que uno de los mecanismos principales de protección de los consorcios anaerobios contra la inhibición por oxígeno es la respiración aerobia heterótrofa