Université de Bretagne Occidentale

Post-induction hypotension is a common complication in general anesthesia, particularly in patients with chronic hypertension. This study aims to analyze the practices of Certified Registered Nurse Anesthetist (CRNA) in collaboration with anesthesiologists of hemodynamic management in these patients.

A multicenter quantitative descriptive survey was conducted among CRNAs working in 11 public and private hospitals. A questionnaire was developed to compare the management of two clinical cases: the first involved a hypertensive patient undergoing low-risk surgery, while the second described an older patient with multiple comorbidities undergoing high-risk surgery. The hemodynamic monitoring methods used by CRNAs were evaluated.

Of the 158 CRNAs who responded (48.2% of 352 surveyed), 85% reported using mean arterial pressure (MAP) as their monitoring target. MAP targets ranged from 75 ± 9 mmHg for the first case to 80 ± 11 mmHg for the second. The study shows that 88% of CRNAs titrate anesthetics (over 70% using depth monitoring), and 70% start norepinephrine before the first induction. These rates rise to 94% and 99% for the second case. Norepinephrine is the first-line treatment for hypotension, while fluid loading comes fourth after Trendelenburg and anesthetic reduction. In the second, pulse wave analysis is most used (53%), followed by oesophageal Doppler (25%). Despite the availability of non-invasive stroke volume monitoring, 35% of CRNAs express interest in its implementation.

These findings highlight a predominant shift among CRNAs toward proactive, vasoactive-centered hemodynamic management.

The age-adjusted D-dimer cutoff (age × 10 µg/L in patients 50 years or older), safely increases the diagnostic yield of D-dimer in patients with suspected pulmonary embolism but has not been validated in patients with suspected leg deep vein thrombosis (DVT).

To prospectively validate whether using an age-adjusted D-dimer cutoff allows clinicians to safely rule out DVT.

Multicenter, multinational prospective management outcome study conducted in 27 centers in Belgium, Canada, France, and Switzerland between January 2015 and October 2022 (last follow-up visit, January 30, 2023) and including outpatients presenting to the emergency department with suspected DVT.

Patients were assessed by a sequential diagnostic strategy based on the assessment of clinical pretest probability by the Wells score, a highly sensitive D-dimer test, and leg compression ultrasonography. Patients in whom DVT was ruled out were followed up for a 3-month period.

The primary outcome was the rate of adjudicated symptomatic venous thromboembolic events during follow-up in patients in whom DVT was ruled out based on a D-dimer value between the conventional cutoff of 500 µg/L and their age-adjusted cutoff.

A total of 3205 patients were included. Median age was 59 years, and 1737 (54%) were female. DVT prevalence was 14%. Among the 2169 patients with a non-high or unlikely clinical probability, 531 (24.5% [95% CI, 22.7%-26.4%]) had a D-dimer level less than 500 µg/L, and 161 additional patients (7.4% [95% CI, 6.4%-8.6%]) had a D-dimer level between 500 µg/L and their age-adjusted cutoff. No failures were identified in patients with a D-dimer level 500 µg/L or greater but below the age-adjusted cutoff (0% [95% CI, 0%-2.3%]). Among patients 75 years or older, using the age-adjusted cutoff instead of the 500-µg/L cutoff increased the proportion of negative D-dimer from 33 of 379 (8.7% [95% CI, 6.3%-12.0%]) to 99 of 379 (26.1% [95% CI, 22.0%-30.8%]), without any false-negative test results.

The age-adjusted D-dimer cutoff may safely rule out DVT and was associated with a larger number of patients in whom DVT could be effectively ruled out.

ClinicalTrials.gov Identifier: NCT02384135 .

In this paper, we present the design of a new automatic fluorescence monitoring system (AUTOFLUO) for real-time control of pesticide contamination in natural waters. This system was used to analyse two fluorescent pyrethroid insecticides, phenothrin (PHE) and permethrin (PER), currently used in the Niayes agricultural district in Senegal. The results were then compared with those obtained using the classical fluorescence method (FLUO). The analytical parameters (λex, λem, and pH) were optimised. Phenothrin exhibits maximum excitation and emission wavelengths of 221 and 321 nm, respectively, whereas permethrin has these values at 210 and 297 nm. The optimum pH value was determined to be 7 for PHE and 8 for PER. The linearity of both the calibration and standard addition curves was validated through variance analysis. A Student's t-test demonstrated that the intercept values of the calibration curves were not significantly different from zero (p > 5 %). The limit of detection (LOD) ranges from 0.02 to 5.16 ng mL^-1, while the limit of quantification ranges from 0.07 to 17.18 ng mL^-1. Comparing these LOD values with those reported in the literature demonstrates the high sensitivity of the AUTOFLUO method. Both insecticides were analysed in spiked natural waters using the standard addition procedure. Satisfactory recovery rates were obtained by the FLUO (88.9 % to 97.6 %) and the AUTOFLUO (95.7 % to 102.8 %) methods. The low intraday and interday relative standard deviations (< 2 % and < 4 % respectively) attest to the repeatability and reproducibility of the measurements. The satisfactory tolerance limits of the interfering species validate the method's selectivity. These results demonstrate that the AUTOFLUO system is suitable for reliably monitoring pesticides in natural waters.