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J M Conil

Publications and source records attributed to J M Conil.

18 recordsLinked to original sources
PubMed2006

Assessment of renal function in clinical practice at the bedside of burn patients.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * In burn patients it has been shown ([2]), that there is a correlation between the creatinine clearance (CL(CR)) and the clearance of inulin. * The CL(CR) has never been studied in burn patients who have normal serum creatinine. * The Robert, Kirkpatrick and sMDRD formulae have never been evaluated in burn patients. WHAT THIS STUDY ADDS: * Despite burn patients having normal serum creatinine concentrations, the study showed that there are large variations in CL(CR) which cannot be detected by single serum creatinine measurements, and which have important implications for drug therapy. * It showed that the formulae currently used to calculate creatinine clearance on the basis of serum creatinine are inadequate for use in burn patients, and they should be abandoned in favour of direct measurement from a 24 h urine collection. AIMS: The aim of this study was to evaluate whether the renal function of burn patients could be correctly assessed using a single serum creatinine measurement, within normal limits, and three prediction equations of glomerular filtration taking into account, serum creatinine, age, weight and sex. METHODS: This was a prospective study comprising 36 adult burn patients with a serum creatinine <120 micromol l(-1), within the second or third week following the burn injury. Renal function was assessed using serum creatinine, 24 h urinary CL(CR), and the Cockcroft-Gault, Robert, Kirkpatrick and simplified MDRD equations. RESULTS: Despite normal serum creatinine concentrations in all patients, a significant number had a decreased CL(CR). The urinary CL(CR) was <80 ml(-1) min(-1) 1.73 m(-2) in nine patients (25%), and <60 ml(-1) min(-1) 1.73 m(-2) in five patients (14%). Between the groups having a CL(CR) lower or greater than 80 ml(-1) min(-1) 1.73 m(-2) there were no differences in gender, burn indices, percentage of mechanically ventilated patients or length of hospital stay, but a difference in age. The highest CL(CR) (>140 ml(-1) min(-1) 1.73 m(-2)) was found in 13 patients younger than 40 years. Regression analysis, residual and Bland-Altman plots revealed that neither the Cockcroft-Gault, Robert, Kirkpatrick nor sMDRD equations were specific enough for the assessment of renal function. CONCLUSIONS: In burn patients with normal serum creatinine during the hypermetabolic phase, serum creatinine and creatine based predictive equations are imprecise in assessing renal function.

Adult↗
PubMed2006

Increased amikacin dosage requirements in burn patients receiving a once-daily regimen.

Altered pharmacokinetics in burn patients may affect antibiotic plasma concentrations. Typical once-daily dosing (ODD) of 15 mg/kg amikacin (AMK) in burn patients does not always produce peak concentrations (C(max)) reaching the therapeutic objective of six to eight times the minimal inhibitory concentration (MIC). We recorded plasma concentrations following administration of 20 mg/kg AMK in burn patients and studied factors affecting pharmacokinetics. Mean C(max) was 48.3+/-10.8 mg/L and the C(max)/MIC ratio was 6+/-1.35. Statistical analysis demonstrated a relationship between C(max) and the area of the burn and Unit Burn Standard, and between AMK clearance and creatinine clearance (Cl(CR)). We conclude that ODD regimens of AMK in patients with burns >15% body surface area and/or with Cl(CR) >120 mL/min could require doses >20 mg/kg to reach adequate C(max). In all cases, patient therapeutic drug monitoring is essential to ensure the safe usage of these dosing recommendations.

Adolescent↗
PubMed2005

Cefepime in critically ill patients: continuous infusion vs. an intermittent dosing regimen.

The aim of this study was to compare the pharmacokinetic and pharmacodynamic parameters of a continuous infusion of cefepime vs. an intermittent regimen in critically ill adult patients with Gram-negative bacilli infection. The prospective randomized parallel study was carried out in 50 patients with severe pneumonia (n = 41) or bacteremia (n = 9). They received cefepime 4 g/d either as a continuous infusion or intermittent administration 2 x 2 g in combination with amikacin. Patient characteristics and the minimal inhibitory concentration (MIC) of the isolated bacteria were comparable. Clinical outcomes were assessed along with pharmacodynamic indices and compared in both groups (chi2 and Mann-Whitney U-tests). Mechanical ventilation, clinical outcome and bacteriological eradication did not significantly differ between the two groups. Also, the area under the plasma cefepime concentration curve at steady state (AUCss: 612 +/- 369 vs. 623 +/- 319 mg x 1(-1) x h), AUCss > MIC (595 +/- 364 vs. 606 +/- 316 mg x 1(-1) x h) and the area under the inhibitory concentration curve (AUICss: 4258 +/- 5819 vs. 5194 +/- 7465 mg x 1(-1) x h) were similar. If the time above MIC (t > MIC) was not significantly higher in Group 1 (100 +/- 0%) than in Group 2 (90 +/- 11%), t > five-fold MIC in Group 1 (100 +/- 0%) was significantly higher (p < 0.01) than in Group 2 (82 +/- 25%). The mean time over the French breakpoint (4 mg/l) was 100 +/- 0% and 72 +/- 27% in Group 1 and 2 (p < 0.001), respectively. In contrast to intermittent cefepime administration, continuous infusion of cefepime consistently maintained a serum concentration > 5 x the MIC of typical Gram-negative nosocomial pathogens. This results in greater bactericidal activity against organisms with a higher (2 mg/l) cefepime breakpoint even if the clinical outcome is not significantly modified.

Adult↗
PubMed2002

[Importance of a cefpirome-vancomycin combination on bactericidal kinetics in severe MRSA infections in intensive care].

UNLABELLED: Vancomycin is always the drug of choice for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in spite of his bactericidal kinetic. BACKGROUND: The aim of this study was to evaluate in vivo the improvement of bactericidal kinetic of vancomycin associated with cefpirome against MRSA infection in critically ill patients. METHODS: The prospective cross-over study was carried out in 20 patients with severe pneumonia or bacteremia. There were randomized to receive vancomycin 2 g per day (Group 1, n = 10) or vancomycin with cefpirome 2 g x 2 (Group 2, n = 10). Clinical recovery, bacteriologic parameters (bactericidal kinetic and bactericidal power in vivo at the peak and the valley), duration of ventilation and stay in ICU were comparatively explored in both groups. RESULTS: Clinical outcome did not significantly differ between Group 1 and 2. Bactericidal kinetics were better in the Group 2 (40% vs 60% after 6 hours to the dilution for 1/8e) but the difference was not significant. However, bactericidal power in sera was also better in the Group 2 with more bactericidal dilution at 1/16e (68% vs 88.8%: NS) and overall at 1/32e (10.5% vs 50%: p < 0.05) and CRP, an inflammatory marker, was significantly lower in the Group 2 than in the Group 1 (119.5 +/- 24 mg/l vs 198.6 +/- 78 mg/l: p < 0.05) on the third day.

Adult↗
PubMed1994

[Continuous administration of vancomycin in patients with severe burns].

OBJECTIVES: In the severely burned patient, a marked, rapid fall in serum concentrations is often observed after intermittent infusion of vancomycin at the usual dose of 30 mg/kg. This specific "jagged" pharmokinetic course with inadequate residual concentrations raises the problem of the efficacy of this time-dependent antibiotic. Studies in patients in general resuscitation units have shown the interest of vancomycin administration in continuous infusion. METHODS: We analyzed variations in serum concentrations of vancomycin during continuous infusion in 18 patients with burns involving a mean of 40% total body surface and reported the doses necessary to maintain serum vancomycin at therapeutic levels; the possible correlations between serum vancomycin concentrations, burn parameters, age and renal function; and clinical and biological tolerance. RESULTS: Higher initial doses were required in burn patients (40 mg/kg in patients aged under 60) than in other patients. Impairment of renal function is a contra-indication of continuous infusion. CONCLUSION: This mode of administration has the advantage of ensuring greater efficacy by preventing fluctuations in serum concentrations.

Adult↗
PubMed1988

[Constant-flow drug administration in anesthesia].

The authors describe a technique of constant flow perfusion of several anaesthetic drugs, using a simple formula to adjust the perfusion rate to the weight of the patients. Calculation of dilutions is easy: the drug concentration is equal to ten times the rate, per hour and per kg, in practical cases. The flow rate is then a tenth of the patient's weight. This method is easy to apply to several drugs, of which pharmacokinetic parameters justify this administration mode: alfentanil, etomidate, vecuronium bromide... but clinical and instrumental observations should be taken into account for the adjustment of the flow.

Alfentanil↗
PubMed1986

[Interaction between electrocautery and a pacemaker].

Following a new case of inhibition of a sentinel pacemaker by the cutting current of an electrocoagulator during endoscopic urologic surgery, the mechanism of this complication is recalled. The non-selectivity of the pacemaker detector circuit is responsible for interpreting the electrical disturbances due to the electrocoagulator as cardiac activity. The problems seen with other types of stimulators are discussed, especially programmable stimulation where the use of a magnet can lead to variations in the stimulator frequency. The stimulating wire can also be responsible for accidents, such as myocardial burns, and rhythm disturbances. The safety rules for the use of the electrocoagulator in patients with a non programmable sentinel pacemaker.

Aged↗
PubMed1985

[Anaphylactic shock caused by pancuronium and vecuronium].

A case is reported of anaphylactic shock due to vecuronium occurring in a patient who had already had such a shock, due then to pancuronium, during a previous general anaesthesia. The need for a full immuno-allergological investigation, the occasional efficiency of the anti-histamine premedication, and crossed allergies between muscle relaxants are stressed. It is noted that an anaphylactic shock can be seen on first using a new molecule, as the patient can have been sensitized to it by other muscle relaxants. This case was the first to be described of an anaphylactic shock due to vecuronium bromide.

Adult↗
PubMed1985

[Use of netilmicin for antibiotic prevention of urinary infections after endoscopic surgery in urology].

We studied for one year 60 patients separated in 3 groups of 20: first reference group without treatment; second group receiving netilmicin in premedication; third group treated by netilmicin for 2 days postoperatively. This series clearly demonstrates the high urinary tract infection rate after transurethral surgery, the benefit of antibioprophylaxis with netilmicin and the efficiency of one dose of this aminosid given one hour preoperatively.

Aged↗
PubMed1981

[Comparative analgesic kinetics of fentanyl and droperidol-fentanyl association (author's transl)].

UNLABELLED: To specify pharmacological interferences between droperidol and fentanyl an experimental study was carried out on mice. The analgesic kinetic was studied after the administration of the two drugs in a concentration ratio between 25/1 and 150/1. RESULTS: Fentanyl is a potent analgesic with a short time effect. It has very good correlations between dose effect and time effect. Droperidol does not have a analgesic effect. The behaviour of the two drugs depends on the way they are administered, either simultaneously or consecutively: simultaneous administration of the two drugs increases the level and duration of analgesia: nalaxone reverses analgesia, a fentanyl injection given 5 minutes before a droperidol injection produces the same analgesia as fentanyl alone, a droperidol injection given 5 minutes before a fentanyl injection induces a level of analgesia lower than fentanyl alone. Droperidol appears to reverse the fentanyl analgesia.

Analgesics↗
PubMedDate not supplied

[Use of vecuronium bromide administered at a constant rate during renal transplantation].

The authors describe a technique of vecuronium bromide perfusion at constant flow used to obtain curarisation during 50 renal transplantations. The muscular effects of the drug were monitored through an electromyographical recorder, so as to adjust the perfusion rate. The dose of vecuronium bromide was 47.7 +/- 0.74 micrograms X kg-1 X h-1 (mean +/- SEM), this being lower than the dose recommended by D'Hollander (60 micrograms X kg-1 X h-1) for patients with normal renal function. Furthermore, no recurarisation was observed. Therefore, vecuronium can be considered as a satisfactory muscle relaxant in patients with renal failure, but neuromuscular monitoring appears to be a most important safety factor.

Adult↗
PubMedDate not supplied

[Induced normovolemic hemodilution. Calculation of the amount of blood to be withdrawn].

The authors study the variation of the hematocrit during a provoked normovolemic hemodilution. To get a predetermined hematocrit rate they use a simple and original biophysical model which gives the exact blood volume to be extracted. Then they use the same method to evaluate the hematocrit of the extracted blood after its conditionnement in packs.

Hematocrit↗