Papers by Jean-yves Martinez
Journal of Burn Care & Research, 2017
We read with great interest the article by Escolas et al1 evaluating the postdischarge cause-of-d... more We read with great interest the article by Escolas et al1 evaluating the postdischarge cause-of-death of combat-related burn patients. They report that combat operations in Iraq and Afghanistan have resulted in up to 8.8% of combat-related casualties suffering burns with an overall case fatality rate of 1.3%, which is less than the 4% observed from World War I through Desert Storm. The authors suggest that combat burn injury did not appear to increase the risk of death by suicide. They discuss, as factors that may partially explain this low incidence, close support from multidisciplinary burn teams, social, and family support. We totally agree with this and propose that some medications like ketamine (K) may be an additional factor for reducing the risk of posttraumatic stress disorder (PTSD) and suicide. K has been widely used in anesthesia for many years and in various environments2 and can be used to induce anesthesia, sedation, analgesia, and amnesia. Main advantage is to preserve functional residual capacity, induce bronchodilation, and avoid cardiovascular depression.3 K is very popular among military anesthesiologist for rapid sequence induction, maintenance of anesthesia, or pain control.4 It also offers a useful option to the combat medic’s options for battlefield pain management.5 It appears that burned casualties studied by Escolas et al were likely to be treated with K which seems to be the most commonly used analgesic drug for prehospital and en route use in the combat setting.6 Since K is associated with psychosomatic effects, there is possible concern that ketamine may increase the risk of developing PTSD. Contrary to expectations, this is not the case.7 Not only K do not increase the risk of PTSD but is currently being investigated as a novel therapeutic for depression and suicidality.8 It is proposed that K has potential for treatment of major depression associated with PTSD in combat veterans.9 Ketamine is also effective after a single injection for rapid conversion of suicidal to nonsuicidal intentional thought processes in patients presenting to the emergency department.10 Despite further studies are warranted, we think that controlled use of ketamine may play, in combination with social an family network, a central role in preventing suicide in combat veterans.
La Presse Médicale, 2006
ABSTRACT
Le Praticien en Anesthésie Réanimation, 2004
Points essentiels ■ Le conflit actuel en Afghanistan, pays de montagne, est l'occasion de fai... more Points essentiels ■ Le conflit actuel en Afghanistan, pays de montagne, est l'occasion de faire la revue des pathologies et des contraintes médicales liées à l'altitude en opérations extérieures. ■ L'exposition progressive à l'hypoxie hypobare en montagne est à distinguer des accidents hypoxiques aigus par décompression en vol. ■ Aucun cas de pathologie lié à l'altitude n'a été rapporté chez les soldats acclimatés près de Kaboul (1 800 mètres) et évoluant à des altitudes généralement inférieures à 2 500 mètres. ■ Les équipages des avions de transport, contraints à des niveaux de vol de sécurité élevés en Afghanistan, sont exposés aux effets de l'altitude. ■ Si les lésions thoraciques sont devenues moins fréquentes (6 %), les pneumothorax compressifs restent à l'origine de décès évitables et leur exsufflation s'impose pour l'évacuation aérienne. ■ Le diagnostic échographique des pneumothorax est performant et trouve sa place au cours des évacua...
Military Medicine, 2014
Needle decompression of tension pneumothorax in soldiers of the French infantry has a risk for fa... more Needle decompression of tension pneumothorax in soldiers of the French infantry has a risk for failure when the standard procedure that involves the insertion of a 14-gauge, 5-cm catheter into the 2nd intercostal space (ICS) is used. This study measured the chest wall thickness (CWT) to assess whether this approach is appropriate. CWT was measured by ultrasound in 122 French soldiers at the 2nd and 4th ICSs on both the right and left sides. CWT was measured at 4.19 cm (± 0.96 cm) at the 2nd ICS and 3.00 cm (± 0.91 cm) at the 4th ICS (p < 0.001). CWT was greater than 5 cm in 24.2% of cases at the 2nd ICS and 4.9% of cases at the 4th ICS (p < 0.001). This study suggests a high risk of failure when using the technique currently taught in the French army. A lateral approach into the 4th ICS could decrease this risk. The results of this study must be validated in patients presenting tension pneumothorax.
Anesthesia & Analgesia, 2010
BACKGROUND: We sought to determine whether online use of a beat-by-beat cardiovascular index, CAR... more BACKGROUND: We sought to determine whether online use of a beat-by-beat cardiovascular index, CARDEANா (Alpha-2, Lyon, France), modifies the incidence of patient movement during colonoscopy under anesthesia. METHODS: Monitoring included an electrocardiogram, oscillometric and noninvasive beat-bybeat arterial blood pressure, O 2 saturation, bispectral index (BIS), and CARDEAN. CARDEAN consists of beat-by-beat Finapresா (Ohmeda, Madison, WI) combined with an algorithm that detects hypertension followed by tachycardia and produces an index scaled 0 to 100. The anesthesiologist was denied access to Finapres and CARDEAN. Propofol was adjusted to keep 40ϽBISϽ60. Alfentanil 3.5 g ⅐ kg Ϫ1 was administered according to conventional signs (tachycardia, hypertension, and movement), unless the patient had signs of brady/apnea or SpO 2 Ͻ95%. One hundred fifty-nine patients presenting for colonoscopy under propofol anesthesia were prospectively randomized to (i) control: no other intervention, or (ii) CARDEAN: in addition to conventional signs, an observer instructed the anesthesiologist to administer alfentanil when CARDEAN was Ͼ60. The primary outcome was the number of observed movements. RESULTS: Data were analyzed in 146 patients (control: 75; CARDEAN: 71). The doses of propofol and alfentanil were similar in both groups. When BIS was Ͻ60, movements were less frequent in the CARDEAN group (3.3 movements/100 min [2.3-4.8]) than in the control group (6.7 [5.3-8.5]) (odds ratio: 0.5 [0.32; 0.76], P ϭ 0.001). During the first 10 minutes of the procedure, the incidence of movements was 38% and 59% in the CARDEAN and control groups, respectively (P ϭ 0.04). CONCLUSION: With BIS Ͻ60, CARDEAN-guided opioid administration is associated with a reduction of 51% of clinically unpredictable movements in unparalyzed patients undergoing colonoscopy. More studies are required to refine the role of CARDEAN in surgical settings.
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Papers by Jean-yves Martinez