Effect of a fluid challenge on the Surgical Pleth Index during stable propofol-remifentanil anaesthesia.
; VERSCHEURE, Sara ; et al
in Acta Anaesthesiologica Scandinavica (2012), 56(6), 787-96
BACKGROUND: The Surgical Pleth Index (SPI), derived from pulse amplitude and heartbeat interval, is proposed to monitor anti-nociception during anaesthesia. Its response to noxious stimulation can be ... [more ▼]
BACKGROUND: The Surgical Pleth Index (SPI), derived from pulse amplitude and heartbeat interval, is proposed to monitor anti-nociception during anaesthesia. Its response to noxious stimulation can be affected by the intravascular volume status. This study investigated the effect of a fluid challenge (FC) on SPI during steady-state conditions. METHODS: After Institutional Review Board approval, 33 consenting patients undergoing neurosurgery received a 4 ml/kg starch FC over less than 5 min under stable surgical stimulation conditions and stable propofol (Ce(PPF) ) and remifentanil (Ce(REMI) ) effect-site concentrations as estimated by target-controlled infusion systems. Intravascular volume status was assessed using the Delta Down (DD). We looked at the SPI response to FC according to DD, Ce(PPF) , and Ce(REMI) . RESULTS: Following FC, SPI did not change in 16, increased in 12, and decreased in 3 patients. Ce(REMI) poorly affected the SPI response to FC. In normovolaemic patients, the probability of an SPI change after FC was low under common Ce(PPF) (0.9 to 3.9 mug/ml). A decrease in SPI was more probable with worsening hypovolaemia and lowering Ce(PPF) , while an increase in SPI was more probable with increasing Ce(PPF) . SPI changes were only attributable to modifications in pulse wave amplitude and not in heart rate. CONCLUSIONS: During stable anaesthesia and surgery, SPI may change in response to FC. The effect of FC on SPI is influenced by volaemia and Ce(PPF) through pulse wave amplitude modifications. These situations may confound the interpretation of SPI as a surrogate measure of the nociception-anti-nociception balance. [less ▲]Detailed reference viewed: 109 (8 ULg)
Structures et fonctionnements des marchés du carbone
Master's dissertation (2010)
This study is interested in the theoretical and actual functioning of the emissions trading systems resulting from the coming into force of the Kyoto protocol in 2005 and the implementation of the ... [more ▼]
This study is interested in the theoretical and actual functioning of the emissions trading systems resulting from the coming into force of the Kyoto protocol in 2005 and the implementation of the European Union Emissions Trading Scheme (EU ETS) in 2002. The first part of the work is devoted to a literature-based analysis of the Kyoto flexible mechanisms: Emissions Trading (ET), Clean Development Mechanism (CDM) and Joint Implementation (JI). These mechanisms allow the protocol's parties to achieve their objectives at the lowest cost, using a "cap and trade" strategy. Concerning ET, the issues of the surplus of emissions rights (called "hot air") and the effects of the economic crisis are tackled. An analysis of the spatial and sectoral distribution of CDM and JI is also conducted. The second part concerns the EU ETS, the coordinated emissions trading system of the European Union. With this system, companies with a high level of emissions established in at least one of the member countries directly support a part of the global constraint resulting from the involvement of the EU in the Kyoto protocol. The system also use a "cap and trade" strategy and has been progressively spatially and sectorally extended. As for Kyoto flexible mechanisms, an analysis of the structure and the functioning of this market is done on the basis of the literature. In addition, the implementation of this system within the firms is described through actual business cases and is compared with theoretical observations. In particular, we focus on emissions monitoring and portfolio optimization. In the third part of the work, we conduct and in-depth qualitative analysis of the impact of EU ETS on the competititveness of firms subject to the constraint in Belgium. Interviews has been done with heads of four companies selected for their differences in terms of size, emissions level, sector and environmental policy. The answers collected are systematically compared with the multinational survey of the independent specialized consultant PointCarbon (2010). Results show that opinions about the impact on the competitiveness are strongly influenced by sector and size of the firms. [less ▲]Detailed reference viewed: 144 (102 ULg)
L'Industrie. Des Ressources naturelles et du Savoir-Faire.
in Classes du Patrimoine. Liège (1996)Detailed reference viewed: 28 (2 ULg)
La Linière Saint-Léonard. Historique et présentation
Frankignoulle, Pierre ;
in Lieu (1987)Detailed reference viewed: 79 (8 ULg)
Images de la société belge de 1830 à 1839. Etude comparative de trois quotidiens liégeois.
Master's dissertation (1982)Detailed reference viewed: 48 (8 ULg)