1 The in¯uence of bradykinin (BK) on blood glucose and plasma insulin levels was investigated in anaesthetized rats. 2 Blood glucose level was dose-dependently increased by intravenous infusion of BK. This eect of BK was enhanced by captopril, an inhibitor of angiotensin-converting enzyme (ACE). Des-Arg 9 -bradykinin (DABK), a kinin B 1 receptor agonist, did not modify blood glucose levels while the eect of BK was inhibited by Hoe-140, a kinin B 2 receptor antagonist. The eect of BK was reduced by the NO-synthase inhibitor, N o -nitro-L-arginine methyl ester (L-NAME), and by the cyclo-oxygenase inhibitor, indomethacin. 3 The eect of BK was suppressed by the association of propranolol with phentolamine or phenoxybenzamine. It was also reduced by hexamethonium, a ganglion-blocking drug. In adrenalectomized rats, the infusion of BK slightly decreased blood glucose levels. 4 The hyperglycaemic eect of adrenaline was suppressed by propranolol associated with phentolamine or phenoxybenzamine, but it was not modi®ed by L-NAME. 5 Infusion of BK did not modify plasma insulin levels. However, after phentolamine and propranolol, BK induced a transient 2 fold rise in plasma insulin levels. The release of insulin was dose-dependent and inhibited by Hoe-140. 6 We conclude that infusion of BK induces, via a stimulation of B 2 receptors, the release of NO and of prostanoids. The latter agents activate through a re¯ex pathway the release of catecholamines from the adrenal medulla. This release increases blood glucose levels and reduces plasma insulin levels. After adrenoceptor inhibition, BK induces a secretion of insulin, via the stimulation of B 2 receptors.

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IntroductionSelf-efficacy is defined as people’s internal beliefs about their ability to have an impact on events that affect their lives. As part of the COVID-19 pandemic, we carried out in situ simulation for anaesthesiologists and operating room (OR) nurses. Simulation was focused on the recommendations on the use of specific personal protective equipment (PPE) as well as on airway management and intubation. We hypothesised that in situ procedural simulation should increase their perceived self-efficacy.MethodsBetween 16 March and 20 March 2020, 208 healthcare workers took part in in situ procedural simulation. A questionnaire was sent to participants on 21 April 2020. Six self-efficacy items related to PPE and airway manoeuvres were assessed before and after training on a Numeric Rating Scale from 0 to 10.ResultsSixty-seven participants (32%) replied to the questionnaire. The before–after comparison of the six items revealed an increase in perceived self-efficacy for each of them. A before training difference was observed between nurses, board-certified anaesthetists and trainees in anaesthesia in perceived self-efficacy for putting on (6 (3–8) vs 4.5 (2.25–6) vs 2 (0–6), p=0.007) and remove PPE (8 (5–8) vs 4.5 (3.25–6) vs 4 (1–6), p=0.009). No difference in perceived self-efficacy after training was observed between nurses, board-certified anaesthetists and trainees in anaesthesia.ConclusionsIn situ simulation improves the perceived self-efficacy of OR nurses and anaesthesiologists on specific skills related to the care of patients with COVID-19.

To develop a model for estimating the time delay between last heroin consumption and blood sampling in chronic drug users. Eleven patients, all heroin inhalers undergoing detoxification, were included in the study. Several plasma samples were collected during the detoxification procedure and analyzed for the heroin metabolites 6-acetylmorphine (6AM), morphine (MOR), morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G), according to a UHPLC/MSMS method. The general linear mixed model was applied to time-related concentrations and a pragmatic four-step delay estimation approach was proposed based on the simultaneous presence of metabolites in plasma. Validation of the model was carried out using the jackknife technique on the 11 patients, and on a group of 7 test patients. Quadratic equations were derived for all metabolites except 6AM. The interval delay estimation was 2-4 days when only M3G present in plasma, 1-2 days when M6G and M3G were both present, 0-1 day when MOR, M6G and M3G were present and <2 h for all metabolites present. The 'jackknife' correlation between declared and actual estimated delays was 0.90. The overall precision of the delay estimates was 8-9 h. The delay between last heroin consumption and blood sampling in chronic drug users can be satisfactorily predicted from plasma heroin metabolites.

Rapid-onset dystonia-parkinsonism also known as DYT12-ATP1A3 is an extremely rare neurological disease. Patients develop dystonia, bradykinesia, postural instability, dysarthria, and dysphagia. Injection of botulinum toxin is the first-choice treatment for focal dystonia. We report the case of a 14-year-old patient diagnosed with rapid-onset dystonia-parkinsonism who was scheduled for injection of botulinum toxin in his upper limbs under general anesthesia. To our knowledge, there is no previous report about the anesthetic management of patients with rapid-onset dystonia-parkinsonism.