Publications by authors named "Maneglia R"

The dramatic increase in digestive surgery among patients of advanced age is the logical consequence of the aging population demographics in developed countries. Surgery in the aged is not fundamentally different, but it demands precise and tailored assessment and management of surgical indications and surgical and anesthetic techniques. Advanced age is not a contraindication to even major digestive surgery, but every effort must be made to avoid urgent operations by attention to pre-existing symptoms which are all-too-often neglected in the aged.

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Central venous catheters are usually inserted and manipulated by anaesthetists-intensivists and others familiar with their use under surgical conditions, yet they are often removed on the wards by junior doctors or nurses insufficiently trained in the removal procedure. In order to illustrate the risks presented by such a practice, we report a case of cerebral air embolism following the withdrawal of an internal jugular catheter in a sitting patient. The mechanisms of air entry into the venous and systemic circulation are considered, as well as the preventive and therapeutic measures.

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Severe ovarian hyperstimulation syndrome is a rare complication of ovulation induction with exogenous gonadotrophins. Severe forms involve acute renal failure, coagulation disorders, massive ascites, pleural effusion and may require pleural and peritoneal puncture. We report a case of severe ovarian hyperstimulation syndrome effectively treated by simple procedures in an intensive care unit.

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Some patients with diaphragmatic paralysis or dysfunction maintain ventilation by use of other muscles. Anaesthesia, in modifying the performance of these muscles, presents a potential risk to such patients. To evaluate this risk, the effects of halothane on ventilation and arterial blood gases were studied on a model of bilateral diaphragmatic paralysis, the phrenectomized rat.

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The effects of progressive hypoxia, obtained by decreasing FIO2 from 0.21 to 0.12, on arterial blood gases and acid-base balance were studied in 13 awake rats and 13 rats anaesthetized with halothane (inspired concentration 1.

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Halothane decreases the ventilatory response to hypoxia and the activity of peripheral arterial chemoreceptors, resulting in "chemical chemodenervation." In order to evaluate the role of this halothane-induced "chemical denervation" in acid-base and arterial blood gas changes, these values were measured in intact and chemodenervated rats, awake and under anaesthesia. Since the depth of anaesthesia could be modified by the anatomical chemodenervation, the ED50 of inspired halothane was determined in six rats before and after anatomical chemodenervation.

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Changes in systemic haemodynamic variables (mean arterial pressure, MAP; heart rate, HR; cardiac output, Qc), in oxygen consumption, VO2, and in ventilation (minute ventilation, V; respiratory frequency, f; tidal volume, VT; and arterial blood gases) with particular attention to respiratory times (duration of inspiration, TI; duration of expiration, TE; duration of the breathing cycle, TTOT), to respiratory timing (TI/TTOT) and respiratory drive (VT/TI) were studied during moderate progressive hypothermia (36 degrees C to 28 degrees C) during stable halothane anaesthesia (MAC = 1.5) in six dogs. MAP, HR and Qc decreased; V and f decreased, the decrease in f being correlated with that in temperature (r = 0.

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An enquiry was carried out by sending 368 women a double questionnaire at the eighth month of pregnancy and after delivery, in order to assess their opinions and motivations as far as epidural anaesthetic was concerned, and how far their expectations had been fulfilled. One hundred forms were returned. The sample was: 64% primipara and 36% multipara, of whom 64 women were married, 27 living in a stable relationship and 9 living on their own.

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Morphinic drugs added to epidural local anesthetic during labour enhance analgesia and obstetrical conditions. Fentanyl, 1 microgram/kg-1, is safe for the newborn. Alfentanil is of faster and shorter duration and its pharmacokinetics suggests less accumulation than fentanyl.

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The haemodynamic effects of propofol and ketamine were studied in two groups of eight randomly allocated elderly patients (mean age 85.8 years) anaesthetised for hip replacement. Group 1 patients patients received propofol 1 mg/kg by intravenous bolus for induction and 0.

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Arterial and/or venous thrombosis is a frequent complication in experimental or human pancreatic transplantation. A canine experiment was used to study the hemodynamic effects of spleno-splenic arteriovenous fistula during segmental pancreatic transplantation. An increase in blood flow, without "steal" syndrome in the pancreatic blood supply or pressure increase, was found.

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7,500 deliveries occurred from the date of opening of the Maternity Hospital Jean-Rostand. 3,500 of these were conducted under epidural anaesthesia. At different stages prospective studies were carried out to recall the effect of adding fentanyl to bupivacaine when the epidural injection was made.

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The haemodynamic changes following anaesthesia for hip surgery in 16 very old ASA II or III patients (mean age 85.8 +/- 5 years) were studied. Patients were randomly assigned to two groups: group I 1 mg X kg-1 propofol, group II 1.

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Endocavitary fulguration, is a new technique to ablate the arrhythmogenic substrate of chronic ventricular tachycardias (VT). This method is used in patients with ventricular tachycardias of varied etiologies. 47 fulgurations in 36 patients with 40 hemodynamic and 12 myocardial metabolic studies are presented.

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Two methods of epidural analgesia were compared in two randomized groups each of 16 normal women in labour, using bolus or continuous infusion. Analgesia was provided by a mixture of bupivacaine 0.25% and fentanyl.

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A series of 144 patients of over 75 years of age (average 83.2 years) were operated over a 5 year period for gall stones. Factors associated with a poor prognosis were age, infection and jaundice.

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