Objective: The manual injection of a bolus of opioid in patients with brain injury induces an increase in intracranial pressure related to a decrease in mean arterial pressure. Such an effect has not been observed with the use of ketamine. The use of target-controlled infusion would minimize or suppress this adverse effect of opioid.
View Article and Find Full Text PDFAnn Fr Anesth Reanim
December 2004
We present a case of an emergency Caesarean section due to misinterpretation of the cardiotocography (CTG) trace during general anaesthesia for treatment of dental abscess. Following failure of the dental abscess treatment under local anaesthesia, a 29-year-old female in the 36th week of a twin pregnancy was to undergo general anaesthesia. Foetal well-being was monitored with ultrasonographic evaluations of foetal heart rate.
View Article and Find Full Text PDFIn patients with severe traumatic brain injury, bronchotracheal toilet may be accompanied by deleterious variations in intracranial pressure (ICP). To avoid these effects, IV opioids have been proposed. Twenty mechanically-ventilated patients received 3 ascending IV doses of remifentanil: dose 1 (1 microg/kg bolus, 0.
View Article and Find Full Text PDFBackground: The target blood concentrations of propofol and remifentanil, when used in combination, required to blunt the cough response to tracheal intubation, cuff inflation, and tracheal suctioning without neuromuscular blocking agents are not known.
Methods: In a randomized prospective study, 81 patients were enrolled to determine which of three target remifentanil blood concentrations was required to blunt coughing during intubation, cuff inflation, and tracheal suctioning. Anaesthesia was achieved with propofol at a steady effect-site concentration of 3.
Twenty-one women undergoing termination of pregnancy for severe fetal abnormality received remifentanil and propofol using a target-controlled infusion system and were studied prospectively. Target concentrations were initially set at 1 ng.mL(-1) for remifentanil and 0.
View Article and Find Full Text PDFAnn Fr Anesth Reanim
April 2004
Remifentanil is the latest available compound of the 4-anilidopiperidine derivatives. It is characterized by an ultrashort duration of action and a metabolism independent of both hepatic and renal functions. Its main drawback is a lack of residual analgesia and the risk of postoperative hyperalgesia.
View Article and Find Full Text PDFBackground: Motor evoked potentials can be affected by propofol anaesthesia. We studied how increasing target concentrations of propofol altered transcranial motor evoked potentials (tcMEP) during scoliosis surgery.
Methods: Fifteen patients undergoing surgery for scoliosis were anaesthetized with remifentanil and propofol without nitrous oxide or neuromuscular blocking agents (BIS<60).
Background: The aim of this prospective study was to determine the target concentration (CPRED) curves for laryngeal mask airway (LMA) insertion in children.
Methods: The CPRED of propofol required for insertion of the LMA was determined in 72 unpremedicated children, aged 3-10 years, ASA physical status I. CPRED was reached in 2 min according to a sequential allocation.
Background And Study Aims: Complications of endoscopic sphincterotomy (ES) have been assessed in recent multicenter studies. The aim of this series was to report and identify risk factors for complications of ES at a single tertiary referral center.
Patients And Methods: Between 1996 and 2000, 1159 consecutive endoscopic retrograde cholangiopancreatographies (ERCP) procedures were performed and their related complications were assessed.
Objective: Ventilator-associated pneumonia is said to be associated with an increased mortality or a prolonged intensive care unit stay. In multiple trauma, the use of selective digestive decontamination has been reported to decrease morbidity and mortality associated with pneumonia. We performed a study to evaluate the attributable morbidity and mortality of ventilator-associated pneumonia in multiple trauma patients with head trauma treated with selective digestive decontamination.
View Article and Find Full Text PDFObjective: To determine whether the combination with a new device (Booster ) for active humidification improves the efficacy of a hydrophobic heat and moisture exchanger (HME).
Design And Setting: Prospective, interventional study in the ICU of a university hospital.
Patients: Consecutive patients requiring controlled mechanical ventilation
Interventions: Patients were ventilated with a HME, and a Booster was added for 96 h to the ventilatory circuit.
Objective: To evaluate overall awareness of TCI and the need for training in the TCI technique. To assess, among trained anaesthetists, the value of the session and the impact of TCI technique on their working practice.
Study Design: Two prospective domestic surveys during the first quarter of 1999.
Background: Minimizing total respiratory heat loss is an important goal during mechanical ventilation. The aim of the present study was to evaluate whether changes in tracheal temperature (a clinical parameter that is easy to measure) are reliable indices of total respiratory heat loss in mechanically ventilated patients.
Method: Total respiratory heat loss was measured, with three different methods of inspired gas conditioning, in 10 sedated patients.
Objective: Sepsis and septic shock are a common cause of mortality in critically ill patients. Many substances have been implicated in the pathophysiology of these syndromes. We postulated that adenosine may be implicated in the sepsis- or septic shock-induced blood pressure failure.
View Article and Find Full Text PDFObjective: Despite increasingly sophisticated critical care, the mortality of septic shock remains elevated. Accordingly, care remains supportive. Volume resuscitation combined with vasopressor support remains the standard of care as adjuvant therapy, and many consider dopamine to be the pressor of choice.
View Article and Find Full Text PDFObjective: Complications following ventilation with dry and cold gases may be prevented by the use of artificial noses or heat and moisture exchangers, which are a solution to both the problems of humidification and heat preservation. The aim of the present study was to determine whether changing hydrophobic heat and moisture exchangers (HMEs) every 48 h rather than 24 h would affect their efficacy to preserve the heat and moisture of inspiratory gases. The impact of a prolonged use of the HME on its microbial colonization was also assessed.
View Article and Find Full Text PDFObjective: To determine the frequency of central venous catheter-induced thrombosis of the axillary vein.
Design: Prospective, controlled study.
Setting: Tertiary care university center.
Objective: To determine the hemodynamic effects of the combination of norepinephrine-dobutamine in adult patients with septic shock. Specifically, we tested the hypothesis that norepinephrine in addition to dobutamine would improve cardiac index (CI) and stroke volume index (SVI) and increase left-ventricular afterload.
Design: Prospective, descriptive, interventional study with no control group.
Background: There is a lack of information and knowledge about the practical importance of even low concentrations of the excretion of local anesthetics into breast milk, particularly concerning bupivacaine. The present work aims to confirm, under practical clinical conditions of admission of parturients, the passage of local anesthetics (lidocaine and bupivacaine) into breast milk after an epidural anesthesia.
Methods: Twenty-seven pregnant women admitted for cesarean delivery received epidural anesthesia with 0.
Objectives: To determine the effects of bolus injection and infusion of sufentanil, alfentanil, and fentanyl on cerebral hemodynamics and electroencephalogram activity in patients with increased intracranial pressure (ICP) after severe head trauma.
Design: Randomized, unblended, crossover study.
Setting: Intensive care unit and trauma center in a university hospital.
Objective: Many heat and moisture exchangers with filter (HMEF) have been developed. In-house data from companies provide some information about their performances; unfortunately, to our knowledge, no comparative evaluation in clinical conditions has been undertaken of these newer products. The aim of this study was to compare the efficiency of two HMEFs, one hydrophobic and one hygroscopic, on humidifying capacity and the rate of bronchial colonization and ventilator-associated pneumonia in ICU patients.
View Article and Find Full Text PDFAnn Fr Anesth Reanim
October 1998
A survey was carried out in 39 hospitals regarding the prescribing of perioperative antibiotics. The day of the survey, hospital pharmacists collected information on prescription patterns of antibiotics and, for 3 days, the duration of their administration. A total of 1,131 cases were surveyed, originating from digestive surgery (20%), orthopaedics (31%), gynaecology (15%), ophthalmic surgery (15%), and others (19%).
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