Biomedical subjects
Publications and source records attributed to A Ducart.
Cardiac surgery was associated with a marked reduction in circulating LDL and HDL particles, which in turn largely affectd alpha-toc transport. alpha-toc was decreased in WBCs but not in PLTs and RBCs. An increased hydroperoxide content was observed in LDL and possibly in HDL after cardiac surgery.
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The Department of Anesthesiology and Reanimation is organised in units with clinical activities, which include the pre-operative care of patients, anesthesiological care and immediate post-operative supervision. Two post-operative treatment rooms also form part of the department. The main fields of research of the various units result from collaborations with other departments of Hôpital Erasme, in particular with regard to the development of advanced techniques or fit within the confines of the speciality.
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OBJECTIVE: To compare intraoperative hemodynamics profiles and recovery characteristics of propofol-alfentanil with fentanyl-midazolam anesthesia in elective coronary artery surgery. DESIGN: Prospective, randomized study. SETTING: University hospital. PARTICIPANTS: Fifty patients with impaired or good left ventricular function. INTERVENTIONS: In group 1, (n = 25) anesthesia was induced with an infusion of propofol, 3 to 4 mg/kg/h, alfentanil, 500 micrograms, and pancuronium 0.1 mg/kg, and maintained with propofol, 3 to 6 mg/kg/h (variable rate), and alfentanil infusions, 30 micrograms/kg/h (fixed rate). Additional boluses of alfentanil, 1 mg, were administered before noxious stimuli; group 2 (n = 25) received a loading dose of fentanyl, 25 micrograms/kg, midazolam, 1.5 to 3 mg, and pancuronium, 0.1 mg/kg for induction, followed by an infusion of fentanyl, 7 micrograms/kg/h, for maintenance. Additional boluses of midazolam (1.5 to 3 mg) and fentanyl (250 micrograms) were administered before noxious stimuli. MEASUREMENTS AND MAIN RESULTS. Cardiovascular parameters at eight intraoperative time points as well as time to extubation, morphine consumption, and pain scores were recorded. Induction of anesthesia was associated in both groups with a small but significant decrease in mean arterial pressure (1: 15 mmHg (15%); 2: 8 mmHg (8%) with significant decreases in cardiac index (1: 8%; 2: 8%) and left ventricular stroke work index (1: 24%; 2: 21%). Throughout surgery, hemodynamic profiles were comparable between groups except after intubation when the MAP was significantly lower in group 1 (75 +/- 12 mmHg) than in group 2 (89 +/- 17 mmHg). Group 1 required less inotropic support. Extubation was performed faster in group 1 (7.6 h) than in group 2 (18.0 h). Morphine requirements and pain scores were comparable between groups. CONCLUSIONS: Propofol-alfentanil anesthesia provides good intraoperative hemodynamics and allows early extubation after coronary artery surgery.
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Explore the source record for details and available documents.
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Although numerous studies have reported the use of intraoperative blood salvage in elective spine, cardiac, and vascular surgery, very few have assessed its efficiency during emergency surgery after spine trauma. We therefore retrospectively analyzed 238 cases of patients with spine trauma who had emergency surgery. Three variables were significantly associated with the risk of perioperative blood transfusion: thoracolumbar spine injury, a preoperative hematocrit < 35%, and an Injury Severity Score > 20. Among the 118 patients who received blood transfusions, 53 benefitted from intraoperative blood salvage using the Cell-Saver apparatus (Cell-Saver group) and 65 did not (control group). The Cell-Saver enabled a 47% reduction in homologous blood requirements (743 +/- 1191 mL vs. 1403 +/- 1453 mL, p < 0.008) and a 45% reduction in the number of patients who received homologous blood (45% vs. 82%, p < 0.001). Between these two groups, no significant differences were observed in the evolution of hematocrit, platelet count, and hemostasis values, but a slight increase in postoperative blood loss was noted in the Cell-Saver group (465 +/- 383 mL vs. 301 +/- 292 mL, p < 0.01). In conclusion, the efficiency of intraoperative blood salvage in emergency surgery for spine trauma is high and similar to that previously reported in elective spine surgery. The cost-effectiveness of this technique may be improved by appropriate selection of the patient.