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Biomedical subjects

B Vigué

Publications and source records attributed to B Vigué.

7 recordsLinked to original sources
PubMed1996

Left ventricular function after severe trauma.

OBJECTIVE: To evaluate cardiac function at the early phase of severe trauma. DESIGN: Prospective, clinical study. SETTING: Anesthesiological Intensive Care Unit. PATIENTS: 7 consecutive patients admitted after severe trauma (ISS: 38 +/- 9, mean +/- SD), without preexisting cardiac disease. INTERVENTIONS: Each patient received midazolam and sufentanyl for sedation. Right heart catheterization (Swan-Ganz) and transesophageal echocardiography (TEE) were performed. The fractional area change (FAC) of the left ventricle was calculated within 6 h following trauma and at day 1 and day 2 in order to evaluate left ventricular function. MEASUREMENTS AND RESULTS: All of the patients had a low FAC value < 50% at day 0 (43.2 +/- 2.4%, range 39-46%), which increased significantly at day 2 (52.5 +/- 4%, range 47-59%, p = 0.001), whereas heart rate and preload (assessed by left ventricular end diastolic area and pulmonary arterial occlusion pressure) were constant and afterload, assessed by systolic blood pressure, increased significantly between day 0 and day 2 (112 +/- 21 to 145 +/- 24 mmHg, p = 0.02). CONCLUSION: The initial phase of severe trauma is associated with an abnormal cardiac function, suggested by a low FAC value. This myocardial dysfunction must be taken into account for early resuscitation after severe injury.

Adult↗
PubMed1995

Role of systemic inflammatory response syndrome and infection in the occurrence of early multiple organ dysfunction syndrome following severe trauma.

OBJECTIVE: To evaluate the role of infection and systemic inflammatory response syndrome (SIRS) on the occurrence of early posttraumatic MODS. DESIGN: Retrospective study. SETTING: University Teaching Hospital ICU. PATIENTS: 163 consecutive patients hospitalized for more than 48 hours following severe trauma. MEASUREMENTS AND MAIN RESULTS: The patients were classified into two groups in respect to the existence of MODS at day 2. There was 27 patients in the MODS group and 136 patients in the no MODS group. The two groups were similar with respect to age, sex ratio and Simplified Acute Physiology Score. The MODS group had a higher mortality (52 versus 7%), Injury Severity Score (45 +/- 14 versus 31 +/- 13), hypovolemic shock rate (74 versus 30%), massive volume replacement rate (59 versus 6%) and SIRS rate (81 versus 54%) than the no MODS group (P < 0.05). The rate of infection was similarly low in the MODS and no MODS group (4 versus 6% respectively). CONCLUSION: Early MODS is often associated with hypotension and massive volume administration but very rarely with infection, despite the high rate of SIRS.

Adult↗
PubMed1994

Role of vascular endothelium in exercise-induced dilation of large epicardial coronary arteries in conscious dogs.

BACKGROUND: The role of vascular endothelium in the control of epicardial coronary artery vasomotion during treadmill exercise remains unclear. Therefore, we examined the consequences of in vivo balloon endothelial denudation on external coronary diameter of the left circumflex artery during exercise in conscious dogs. METHODS AND RESULTS: Seven dogs instrumented for the measurement of arterial blood pressure, external coronary artery diameter, and coronary blood flow were studied during exercise before and up to 21 days after balloon endothelial denudation of the proximal left circumflex artery. Endothelial denudation was confirmed by abolition of the epicardial coronary artery dilation induced by acetylcholine (0.3 microgram/kg IV) and reactive hyperemia. Epicardial coronary vasodilation was observed in the control state during treadmill exercise (+5.2 +/- 1.0%). In contrast, a marked vasoconstriction was observed 3 (-4.6 +/- 0.6%) and up to 6 days after endothelial denudation. Complete epicardial coronary artery dilation in response to acetylcholine and exercise was restored 9 days after endothelial denudation. In addition, epicardial coronary artery vasomotor responses to acetylcholine and treadmill exercise were closely correlated (r = .82, P < .001). Reactive dilation was not completely restored 21 days after endothelial denudation, but reactive hyperemia and exercise vasomotor responses during the 21 days follow-up were correlated (r = .70, P < .001). Vasodilation induced by nitroglycerin (1 microgram/kg IV) was reduced by 25% (P < .01) 3 days after endothelial denudation and returned to its corresponding control level 3 days later. Prazosin (50 micrograms/kg IV) significantly attenuated the exercise-induced coronary artery constriction after endothelial denudation (+1.5 +/- 1.4% versus -4.6 +/- 1.0%). CONCLUSIONS: These data demonstrate that endothelium is essential for the mediation of epicardial coronary dilation during exercise and may protect these vessels against the vasoconstrictor effect of endogenous catecholamines.

Acetylcholine↗
PubMed1991

[Hemodynamic effects of the induction of general anesthesia after low thoracic epidural anesthesia].

Sixteen ASA 1 or 2 patients scheduled for abdominal surgery were included in the study after they had given their informed consent. Thirty minutes after starting a low-thoracic epidural anaesthesia (median level of sensitivity loss: T5), the patients were randomly given an intravenous bolus injection of either thiopentone (4 mg.kg-1, n = 8) or etomidate (0.5 mg.-1, n = 8), associated with succinylcholine 1 mg.kg-1. One minute after induction of general anaesthesia, the patients were intubated and mechanically ventilated (V(T) 8 ml.kg-1, rate 12 c.min-1). Mean arterial blood pressure (MAP) (oscillometric method), cardiac output (CO) (transthoracic bioimpedance) and heart rate were recorded semi-continuously. Total peripheral resistances (TPR) were calculated using the formula TPR = (MA/CO)*80. There were no differences between the groups in patient age, height, weight, and cardiovascular consequences of epidural anaesthesia. After anaesthetic induction and before endotracheal intubation, there was a slight decrease in CO in both groups, without any change in MAP. After intubation, MAP increased in both groups through peripheral vasoconstriction, whereas CO did not increase further. A significant tachycardia was occurred only seen in the thiopentone group, before and after tracheal intubation. This study showed that thiopentone and etomidate were suitable drugs for anaesthetic induction in a patient under epidural blockade. However, the absence of tachycardia following etomidate may be beneficial in cardiac patients. The monitoring of cardiac output determinants during thiopentone and etomidate anaesthesia require further invasive investigations.

Adult↗
PubMed1988

[Are combinations of local anesthetics dangerous?].

Although local anaesthetic mixtures are often used, there is often no scientific basis for this. Interactions between the local anaesthetics in the mixture can even increase their toxicity. Such interactions may be due to the physical chemical properties of each constituent (this is not a real problem for amide local anaesthetics), to a mutual displacement from the binding sites on the plasma proteins or to an additional effect on membrane receptors. This displacement would seem to benefit the least toxic drug: the toxicity of local anaesthetic mixtures may therefore be reduced; for example, lidocaine and mepivacaine are displaced by bupivacaine. Moreover, the fraction of drug which leaves the blood vessel is greater than the serum free fraction. During chronic administration, neurological toxicity and free fraction are narrowly linked. When using local anaesthetic mixtures, it must be remembered that potency and toxicity of a local anaesthetic are closely correlated and that the toxic effects are, at least, additive.

Anesthetics, Local↗