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Biomedical subjects

C Bléry

Publications and source records attributed to C Bléry.

13 recordsLinked to original sources
PubMed1995

[Effects of preoxygenation methods on the course of PaO2 and PaCO2 in anesthetic post-induction apnea].

This study compares two preoxygenation techniques by blood gases measurements during induction of anaesthesia. After hospital ethics committee approval, 17 adult surgical patients, ASA I, all free of cardiac or lung disease were randomly assigned to two groups. Before preoxygenation, venous and radial artery canulations were performed. The patients were not premedicated and rested supine. Oxygen was given using a Mapleson A system with a 10 l.min-1 flow. In group I, 9 patients breathed 100 per cent O2 with a normal pattern. In group II, 8 patients took four deep breaths of 100 per cent O2 within 30 seconds. After this, the mask was removed and anaesthesia was induced with thiopental (5 mg.kg-1), phenoperidine (0.04 mg.kg-1) and vecuronium (0.1 mg.kg-1). After intubation, patients remained apnoeic until SpO2 decreased to 90%. Samples for arterial blood gas measurements were obtained before preoxygenation and then every minute. The two groups were similar in age (26.8 +/- 8.1 vs 29.2 +/- 9.0 years) and weight. The group I had significantly higher PaO2 immediately after preoxygenation (397 +/- 49 vs 293 +/- 86 mmHg) and the time for SaO2 to decrease to 95% was significantly shorter in group II (3 +/- 1 vs 1.87 +/- 0.99 min). PaCO2 was not different after preoxygenation in group II. In summary, healthy and young patients receive better protection against hypoxia with normal breathing of 100% for 4 minutes.

Adult↗
PubMed1994

[Antibiotic prophylaxis in gastroduodenal surgery].

The incidence of postoperative wound infections is increased up to 35% after gastroduodenal surgery, when gastric motility and acidity are decreased, as in case of gastric ulcer or cancer, obstruction, bleeding, antacid therapy. The endogenous flora contaminating the operative-site consists of organisms of the oropharynx and the jejunum and includes anaerobes like bacteroides, aerobes like streptococci, staphylococci, E. coli. Antimicrobial prophylaxis is therefore indicated in these high risk patients. All groups of antibiotics have been used, however 1st and 2nd generation cephalosporins are the most effective. A single dose given intravenously just before anaesthesia is recommended, a second dose is advisable intraoperatively when surgery is prolonged or massive blood loss occurs. Antibiotic prophylaxis is also recommended in gastric bypass surgery for obesity, but remains controversial for percutaneous endoscopic gastrotomy.

Anti-Bacterial Agents↗
PubMed1992

[Current practice and attitude of anesthesiologists for prescribing preoperative investigative tests].

A telephone enquiry was undertaken to assess current practice among French anaesthetists, and to obtain their opinion, concerning preoperative laboratory screening tests. It included 204 anaesthetists, randomly selected from the membership directory of the French Society of Anaesthetics and Intensive Care. The sample was concordant with the distribution (sex and age) given by the specialists' list of the National Medical Council. It comprised 64.2% male anaesthetists, and the overall mean age was 44.2 years. On average, each anaesthetist carried out 26 elective and 4 emergency anaesthetist a week. An organized preanaesthetic consultation was available in only 73% of public hospitals. However, even when existing, it does not automatically concern all surgical stations of the hospital and only 59% of patients benefit from that consultation. In 55% of patients the screening tests had still been made before the preanaesthetic consultation for scheduled surgery. About 15% of patients were seen for the first time by an anaesthetist on the very day of surgery. A routine prescription of preoperative tests was not systematic. Non prescription ranged from 7 to 34% of patients, depending on the tests. The responders recognized that for the same tests the rate could be comprised between 21 and 66% of patients. Moreover, 38% of anaesthetists admitted that sometimes they did not see results of the prescribed tests before carrying out the anaesthetic. Overprescription of preoperative tests has been recognized. However, legal, organisational, relational or economical reasons are given which may explain difficulties met with to rationalize prescription of these tests.

Anesthesia↗
PubMed1992

[Complementing loco-regional anesthesia in children].

An accomplishment to loco-regional anesthesia. Yes! but dependent on the age of the child; rather mild general anesthesia than progressive sedation. This should not lead to the neglect of certain basic principles: a faultless technique including the highest security standards without neglecting the psychological aspect. Use of these technique as means of outpatient treatment will be the future outlook.

Anesthesia, Conduction↗
PubMed1990

[Should blood coagulation tests be performed before locoregional anesthesia in class 1 ASA patients?].

Coagulation testing is warranted before regional anaesthesia to avoid bleeding complications. The most feared is spinal epidural hematoma causing neurologic deficits if epidural or spinal anaesthesia is performed in patients with hemostatic defects. These concepts are submitted to critical appraisal in the special setting of ASA class 1 patients. If patients are correctly assessed by questionnaire and physical examination as having negative history, asymptomatic coagulopathies are very scarce, mainly represented by hemophilia in men and von Willebrand's disease in women. Activated partial thromboplastin time (APTT) is the main test to assess coagulation defects. APTT is not sufficiently sensitive to identify all patients with coagulopathies, especially mild ones and von Willebrand's disease. Medium specificity combined with low prevalence of the disease to be screened incur false positive results and poor predictive value of positive tests as well for diagnostic purpose as for prognostic evaluation of haemorrhagic risk. Neurologic deficits secondary to compression by haematoma are rare and their frequency presently unknown. Epidural or spinal anaesthesia has been shown to be quite safe when performed in patients with various hemostatic abnormalities. Consequently, routine coagulation testing in ASA class 1 patients seems to provide more drawback than benefit. Lack of coagulation testing prior to regional anaesthesia is probably not a factor of increased risk if patients are correctly assessed.

Anesthesia, Conduction↗
PubMed1987

[Evaluation of a protocol for selective ordering of preoperative tests in healthy subjects].

A protocol for selective ordering of 12 preoperative tests was prospectively evaluated during one year in a teaching hospital. 1600 consecutive healthy patients had an average of 2.4 tests each, but 270 of them had none. Usefulness of tests was assessed by taking into account not simply their abnormality yield, but also their impact on patient care during the whole hospital stay in the anaesthetist view. The possible value of tests omitted was assessed by anaesthetists at the end of hospital stay. As a consequence of test results, surgery was delayed in one patient, and a treatment was started or the anaesthetic management adapted in 16.7% of tests performed (279/3905) were found to be useful and 0.1% of tests not carried out (21/15295) would have been potentially useful. No complication inducing sequelae or death could be linked to tests not carried out. This study showed that routine preoperative investigations in healthy patients could be avoided without any adverse effects on patient care.

Adult↗
PubMedDate not supplied

Designing a study for evaluating a protocol for the selective performance of preoperative tests.

Some basic concepts concerning classification of studies evaluating diagnostic procedures are given. The specific problem of assessment of routine preoperative tests is discussed: actual knowledge and methodological criticisms of previous studies, hypothesis for further evaluations, difficulties in the choice of a design and realization of a clinical study to assess a protocol for selective ordering of preoperative tests during one year in a teaching hospital. 3866 consecutive patients were included. The protocol led to perform only 33 per cent of all potential tests and did not apparently produce major adverse effects on the quality of care as appreciated by a clinical decision analysis.

Clinical Trials as Topic↗