Biomedical subjects

C Colavolpe

Publications and source records attributed to C Colavolpe.

12 recordsLinked to original sources

PubMed1999

[A scale of perioperative satisfaction for anesthesia. I--Construction and validation].

OBJECTIVE: To develop and to validate a scale assessing perioperative patient's satisfaction with anaesthesia (Evan). STUDY DESIGN: Descriptive and evaluative study. PATIENTS: The study included 742 adults undergoing a surgical or a diagnostic procedure under general anaesthesia. Emergency, ambulatory and obstetrical cases were excluded. METHODS: A multidisciplinary working party produced 85 questions focusing on various pertinent areas describing satisfaction. After a validation, 25 out of them were selected for the questionnaire. The latter was completed within the 24 hours following anaesthesia by 742 inpatients. RESULTS: Item analysis showed a homogeneous distribution of the answers to each item. Main component analysis allowed to explain 53% of total variance. Six dimensions were isolated by the exploratory analysis: anxiety, embarrassment, fear, pain-discomfort, information and physical needs. Scoring method followed a simple additive model: for each dimension, the scale scored 0-100. The global score represented the sum of the six dimensions also scored 0-100. Acceptability of Evan questionnaire was satisfactory, with a spontaneous non response rate of less than 1% and a completion duration at 11 +/- 8 min. CONCLUSION: A self-completed questionnaire on patient's satisfaction with anaesthetic period was validated, allowing a global and multidimensional assessment of patient's satisfaction.

Adult↗

PubMed1999

[The use of curare-like agents in resuscitation].

OBJECTIVE: To analyse current data on use of neuromuscular blocking agents (NBA) in the intensive therapy unit (ITU) patients and to propose practice guidelines. DATA SOURCES: We did a Medline search of French and English language articles on NBA administration in ITU patients from 1960 to 1998. Data were also selected from our own collection of articles and books. STUDY SELECTION: Original articles, clinical cases, letters to the editor and review articles were considered. DATA EXTRACTION: Data on pharmacology of NBA in the ITU patient were extracted, as well as data on administration patterns and cost. DATA SYNTHESIS: The indications for myorelaxation in ITU patients include either short term use, as in anaesthesia, or long term administration for facilitation of mechanical ventilation, control of increased intracranial pressure, status epilepticus, tetanus and oxygen demand in case of muscular hyperactivity, diagnostic and therapeutic procedures facilitation. A beneficial effect of NBA on the prognosis of the disease for which these agents have been used is not yet proven. Suxamethonium, because for its short onset time and duration of action, is the agent of choice for endotracheal intubation if myorelaxation is required. Among the benzylisoquinolines, atracurium and besilate of cisatracurium are convenient agents in ITU patients, whereas mivacurium is of no special interest. Among the aminosteroids, pancuronium and vecuronium are the most often used agents in the ITU. Rocuronium has not yet been extensively assessed. Myorelaxants carry risks for morbidity and mortality. The difficulty to assess the neurological status and the level of sedation is a recognised adverse effect. An accidental disconnection from the circuit and the resulting asphyxia is nowadays recognised without delay by the ventilator. NBAs increase the rate of bronchopulmonary infections. Cardiovascular complications include extreme bradycardia or sinus arrest following vecuronium administration, and cardiac arrest after suxamethonium injection mainly in burned or traumatised patients. Conversely to anaesthesia, NBAs do not carry a significant risk for anaphylactic or anaphylactoid complications in the ITU. Tachyphylaxis occurs mainly in burns and other pathologies modifying acetylcholine receptors. Neuromuscular complications include myopathy from steroids, postparalytic syndrome, deconditioning syndrome and intensive care polyneuropathy. Prolonged curarisation after discontinuation of NBA administration has a multifactorial origin and must be differentiated from neuromuscular complications. For prolonged neuromuscular blockade, pancuronium, vecuronium and atracurium are the agents of choice. The association with an adequate sedation is essential. Assessment of depth of neuromuscular blockade is not based on clinical symptoms but on train-of-four (TOF) twitch monitoring. A convenient basic relaxation is usually obtained with the suppression of the two last responses to TOF. CONCLUSION: The use of NBA in ITU patient should result from a rational decision making procedure, the blockade titrated with a TOF monitor and maintained as superficially and shortly as possible.

Anesthesia↗

PubMed1994

[Anesthetists and continuing education].

Although the importance of continuing medical education (CME) is a recognized fact, its modalities are still a controversial matter. In order to obtain informations on the demands and the difficulties to which French anaesthetist (AN) are faced with, the Committee for Education of the French Society of Anaesthesia (SFAR) carried out an inquiry with a questionnaire circulated to 7000 AN. The rate of answers was about 10%. With regard to age, gender, mode of activity and length of service in the specialty, the group of responders was representative of the French population of AN. The inquiry seems to demonstrate a strong motivation for CME, as well as demands for training courses, courses extending over two days or more, and a self-assessment. The funding of the expenses as well as the difficulties to obtain a locum tenens were the two main obstacles which limited the access to CME.

Anesthesiology↗

PubMed1993

[Peroperative use of Cell Saver in elective surgery on the abdominal aorta].

In order to determine the impact of intraoperative autotransfusion on vascular surgical care, data related to 200 abdominal aortic surgical operations performed over a 20 months period were prospectively analysed. Volumes of blood salvaged and transfused during and after each operation were considered. One hundred and twenty one patients had an intraoperative autologous transfusion at a mean volume of 616 +/- 410 ml. Among them, 36 patients (43%) had only their own autotransfused blood and no other homologous blood components were required. Rapid autotransfusion was associated neither with significant haemolysis, nor with coagulopathy. Neither mortality nor morbidity was related to intraoperative autotransfusion. These data suggest that intraoperative autotransfusion is a safe replacement method in major vascular surgery. The procedure should be used in conjunction with preoperative donations when feasible.

Aged↗

PubMed1984

[So-called pocket-sized spirometry versus respiratory function tests: a comparative study of vital capacity, forced expiratory volume in 1 second and Tiffeneau's coefficient].

A simplified preoperative respiratory assessment was carried out in order to assess the reliability of a pocket-sized spirometer. 30 patients were each tested using two methods: 1) the traditional extensive laboratory lung function tests and 2) a bedside test using a pocket-sized spirometer, which measured the vital capacity (VC), the forced expiratory volume in 1 second (FEV1), the peak flow (PEF) and the ratio of FEV1 to VC. The correlation between the two series of VC and FEV1 measurements was highly significant (p less than 0.001). Therefore, these two parameters could be considered as reliable when testing was performed at the bedside. However, the sensitivity of the FEV1/VC ratio was decreased; in three of the patients, the significance of this third parameter was not the same with the two methods. Measurements of peak flow were only collected at the bedside, and a statistical comparison was not established. Analysis of this last parameter always allowed us to confirm or not an obstructive syndrome when the values of FEV1 or FEV1/VC were in disagreement. The pocket-sized spirometer would seem to be a simple and reliable means of diagnosing respiratory insufficiency, its type (obstructive or restrictive) and its seriousness.

Aged↗

PubMed1984

[Urinary excretion of nitrogen from 15N leucine during infusion of an amino acids solution rich in branched amino acids].

Branched chain amino acid enriched solutions have been proposed in several situations. The fate of the nitrogen contained in those amino acids, particularly the immediate urinary excretion, has not been established yet. In the present study, the rates of urea and total urinary nitrogen loss from 15N leucine were measured in a patient receiving a branched chain amino acid enriched solution. The results showed that: 1) the urinary excretion of leucine represented less than 1% of the amount of injected leucine; 2) 15N excreted from leucine was 5.37% of the 15N injected during the 24 h of the infusion and 7.66% during the following day; 3) the excretion of 15N urea represented 62% of the total 15N excreted during the first 24 h and 72% for the following day. Finally, in this patient, the amount of nitrogen from leucine immediately excreted in the urine was moderate.

Amino Acids↗

PubMed1983

[Severe confusion following a theophylline-cimetidine combination].

Cimetidine and theophylline were given together to a 67 year old chronic bronchitic post-operatively: the patient became very confused, shook of all his limbs, vomited, and presented a tachycardia. The greater than normal blood levels of theophylline (27.8 mg . 1(-1) confirmed its involvement in this clinical state. But, as there was no real overdose, the simultaneous administration of cimetidine was probably responsible for inducing this state. Three days after stopping this treatment, the disorder had completely disappeared.

Aged↗

PubMed1982

The infusion of catecholamines in dogs under general anaesthesia with fentanyl. The effects on intrapulmonary shunt.

The pulmonary venous admixture, PaO2, and pulmonary and systemic haemodynamics were studied in six mongrel dogs during infusion of dobutamine (infusion rate 7.5 micrograms . kg-1 . min-1), dopamine (7.5 micrograms . kg-1 . min-1) and isoproterenol (0.1 microgram . kg-1 . min-1). Anaesthesia was performed by a single injection of Fentanyl (0.35 mg/kg). The carbon dioxide tension and body temperature were strictly maintained within limits. Only isoproterenol produced a significant change in pulmonary arterial pressure from an average of 1.2 +/- 0.4 kPa to 1.6 +/- 0.2 kPa (P less 0.05). There was no significant change in systemic haemodynamics with any of the three drugs. The use of catecholamines in dogs with healthy lungs does not induce any development in pulmonary venous admixture when haemodynamics are unchanged. Changes in these variables are dependent upon changes in pulmonary blood flow rather than being direct effects of the catecholamine.

Anesthesia, General↗

PubMed1982

[Postoperative weaning from mechanical ventilation in adults].

Pulmonary complications remain the most frequent of postoperative complications (32-60), especially after upper abdominal surgery (14-41). Chronic respiratory insufficiency (80) also continues to be a major risk factor, in spite of the progress made in both anesthesiology and postoperative care. In the immediate postoperative period, weaning from mechanical ventilation is one of the most dangerous phases of anesthesia (84). We discuss the importance of weaning procedures, in particular, in patients with a high risk of pulmonary complications.

Adult↗

PubMed1981

[Occult intrapulmonary hemorrhage caused by anticoagulants].

Intrapulmonary occult bleeding is a serious complication of anticoagulants. Diagnostic difficulties are such that this complication is rarely described: 8 cases in the literature. The authors report two new cases. In both of these patients oral anticoagulant therapy resulted in a severe haemorrhagic syndrome on a clinical (melaena and/or epistaxis) and laboratory (haemoglobin less than 9 g/100 ml and prothrombin time less than 10 p. 100) basis. After a period of 24 to 48 hours, an acute respiratory distress syndrome developed. There was dyspnoea without major haemoptysis, a hypoxia/hypercapnia syndrome and, by X-ray, the rapid development of a diffuse micronodular miliary picture. The diagnosis of intrapulmonary occult bleeding was based upon fibroscopy with bronchoalveolar lavage (BAL) showing the pathological presence of large numbers of alveolar siderophages. However, the worsening of hypoxia brought about by bronchoalveolar lavage is such that careful consideration must be taken before the technique is used. Intrapulmonary occult bleeding must therefore be borne in mind in the presence of an imbalance in anticoagulant treatment complicated by respiratory distress and a reticulonodular radiological appearance.

Anticoagulants↗

PubMed1981

[Clinical pharmacokinetics of flunitrazepam (Nacrozep) in intensive care patient (preliminary results)].

A protocol of repeated I. V. injections of flunitrazepam was constructed by mathematical simulation on the basis of pharmacokinetic data obtained from single intravenous injections given to healthy subjects. This protocol would given serum blood levels equal to 15 ng . ml-1, rapidly and compatible with long term artificial ventilation, thanks to the pharmacological action of flunitrazepam. Four patients in the ICU benefited from this protocol. The levels desired were not reached but in two cases out of four it was possible to continue artificial ventilation without the addition of any other drug. Furthermore it was possible to show that the three compartment model developed from healthy subjects remains valid in pathological circumstances. A second protocol based on pharmacokinetic data from four patients should allow us to obtain the objective aimed at.

Adult↗

PubMedDate not supplied

[Satisfaction with anesthesia: a review of the existing instruments].

EVALUATING PATIENT SATISFACTION: In France, patient satisfaction is a criteria for health care facility accreditation. In this context, the anesthesia community has studied tools available for assessing satisfaction with anesthesia. LIMITATIONS OF AVAILABLE INSTRUMENTS: The construction of a satisfaction assessment instrument can be divided into three phases: design, sorting items, validation. Instruments available in the currently literature (1987-1997) focus mainly on pre, per- or postoperative management but little on overall patient satisfaction. As the concept of satisfaction concerns a variety of elements, many of the available instruments use a multidimensional approach. The areas explored however vary greatly depending on the author or the study. In addition, patient experience is rarely taken into consideration when designing instruments. FOUR INSTRUMENTS: Among the available instruments we retained 4 questionnaires: Patient Satisfaction with General Anaesthesia, Peri-operative Anesthesia Experience Scale, Iowa Satisfaction with Anesthesia Scale, and Amerstadam Preoperative Anxiety and Information Scale. These last 2 scales only assess patient information and anxiety. The Peri-operative Anesthesia Experience Scale alone is available in French (Echelle de Vécu périopératoire de l'Anesthésie). Patient satisfaction is also approached with specialized instruments designed to assess specific items. The most widely used scales assess anxiety and pain. Based on these findings, it is dear that the fundamental concept of patient satisfaction must be revisited. We propose a few points for thought.

Anesthesia↗