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Biomedical subjects

E Viel

Publications and source records attributed to E Viel.

At least 19 recordsLinked to original sources
PubMed1999

[Propacetamol: from basic action to clinical utilization].

OBJECTIVE: To review pharmacology and therapeutic use of propacetamol, an injectable prodrug of acetaminophen (paracetamol). DATA SOURCES: Extraction from the Medline database of French and English articles on pharmacology and clinical use of propacetamol. STUDY SELECTION: Articles providing new data into the mechanisms of the analgesic action of paracetamol. Selection of controlled studies (original articles and abstracts of oral communications on therapeutic trials with propacetamol as a single agent or part of balanced analgesia protocols). Case reports and letters to the editor were not considered in this analysis. DATA EXTRACTION: Clinical articles were selected for advantages and adverse effects of propacetamol. Articles dealing with mechanisms of action of propacetamol and paracetamol were selected for the more recent data, excluding those reporting outdated theories not confirmed or abandoned. DATA SYNTHESIS AND CONCLUSION: Mechanisms of action of paracetamol differ from those of NSAIDs, giving account of a low risk of adverse renal, gastrointestinal and haematological effects. Thanks to their high therapeutic index, prescription of propacetamol and paracetamol is quite simple and safe. Main indications of both drugs are painful conditions, especially but not exclusively in the postoperative period, not requiring opioids and also in combination with other analgesic drug and/or techniques (balanced or multimodal analgesia). Because of cost, IV propacetamol is changed for oral paracetamol as soon as possible.

Acetaminophen↗
PubMed1999

Management of reflex sympathetic dystrophy.

Reflex sympathetic dystrophy (RSD) is currently defined as CRPS type I (complex regional pain syndrome). Due to the lack of comprehensive understanding of underlying pathophysiological mechanisms, a wide variety of therapeutic approaches are proposed, all of them being of unpredictable and variable efficacy. This is also due to the lack of controlled studies and randomized therapeutic trials. Most of the so-called "efficient" treatments are in fact based on anecdotal case reports and/or uncontrolled studies with small number of cases. Sympathetic blocks and active physiotherapy are, for many authors, the cornerstones of the efficient management. The role of prevention must be strongly emphasized, focusing, if RSD occurs following surgery, on the importance of pre- and postoperative efficient analgesia.

Analgesia↗
PubMed1998

[Postoperative locoregional analgesia in the adult: epidural and peripheral techniques. Indications, adverse effects and monitoring].

Regional analgesia is a very effective way to treat postoperative pain. Lumbar and thoracic epidural analgesia are well adapted to major abdominal and thoracic surgery. Nevertheless, respiratory side effects induced by opioids are potentially severe and an adequate monitoring is essential. In orthopaedic surgery, perineural blocks are the best technique to manage postoperative pain and perineural catheters may be used. The importance of intra-articular analgesia, simple and safe, is not fully understood. The association of a local anaesthetic inducing a minor motor block and a strong sensitive block (bupivacaine, ropivacaine), with an opioid seems to be the best pharmacologic choice regarding quality of analgesia and safety. Benefits of postoperative regional analgesia on mortality and morbidity are not demonstrated. Medical and nursing staff and specialized units should improve quality of postoperative regional analgesia as well. General guidelines for the practice of regional anaesthesia must be closely followed.

Analgesia, Epidural↗
PubMed1997

[Locoregional anesthesia in digestive surgery].

Many regional anesthetic techniques can be used in the setting of abdominal surgery. Spinal anesthesia has limited indications for lower abdominal surgery (below T10), especially abdominal wall surgery and anal surgery. Indications of epidural anesthesia are quite similar, while epidural analgesia can be extensively used for postoperative analgesia, provided great attention is paid to strict monitoring and safety rules. Finally, peripheral regional anesthetic techniques are discussed, highlighting their advantages in this particular setting.

Anesthesia, Conduction↗
PubMed1997

[Effectiveness of the Palmaz Schatz stent in elderly patients with unstable angina: factors predictive of short-term and long-term events].

INTRODUCTION: To evaluate clinical, procedural and therapeutical predictors of in- and out-hospital events in the elderly, we analyzed 69 consecutive patients (age: 74, range: 70-87) with unstable angina who successfully underwent Palmaz Schatz coronary stenting. METHODS: Between March 1991 and March 1994, after the stenting procedure, a cohort of 38 patients (AC) was treated with iv heparin for 48 hours, warfarin (dosage titrated on INR) and dipiridamole (75 mg tid) for 3 months, aspirin (325 mg a day) chronically; between April 1994 and April 1995, after 48 hours of iv heparin, a second cohort of 31 patients (NO AC) received subcutaneous low molecular weight heparin (4000 U a day) for a week, ticlopidine (250 bid) for 1 month, and aspirin (100 mg a day) chronically. NO AC patients showed, by protocol, a higher postdilatation pressure (14 +/- 2 vs 9 +/- 3 atm, p < 0.0001). RESULTS: The 2 cohorts of patients were similar with respect to baseline clinical and angiographic findings. A shorter hospital stay (5 +/- 2 vs 10 +/- 6 days, p < 0.0001) and a lower incidence of in-hospital events were seen in the NO AC group (3.2 vs 24%, p = 0.028), both by a reduction of ischaemic events (3.2 vs 10.5%, p = ns) and hemorrhagic events (0 vs 13.2%, p = 0.03). During a mean follow-up of 21 +/- 13 months, NO AC patients did not show a significant lower rate of out-hospital events (1 year event-free survival respectively 94.7% in NO AC cohort vs 85.7% in AC cohort, p = ns). At logistic regression model, anticoagulant therapy (OR 10.89, Cl 1.39-85.28, p < 0.05) and refractory angina (Braunwald C3) (OR 5.70, Cl 1.12-29.03, p < 0.05) were significantly related to the incidence of acute events, while refractory angina (OR 5.76, Cl 1.27-26.00, p = 0.02) and multivessel disease (OR 3.31, Cl 0.89-12.20, p = 0.07) to the occurrence of late cardiac events, particularly for a higher risk of non-target site new revascularizations. Stent implantation on saphenous vein graft was also associated to a higher risk of repeating a revascularization of non-treated sites (20 vs 4%, p = 0.021). CONCLUSIONS: In elderly with unstable angina treated with Palmaz Schatz stenting, NO AC patients showed a significant reduction of in-hospital events without a subsequent higher risk of late events. In addition, refractory angina, multivessel disease and stent implantation on saphenous vein graft were the other main clinical variables predictive of out-hospital events particularly for higher risk of non-target site new revascularizations.

Age Factors↗
PubMed1995

[Does neuroplasticity have a role on postoperative pain?].

The neurophysiologic concept of neuroplasticity represents one of the current basis of the pathophysiology of painful post-injury phenomenons (postoperative, post-traumatic...). Deriving directly from these experimental data, the idea of preemptive analgesia has gradually developed in the last five years, the central question being to know if an analgesic intervention preceding surgical intervention is more efficient, as efficient, or less efficient than the same intervention following surgery. The authors bring current data of the literature in favor of the role of neuroplasticity in the genesis and the persistence of painful states in the course of postoperative outcome. A review of the various clinical studies and controversies published is proposed, in the attempt to make the point on current therapeutic implications of the concept of preemptive analgesia.

Analgesia↗
PubMed1995

[Reflex sympathetic algodystrophies. Preventive and therapeutic aspects].

Deafferentation syndromes have in common the existence of a physical injury and/or of a functional impairment of a nerve, either somatosensory afferent (Phantom Limb Pain) and/or sympathetic efferent (Reflex Sympathetic Dystrophy). These progressively debilitating syndromes are the witness of the absence of self-limitation of neuronal sensitization, which is normally the evolution of any painful stimulation of spinal cord neurons. To some extent deafferentation syndromes could be defined as a maladaptive neuronal plasticity. The lack of complete understanding of underlying pathophysiological mechanisms gives account of the wide variety of proposed treatments and of their unpredictable and variable efficacy. This fact is also due in part to the lack of controlled studies of most of the therapeutic propositions, whose purported efficacy is usually based on anecdotal reports. Finally, the role of prevention must be strongly emphasized, focusing, if those syndromes are likely to occur following surgery, on the importance of pre- and postoperative efficient analgesia, and also, possibly, on the preemptive role of regional anaesthetic techniques.

Anesthesia, Conduction↗
PubMed1994

[Role of analgesia for sedation in intensive care medicine].

Giving a definition of analgesia in ICU needs to answer several questions: Why sedation? Which drugs can we use? How can we deal with sedation? (monitoring, continuous administration, weaning...)? Two different types of sedation must be considered: treatment-sedation (status epilepticus, tetanus, intracranial hypertension...) and comfort-sedation in anxious and/or restless and/or painful patients and in those necessitating mechanical ventilation. Analgesic consumptions vary widely with diseases and their outcome, background diseases and ICU environment. Several studies have shown that pain and analgesia are frequently neglected in ICU. The authors review the different drugs in use, with their advantages and drawbacks. A particular place is reserved to regional techniques, often underused in ICU. Indications are then fully discussed, according to several specific pathological conditions. Monitoring and weaning of sedation are also discussed at the end of the review.

Analgesia↗
PubMed1994

[Locoregional anesthesia for non cardiac surgery in the cardiac patient].

Perioperative cardiovascular morbidity is a common challenge for the anaesthesiologist, who has daily to manage patients with coronary and/or cardiac insufficiency and/or arrhythmias. Regional anaesthesia (RA), especially epidural could reduce morbidity and mortality in the cardiac patient, but the topic remains controversial. The authors propose a review of the cardiovascular effects of RA and of various RA techniques that can be used in the cardiac patient. Finally, they discuss the choice of the anaesthetic technique according to the cardiac disease.

Anesthesia, Epidural↗
PubMed1994

[Neurophysiological bases of preventive analgesia].

The key-question, when dealing with preemptive analgesia, its to know whether an analgesic intervention coming before surgery is as efficient, more efficient or less efficient than the same intervention following surgery. Surgical tissular damaging leads to a dual phenomenon of peripheral and central sensitization. The result is a state of neuronal hyperexcitability, so-called "wind-up phenomenon", which could partially explain postoperative painful states. Peripheral mechanisms involve many factors, especially prostaglandins that could be blocked by NSAIDs. Central mechanisms and neuroplasticity are analyzed, insisting on inter and intracellular biochemical events. The role of excitatory amino-acid is explained, especially of glutamic acid and the NMDA (N-methyl-D-aspartate) receptor at the spinal level.

Analgesia↗
PubMed1994

[Do morphines improve the quality of analgesia with local anesthetics?].

Use of opioids for regional anaesthesia aims to improve the quality and to enhance the duration of local anaesthetics-induced analgesia, and also to reduce the rate of adverse effects due to these agents. Experimental data give evidence for a synergistic effect between local anaesthetic and opiates at the spinal level (dorsal root entry zone). A lot of clinical studies have shown the improvement of analgesia when opioids are added to local anaesthetics, by the subarachnoid as well as by the epidural route. The most frequent associations in use are fentanyl-bupivacaine and morphine-bupivacaine. The efficacy of these associations by peripheral perinervous routes is more controversial. In any cases, one must be aware of the incidence of potential side-effects of opioids and, consequently, of the need for a close clinical monitoring of the patients, at least for the duration of action of the agent injected by the spinal or the epidural route.

Adult↗