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Biomedical subjects

F D'Athis

Publications and source records attributed to F D'Athis.

At least 19 recordsLinked to original sources
PubMed1999

Preoperative screening for von Willebrand disease type 1: low yield and limited ability to predict bleeding.

Type 1 von Willebrand disease (vWd) is the most common hereditary bleeding disorder. The objective of this study was to measure the von Willebrand factor antigen (vWf:Ag) in a large cohort of patients who underwent surgery to assess the role of a new rapid immunoassay in a screening procedure for vWd in preoperative conditions. We studied 832 consecutive patients (540 children, 292 adults) referred to the surgical departments. For each patient we determined the vWf:Ag level with two different assays, an enzyme-linked immunosorbent assay (ELISA)(Asserachrom vWf:Ag; Diagnostica Stago, France) and a rapid immunoassay (Liatest vWf:Ag; Diagnostica Stago). Using the reference test, we found 30 of 832 patients with a vWf:Ag value below the lower limits (21 U/dL to 46 U/dL). The coefficient of correlation between the two tests was 0.77 (P = .001). When receiver operating characteristic curves were used, the cutoff value calculated to detect vWf:Ag defect with the rapid assay was 68.5 U/dL, leading to 0.36% false negatives and 9.7% false positives. Thus the rapid immunoassay appears to be a useful and easy method that is adaptable to urgent situations. Among the 30 patients with low values in ELISA, 8 had personal or familial bleeding history. Repeat blood samples confirmed the diagnosis of vWd in 5 cases, leading to a prevalence of vWd type 1 of 0.6%. However, in our series the absence of severe bleeding complications raises the question of the screening and the management of patients bearing a type 1 Willebrand disease during surgery.

Adolescent↗
PubMed1996

Spinal anaesthesia in newborns: total and free bupivacaine plasma concentration.

This study was designed to measure total and free bupivacaine (B) after spinal anaesthesia in newborns and to evaluate a possible influence of adrenaline on B absorption. Twenty-two newborns were randomly allocated to receive either plain B (group 1) or adrenaline added to B (group 2) for spinal anaesthesia. A single blood sample was collected ten min after spinal injection. Total B concentration was found 0.31 +/- 0.17 microgram ml-1 in group 1 and 0.25 +/- 0.09 microgram ml-1 in group 2. Bound B concentration was 0.27 +/- 0.17 microgram ml-1 in group 1 and 0.22 +/- 0.09 microgram ml-1 in group 2. No difference was found between the two groups for these parameters. Albumin but not alpha 1-acid-glyco-protein correlated to age and weight, bound B correlated to alpha 1-acid-glyco-protein but not to albumin. Despite the low plasma concentration of binding proteins in newborns, spinal anaesthesia with B does not result in a high level of free drug. Adrenaline does not have any pharmacological advantage in these patients.

Absorption↗
PubMed1993

Pharmacodynamics of vecuronium in patients with and without renal failure: a meta-analysis.

Eight trials comparing the effects of vecuronium in patients with either normal renal function or renal failure were subjected to a meta-analysis. Vecuronium doses were similar in the different trials, identical in the two patient groups of any given trial, and ranged from 0.05 to 0.14 mg.kg-1. Neuromuscular blockade was assessed by TOF or single twitch stimulation, and recorded by either mechanomyography or electromyography. Indices of blockade included onset time (from injection to maximal twitch depression), duration of action (from injection to recovery to 25% of control twitch) and 25-75% recovery index. Statistical analysis used Hedges method: effect size and variance were calculated for each relevant outcome, then the global effect size was estimated by pooling the effect sizes of each trial. Three separate meta-analyses were conducted. No differences were found either in onset time, or in recovery index between the two groups, whereas the duration of action was longer in the renal failure group. It is concluded that renal function is likely involved in the pharmacokinetic parameters of vecuronium.

Adult↗
PubMed1993

[The Relative Complexity Index beta: value of each parameter].

The French health policy PMSI project (Program for a Medical Information System) is mainly aimed at development of cost analysis based on diagnosis related groups. An indicator of the relative costs of anaesthetics, the relative complexity index (ICR beta), was defined as the result of a computation of different indexes of surgical and anaesthetic procedures such as duration, patients ASA status, degree of emergency, stay in the recovery room. The aims of this study were 1) to analyze relative part of each index in ICR beta value and in ICR beta variance and 2) to assess the value of ICR beta as a cost or a complexity index. The study included 14,435 anaesthetics analyzed with the Dunn and Clarks multiple linear regression. Mean ICR beta was 267.28. The duration of the procedure accounted for 46% of the ICR beta value and surgery for 25%. The anaesthesia and the recovery accounted for 15% of the ICR beta value, but only for 0.0341 and 0.0347 respectively of the ICR beta variance. The product of the surgical procedure index by the ASA status index accounted for 0.259 of the ICR beta variance and the duration index for 0.650. The comparison of homogeneous groups with regard to the surgical procedure shows that intravenous anaesthesia accounts for 12.4% of the ICR beta value, inhalational anaesthesia for 13.84%, but exceeds 15% for regional anaesthesia (44.5% for caudal anaesthesia). For appendectomies (n = 114) duration index is still an important parameter in ICR beta variance (delta R2 = 0.354) but equivalent to the emergency index (delta R2 = 0.363).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1989

Is epidural anaesthesia using bupivacaine safe in patients with atrio-ventricular conduction defects?

Bupivacaine is known to interact with the conductive system of the heart, also when used in epidural anaesthesia. Ten patients, undergoing bupivacaine epidural anaesthesia for lower limb or pelvic surgery, who presented a history of cardiac conduction disturbances, were studied. The ECG was continuously monitored and a right ventricular bipolar electrode was used to monitor the following parameters: heart rate, QRS duration, QT, Atria-His and His-Ventricle intervals. No significant change was noticed, even in patients with a high grade conduction defect. The mean plasma level of bupivacaine was 0.33 +/- 0.23 micrograms/ml. Based on this experience, it seems that lumbar epidural anaesthesia with bupivacaine can be safely used in patients with asymptomatic AV conduction abnormalities.

Anesthesia, Epidural↗
PubMed1988

Epidural analgesia with a bupivacaine-fentanyl mixture in obstetrics: comparison of repeated injections and continuous infusion.

We compared the efficacy and side-effects of continuous infusion versus repeated injections of epidural bupivacaine-fentanyl during labour. Forty-four parturients were randomly distributed into two groups balanced for population size, morphology and parity. Analgesia was begun at the same stage of labour with a mixture of 20 ml 0.25 per cent plain bupivacaine and 2 ml (100 micrograms) fentanyl. In Group I the initial dose ranged from 8-12 ml as a function of height; an injection of the same dose was repeated immediately upon recurrence of pain. In Group II, after an initial dose of 5-7 ml, a continuous infusion of 3 ml.h-1 was begun, and continued until full dilatation. Analgesia was rated using a pain scale; effects on maternal blood pressure, respiratory rate and neonatal status were noted. Bupivacaine and fentanyl assays were carried out on maternal venous blood in 30 parturients during the course of labour. There was a longer latency to onset of analgesia in Group II (approximately five minutes), followed by a more constant degree of analgesia. This better analgesia cannot be accounted for by a difference in dosage; doses were significantly lower in Group II, despite the fact that labour was of the same duration. The course of labour, and maternal and neonatal status were comparable in the two groups. Assays showed no difference in bupivacaine blood concentrations between the two groups nor signs of drug accumulation. The constant infusion technique is advantageous since it provides a more regular degree of analgesia with lower doses than those required for patients having repeated injections.

Adult↗
PubMed1984

[Abdominal injuries. Value of emergency abdominal echotomography].

The purpose of this study was to evaluate the usefulness of abdominal ultrasonic tomography, among other methods, to detect visceral lesions in multiple traumas of the abdomen. Forty-seven case-records of abdominal traumas observed over an 8-month period were selected. We used a real-time sectorial ultrasound scanner with a 3.5 MHz probe. Positive results were obtained in 11 patients who were operated upon. None of the 33 patients with negative results and only one of the 3 patients with doubtful results underwent surgery. We found that suggestive symptoms were compatible with the absence of any severe visceral lesion and, conversely, that patients with multiple traumas but little suggestive symptoms could present with one or several intra-abdominal lesions. Abdominal ultrasonic tomography can rapidly be performed and its indications are different from, but wider than, those of peritoneal lavage. It is a safe and reliable emergency examination which does not interfere with resuscitation procedures.

Abdominal Injuries↗
PubMed1984

[Effects of lidocaine at the plasma concentrations obtained by peridural injection on atrioventricular conduction disorders].

The aim of this study was to measure plasma concentrations obtained during lidocaine extradural blocks, and to determine whether these concentrations were able to induce high degree AV blocks in patients with impaired AV conduction. In a preliminary study, 12 patients were given an extradural block with an initial bolus of 3.4 mg . kg-1 lidocaine. After repeat injections, the mean total dose was 4.7 mg . kg-1. Plasma lidocaine concentrations were determined over an 8 h period after the first injection. The study itself was carried out in 14 patients with conduction disturbances undergoing His-bundle exploration. After informed consent had been obtained, the patients received an intravenous bolus of lidocaine (1.6 mg . kg-1 over 30 s). After baseline values had been measured. His conduction and lidocaine plasma concentrations were recorded 2, 5, 10, 30 and 60 min after lidocaine injection. In the preliminary study, the peak plasma lidocaine concentration was obtained at the 15th min (1.22 +/- 0.81 microgram . ml-1). In the second series, no clinical disturbance was seen after the i.v. injection of lidocaine. The peak plasma lidocaine concentration was obtained at the 2nd min (3.05 +/- 1.44 micrograms . ml-1). No significant alteration of conduction occurred after intravenous lidocaine. It is therefore possible to conclude that bifascicular AV disturbances do not constitute a contraindication to extradural anaesthesia with lidocaine.

Aged↗
PubMed1980

[Improvement in nitrogen sparing by branched amino acids during parenteral nutrition].

Two groups of ten patients each, staying in a Intensive Care Unit, received exclusive parenteral alimentation with different concentrations of branched chain amino acids (BCAA). Group A received studied solution containing 12 g N (852 mmol) with 41,1 p. 100 BCAA. Group B received control solution containing 18 g N (1278 mmol) with 21,1 p. 100 BCAA. Every patient received 60 nonprotein Kcal x kg-1 body weight/24 hr. The study was performed on five days. Measured parameters were: daily (D0 to D5) N balance, blood urea N and total protein and urinary alpha amine N, and after therapy (D6) amino acid levels. Results have shown no statistical significant difference between both groups. N balance became less negative during the therapy. Amino acid levels were in the normal range and alpha amine urinary elimination remained low in patients with parenteral nutrition. These results indicate that 12 g (852 mmol) N in BCAA rich solution are as efficient as 18 g (1278 mmol) N in standard solution, allowing a N sparing.

Amino Acids↗
PubMed1978

[Choice of a local anesthetic in obstetrical analgesia].

A local anaesthetic may be selected from amongst the two major groups of drugs of this type: amino-alcoyl-esters and amino-acylamides. In practice, three substances are available or will shortly be available in France: lignocaine, etidocaine and bupivacaine, thus limiting the choice. This choice is guided by the toxicity of the substance, its clinical effects and 1st side effects. 1-Toxicity depends upon the nature of the substance, the dose necessary to obtain analgesia and to prolong it for a sufficient time. 2-Amongst the clinical effects which should be noted in the choice of a local anaesthetic are the latent period before analgesia is obtained, the degree of sensory block, the degree of motor block and the duration of action. The three substances available are compared in relations to these parameters and in the light of the specific requirements of obstetric analgesia. The value of the addiction of adrenalin is discussed. 3-The side effects are those of the local anesthetic itself and of its possible association with adrenalin. On the basis of the various criteria mentioned, it would seem that the analgesic of choice for obstetric analgesia is bupivacaine used with or without adrenalin.

Anesthesia, Obstetrical↗
PubMed1978

[Effects of peridural analgesia on labor].

A review of the effects during labour of epidural analgesia on dilatation, expulsion and delivery of the placenta. Uncertainties in knowledge of the precise organisation of uterine innervation and of the intrinsic innervation of the organ render the study of changes in uterine contraction and in cervical resistances difficult. At circulating levels higher than those found in clinical practice, local anaesthetics have a definite oxytocic e-fect, local anaesthetics have a definite oxytoci effect, whilst adrenalin is a powerfult tocolytic. By contrast, the indirect effects related to neurolysis in extradural analgesia are negligeable. Cervico-segmentary resistances are decreased. In practice, there is no increase in the period of dilatation in the absence of any haemodynamic disturbances and if mixtures containing adrenalin are avoided. Expulsion is favourised by muscular relaxation but impaired by the lack of voluntary expulsive effort, hence the choice of a local anaesthetic with the lowest possible motor effect. Delivery of the placenta, which involves only uterine contraction, which is not affected, may be accelerated by oxytocics.

Anesthesia, Epidural↗
PubMed1976

[Use of the diazepam-pentazocine (pentazepam) combination in anesthesiology].

The authors report on 50 surgical or endoscopic cases in which local or regional anaesthesia was completed with a combination of diazepam and pentazocine (Pentazapam). This "diazanalgesia" was performed either as a routine or as a complement to regional anaesthesia (mostly an epidural) in which restlessness or insufficient analgesia were noted. Both drugs are injected separately. Diazepam being used to combat anxiety and pentazocine to allay pain. Sedation was considered to be sufficient in 43 cases out of 50 and analgesia in 47 cases out of 50. In all but one case, recovery was calm. In 24 cases, the patients regained consciensness quickly. There was only little effect on respiratory frequency, blood gases, blood pressure or cardiac rate. Thus, pentazepam combination can be considered as a useful method of "wake diazanalgesia" as far as it is used to complement a local or regional anaesthesia. This technique seems particularly useful in the aged or bad risk patient because of its moderate cardiovascular or respiratory aciton.

Adjuvants, Anesthesia↗
PubMed1976

[Indications for anti-inflammatory corticoids in anesthesia-resuscitiation].

The use of anti-inflammatory corticoids in anesthesia and resuscitation is a long-standing fact, but their indications, owing to the risks to which they expose certain patients and owing to the uncertitude concerning their mechanism of action, are still badly defined. If certain indications (attacks of asthma, laryngeal oedema, certain peri-lesional oedemas) are considered as being categorial, the usefulness of anti-inflammatory corticotherapy is being more and more and more debated in other pathological conditions : infectious or chemical pneumonias, drowning, shocked lung, post-traumatic neuro-surgical conditions, cirrhosis. Very useful in precise indications, anti-inflammatory corticoids should not be prescribed, particularly in fragile patients whom we well know in resuscitation, without having weighed up the advantages and disadvantages related to this remarkable therapeutic instrument.

Adrenal Cortex Hormones↗