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Biomedical subjects

J C Granry

Publications and source records attributed to J C Granry.

At least 37 records · Page 2Linked to original sources
PubMed1997

The analgesic efficacy of an injectable prodrug of acetaminophen in children after orthopaedic surgery.

The analgesic efficacy and safety of propacetamol, an injectable prodrug of acetaminophen, (paracetamol) were studied in 87 children (36 boys, 51 girls; age 6-13; mean age 9.5 years) immediately after limb surgery. Using a double-blind, randomized, parallel group design, the effects of a single IV infusion of 30 mg.kg-1 propacetamol (i.e. 15 mg.kg-1 acetaminophen) were compared with a single injection of placebo (PL). Efficacy was assessed on pain scores rated on a four-point verbal scale, a five-point visual scale (faces) and on a four-point relief verbal scale before administration (T0) and 0.25, 0.5, 1, 2, 3, 4, 5, 6 h after administration. At the end the global efficacy was rated by the physician on a five-point verbal scale. Propacetamol was statistically superior to placebo on all assessment criteria. Seven side-effects were recorded: five in the propacetamol group and two in the placebo group. 30 mg.kg-1 propacetamol provided a significantly greater analgesic effect than placebo in children after orthopaedic surgery.

Acetaminophen↗
PubMed1997

The benefit of using a heat and moisture exchanger during short operations in young children.

We studied the efficiency of a heat and moisture exchanging filter (HMEF; Pall BB25) as a means of compensating for the heat and moisture loss during anaesthesia in young children using cold and dry gas supplied from open circuits. Forty ASA I children (mean age: 48 months +/- 20; mean weight: 16 +/- 3.5 kg) were randomized into two groups: Group I without HMEF/Group II with HMEF. The two groups did not show any significant differences for morphometric data or ventilation parameters. Relative humidity and temperature measurements in anaesthetic gases were taken using a combined temperature/humidity probe introduced into the circuit. Absolute humidity in the circuit was calculated from these measurements. In Group II, a significant increase (P < 0.001) in absolute humidity was demonstrated (Group I: 12 mg H2O.1(-1) vs Group II: 22 mg H2O.1(-1). This increase appeared immediately after introduction of the HMEF in the circuit and remained constant throughout the duration of the operation. Thus, the use of the device is recommended for young children, even for operations of short duration.

Anesthesia, Closed-Circuit↗
PubMed1996

Excision of bronchogenic cysts in children using an ultrathin fibreoptic bronchoscope.

PURPOSE: We report the use of an ultrathin fibreoptic bronchoscope (Olympus N20: external diameter: 2.2 mm) as the means of airway endoscopic monitoring during anaesthesia for the excision of mediastinal bronchogenic cysts in two young children. CLINICAL FEATURES: The first, a four-month old boy, presented with stridor and wheezing due to a subcarinal bronchogenic cyst compressing the two main bronchi. The second, an eight-day-old girl whose trachea was intubated, presented with respiratory noise in relation to a bronchogenic cyst compressing the end of the trachea. In both cases, airway endoscopy was performed during anaesthesia with the ultra thin fibreoptic bronchoscope. Endoscopic monitoring allowed, first, a good evaluation of the degree of cyst compression on the airways. Second, the endotracheal tube could be positioned or repositioned with precision in order to avoid severe compression or spilling of liquid into the airways and to allow protection of the suture. Finally, video transmission helped the surgeon to visualize the surgical repair from the inside. CONCLUSION: When added to the classical monitoring using SpO2, PETCO2 and airway pressure, peroperative endoscopic control provides complementary information which can help to detect possible complications more rapidly. This technique could be extended to all airway surgery on very young children.

Bronchogenic Cyst↗
PubMed1996

[Programmed autologous blood transfusion in children. Results of a national survey].

OBJECTIVE: To assess the development and the current practice of predeposit autologous blood transfusion (PABT) in children in France. STUDY DESIGN: Nationwide survey with a questionnaire. METHOD: Survey conducted in January 1995, including 121 blood transfusion centres (BTC) out of which 101 replied. RESULTS: Initiated in 1979, PABT is practiced at present in 66% of BTC. This figure increased by 12% from 1993 to 1994. Orthopaedic surgery was the main indication. Other indications included bone marrow harvesting for allogenic transplantation. Concerning the inclusion criteria, the lower limit of age was 9 +/- 4 years and weight 26 +/- 10 kg. The youngest child was one-year-old and his body weight was 8 kg. CONCLUSION: The production of codified protocols would probably favour the development of PABT in children and increase its safety and its efficiency.

Adolescent↗
PubMed1995

[Familial form of pyknodysostosis with hematologic manifestations in a child].

BACKGROUND: Pyknodysostosis is characterized by post-natal onset of short-limbed short stature and generalized hyperostosis. It must be differentiated from osteopetrosis with precocious manifestations in which hyperostosis may crowd the marrow cavity with extramedullary hematopoiesis. CASE REPORTS: A boy, born from consanguineous parents presented with classical features of pyknodysostosis: short-limbed stature, large skull, frontal bossing, wide anterior fontanelle and tendency to fracture. His sister had the same features at the age of 3 months; she had hepatosplenomegaly at the age of 5 months with anemia, erythroblastosis (13%), myelemia and, at 10 months, thrombocytopenia. CONCLUSION: Hyperosostis can be complicated by development of such severe hematological manifestations as classically seen in osteopetrosis. Differential diagnosis between both entities is based upon radioclinical investigation.

Craniofacial Dysostosis↗
PubMed1995

[Indications for the use of magnesium in anesthesia and intensive care].

Magnesium (Mg), a cofactor in numerous enzymatic reactions, is often ignored by clinicians, as the symptomatology of Mg depletion is not specific and usually associated with that of the cause of the depletion. Furthermore, the plasma Mg concentration (0.8 to 1.1 mmol.L-1) is only equivalent to one percent of the total body content. A Mg deficit may exist while plasma Mg concentration is normal. Therefore other techniques for Mg assessment, such as the repletion test, as well as red blood cell and lymphocyte concentrations have been used. A renewed interest for Mg occurred as numerous studies have shown the therapeutic efficiency of Mg and as the mechanisms of its haemodynamic effects have been recognized. Mg regulates Na-K-ATPase activity, K channels activity and, most of all, it is a natural calcium channel blocking agent. These properties explain its important place in electrophysiology of myocardial cells and the effects on the tension of smooth muscles, resulting in a vasodilation and a bronchodilation respectively. The antagonistic effect of Mg on calcium decreases the presynaptic release of acetylcholine at the neuromuscular junction and the release of epinephrine at the peripheral sympathetic nerves and the adrenals. Mg potentiates the effect of non-depolarizing muscle relaxants. A Mg deficiency occurs often in ICU patients, in alcoholics and during use of diuretics. Simultaneous administration of Mg is often required for treatment of potassium deficiency. Mg has an anti-arrhythmic effect towards digoxin-mediated dysrhythmias and torsades de pointes, and can be efficient in other arrhythmias. Systematic use of Mg seems to decrease mortality of acute myocardial infarction and is justified during cardiac surgery, often associated with hypomagnesemia, because of vasodilation of coronary arteries and in order to prevent occurrence of arrhythmias. Mg, because of its calcium channel blocking properties and as it lowers the release of epinephrine, is indicated for surgery of pheochromocytoma. In eclamptic and pre-eclamptic patients, the use of Mg is valuable, but not as an anti-epileptic agent. Other clinical uses of Mg have been proposed, but they are either anecdotal or of uncertain efficiency.

Anesthesia↗
PubMed1995

[Comparison of vascular effects of magnesium sulfate and nicardipine during extracorporeal circulation].

OBJECTIVE: To evaluate the hypothesis that magnesium sulphate (SO4Mg), usually administered for protecting the myocardium and decreasing the rate of arrhythmias in cardiac surgery, was able to control the hypertensive peaks occurring during cardiopulmonary bypass (CPB), as efficiently as nicardipine (N). STUDY DESIGN: Randomized controlled trial. PATIENTS: Forty patients were allocated into two groups when hypertensive peaks occurred during CPB. The patients of the N group were then given nicardipine 0.016 mg.kg-1 and those of the SO4Mg group received magnesium sulphate 50 mg.kg-1. METHODS: Anaesthesia technique was identical and during normothermic CPB the flow remained constant at 2.4 L.min-1, during the 10 min following N or SO4Mg administration. The usual haemodynamic variables were monitored. RESULTS: Both N and SO4Mg decreased significantly the MAP and the SVR over the 9 min following their administration. The decrease was more marked after SO4Mg. As the flow of the pump was unchanged after their injection the decrease can be attributed to the relaxing effect of these agents on the smooth vascular muscles. CONCLUSIONS: SO4Mg permits to treat hypertensive peaks occurring during CPB as efficiently as N. Three grammes of SO4Mg have an hypotensive effect equivalent to that of 1 mg of nicardipine. However repetitive injections of SO4Mg cannot be recommended because of the risk for hypermagnesemia.

Aged↗
PubMed1995

[Tracheal compression by mediastinal mass in children. Value of fiberoptic tracheobronchoscopy for anesthetic management].

Due to the action of the drugs and the position of the patient, general anaesthesia in a child with a mediastinal tumor can complete the obstruction of the trachea and/or the main bronchi and possibly result in irreversible respiratory failure. The risk is directly linked to the degree of lumen amputation of the trachea, usually evaluated by CT-scan: there is a risk of accident if the degree of lumen amputation is greater than 30%. The case reports underline the value of the flexible fibreoptic bronchoscopy under local anaesthesia. This examination, as well as the CT-scan, allows to evaluate the degree of tracheal compression. Moreover, it carries a lower risk than the CT-scan which requires, in a small child, either general anaesthesia or heavy premedication which could lead to asphyxia. Total obstruction most often occurs with anterior mediastinal tumors. However, even posterior or lateral tumors can extend to an anterior position, especially in the young child. If the obstruction of the lumen is greater than 30% and if general anaesthesia is required, the fibreoptic bronchoscopy allows endotracheal intubation under local anaesthesia before general anaesthesia. We report 5 cases which illustrate the risk of tracheal compression during general anaesthesia in patients with a mediastinal tumor and substantiate the advantages of a flexible fibreoptic bronchoscope in the management of these patients before and during general anaesthesia.

Anesthesia, General↗
PubMed1994

[Comparison of the analgesic efficacy of nalbuphine and its combination with propacetamol during the immediate postoperative period in gynecologic-obstetric surgery].

This prospective randomized single-blind study compared the efficacy of a combination of propacetamol (2 g) and a low dose of nalbuphine hydrochloride (10 mg) with nalbuphine hydrochloride (20 mg) alone, in a population of 152 white female patients after gynaecologic or obstetrical surgery, for alleviation of postoperative pain in recovery room. The drugs were administered intravenously in case of pain. The population was divided into two groups: group 1 received 20 mg of nalbuphine hydrochloride and group 2 received 2 g of propacetamol combined with 10 mg of nalbuphine hydrochloride. The pain intensity was studied with the visual analogue scale and comparisons use no parametric tests (Mann and Whitney test, Kruskall and Wallis test) and Chi2 test. Groups were similar for age, surgical and anaesthesia procedures and initial pain level. The propacetamol-nalbuphine hydrochloride 10 mg association provided a significantly better analgesia than nalbuphine 20 mg during the first two postoperative hours (p < 0.05). In group 1, the analgesia score decrease was respectively 28 +/- 25 mm (range: 33-75 mm) after 1 h and 31 +/- 25 mm (range: 26-84 mm) after 2 h. In group 2, the decrease was more important: 37 +/- 21 mm (range: 5-84 mm) after 1 h and 42 +/- 23 mm (range: 20-84 mm) after 2 h. Side effects were minimal and similar in both groups (nausea, drowsiness). It is concluded that a propacetamol-nalbuphine hydrochloride 10 mg association provides better analgesia than single dose of 20 mg of nalbuphine. This association convenient analgesia with a decreased dose of nalbuphine.

Acetaminophen↗
PubMed1994

[Value of transcranial Doppler ultrasonography in the management of severe head injuries].

Transcranial doppler ultrasonography (TCD) is a non invasive technique for the assessment of cerebral blood flow (CBF). The aim of this prospective study was to evaluate the benefit of TCD for the monitoring of major head trauma patients. Therefore 10 of such patients, aged 17 to 37 years, had a TCD at admission and subsequently at least twice a day. Following data were measured simultaneously at the site of the right and the left middle cerebral arteries: the systolic (SV), diastolic (DV) and mean (MV) blood velocity, the resistance index (RI) of Pourcelot (RI = SV-DV/SV) and the pulsatility index (PI) of Gosling (PI = SV-DV/MV). Simultaneously, the mean intracranial pressure (ICP) obtained with a subarachnoid probe, the PaCO2 and the mean arterial pressure (Pa) were measured. The cerebral perfusion pressure (CPP) was calculated with the formula: CPP = Pa-ICP. A total of 132 measures were analysed. There was a linear relation between RI and CPP (r = 0.566; p < 0.001), between RI and ICP (r = 0.822; p < 0.001), as well as between PI and CPP (r = 0.563; p < 0.001) and between PI and ICP (r = 0.837; p < 0.001). In the opposite there was no statistically significant relation between ICP and MV (r = 0.18) nor between CPP and MV (r = 0.23). However, a MV over 100 cm.s-1 was regularly associated with a ICP over 60 mmHg. The close correlation between RI, PI and ICP allows to use RI or PI to estimate ICP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Value of fiberoptic bronchoscope in children with epiglottitis].

Acute epiglottitis is an infectious disease causing a severe respiratory distress. Any attempt to move the child in the horizontal position or to examine his throat can result in cardiac arrest. Diagnosis, endotracheal intubation as well as decision making of the optimal time for extubation are greatly facilitated by the use of a fiberoptic bronchoscope. The device is a paediatric model (external diameter 3.6 mm with an operating channel). It is inserted through the nare in the child in the sitting position. Oxygen is delivered through a nasal tube. The examination is performed under local anaesthesia (lidocaine 0.5%). Midazolam is sometimes added via the rectal or i.v. route. The clinical signs are monitored as well as the heart rate and SpO2. The diagnosis of epiglottitis as it is visual, is very easy and rapid once the epiglottis is observed through the fibreoptic bronchoscope. The advantage of the examination under fibreoptic bronchoscope is to allow visualization without aggression or stimulation of the pharyngolaryngeal structures and without modification of the child's position. Endotracheal intubation, which is always required, is facilitated as the child is breathing spontaneously. The expiratory flow blows bubbles of saliva, which guide the bronchoscope to the glottis. When the internal diameter of the endotracheal tube is larger than 4 mm, the bronchoscope is used as a guide. When it is less than 4 mm. the bronchoscope is inserted in the trachea with a guide wire slipped in the operating channel; the bronchoscope, but not the wire is withdrawn and the endotracheal tube is inserted over the guide wire.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchoscopy↗
PubMed1994

[Shaken baby syndrome].

The shaken baby syndrome is a relatively recent concept concerning mishandled children and characterized by cerebral lesions (subarachnoid haemorrhage, oedema, axonal injuries). A case is reported of a 11-month-old female infant, who was admitted in a paediatric intensive care unit with clinical signs of brain death after cardiopulmonary resuscitation. The CT scan showed subdural haemorrhage. Pathological examination confirmed the major blunt head trauma. The father admitted that he had shaken his daughter as "she cried too often". The mechanism of the lesions is a combination of several factors, especially the large size of infant's head and the weakness of the neck muscles. It is possible to recognize still in the perinatal period children at risk of mishandling, allowing an efficient prevention of the shaken baby syndrome.

Battered Child Syndrome↗
PubMed1994

[Is hemodilution sufficient to avoid homologous blood transfusion in reduction mammaplasties?].

The unpredictability of blood loss during reductive mammoplasties induced the authors to use a blood-sparing technique so as to avoid homologous transfusions. Intentional isovolaemic haemodilution (IIH) was performed in 38 patients. Clinical and biological criteria were used for analyzing the results. In this prospective study, IIH could not prevent the necessity of homologous transfusion for 3 patients, in the early postoperative period. In one of these cases, clotting of blood prevented its utilization. Therefore IIH appears to be an interesting alternative blood-sparing method in patients who cannot benefit easily from preoperative programmed blood auto-donation.

Adult↗
PubMed1993

Effects of thiopental on middle cerebral artery blood velocities: a transcranial Doppler study in children.

The effect of an intravenous injection of thiopental on middle cerebral artery blood velocities was assessed by transcranial pulsed Doppler monitoring in 20 children: ten head-injured patients and ten control subjects. Thiopental induced a moderate but immediate decrease of middle cerebral artery blood velocities in both groups; this variation was significant (P < 0.01) and more prolonged in the head-injured than in control patients. Transcranial Doppler ultrasonography thus appears to be suitable for monitoring children in intensive care units and could help to avoid the use of thiopental in patients with low cerebral artery blood flow velocity.

Adolescent↗
PubMed1992

[Premedication with midazolam in infants. A comparison of different modes of administration].

Midazolam presents the properties of a good premedication because of its sedative and anxiolytic activity. The aim of this study, concerning 84 children, was to compare the efficacy of midazolam according to the three ways of administration: intrarectal, oral and intranasal, in reference to a group without premedication. Results have shown the superiority of intrarectal midazolam at the dose of 0.35 mg.kg-1 30 minutes before surgery. The tolerance of this way of administration is excellent and it allows a greater sedative activity compared to the control group and to the intranasal group.

Administration, Intranasal↗
PubMed1992

[The effect of a combination of propofol and fentanyl on cerebral blood flow. A study using transcranial doppler].

The results of the association propofol fentanyl on the velocity of the middle cerebral artery were studied by means of a transcranial doppler on twenty ASA I patients without any intracranial pathology. Anaesthesia induction by propofol (2.5 mg.kg-1) and fentanyl (2 micrograms.kg-1) induced a significant fall of average velocities (p: 0.0001) and an increase of the resistance index (p: 0.0001) without any associated variation of mean blood pressure and CO2 expiratory fraction. These results corroborate the variations of cerebral blood flow and cerebral vascular resistances reported in the literature and give evidence, in all probability, of a cerebral autoregulation phenomenon.

Adolescent↗
PubMed1991

[Transcranial Doppler in anesthesia and intensive care].

Transcranial Doppler sonography (TCD) is a non invasive technique whereby ultrasonic signals may be recorded from the basal cerebral arteries by using a low frequency probe. Three routes can be used: the transtemporal approach, which studies the anterior, middle and posterior cerebral arteries; the transorbital approach, which evaluates the ophthalmic artery and the carotid canal; and the sub-occipital approach, which assesses the basilar, posterior cerebral and intracranial vertebral arteries. Normal reference values for Doppler parameters have been established for these arteries. Many factors influence them, such as the diameter of the examined blood vessel, PaCO2, cerebral blood flow and cerebrovascular resistances. There are numerous clinical applications of TCD. In anaesthesia, monitoring with this method is useful during cardiopulmonary bypass, controlled hypotension, or carotid endarterectomy. After subarachnoid haemorrhage, the degree of vasospasm can be assessed by TCD. Monitoring cerebral blood flow velocities in intensive care provides important information for the treatment of patients suffering from meningitis, or experienced a head injury, or another ischaemic-anoxic disease. The field of clinical applications of TCD is increasing greatly, but the results must always be carefully interpreted, taking into account the data of other investigations.

Anesthesia↗