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Biomedical subjects

J C Rouge

Publications and source records attributed to J C Rouge.

At least 19 recordsLinked to original sources
PubMed2000

[Medical responsibility and nosocomial infections].

Modifications of the civil and administrative jurisprudence regarding nosocomial infections reflect the will to pay the patient for compensation for injury. The June 29, 1999 decree of the French Court of Cessation shows the transition from presumption of malpractice to obligation of safety. The authors describe those modifications, including the physician's and hospital liabilities, and assess their consequences, as proof of an external cause is now mandatory while proof of absence of malpractice is no longer sufficient.

Cross Infection↗
PubMed2000

Epidural sufentanil during paediatric cardiac surgery: effects on metabolic response and postoperative outcome.

The metabolic and neuroendocrine effects of caudal epidural analgesia were studied during paediatric cardiac surgery. Combined epidural and general anaesthesia (EPI group; n=12) was compared with deep opioid anaesthesia (DOA group; n=12). During anaesthesia and surgery, haemodynamic stability was similar in the two groups. There was no significant difference between groups concerning the metabolic response to surgery but circulating catecholamines were significantly lower in the EPI group during and after surgery. Perioperative release of IL-6 was higher in the EPI group possibly reflecting a longer aortic clamp time. Incidence of postoperative life-threatening dysrhythmias was very low in the two groups. No significant reduction of postoperative mechanical ventilation, intensive care unit or hospital stays was reported with epidural analgesia. The incidence of postoperative infections was higher than expected in the two groups because of the poor properative clinical status of most of the children included in the study.

Analgesia, Epidural↗
PubMed1999

Can gastric intramucosal pH (pHi) predict outcome of paediatric cardiac surgery?

In forty-two children undergoing cardiac surgery using hypothermic cardiopulmonary bypass (CPB), a gastric tonometer was used intraoperatively to estimate pHi, reflection of splanchnic perfusion. PHi monitoring was used to predict early postoperative complications. Intramucosal acidosis appeared after removal of the aortic clamp and remained after weaning of CPB. Fifteen children (group C) developed early postoperative life-threatening complications. Twenty-seven children (group NC) had no major complications. Retrospective data analysis showed a decrease of pHi during hypothermic CPB in the two groups but at completion of surgery, pHi was significantly lower in the group C (7.13 +/- 0.04 vs 7.31 +/- 0.001, P < 0.001). Bypass and aortic clamp times were also longer in group C and intraoperative core temperature lower. Continuous automated tonometer gas analysis appeared more accurate for the monitoring of acute haemodynamic and respiratory changes and should probably improve the predictive value of tonometry in the future. Tonometry is highly sensitive and represents an interesting and minimally invasive monitoring for critically ill children.

Cardiac Surgical Procedures↗
PubMed1997

Successful weaning from cardiopulmonary bypass after cardiac surgery using inhaled nitric oxide.

Two cases of very difficult weaning from cardiopulmonary bypass after cardiac surgery in children with pulmonary hypertension and ventricular dysfunction are reported. Children fail to respond to conventional therapy combining nitrovasodilators and inotropic support and react successfully to combined inhaled nitric oxide (NO) and epinephrine or left atrial infused norepinephrine. Postoperative NO inhalation must be prolonged and no toxicity appears. Pulmonary endothelial function recovers only after several days.

Administration, Inhalation↗
PubMed1996

Monosegmental liver transplantation from an adult to an infant.

A shortage of small pediatric organ donors has led to the development of reduced size liver transplantation in children. However, the discrepancy between donor and recipient weight can limit the use of this procedure despite transplantation of the left lobe only. Monosegmental liver transplantation using segment III only was recently described. We report here the case of an 11 month old, 6.9 kg boy who received another monosegmental graft (segment II) from a 78 kg donor on an urgent basis. Because of the lack of parenchymal landmarks between segments II and III, sterile methylene blue solution was injected into the portal vein of segment III: parenchyma of this segment colored immediately and was resected accordingly. Three and a half years later, the growth, development, and nutrition of this child were normal. This procedure seems to be helpful when the left lobe of the graft is obviously too large.

Adult↗
PubMed1996

Doxacurium pharmacodynamics in children during volatile and opioid-based anaesthesia.

The interaction between doxacurium and halothane, isoflurane or alfentanil has not been studied in children. Using the cumulative dose-response technique and electromyography, we determined ED50 and ED90 of doxacurium during halothane (n = 9), isoflurane (n = 12) or alfentanil (n = 9) based anaesthesia in children aged 2-10 years. Both isoflurane and halothane potentiated the effects of doxacurium compared to alfentanil. The ED50 for doxacurium/halothane was 23.9 micrograms.kg-1 compared to 32.7 micrograms.kg-1 for doxacurium/alfentanil. The ED90 for doxacurium/isoflurane was 32.7 micrograms.kg-1 compared to 48.2 micrograms.kg-1 doxacurium/alfentanil (p < 0.05). There were no significant time course differences between the groups. When equipotent doses of doxacurium were used to provide muscle relaxation the duration of the neuromuscular block was similar in children who received aflentanil, halothane or isoflurane supplementation of N2O/O2 anaesthesia.

Alfentanil↗
PubMed1996

A comparison of sevoflurance to halothane in paediatric surgical patients: results of a multicentre international study.

Induction, emergence and recovery characteristics were compared during sevoflurane or halothane anaesthetic in a large (428) multicentre, international study of children undergoing elective inpatient surgical procedures. Two hundred and fourteen children in each group underwent inhalation induction with nitrous oxide/oxygen and sevoflurane or halothane. Incremental doses of either study drug were added until loss of eyelash reflex was achieved. Steady state concentrations of anaesthesia were maintained until the end of surgery when anaesthetic agents were terminated simultaneously. Time variables were recorded for induction, emergence and the first need for analgesia in the recovery room. In addition, in 86 of the children in both groups, venous blood samples were drawn for plasma fluoride levels during and after surgery. There was a trend toward smoother induction (induction of anaesthesia without coughing, breath holding, excitement laryngospasm, bronchospasm, increased secretion, and vomiting) in the sevoflurane group with faster induction (2.1 min vs 2.9 min, P = 0.037) and rapid emergence times (10.3 min vs 13.9 min, P = 0.003). Among the children given sevoflurane, 2% developed bradycardia compared with 11% in the halothane group. Postoperatively, 46% of the children in the halothane group developed nausea and or vomiting versus 31% in the sevoflurane group (P = 0.002). Two children in the halothane group developed cardiac dysrhythmia and were dropped from the study. In addition, a child in the halothane group developed malignant hyperthermia, received dantrolene, and had an uneventful recovery. Mean maximum inorganic fluoride concentration was 18.3 microM.l-1. The fluoride concentrations peaked within one h of termination of sevoflurane anaesthetic and returned rapidly to baseline within 48 h. This study suggests that sevoflurane may be the drug of choice for the anaesthetic management of children.

Adolescent↗
PubMed1994

[Results of liver transplantations in Geneva or 32 consecutive transplantations without mortality in 2 years].

Between 1 january 1992 and 31 december 1993, 32 liver transplantations were performed in 29 patients (5 transplants in 3 children and 27 transplants in 26 adults) at Geneva University Hospital. Despite 5 super-urgent transplantations (3 fulminant hepatitis, 1 end-stage Wilson disease and 1 primary nonfunction), all patients are still alive and all have lived more than 10 months. On 1 october 1994, all patients were at home and 93% were in good general condition. No patient of this series had been transplanted for cancer and all patients positive for hepatitis B surface antigen receive long-term administration of anti-HBs immune globulin: in this respect, the long-term mortality risk of the present series of patients seems to be very low. Although these results highlight that liver transplantation can be performed safely by a competent medico-surgical team, two significant difficulties have to be outlined. First, patients are likely to die on the waiting list due to unavailable grafts, especially in emergency cases. Second, the postoperative period of patients with decompensated end-stage liver disease at the time of liver transplantation is still one of high morbidity. These facts underline that chronic liver disease patient should be evaluated for liver transplantation prior to the terminal decompensated stage of the disease, when the candidate's invariably poor general condition precludes successful liver transplantation.

Adolescent↗
PubMed1994

Use of Gianturco Z stents in the treatment of vascular compression of the tracheobronchial tree in childhood. A feasible solution when surgery fails.

Severe tracheomalacia secondary to extrinsic vascular compression following a switch operation for transposition is reported. Two attempts at surgical correction failed but successful treatment has been achieved by implantation of two endobronchial Gianturco Z stents. Nonabsorbable stenting in children should be used only in severe obstruction as a last resource, but this technique proved to be feasible in a child weighing 6.2 kg.

Bronchial Diseases↗
PubMed1993

Relief of severe pulmonary hypertension after closure of a large ventricular septal defect using low dose inhaled nitric oxide.

A 16-month-old girl developed severe pulmonary hypertension after closure of a large ventricular septal defect. All conventional therapeutic measures failed; an attempt to add nitric oxide at a continuous low dose to the inspired gas allowed resolution of pulmonary hypertension and low cardiac output. This report documents that continuous inhalation of low dose nitric oxide is capable of selective resolution of pulmonary hypertension following cardiac surgery for a large septal defect in a child. This suggests that a transient dysfunction in the release of nitric oxide by the pulmonary endothelial cell is responsible for the vasoconstriction.

Administration, Inhalation↗
PubMed1992

[Transesophageal echocardiography--is it indicated for children undergoing heart surgery?].

In adults transesophageal echocardiography (TEE) has become a well-established method for the assessment of cardiac malformations. In children the transthoracic approach (TTE) gives excellent resolution and cardiac malformations can be well defined in most of the cases. Uncertainty may, nevertheless, exist in complex anomalies in spite of TTE and angiography or after surgical interventions. Recently pediatric 5-mHz TEE probes have been developed with acceptable diameters of 6, 9 and 11 mm. The feasibility and the potential risks of TEE were studied in 47 patients, aged from 5 months to 16 years (mean 5 9/12 years), weighing from 5 to 47 kg (mean 19.7 kg). 35 children had congenital malformations: 15 VSD + PS, 5 VSD + PHT, 3 ASD, 5 A-V canal malformations, 1 tricuspid atresia, 2 subvalvar aortic stenosis, 3 endocarditis, 1 normal. Twelve children had rheumatic heart disease. Eight patients had more than 1 TEE. The examination was performed either under general anaesthesia just before of after surgical intervention in 32 or under sedation and with local anaesthesia in the others. There was no complication, but in 3 intubated children under 3 years of age TEE was not possible; obstruction of the endotracheal tube occurred. Adequate imaging was obtained in most of the children with one or the other probe. Additional information was obtained in 28 patients (52%). In 5 of them these informations modified the surgical procedure. We conclude that TEE is feasible in children and has a low risk of complications when practised with care.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Combined high-frequency ventilation in children with severe adult respiratory distress syndrome.

Six children conventionally ventilated for acute pulmonary parenchymal failure developed severe hypoxemia (mean PaO2 48 +/- 7 mmHg at an FiO2 of 0.95 +/- 0.08) persisting for more than 6 h despite a progressive increase in positive end expiratory pressure (PEEP) to 14.7 +/- 1.5 cmH2O. Combined high-frequency jet ventilation (HFJV, mean rate 225 b/min superimposed on small tidal volume conventional ventilation) resulted in a sustained increase in PaO2 to 93 +/- 21 mmHg, p less than 0.05 while peak inspiratory pressure decreased from 47 +/- 8 to 35 +/- 6 cmH2O and positive end expiratory pressure could be reduced to 5.8 +/- 4.5 cmH2O, p less than 0.05 and FiO2 to 0.88 +/- 0.10. This improvement occurred without new barotrauma nor deleterious effects on hemodynamic function or diuresis. After a mean of 62 h of combined function or diuresis. After a mean of 62 h of combined HFJV, persistent improvement in gas exchange allowed us to resume conventional mechanical ventilation at lower airway pressures in 4 children who continued to improve and survived. The 2 other children maintained satisfactory gas exchange on combined HFJV, but ultimately died from multiple organ failure. We conclude that combined HFJV might prove helpful to relieve profound hypoxemia and possibly decrease the risk of barotrauma in children with catastrophic pulmonary failure.

Adult↗
PubMed1991

[Verification of bacteriological safety of PCM 40 air conditioner].

This study assessed the bacteriological safety of the bedside air conditioner PCM 40 (Howorth Airtech), used for prevention of intraoperative hypothermia, by blowing filtered warm air through a special mattress. The 3 microns bacterial filter of the device released 2,968 +/- 5,618 particles of diameter less than 3 microns per m3 of room air, containing 78,798 +/- 37,243 of such particles per m3. The amount of bacteries in the air pulsed from the mattress was 30 +/- 41 cfu/m3 vs 120 cfu/m3 in the ambient air and in the hot air supply tubing it reached 6 +/- 5 cfu/m3 vs 175 +/- 77 cfu/m3. It is concluded that bacteriological data do not contra-indicate the use of this air conditioner in the operating theater. The only limitations for use are the position (prone or lateral position) and type of surgery (neurosurgery).

Air Conditioning↗
PubMed1991

Atrial natriuretic factor after heart operations in children. Relation to hemodynamic and renal parameters.

The purpose of this study was to measure changes in serum atrial natriuretic factor concentrations immediately after heart operations in children under baseline conditions and in response to continuous infusion of dopamine (2.5 and 5.0 micrograms/kg/min). During control periods, levels of atrial natriuretic factor were elevated at 190 +/- 24 and 199 +/- 36 pg/ml. The cardiac index was 2.6 L/min/m2 and the renal plasma flow was decreased to 269 +/- 41 ml/min/1.73 m2, indicating a state of renal vasoconstriction (mean renal fraction of cardiac index of 10.0% +/- 1.0%). The mean sodium fractional reabsorption was 99.0% +/- 0.2%. During dopamine infusion, atrial natriuretic factor concentrations increased to 259 +/- 57 pg/ml and to 280 +/- 56 pg/ml, with dopamine 2.5 and 5.0 micrograms/kg/min, respectively (p = not significant), whereas left atrial pressure decreased from 11.7 +/- 0.9 mm Hg during the control period to 10.1 +/- 0.9 and to 9.9 +/- 1.0 mm Hg (p less than 0.05). No correlation was found between changes in left atrial pressure and atrial natriuretic factor levels. Dopamine at 5 micrograms/kg/min increased the cardiac index to 3.0 +/- 0.2 L/min/m2 (p less than 0.001) and the renal plasma flow to 406 +/- 61 ml/min 1.73 m2 (p less than 0.001), alleviating the renal vasoconstriction. The mean urinary sodium excretion increased to 0.33 +/- 0.08 mmol/kg/hr (p less than 0.01). The atrial natriuretic factor plasma concentrations were not related to the urinary sodium excretion, renal plasma flow, or glomerular filtration rate during the control period or during dopamine treatment. These data indicate that after heart operations in children, low urinary sodium excretion occurs despite high circulating atrial natriuretic factor levels. Atrial natriuretic factor concentrations were related neither to left atrial pressures nor to the renal changes induced by dopamine.

Adolescent↗
PubMed1991

Late results of surgery for congenital heart defects.

Surgery for congenital heart defects started 50 years ago with "closed" procedures, and open heart surgery is in its forth decade. Thus, long-term results are now available. Although a majority of patients lead normal lives, problems do exist. Hemodynamic anomalies can be related to residual lesions or to persistent systemic hypertension (after coarctation repair) or pulmonary hypertension (after late repair of left to right shunt lesions). Right or left ventricular dysfunction may be observed, due to longstanding overload, hypoxia or to the open heart procedure itself. Rhythm disturbances have a tendency to increase with the passage of time after surgery. After ventricular surgery (repair of ventricular septal defect and tetralogy of Fallot), conduction defects and ventricular arrhythmias are prevalent. They may lead to late sudden death. After atrial surgery, sinus node dysfunction and atrial arrhythmias are observed. Problems related to growth of the patient exist essentially in cases where foreign material (conduits, prostheses) have been implanted. Many patients, with definitive repair or palliative operation, have become adults. This is a new challenge for the adult cardiologist, and it is a duty of the pediatric cardiologist to hand over his knowledge of this pathology.

Adolescent↗
PubMed1990

Hemodynamic effects of amrinone in children after cardiac surgery.

The hemodynamic effects of amrinone were assessed in seven children following cardiac surgery. Amrinone was administered as a bolus of 1 mg kg-1 body wt., followed by continuous infusion at 10 micrograms kg-1 min-1 for 1 h and two stepwise increases to 20 and 40 micrograms kg-1 min-1 for 30 min each. Hemodynamic data were obtained and plasma concentrations of amrinone measured 1 h after the bolus dose and immediately before each increment of the infusion rate. Amrinone levels ranged from 0.7 to 2.3 mg l-1. Administration of amrinone lowered systemic vascular resistance from 20.0 +/- 4.3 to 16.5 +/- 4.6 mmHg l-1 min-1 m-2 (p less than 0.05) and reduced mean arterial pressure from 71.7 +/- 9.5 to 62.6 +/- 13.5 mmHg (p less than 0.05) at the highest infusion rate, confirming the known vasodilative effect of the drug. However, these effects did not result in a statistically significant increase in stroke volume (35.0 +/- 7.5 to 35.5 +/- 7.0 ml m-2, NS) or cardiac index (3.10 +/- 0.50 to 3.20 +/- 0.40 l min-1 m-2). One additional patient, in whom a higher loading dose was tried in order to achieve a higher plasma concentration, developed systemic hypotension. A correlation was established between the plasma concentrations of amrinone and the percentage decrease in systemic resistance (r = 0.70, p less than 0.05). These results suggest that in children after open heart surgery, amrinone acts primarily as a systemic vasodilator, with questionable inotropic effect. Accordingly, its use should be restricted to children with severe cardiac failure and documented highly elevated afterload.

Adolescent↗
PubMed1990

Neuromuscular effect of pipecuronium bromide in infants and children during nitrous oxide-alfentanil anesthesia.

To determine in infants and children the neuromuscular effect of pipecuronium during alfentanil-N2O/O2 anesthesia, the authors studied 32 ASA Physical Status 1 and 2 pediatric patients undergoing minor elective surgery, divided into three groups according to their age: group 1 included 12 infants, 1.9 +/- 0.2 months old (mean +/- SE; range, 20 days to 3 months), weighing 5.2 +/- 0.3 kg; group 2, 10 infants, 6.1 +/- 0.9 months old (range, 3-11 months), 6.9 +/- 0.4 kg; and group 3, 10 children 5.6 +/- 0.9 yr old (range, 2-9 yr), 19.6 +/- 2.2 kg. Neuromuscular blockade at the ulnar nerve-adductor pollicis muscle was measured by electromyography. Incremental iv doses of pipecuronium were given (one 20 micrograms/kg first dose, followed by 10 micrograms/kg increments) to reach a 95 +/- 2% twitch depression (ED95). In children ED50 and ED95 of pipecuronium were 45.0 +/- 5.8 micrograms/kg (mean +/- SE) and 70.5 +/- 9.3 micrograms/kg, respectively. In 3- to 12-month-old infants ED50 and ED95 were 25.8 +/- 1.5 micrograms/kg and 48.7 +/- 3.5 micrograms/kg, respectively, and both significantly (P less than 0.05) less than those in children. In 0- to 3-month-old infants ED50 and ED95 were 23.7 +/- 1.7 micrograms/kg and 46.5 +/- 2.9 micrograms/kg, respectively, and also significantly (P less than 0.05) less than those measured in children. Time from maximal initial neuromuscular blockade to 75% recovery was 64.5 +/- 8.8 min in children and significantly shorter (P less than 0.05) in the two infant groups (0- to 3-month-old: 38.7 +/- 5.7 min, 3- to 12-month-old: 43.8 +/- 5.3 min, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Alfentanil↗