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J C Rouge

Publications and source records attributed to J C Rouge.

At least 37 records · Page 2Linked to original sources
PubMed1990

Effect of volatile anesthetics on vecuronium-induced neuromuscular blockade in children.

We studied 60 children undergoing elective surgery to evaluate the effect of interactions between vecuronium and isoflurane or halothane on the potency and duration of neuromuscular blockade, as measured by electromyography. Vecuronium was first administered by a logarithm-based cumulative method (14, 22, 35, 56, 89 micrograms/kg) in 10 children anesthetized with thiopental (5 mg/kg), alfentanil (15 micrograms/kg first dose, then 10 micrograms/kg), and N2O/O2 (60:40) until a 95% +/- 2% twitch depression (ED95) was obtained. Thirty children given the same balanced anesthesia were then randomly assigned to three groups (n = 10 in each) to receive a single ED20 (21 micrograms/kg), ED50 (33 micrograms/kg), or ED80 (47 micrograms/kg) intravenous bolus of vecuronium calculated from the mean regression line of twitch responses of the first 10 children. In the second part of the study, 20 children were anesthetized with isoflurane (1.2%) or halothane (0.7%) and compared with the previous 10 children anesthetized with alfentanil-N2O. Potency of vecuronium determined by single-bolus or logarithm-based cumulative techniques was not significantly different. Isoflurane and halothane significantly decreased ED50 (22.3 +/- 1.6 and 25.4 +/- 1.4 micrograms/kg, respectively; mean +/- SE) and ED95 (41.5 +/- 3.3 and 46.7 +/- 3.2 micrograms/kg, respectively) compared with alfentanil-N2O (ED50: 32.8 +/- 0.8 micrograms/kg, ED95: 70.5 +/- 2.6 micrograms/kg). Recovery rate from vecuronium-induced neuromuscular blockade was significantly longer with isoflurane than with alfentanil-N2O or halothane. We conclude that in children single-bolus and logarithm-based cumulative techniques give similar potency estimates for vecuronium. Isoflurane and halothane increase by similar amounts the neuromuscular potency of vecuronium.(ABSTRACT TRUNCATED AT 250 WORDS)

Alfentanil↗
PubMed1990

[Is the progesterone test a generalizable method of screening for neoplastic and preneoplastic lesions of the endometrium?].

A "progesterone test" has recently been proposed as a tentative method to detect early neoplastic and pre-neoplastic lesions of the uterus endometrium. At the time progesterone is stopped, a "deprivation" metrorragia demonstrates a remanent hyperoestrogenism, which represents a well-known risk factor for this type of lesion. The method has been evaluated in private practice; 389 patients were offered the test: 87% accepted. Metrorragias were observed in 28% of the cases; however, no neoplastic nor pre-neoplastic lesions could be detected in this group of patients. Moreover, one patient presented with an advanced endometrial cancer one year after a negative test. The reliability of such a test clearly needs further evaluation.

Aged↗
PubMed1989

Pipecuronium-induced neuromuscular blockade during nitrous oxide-fentanyl, isoflurane, and halothane anesthesia in adults and children.

To determine in adults and children the dose-response relationship and the duration of action of pipecuronium bromide during fentanyl-nitrous oxide (N2O), isoflurane, and halothane anesthesia, the authors studied 30 ASA Physical Status 1-2 adults (age: 16-55 yr) and 30 ASA Physical Status 1-2 children (age: 1.7-11.5 yr) during minor elective surgery. Patients were anesthetized with N2O/O2 (60:40) supplemented with either fentanyl (4 micrograms/kg), or isoflurane (adults, 0.9%; children, 1.2%), or halothane (adults, 0.6%; children, 0.7%). Neuromuscular (NM) blockade was measured by electromyography. Incremental iv doses of pipecuronium were administered to determine the cumulative dose-response relationship of pipecuronium until a 95% twitch depression (ED95) had been obtained. In adults, ED50 was 31.7 +/- 2.9 micrograms/kg (mean +/- SE) during fentanyl-N2O/O2, reduced by isoflurane (18.0 +/- 4.8 micrograms/kg, P less than 0.05) but not by halothane (25.0 +/- 2.6 micrograms/kg, NS). ED95 was 59.4 +/- 5.4 micrograms/kg during fentanyl-N2O/O2, reduced by isoflurane (42.3 +/- 2.5 micrograms/kg, P less than 0.05), but not by halothane (49.7 +/- 3.1 micrograms/kg, NS). In children, ED50 was 43.9 +/- 4.7 micrograms/kg during fentanyl-N2O/O2, reduced by isoflurane (23.1 +/- 1.6 micrograms/kg, P less than 0.05), and halothane (33.2 +/- 3.2 micrograms/kg, P less than 0.05). ED95 was 79.3 +/- 9.8 micrograms/kg during fentanyl-N2O/O2, and reduced by isoflurane (49.1 +/- 3.1 micrograms/kg, P less than 0.05), but not by halothane (62.5 +/- 7.3 micrograms/kg, NS). Comparison between adults and children reveals no statistically significant differences, except for ED50 during fentanyl-N2O/O2 anesthesia which was increased in children.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Effect of low dose dopamine on hemodynamic and renal function in children.

The purpose of the study was to investigate the effect of low doses of dopamine in children. Fourteen cases were studied after open heart surgery. Cardiac output and renal parameters were determined under baseline conditions and under continuous infusion of dopamine 2.5 and 5 micrograms/kg/min. During the control period cardiac index was 2.62 +/- 0.19 L/min/m2, renal plasma flow was decreased at 269 +/- 41 mL/min/1.73 m2, GFR was 86.6 +/- 9.2 mL/min/1.73 m2, and filtration fraction was elevated at 37.1 +/- 1.9%. Plasma concentration of aldosterone correlated with the filtration fraction. At 5 micrograms/kg/min dopamine increased significantly cardiac output, renal plasma flow, and to a lesser extent GFR, thus decreasing the filtration fraction. At 2.5 micrograms/kg/min dopamine, increased renal plasma flow only in patients older than 5 y and had no effect on the other parameters. The increase of cardiac output in response to dopamine was abolished by propranolol pretreatment. By contrast, the hemodynamic renal response to dopamine was not altered by beta-blockade. These results indicate that 5 micrograms/kg/min of dopamine could prevent renal failure after open heart surgery in children by increasing renal blood flow and attenuating renal compensatory mechanisms.

Adolescent↗
PubMed1989

Chronotropic and inotropic supports are both required to increase cardiac output early after corrective operations for tetralogy of Fallot.

To assess the respective roles of chonotropism, inotropism, and afterload reduction in increasing cardiac index early after corrective operations for tetralogy of Fallot, we measured vascular pressures and cardiac output and evaluated left ventricular dimension changes before and after a 35% rise in heart rate over baseline. This rise was induced by atrial pacing with intact atrioventricular conduction, isoproterenol, or atrial pacing together with dobutamine. With atrial pacing, left ventricular end-diastolic diameter decreased (38.7 +/- 4.3 to 34.2 +/- 5.6 mm, p less than 0.05), the shortening fraction (ratio of the difference between left ventricular end-diastolic and end-systolic diameters to left ventricular end-diastolic diameter) remained constant, and stroke volume index was reduced (28.8 +/- 4.5 to 19.7 +/- 4.6 ml/m2, p less than 0.05). As a result, cardiac index was left unchanged. When dobutamine was added as supplemental inotropic support, left ventricular end-diastolic diameter remained constant, shortening fraction increased (30% +/- 5.4% to 36% +/- 3.3%, p less than 0.05), and cardiac index rose significantly (3.04 +/- 0.61 to 4.18 +/- 0.85 L/min/m2, p less than 0.05). Heart rate acceleration with isoproterenol, combining chronotropism, positive inotropic support, and afterload reduction, slightly increased left ventricular end-diastolic diameter, significantly raised shortening fraction, and markedly enhanced cardiac index (3.03 +/- 0.55 to 4.9 +/- 1.09 L/min/m2). Atrial pacing with intact atrioventricular conduction, as an isolated chronotropic stimulus, is not suited to increase cardiac index early after operations for tetralogy of Fallot unless additional inotropic support is simultaneously provided.

Adolescent↗
PubMed1988

Propranolol treatment in children with tetralogy of Fallot alters the response to isoprenaline after surgical repair.

When propranolol is given to prevent hypoxaemic episodes in children with tetralogy of Fallot who are awaiting operation it is advisable to continue the treatment until shortly before the induction of anaesthesia. Because catecholamines are often required to maintain adequate cardiac output after surgical correction the effect of preoperative treatment with beta blockers on the response to isoprenaline after the operation was investigated in nine children given propranolol before operation and nine who were not. They were studied three and 24 hours after cardiopulmonary bypass. The haemodynamic response to increasing doses of infused isoprenaline was monitored. Immediately after cardiopulmonary bypass the response to isoprenaline was significantly blunted in the patients who had been given propranolol before operation. Their dose-response curve lay to the right of that for patients not given propranolol, and this indicates competitive inhibition. Propranolol concentrations in the blood and myocardium correlated significantly with the heart rate response to isoprenaline. Twenty four hours after operation the isoprenaline response was similar in both groups and concentrations of propranolol in the blood were minimal or undetectable. beta Blockers given up to the time of operation significantly altered the postoperative response to catecholamines.

Blood Pressure↗
PubMed1987

Prosthetic heart valve replacement in children. Results and follow-up of 273 patients.

We report the results and long-term follow up in 273 children (aged 2 to 16 years) who underwent prosthetic valve replacement. Mechanical valves (mostly Starr-Edwards) were used in almost all, and in 62 children more than one valve was replaced. Operative mortality was 4.7%. Actuarial survival curves (including hospital mortality) indicate a 86% survival rate at 5 years and 75% at 10 years. For isolated mitral valve prostheses (the largest subgroup), the figures are 87% at 5 years and 82% at 10 and 15 years. The main complication was thromboembolism, which occurred at a linearized rate of 2.7 per 100 patient-years. Actuarial curves indicate that 88% of patients are embolus free at 5 years, and 77% at 10 years. No patient with aortic valve replacement only had an embolism. Five of eight tricuspid prostheses thrombosed. Patients given aspirin and dipyridamole only did not have a higher rate of thromboembolic events than those given warfarin. There were five cases of endocarditis (two fatal) and four of dehiscence. No patient so far has needed replacement of a prosthesis because of somatic growth. Thus valve replacement can be performed with low mortality in children, and with satisfactory long-term survival. Thromboembolism remains a significant problem, although it appears to be less common than in adults. In this study, treatment with antiplatelet drugs only did not carry a higher rate of thromboembolic events than did treatment with warfarin.

Actuarial Analysis↗
PubMed1986

[Tetralogy of Fallot: long-term evolution following corrective surgery].

To evaluate the immediate and long term results of complete correction of tetralogy of Fallot (TF), we have reviewed the records of 275 children operated on in Geneva between 1972 and end 1984. The average age at operation was 6 7/12 years (range 7 months to 16 years). Postoperative follow-up ranged from 1 year to 12 years (average 3 7/12 years). The survival rate, taking into account immediate postoperative mortality, was 90 +/- 2% after one year, 88 +/- 2% after 5 years and 88 +/- 2% after 11 years for the entire patient group. The total mortality of 9.8% has markedly decreased in recent years (14.5% before and 5.7% after 1978). Mortality is highest within the first 30 days after the operation (20 cases, 7.3%). Mortality was higher after previous palliative surgery (5/51) and for children who had to be reoperated for a residual lesion (4/23). Once the first postoperative year has passed, mortality is low: 2 deaths occurred between 1 and 2 years, and one between 2 and 5 years after the operation. Cardiac catheterization in 218 patients between 2 months and one year after surgery showed severe residual pulmonary stenosis in 4 children which made reoperation necessary; a second operation was needed for a large left-to-right shunt in 5 cases, and because of a ventricular septal defect with residual pulmonary stenosis in 6 others. Pulmonary insufficiency was noted in 106 cases (38.5%) but only 3 children showed right heart insufficiency. One child underwent pulmonary valve replacement by Björk-Shiley prosthesis. It can be concluded that a child with surgically treated TF has excellent long term survival, and that life threatening complications after the first postoperative year are rare.

Adolescent↗
PubMed1986

Multiple complications after internal jugular vein catheterisation.

We report a case of a young female who developed multiple life threatening complications after a single internal jugular vein catheterisation. They consisted of pleural misplacement of the catheter, massive haemorrhage with cardiovascular collapse following catheter removal, and development of arteriovenous fistula, diagnosed 18 months later.

Adolescent↗
PubMed1984

Hemodynamic effect of isoprenaline and dobutamine immediately after correction of tetralogy of Fallot. Relative importance of inotropic and chronotropic action in supporting cardiac output.

In order to compare the effect of isoprenaline and dobutamine immediately after correction of tetralogy of Fallot, 12 randomly selected patients were studied postoperatively. Left ventricular end-diastolic volume, measured preoperatively by means of left ventricular angiograms in eight patients, was decreased to a mean value of 58.6 +/- 5.5 ml/m2 (mean +/- standard error of the mean). Postoperatively, cardiac output was measured by thermodilution before, during, and after infusion of increasing doses of isoprenaline (0.05, 0.1, and 0.2 micrograms/kg/min) and dobutamine (2.5, 5, and 10 micrograms/kg/min) successively given in each patient. Simultaneously, central venous, left atrial, pulmonary arterial, and systemic arterial pressures were recorded. Cardiac index increased significantly in response to all three doses of isoprenaline. Dobutamine produced only a small increase which was not statistically significant. Stroke volume index did not vary significantly with either drug. Consequently, cardiac index was directly related to heart rate. Preload of the left ventricle as well as afterload was significantly reduced (p less than 0.01 and p less than 0.05, respectively) by isoprenaline but not by dobutamine. An increase in left ventricular work index per minute was found with both drugs; however, only with isoprenaline was the increased work accompanied by a significant increase in cardiac index. We conclude that patients with tetralogy of Fallot usually have a small left ventricle which, immediately after correction, reacts to catecholamines by only an insignificant increase in stroke volume index. Consequently, isoprenaline is more effective than dobutamine in raising cardiac index due to the increase in heart rate. Moreover, it decreases systemic vascular resistances and obviates the need for administration of a vasodilator.

Adolescent↗
PubMed1983

[Long-term evolution of children operated on for tetralogy of Fallot].

While open heart surgery has much improved the prognosis of tetralogy of Fallot, surgical repair does not usually restore completely normal anatomy. Residual defects include some degree of pulmonary stenosis, pulmonary regurgitation (unavoidable if the pulmonic valve and valve ring need to be widened by patch), and, sometimes, residual ventricular septal defect. In addition, left and right ventricular dysfunction of mild to moderate degree, unrelated to residual lesions, may be observed. Other late complications may arise from conduction disturbances and ventricular arrhythmias. The occurrence of late sudden death is related to such rhythm disturbances, it occurs particularly in patients with ventricular premature beats on routine ECGs and is probably due to ventricular fibrillation. Patients with such premature beats must therefore be treated with antiarrhythmic drugs. In spite of these late complications, the majority of patients lead a normal life and professional integration is usually excellent. Many patients practise sports. Exercise tests late after surgery show mild or moderate decrease in maximal exercise performance if there are residual lesions of significance, and especially when there is more than one such residua (e.g. pulmonic stenosis and regurgitation). Life expectancy should be normal, at least for postoperative patients with minimal residual lesions.

Age Factors↗
PubMed1983

The hemodynamic effect of phentolamine and dobutamine after open-heart operations in children: influence of the underlying heart defect.

The hemodynamic effects of phentolamine alone and in combination with dobutamine were studied in the immediate postoperative period in two groups of children. Group 1 (N = 6; mean age, 152 months) had open-heart operation for acquired mitral valve disease. Group 2 (N = 6; mean age, 60 months) had intracardiac repair for tetralogy of Fallot. Before drug administration, cardiac index did not differ between groups, but patients with tetralogy of Fallot had a higher heart rate and smaller stroke volume index; systemic vascular resistance was high in both groups. With phentolamine (10 micrograms/kg/min), cardiac index and stroke volume index increased similarly in both groups (+ 13% for cardiac index in Group 1, +9% in Group 2), while systemic vascular resistance, pulmonary vascular resistance, and pulmonary wedge pressure decreased. When dobutamine (5 micrograms/kg/min) was added, there was a further increase in cardiac index in both groups, but it was greater in Group 1 (+17% vs +12%, p less than 0.01, compared with phentolamine alone; +33% vs +22%, p less than 0.01, compared with control). Systemic vascular resistance remained unchanged and heart rate increased in both groups, so that the left ventricular stroke work index increased. Although stroke volume index increased significantly with dobutamine in Group 1 (+11%, p less than 0.01), it remained unchanged in Group 2 (+3%, not significant). Thus in Group 2, dobutamine increased cardiac index only by increasing heart rate. This suggests that the relatively small, noncompliant left ventricle in patients with tetralogy of Fallot cannot further respond to inotropic drugs by increasing stroke volume index.

Adolescent↗