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Biomedical subjects

J Deschodt

Publications and source records attributed to J Deschodt.

13 recordsLinked to original sources
PubMed1991

Brachial plexus block with bupivacaine: effects of added alpha-adrenergic agonists: comparison between clonidine and epinephrine.

The effects of clonidine and epinephrine, administered into the brachial plexus sheath, were evaluated in 60 patients who underwent surgery of the upper limb. All patients received 40 to 50 ml of 0.25% bupivacaine, injected into the brachial plexus sheath, using the supraclavicular technique. The patients were randomly allocated to two groups so that 30 patients received 150 micrograms clonidine hydrochloride (Group I), and 30 received 200 micrograms epinephrine (Group II). The quality and the duration of analgesia were assessed as well as the possible side-effects. The block produced with the addition of clonidine was longer (994.2 +/- 34.2 vs 728.3 +/- 35.8 min) and superior to that with epinephrine (P less than 0.001). No major side-effects were recorded. We conclude that the injection of clonidine into the brachial plexus sheath is an attractive alternative to epinephrine to prolong the duration of analgesia following upper limb surgery under conduction anaesthesia.

Adult↗
PubMed1989

[Anaphylaxis caused by lidocaine].

A case of a severe anaphylactic reaction in a 30 year old man after 2 ml of 1% lidocaine injected subcutaneously is reported. It consisted in pruritus, urticaria, hypotension (Pasys: 50 mmHg), tachycardia (170 b.min-1) and a coma of short duration. The patient recovered after 1 mg adrenaline injected subcutaneously. The patient's history included a less severe but similar accident, but no manifestations of atopy. The total IgE, two months after the accident, were at the upper limit of normal. A human basophil degranulation test was positive for lidocaine and negative for other amide local anaesthetic agents and preservatives. Similarly, lidocaine was the only molecule giving a positive reaction with intradermal testing. Skin sensitivity to histamine was negative. Although for several authors true allergy to lidocaine is questionable, the case reported here can be added to the other 47 published since 1961.

Adult↗
PubMed1988

[Comparison of propofol and propanidid administered at a constant rate].

So as to compare the anaesthesia obtained using propofol with that obtained using propanidid, 40 ASA I patients, aged between 18 and 50 years, who were to undergo elective orthopaedic or plastic surgery lasting more than 60 min, were randomly divided into two equal groups, one receiving propofol (PF) and the other propanidid (PD). All the patients received 0.5 mg atropine, 100 mg pethidine and 7.5 mg droperidol (10 mg if weight greater than 60 kg) intramuscularly 45 min before induction. Patients in group PF were then given 2 mg.kg-1 propofol over 1 min and 0.9 microgram.kg-1 fentanyl over 3 min, followed by a constant rate infusion of 5 mg.kg-1.h-1 propofol and 3 micrograms.kg-1.h-1 fentanyl. For PD patients, the doses of fentanyl were identical; they were given 10.6 mg.kg-1 propanidid over 3 min for induction, and 37 mg.kg-1.h-1 for maintenance. All the patients were intubated and ventilated mechanically. The usual anaesthetic parameters were monitored at induction, during surgery, and during recovery. Consciousness was lost more quickly with propofol (p less than 0.05), but the corneal reflex returned more rapidly in group PD (p less than 0.02). The time required for a full return to normal consciousness was identical in both groups. The fall, during induction, and the increase, during recovery, of Pasys were greater in group PD (p less than 0.05 and less than 0.001 respectively). Padia and heart rate were lower in group PF after the 30th min (p less than 0.05 and less than 0.01 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Course of the neuromuscular block under atracurium. Comparison with alcuronium].

Using a standardized anaesthetic protocol, the continuous monitoring of the twitch height after a 0.1 Hz stimulus was used to follow the evolution of curarization following injection of either atracurium (0.6 mg . kg-1) or alcuronium (0.2 mg . kg-1). The maximum twitch height inhibition was always greater than 99% of the control value and occurred after 107 +/- 50 s with atracurium (n = 30) and 172 +/- 120 s for alcuronium (n = 30) (p less than 0.02). Although surgical stage of muscular relaxation (twitch height less than 25% of reference value) was the same for both drugs (55 +/- 15 min for alcuronium versus 52 +/- 10 min for atracurium; n = 30 for both groups), the clinical duration (spontaneous restoration of twitch height to 90% of the reference value) was significantly longer (p less than 0.005) for alcuronium: 89 +/- 20 min (n = 10) versus 62 +/- 9 min for atracurium (n = 10). The spontaneous return to normal of the train of four was also significantly longer (p less than 0.001) for alcuronium: 118 +/- 23 min (n = 10) versus 69 +/- 7 min for atracurium (n = 10). The recovery index (the time required for twitch height to rise from 25% to 75%) was three times quicker (p less than 0.01) for atracurium (10 +/- 3 min; n = 10) than for alcuronium (30 +/- 13 min; n = 10).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1978

Nitroprusside, its metabolites and red cell function.

The effects on metabolism and red cell function of blood levels of thiocyanate (SCN-) and cyanide (CN-) were studied in 42 patients undergoing surgery under controlled hypotension (CH) induced by sodium nitroprusside (SNP). The mean dosage of SNP administered was 21.38 mg (SD = 12). The durating of perfusion was 121 minutes (SD = 11). All operations were performed under neuroleptanalgesia without complications. No tachyphylaxis was encountered. Under SNP a slight increase of blood SCN- (from 13.9 mg/l +/- 1.1 to 23 mg/l +/- 2.6) was found. Blood levels of CN- are increased mostly in the red cell, the mean value being 0.300 mg/l +/- 0.10 for whole blood after two hours of perfusion. This value decreased when perfusion was stopped. All blood samples were negative for methaemoglobin and cyanmethaemoglobin. Carbonic anhydrase activity was not modified, CN- toxicity levels for this enzyme being 50 times higher than those found during our study. 2,3-DPG levels did not vary. Blood gases, acid-base balance and Davo2 did not change significantly, although a slight increase in blood lactate was measured. As shown by this study, appreciable amounts of CN- are detected in blood during SNP perfusion while SCN- stays at relatively low levels. Fortunately most of the CN- released from SNP moves into the red cell and does not alter its functions at clinical concentrations. The low plasma concentration of CN- is not sufficient to cause important metabolic disturbances. However, dosages of SNP higher than those administered during this study could increase the blood and tissue CN- to toxic levels. A toxicity study shows that, during a relatively short period of time, SNP dosage should not exceed 1.16 mg/kg or a maximum of 10 microgram/kg/min for a period of two hours.

Adolescent↗
PubMed1978

[The use of naloxone in neuroleptoanalgesia].

Naloxone was used in 20 patients divided into two series: series A consisted of 10 adults with an average age of 50.6 years (+/- 12.03) and series B 10 children with an average age of 8.5 years (+/- 5.16). Naloxone was given in the treatment of postoperative respiratory depression related to persistence of morphine impregnation, the patients having received either fentanyl (mean dose 0.04 mg/kg/h) or dextromoramide (mean dose 1.15 mg/kg/h). The mean dose of naloxone was 0.26 mg +/- 0.10, i.e. 3.9 microgram/kg in series A, and 0.13 mg +/- 0.11, i.e. 5.3 microgram/kg in series B. In both series, study of ventilatory function showed correction and stabilisation of the various parameters (F/min, Vt and V) up to 180 minutes after the injection. Recovery was rapid in both groups (7 to 10 min) and of good quality. Whilst it was accompanied in a number of cases by the recurrence of pain, the latter never required specific relief. The administration of naloxone was associated with an increase in heart rate (non-significant) at 10 min in series A and 30 min in series B. Apart an episode of nausea in one case of series A, no disagreeable side effects were observed.

Adolescent↗
PubMed1978

[Constant flow anesthesia using a combination of etomidate and fentanyl].

In 35 orthopaedic surgery patients (33 adults and 2 children), anaesthesia was obtained using an association of etomidate and fentanyl. Induction was obtained by injection from a syringe of a mixture of etomidate and fentanyl in an average dose of 21 mg for etomidate and 0,08 mg for fentanyl. Anaesthesia was maintained by constant dose of etomidate was 1.29 mg/kg/h and 4.96 microgram/kg/h for fentanyl. The mixture used for both induction and maintenance contained 1.3 mg of etomidate and 5 mg of fentanyl per ml. The results, value, indications and contraindications of this technique are described.

Adolescent↗
PubMed1978

[Plasma concentration of fentanyl during and after its administration at constant flow].

Using the technique of the radio-immunological estimation with fentanyl-H3, a study was made in sixteen adults anaesthetised by the administration at a constant rate of alfadione and fentanyl, of plasma concentrations of fentanyl during and after anaesthesia. Anaesthesia was induced by the administration of 4.2ml of alfadione and 0.084mg of fentanyl. The maintenance dose was 0.147 ml/kg/hour of alfadione and 2.95 microgram/hg/hour of fentanyl. Five minutes after induction, the concentration of fentanyl was 2.7 microgram/l. The level fell significantly to 2.56 microgram/l at the 45th minute. From this point onwards, it increased regularly up to the 120th minute, when it reached a level of 3.7 microgram/l. When the infusion was stopped, the level first decreased rapidly, the excretion curve then becoming flattened out. At the 120th minute, a level of 1 microgram/l persisted. This study indicates that the administration of fentanyl at a constant rate is not accompanied by a constant blood concentration up to the 120th minute, the point at which the study was terminated. The residual level found after administration and in the absence of any clinical effect implies the need for a reduction in dose at the time of any complementary administration of fentanyl during the postoperative period.

Adult↗
PubMed1976

[Plasma level of the thiocyanate ion in sodium nitroprusside perfusion].

24 subjects were selected at random out of a group of 80 patients undergoing surgery under a hypotensive anaesthetic technique by means of nitroprusside perfusion; the variation of one of the metabolites, the thiocyanide ion, were assayed. Hypotension was of 30 to 380 minutes duration and mean dosage of 12,44 mg (1,99 mug/kg/min). SCN- assays were performed by means of an original technique, which is described in this publication, before any perfusion of nitroprusside, every 30 minutes during perfusion and 30 and 60 minutes after ending the perfusion. Results show that SCN- concentration is increasing during perfusion but not as much as compared with the toxic concentration. Major increase takes place 30 minutes after starting the perfusion (1,27 10(-4) M/l). Increase slows down then and remains on a plateau level until the end of the perfusion where it decreases. Those results allow to reject a toxicity risk related to an increase of SCN- during nitroprusside perfusion. However, the accidents reported after high dosage of NPS and probably related to cyanogenic ion accumulation combined with lactic acidosis as shown in this publication, led the authors to advise a dosage not over 10 mug/kg/min in a maximum of 2 hours time.

Adolescent↗
PubMed1975

[Constant outflow anesthesia with the combination of alfatesine and fentanyl].

In a previous work, the authors showed the value of administering Alfatesine, in interventions of long duration, at a constant rate by using an automatic syringe, and by combining it with destromoramide. In this new work the authors present an analagous study carried out in 47 subjects, in which dextromoramide was replaced by fentanyl. The automatic syringe used was the Braun Perfusor IV equipped with a 50 ml syringe containing 0.3 ml. of CT 13.41 and 0.006 mg. of fentanyl per ml. Induction was achieved at graduation 10, 14 ml of the mixture having been injected in approximately 60 seconds. Maintenance of anesthesia was ensured at graduation 6 corresponding to an hourly administration of 27 to 30 ml of the mixture (9 ml of CT 13.41 and 0.18 mg of fentanyl). The patients were adults of average weight 64 kg., who had undergone sometimes major orthopedic surgery, of an average duration of 161 mn. The results are looked at from the angle of quality of the anesthesia and of the awakening and of the side effects. They confirm the non-accumulation under these conditions of use and these doses of CT 13.41 used and reveals an analagous behaviour of fentanyl. Reserves are however made owing to the mode of elimination of fentanyl, on the use of such a technique in anuric patients or in renal insufficiency.

Adolescent↗
PubMed1975

[Tracheal stenosis after tracheotomy. Apropos of 12 cases in 227 observations].

Out of 543 tracheotomized patients, 227 survived and 12 of them developed a tracheal stenosis syndrome (5,28 p. 100) including: 3 supra-ostial stenosis, 1 ostial and supra-ostial stenosis, 1 ostial stenosis, 3 intermediate stenosis and 4 distal stenosis. In two cases, the stenosis was found out during the removal of the cannula and in the other cases from 3 days to 8 months after the decannulation. The deffered treatment consisted in an anti-inflammatory medical treatment treatment (one case), in a permanent dilation with an Albouker tube (two cases), and in a resection of the stenosed tracheal part plus an anastomosis. Good results were obtained in 9 cases including the recovery of a satisfactory tracheal diameter. Because of a recurrence of the stenosis after resection and anastomosis, it was necessary, in two cases, to resort to another resection and, upon another occasion, to place a permanent cannulation. Finally, in one case, 2 Rethi operations were necessary to get a sub-normal tracheal diameter. From these facts, it emerges that tracheal stenosis are less important if, during the tracheotomy, a partial resection of the tracheal wall is effected (rather than an inverted U flap folded back at the bottom) together with the putting in of a cannula equipped with an elongated cylindrical cuff requiring a less important filing-up pressure (although just as efficient as far as tightness is concerned).

Adolescent↗