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Biomedical subjects

J E Bazin

Publications and source records attributed to J E Bazin.

At least 19 recordsLinked to original sources
PubMed2000

[Effect of bronchial drainage on the improvement in gas exchange observed in ventral decubitus in ARDS].

OBJECTIVES: A bronchial secretion draining effect is frequently suggested as a mechanism for oxygenation improvement during prone positioning (PP) in patients with acute respiratory distress syndrome (ARDS). Nevertheless, it has never really been evaluated. The aim of this study was to search for an interrelationship between the volume of the bronchial secretion and the improvement of the PaO2/FIO2 ratio during prone positioning, with NO inhalation or not. STUDY DESIGN: Open prospective clinical study. PATIENTS: The study included 15 consecutive patients with severe ARDS (PaO2/FIO2 < 200 after alveolar recruitment, Murray score > 2.5). METHODS: They were returned to the prone position for 4 hours (h0-h4) combined with an inhalation of 5 ppm NO during 1 hour (h2-h3). Tracheal suction were performed hourly between h-2 and h6 and weighed on a precision scale from h-1 to h6. Haemodynamic, blood gas and respiratory compliance were recorded at h0, h2, h3, h4 and h6. RESULTS: No significant haemodynamic changes were observed in the various phases. Compared with the baseline condition at h0, PP and PP + NO respectively improved PaO2/FIO2 by 102 +/- 62% at h2 (P < 0.005) and 156 +/- 79% at h3 (P < 0.005/h0 and < 0.01/h2). 14/15 patients responded to PP and 15/15 to PP + NO (gain in PaO2/FIO2 > 10%). Concerning secretions, we collected 3.0 +/- 7.5 g, 4.4 +/- 6.1 g, 1.7 +/- 1.4 g and 1.7 +/- 1.6 between h-2 and h0, h0 and h2, h2 and h4, h4 and h6. Individual assessments showed no relationship between the PaO2/FIO2 evolution at any time and the quantity of secretions obtained during the first 2 hours in the prone position. Six patients presented secretions of less than 1 g between h0 and h2, and for whom the improvement in oxygenation was higher than average (115 +/- 53% at h2). CONCLUSION: In patients with little or moderate secretions, the improvement observed in oxygenation, with or without NO, does not depend on their volume.

Aged↗
PubMed1999

[Laryngoscope. Evaluation of a device for preventing blade contamination].

OBJECTIVE: To evaluate the efficacy and the difficulty of use of a disposable sheath which prevents the contamination of blades. STUDY DESIGN: Prospective bacteriological, virological and clinical evaluation. MATERIAL: A translucid cover sheath, made of polyethylene enclosing the blade of the laryngoscope, and delivered in clean, non-sterile packaging (Prolam, Péters). METHOD: 1) A control of sterility performed by setting-up a culture derived from the solution used for rinsing the device before its use. 2) An in vitro study of the effectiveness of preventing contamination of the blades by a polio virus/RT-PCR technique. 3) Clinical evaluation: after 200 orotracheal intubations by 12 anaesthesiologists and 15 nurse anaesthetists, a questionnaire on the ease of use was completed. RESULTS: The bacteriological study of the sheats before use showed an acceptable level of contamination. The sheath was an effective barrier against poliovirus, even after 12 h of immersion. Clinically, the sheath was easily adapted over the blade of the laryngoscope in 98% of the cases. Insertion in the mouth was considered as easy in 94% of the patients. The visualization was good or excellent in 83% of the cases and in 16% of the patients, the users experienced difficulties to intubate. CONCLUSION: The laryngoscope blade sheath is simple and easy to use, efficient and not expensive.

Bacterial Infections↗
PubMed1999

Lidocaine plus ropivacaine versus lidocaine plus bupivacaine for peribulbar anesthesia by single medical injection.

UNLABELLED: This study was designed to compare the effects of ropivacaine and bupivacaine, each combined with lidocaine, during peribulbar anesthesia by single medial injection for cataract surgery. One hundred patients were included and randomly divided into two groups of 50, given a mixture of 50% bupivacaine (0.5%) and 50% lidocaine (2%) or 50% ropivacaine (1%) and 50% lidocaine (2%), and 25 U hyaluronidase per mL with each combination. After the first injection, patients given ropivacaine exhibited significantly better akinesia than those given bupivacaine, and significantly fewer were reinjected (19/50 vs 31/50). Among the patients reinjected, peroperative akinesia and analgesia proved satisfactory in both groups. We observed three cases of diplopia caused by retraction of the internal rectus muscle and two cases of moderate ptosis after superonasal reinjection. Hemodynamic profiles were similar in the two groups, and no major side effects were noted during the observation. One percent ropivacaine may be a more appropriate agent than 0.5% bupivacaine for peribulbar anesthesia by single medial injection. IMPLICATIONS: One percent ropivacaine may be a more appropriate agent than 0.5% bupivacaine for peribulbar anesthesia by single medial injection. Combined with lidocaine, it provides better akinesia and similar analgesia.

Aged↗
PubMed1998

Assessment of postoperative pain after laryngeal surgery for cancer.

OBJECTIVES: To assess the intensity of postoperative pain after laryngeal surgery for cancer and the efficacy of analgesic injections at fixed hours. DESIGN: A prospective clinical study performed during the 3 days following laryngeal cancer surgery. SETTING: A university medical center. PATIENTS: Fifteen men (age range, 38-74 years) having just undergone a partial or total laryngectomy for epidermoid carcinoma. INTERVENTIONS: The analgesic treatment consisted of intravenous administrations at fixed hours (propacetamol or nalbuphine hydrochloride), with the possibility of rescue doses on demand. Pain and anxiety were assessed by means of visual analog scales (graduated from 0-10) every 3 hours on postoperative day 1, then every 6 hours on postoperative days 2 and 3. Objective criteria, ie, heart and respiratory rates and mean blood pressure, were measured with the same schedule. MAIN OUTCOME MEASURES: Postoperative pain and anxiety intensities and their variations were analyzed. Correlations between postoperative pain and other criteria were researched. RESULTS: Postoperative pain had a high initial level (maximum median, 7), then decreased and reached a score of 3 at the 30th hour. Unpredictable individual peaks of pain were reported. Anxiety was never high (maximum median, 4). No individual correlation was found between pain and objective parameters. CONCLUSIONS: After laryngeal surgery for cancer, pain can reach high levels, particularly in the first hours following recovery. Analgesic administrations at fixed hours are not effective enough. Postoperative analgesic treatment should aim to prevent the high initial pain and be individually adapted.

Acetaminophen↗
PubMed1998

Combined nitric oxide inhalation, prone positioning and almitrine infusion improve oxygenation in severe ARDS.

PURPOSE: To determine the efficacy and side effects of prone positioning (PP) and nitric oxide (NO) inhalation, alone, associated, or combined with i.v. almitrine for the treatment of hypoxaemia in severe acute respiratory distress syndrome (ARDS). METHODS: Over a period of 20 months, 27 consecutive critically ill patients with severe ARDS (Murray score > 2.5, PaO2/FiO2 < 170 after alveolar recruitment) were prospectively and randomly included. They inhaled NO for two hours at concentrations of 5 and 10 ppm for one hour each (H0-H2). One hour later, they were returned to the prone position for four hours (H3-H7). During the last two hours in this position (H5-H7), they were assigned to further inhalation of 10 ppm NO (Group B, n = 9) or to no further inhalation (Group A, n = 9). In group C (n = 9), the procedure for group B was combined with perfusion of 16 mg.kg-1.min-1 almitrine throughout the study. RESULTS: Compared with control values, two hours NO inhalation improves PaO2/FiO2 and shunt effect by +28% and -9%, PP by +88% and -27%, PP + almitrine by +132% and -28%, NO + almitrine by +153 and -28%, PP + NO by +94% and -29%, NO + PP + almitrine by +327 and -48%. NO inhalation reduces pulmonary vascular resistance. Other haemodynamic parameters remain unchanged, whatever the treatment. NO inhalation improves PaO2/FiO2 by over 20% in 50% of the patients and PP is effective in 78% of the cases. CONCLUSION: Prone Position improves PaO2/FiO2 significantly more than NO alone but less than PP + almitrine or NO + almitrine. The best results are obtained with the association of NO + Prone position + Almitrine.

Administration, Inhalation↗
PubMed1998

[Prolonged effect of midazolam with delayed postanesthetic recovery from the possible interference of famotidine].

We report the case of a 79-year-old woman, in chronic renal insufficiency who recovered from anaesthesia after a delay of 24 hours, after flumazenil (Anexate) administration. She was given famotidine (Peptidine) the day before surgery. Midazolam was administered for premedication (5 mg per os) and for the induction of anaesthesia (2 mg intravenous). Among the various causes of delayed recovery in this elderly patient, an interaction between midazolam and famotidine is discussed.

Accidental Falls↗
PubMed1998

[Catabolic aspects of cranial trauma].

During their stay in the intensive care unit, head-trauma patients develop a hypermetabolic and a hypercatabolic status. Their nitrogen balance is highly negative and the muscular proteolysis is largely increased. The nitrogen losses originate mainly in muscles, resulting in muscle wasting and weakness. The whole protein synthesis remains quite normal, but this does not reflect the reality, as muscular protein synthesis is decreased, while hepatic protein synthesis is increased. The increased proteolysis seems to be due to the activation of the three proteolytic pathways, particularly the ATP-ubiquitin-dependent pathway. The causes of the increased muscle proteolysis in head trauma patients remain unclear. The increased glucocorticoid release, which is integrated in the acute phase response to injury, could be one of them. Glutamin, vitamin or zinc supplementation has been proposed in head trauma patients. The use of glucocorticoid antagonists, recombinant growth hormone or anti-cytokines are our fields of research.

Craniocerebral Trauma↗
PubMed1998

The effects of volume and speed of injection in peribulbar anaesthesia.

We have evaluated the effects of the volume and speed of administration of local anaesthetic during peribulbar anaesthesia. One hundred and forty patients scheduled for cataract surgery were randomly allocated to one of four groups of 35. Each patient received an injection of the same mixture of lignocaine, bupivacaine and hyaluronidase. Patients in group A were given 9 ml at a speed of 5 ml.min-1, group B were given the same volume at 12 ml.min-1, group C were given 13.5 ml at 5 ml.min-1 and group D were given 13.5 ml at 12 ml.min-1. A significantly higher incidence of satisfactory akinesia was found in group D, whose pain score at injection was no higher than for the other groups. Large volumes of local anaesthetic significantly affected intra-ocular pressure. The incidences of early and late ptosis or diplopia were not affected by either the rate of injection or the volume of local anaesthetic.

Aged↗
PubMed1998

Effects of etomidate, propofol and thiopental anaesthesia on arteriolar tone in the rat diaphragm.

We have assessed, by intravital microscopy in rats, the effects of different anaesthetics on diaphragmatic arteriolar diameter. Rats were anaesthetized with etomidate, propofol or thiopental (groups E, P and T, respectively) and the diameters of the arterioles were measured sequentially at baseline and after topical application of either mefenamic acid (MA, 20 mumol litre-1) or N omega-nitro-L-arginine (NNA, 300 mumol litre-1), inhibitors of prostaglandins and nitric oxide, respectively. In group E, baseline arteriolar diameters were significantly higher than those in the two other groups (P < 0.01). MA and NNA induced significant constriction in the three groups (P < 0.001). However, whereas constriction induced by NNA was similar in the three groups, constriction induced by MA was significantly higher in group E compared with groups P and T (P < 0.05). We conclude that diaphragmatic arteriolar diameters in rats were greater during etomidate than during thiopental or propofol anaesthesia. This phenomenon may be mediated by prostaglandins.

Anesthetics, Intravenous↗
PubMed1997

[Effects of anesthetic agents on intracranial pressure].

Barbiturates, etomidate and propofol decrease cerebral blood flow (CBF), mediated by a decrease in cerebral metabolism, thus decreasing intracranial pressure (ICP). As the reduction in CBF is secondary to a decrease in cerebral metabolism, these agents will have little effect on CBF or ICP in patients without active cerebral metabolic activity. Ketamine is usually not administered for the anaesthetic management of patients at risk of intracranial hypertension because of the reported increases in cerebral metabolism, CBF and ICP. The increase in CBF, however, may be partly mediated by a sympathetically induced increase in blood pressure and partly by a simultaneous increase in PaCO2 in spontaneously breathing patients. More recent studies report no increase in ICP or flow when ventilation is controlled or when other agents are associated. There is renewed interest in ketamine because it blocks excitatory amino acid receptors in the brain. Synthetic opioids including fentanyl, sufentanil, and alfentanil have been reported to cause an increase in ICP in patients with various intracranial lesions. When blood pressure was supported, no clinically relevant increase in ICP or flow velocity with alfentanil or sufentanil was observed. Thus, the increase in ICP reported with these agents may be related to the compensatory autoregulation-mediated vasodilation, underscoring the importance of administering these agents carefully to avoid systemic hypotension. Halothane consistently increases CBF and should not be used in patients with increased ICP. In contrast, isoflurane does not cause increase in CBF at concentrations below 1 to 1.5 MAC, although the effects on cerebral blood volume are less clear. Desflurane and sevoflurane have similar effects. CO2 reactivity is preserved with all inhaled agents. In patients with increased ICP however, it would be preferable to avoid these agents or to administer very low doses.

Anesthetics↗
PubMed1997

[Brachial plexus block: effect of the addition of sufentanil to local anesthetic mixture on postoperative analgesia duration].

OBJECTIVES: To compare the quality and the duration of analgesia produced by a supraclavicular brachial plexus blockade obtained with a mixture of lidocaine and bupivacaine when supplemented or not with sufentanil. STUDY DESIGN: Prospective, randomized, double-blind study. PATIENTS: The study included 40 patients undergoing osteosynthesis of the upper limb under brachial plexus block, randomly assigned to two groups. METHODS: The patients of the control group were given 0.5% bupivacaine 1 mg.kg-1 and 1% lidocaine 2 mg.kg-1. Those of the sufentanil group, received the same mixture supplemented with sufentanil 0.2 mg.kg-1. During the postoperative period, the characteristics of analgesia were blindly evaluated every hour for 48 h with a visual analogic scale graduated from 0 to 100. Analgesia was considered satisfactory when the score was below 30. Adverse effects of opiates (drowsiness, pruritus, nausea and vomiting) were also assessed. Oxygen saturation was continuously monitored. Blood pressure, heart and respiratory rates were measured at the same intervals than analgesia. Duration of analgesia are expressed as medians (range) and compared using a Mann and Whitney's U test. RESULTS: The respective durations of satisfactory analgesia were significantly different: 12.5 h (8-17) in the control group versus 24 h (8-48) for the sufentanil group. The adverse effects in the sufentanil group were nausea (2), vomiting (1) and pruritus (1). No respiratory depression was noted. CONCLUSION: Sufentanil added to a mixture of lidocaine and bupivacaine increases twofold the duration of postoperative analgesia following branchial plexus blockade.

Analgesics, Opioid↗
PubMed1997

[A rare cause of accidental selective intubation: right upper lobar bronchus originating from the trachea].

A case of accidental selective intubation of a right upper lobar bronchus originating from the trachea, in a woman with a normal preoperative chest X-ray, is reported. The preoperative diagnosis of an asymptomatic tracheal bronchus is often difficult on a standard chest X-ray, especially since a chest X-ray is no longer systematically included in the preanaesthetic assessment. Therefore, the presence of a bronchial malformation should be considered as a cause of ventilatory problems, particularly those occurring after tracheal intubation.

Anesthesia, General↗
PubMed1997

Haemodynamic conditions enhancing gas embolism after venous injury during laparoscopy: a study in pigs.

This study was designed to determine the conditions that promote carbon dioxide embolism after venous injury during laparoscopy in pigs. Injury to an iliac vein was filmed during laparoscopy in the presence of a pneumoperitoneum created at increasing pressures from 0 to 30 mm Hg in 5-mm Hg increments. At intraperitoneal pressures less than 20 mm Hg, there was a parallel increase in femoral venous pressures, resulting in haemorrhage, with persistent blood flow to the inferior vena cava. At intraperitoneal pressures of 20-30 mm Hg, there was collapse of the femoral vein, occurring earlier in the presence of hypovolaemia. Between these two states (haemorrhage and collapse), there was a point of equilibrium which allowed retrograde venous penetration of carbon dioxide bubbles. During release of the pneumoperitoneum, these bubbles were exteriorized through the area of the injury, but some passed into the inferior vena cava where their presence was detected by an oesophageal Doppler probe.

Animals↗