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J Fusciardi

Publications and source records attributed to J Fusciardi.

At least 19 recordsLinked to original sources
PubMed2006

[Relapsing polychondritis: a possible cause of difficult extubation].

We report the case of a 54-year-old woman suspected of relapsing polychondritis who underwent a nasal septum biopsy under general anaesthesia. Tracheal intubation was unremarkable, but extubation attempts failed because of upper airway inspiratory collapse induced ventilatory distress. Definitive tracheostomy placement was mandatory. Cartilage biopsy confirmed severely developed relapsing polychondritis. Even though relapsing polychondritis is rare, anaesthesiologists should be aware of this pathology and preanaesthetic evaluation may focus on particular risks associated with upper airway cartilaginous structure anatomical and histological modifications.

Female↗
PubMed2005

[Impact of Cormack and Lehane's grade on Intubating Laryngeal Mask Airway Fastrach using: a study in gynaecological surgery].

OBJECTIVE: To evaluate the impact of Cormack and Lehane grade on the Intubating Laryngeal Mask Airway (LMA-Fastrach) using in women. STUDY DESIGN: Open prospective study. PATIENTS: The study included 115 scheduled gynaecologic surgery women. METHODS: An LMA-Fastrach was systematically performed in patients with a Cormack's grade > or =3 or when Arne's score was > or =7 whatever the Cormack. After induction of anaesthesia and neuromuscular blockade, Cormack's grade was assessed and LMA-Fastrach was inserted. Proper insertion was confirmed by the easiness of assisted ventilation and the normal aspect of the capnographic curve. Intubation through the LMA-Fastrach was carried out with the specific kit's endotracheal tube. More than two attempts were considered as a failure of the technique and an alternative method was performed. The following parameters were noted: age, weight, height, clinical predictors for difficult intubation (Arne et al.'s score), number of LMA-Fastrach insertion, ventilation efficiency through LMA-Fastrach, successful intubation with LMA-Fastrach and oesophageal intubation. RESULTS: Ventilation through the LMA-Fastrach was efficient in 97%. The success rate of intubation was 94.8% (86% on the first attempt). The success rate of ventilation and intubation were not statistically different according to the different Cormack's grades. The obesity (BMI>30) did not change the success rate of ventilation and intubation through the LMA-Fastrach. CONCLUSION: In women with either predicted or unpredicted difficult intubation, the success rates of ventilation and intubation through the LMA-Fastrach don't seem to be influenced by Cormack grade and obesity.

Adult↗
PubMed2003

[Which propofol target concentration for ASA III elderly patients for conscious sedation combined with regional anaesthesia?].

OBJECTIVE: To determine the optimal propofol target concentration between 0.9-1.1 and 1.3 mg l(-1), for conscious sedation and amnesia using Diprifusor in ASA III patients over 60 years. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: In ASA III patients over 60 years presented for elective vascular procedures under regional anaesthesia, sedation was induced with propofol TCI by increasing target concentrations from 0.9 to 1.3 mg l(-1) by 0.2 mg l(-1) steps up to a sedation score corresponding to light level (patient awakable with tactile stimulation). At baseline and each step, specific pictures were shown to the patient and clinical parameters and unwanted side effects occurrence were recorded. In PACU, memorisation of pictures and events was looked for. RESULTS: Conscious sedation was obtained in 100% of the patients at 0.9 mg l(-1), 94% at 1.1 and 78% at 1.3 mg l(-1). Amnesia was concentration-dependent and for each concentration was always more important for pictures than for events. Haemodynamic parameters did not change significantly. Incidents occurred in 12% of cases at 1.1 and 39.4% at 1.3 mg l(-1). DISCUSSION: None of those three concentrations was satisfying in 100% of cases for the three criterias (sedation < S2, amnesia and none side effects). These results suggest that propofol target concentration 0.9 microg ml(-1) could be used safely for sedation in elderly ASA III patients. Moreover, we have shown that amnesia for events requires higher propofol concentrations than amnesia for pictures during conscious sedation.

Aged↗
PubMed2002

Pigs are not a reliable experimental model in the study of the haemodynamic and respiratory effects of CO2 pneumoperitoneum.

BACKGROUND: Haemodynamic and respiratory effects of a CO2 pneumoperitoneum (intra-abdominal pressure = 12 mmHg) associated to a head-up position(15 degrees ) were studied in 20 pigs using a Swan-Ganz catheter and the Single Breath Test for CO2. The pneumoperitoneum induced a moderate rise in mean arterial pressure (+17%) (P<0.001) without any variation in heart rate, cardiac output and systemic vascular resistances. RESULTS: The following respiratory effects were observed: an increase in PaCO2 (+20%) (P<0.001), PE'CO2 (+31%) (P<0.001), expired volume of CO2 (+28%) (P<0.001), arterial to end-tidal CO2 gradient (+80%) (P<0.001) and alveolar dead space (+40%) (P<0.001) occured. Alveolar ventilation remained stable. Finally and contrary to healthy human patient, intraperitoneal CO2 insufflation in pig induced slight haemodynamic changes and major respiratory modifications. CONCLUSION: Thus, our data do not support the conclusion that the pig is a reliable experimental model for studying the pathophysiology of CO2 pneumoperitoneum-induced changes in haemodynamic and respiratory parameters, in human patients.

Animals↗
PubMed2001

[Clonidine combined with flunitrazepam before carotid endarterectomy decreases cerebrovascular CO2 reactivity].

OBJECTIVE: Assess cerebrovascular CO2 reactivity changes using transcranial Doppler sonography (TCD) after oral premedication associating clonidine (2 micrograms.kg-1) and flunitrazepam (70 micrograms.kg-1) in patients scheduled for carotid stenosis surgery. STUDY DESIGN: Prospective study, not randomized, the patient being his own "control". PATIENTS AND METHODS: Thirteen patients undergoing carotid endarterectomy under cervical plexus block were included. The monitoring included: automated arterial pressure cuff, ECG, radial artery catheter, TCD with probe secured in temporal window. The study of the cerebrovascular CO2 reactivity was performed with TCD recording on the side of operation, on the day before, and on the day of carotid endarterectomy, 90 min after the premedication, immediately before surgery. To change PaCO2, four ventilatory states were successively performed: (1) normoventilation, (2) hyperventilation, (3) hypoventilation, (4) "breath-holding test". At each state, it was noted: HR, MAP, PaCO2, mean blood flow velocity in the middle cerebral artery (Vm-MCA), resistance index of Pourcelot (RI), cerebrovascular reactivity (slope Vm-MCA/PaCO2). The results (+/- SEM) were analyzed by Wilcoxon test or t test. RESULTS: After premedication, cerebrovascular CO2 reactivity decreased (0.043 +/- 0.019 vs 0.034 +/- 0.013; p < 0.05) without modification of RI (0.578 +/- 0.291 vs 0.612 +/- 0.025; NS). No complication during carotid clamping was reported. CONCLUSION: Inclusion of clonidine in premedication before carotid stenosis surgery must be questioned because a decrease of cerebrovascular CO2 reactivity could be deleterious in case of intraoperative stroke.

Adrenergic alpha-Agonists↗
PubMed1998

Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index.

Several clinical multifactorial indexes have been described for predicting difficult laryngoscopy or intubation, or both, mostly in general surgery, and less frequently in ENT surgery. The objective of this study was to develop and validate a single clinical index for prediction of difficulty in tracheal intubation in both ENT and general surgery. We studied a population of 1200 consecutive ENT and general surgical patients. Clinical criteria were tested using univariate and multivariate analysis. Difficult intubation was defined as requiring unusual techniques. Logistic regression identified seven criteria as independent predictors of difficult tracheal intubation; previous history of difficult intubation; pathologies associated with difficult intubation; clinical symptoms of pathological airway; inter-incisor gap and mandible luxation; thyromental distance; head and neck movement; and Mallampati's modified test. Point values were assigned to each of these factors in proportion to regression coefficients representing the relative weight of each predictive intubation difficulty factor, the sum comprising the score. The best predictive threshold was chosen using a receiver operating characteristic curve. We then prospectively studied and validated the score in a population of 1090 consecutive ENT and general surgery patients. The sensitivity and specificity of the predictions were 94% and 96% in general surgery, 90% and 93% in non-cancer ENT surgery, and 92% and 66% in ENT cancer surgery, respectively.

Adolescent↗
PubMed1997

Postthyroidectomy analgesia: morphine, buprenorphine, or bupivacaine?

STUDY OBJECTIVE: To compare three analgesic regimens for pain relief after thyroidectomy. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Inpatient anesthesia in a university department of endocrine surgery. PATIENTS: 342 patients scheduled for elective thyroidectomy with nitrous oxide-oxygen-isoflurane anesthesia in addition to fentanyl. INTERVENTIONS: Group 1 received preoperative oral controlled release morphine 10 mg, and Group 2 received postoperative sublingual buprenorphine 0.2 mg. Group 3 received 0.25% bupivacaine (10 ml) wound infiltration before skin closure. Eight hours after tracheal extubation, patients received a second dose of the same drug in each group except in Group 3, where medication was changed to sublingual buprenorphine 0.2 mg. MEASUREMENTS AND MAIN RESULTS: Patients in Group 2 required fewer additional analgesics: 0.54 +/- 0.68 vs. 0.96 +/- 0.84 in Group 1 and 0.79 +/- 0.78 in Group 3. Patients in Group 2 demonstrated a better pain score and this group showed a higher percentage of satisfied patients: 96% vs. 85% in Group 1 and 91% in Group 3. Group 2 also included more patients requiring no analgesics: 56% vs. 32% in Group 1 and 42% in Group 3. The side effects in all three groups did not differ. CONCLUSION: The administration of sublingual buprenorphine after thyroidectomy provides better analgesia than small doses of oral controlled-release morphine or than 0.25% bupivacaine wound infiltration at the end of surgery.

Administration, Sublingual↗
PubMed1996

Haemodynamic and ventilatory changes during laparoscopic cholecystectomy in elderly ASA III patients.

PURPOSE: To evaluate the haemodynamic and respiratory changes during laparoscopic cholecystectomy in elderly ASA III patients. METHODS: This clinical descriptive study included 16 patients aged > 75 yr. Anaesthesia was induced with fentanyl and etomidate and maintained with N2O in O2 (50%), fentanyl and isoflurane as needed. Inspired minute volume was kept constant during anaesthesia. Cardiovascular monitoring included a radial artery catheter and a pulmonary artery catheter for measurement of CO, RVEF and SvO2, and calculation of right ventricular end diastolic volume indexed (RVEDVI). Haemodynamic variables, arterial and venous blood gas analyses were collected before and 10 min after anaesthetic induction, 15, 30 and 60 min after insufflation (IAP = 12 mmHg) followed by a 10 degrees head-up tilt, and after exsufflation. RESULTS: The mean age was 81 +/- 4 yr. The main cardiovascular depression was recorded after anaesthetic induction. Peritoneal insufflation resulted in improvement of cardiovascular function with increases in cardiac index (+19%), heart rate (+21%), MAP (+ 19%) and SvO2 (+8%), (P < 0.05) which may be the result of a sympathetic stimulation. No change in preload (RVEDVI) and SVR was recorded. Cardiac index was unchanged during pneumoperitoneum. Laparoscopy was associated with an increase in PaCO2 15 min after CO2 insufflation (from 33.9 to 38.3 mmHg, P < 0.05) and a further elevation after 60 min (44.4 mmHg) without any sign of extra peritoneal diffusion. There was no change in the intra-pulmonary shunt and the Pa-ETCO2 gradient remained stable (mean 7.2 mmHg). CONCLUSION: We conclude that gradual abdominal insufflation to 12 mmHg followed by a limited 10 degrees head-up tilt is associated with cardiovascular stability in elderly ASA III patients.

Aged↗
PubMed1996

Afterdrop after hypothermic cardiopulmonary bypass: the value of tympanic membrane temperature monitoring.

OBJECTIVES: After weaning from cardiopulmonary bypass (CPB), a decrease in nasopharyngeal temperature (NPT) occurs (afterdrop). The pathophysiology of the afterdrop remains unclear: It might be caused by either inadequate total body rewarming on CPB or to heterogenous distribution of heat during CPB, with subsequent redistribution of heat from the warmer core to the cooler shell tissues. The study objectives were (1) to determine whether post-CPB afterdrop is the result of a negative CPB thermal balance, and (2) to investigate which sites (if any) could best predict the afterdrop. DESIGN: Prospective evaluation using within-patient comparisons during CPB cooling, CPB rewarming, and 45 minutes post-CPB. SETTING: Adult patients gave informed consent before a cardiac surgical procedure in a university hospital. PARTICIPANTS: Eight patients undergoing CABG or valvular replacement with hypothermic CPB (NPT near 29 degrees C) and standardized general anesthesia. INTERVENTIONS: Each patient was studied with temperature monitors (Mon-a-therm 7000; Mallinckrodt-Medexel, Gemenos, France) attached to disposable thermocouple probes placed as follows: urinary bladder, rectum, deltoid, esophagus, nasopharynx, tympanic membrane, and four skin sites. In addition, the temperatures from the thermistors of the pulmonary artery catheter, and the arterial and venous lines of the CPB circuit were considered. Thirteen sites for monitoring temperature were studied. MEASUREMENTS AND MAIN RESULTS: Temperatures were recorded every 5 minutes, from the beginning of CPB to the 45th minute after CPB, and thermal exchanges were calculated: change in body heat (QBH), thermal exchanges between the patient and the pump (QCPB), metabolic heat production (Qm) (equal to calculated VO2 at the pump level), and heat loss to the environment (QS) (equal to QBH-QCPB-Qm). Thermal exchanges were obtained in six patients during the plateaus of cooling and rewarming, during the whole CPB phase, and after CPB. It was found that despite a change in QBH during rewarming (1,017 +/- 88 kJ) that was slightly greater than during cooling (-1,008 +/- 104 kJ) (mean +/- SEM), a significant decrease in post-CPB "core" temperature occurred (afterdrop: -1.4 degrees C). Magnitude of the afterdrop was directly related to the magnitude of tympanic membrane cooling and was negatively correlated to the temperature difference between the warmest site (tympanic membrane) and the coolest site (cutaneous thigh temperature) observed at the end of rewarming (r = -0.667; p < 0.05). CONCLUSIONS: It is suggested that besides post-CPB heat loss, redistribution of heat may be involved in the mechanism of the afterdrop and that measurements of tympanic membrane and cutaneous thigh temperatures are the best monitors of adequacy of rewarming during CPB.

Adult↗
PubMed1996

A comparison of direct, indirect, and fiberoptic laryngoscopy to evaluate vocal cord paralysis after thyroid surgery.

After thyroidectomy, the anesthesiologist usually performs a laryngoscopy to detect laryngeal edema and nerve palsies. The goal of this study was to compare three different methods of laryngeal examination after tracheal extubation of the patients. For that purpose, between 1990 and 1995, a prospective series of 1608 patients operated for thyroidectomy has been studied. The series was divided into 4 groups. In group I (n = 200), four anesthesiologists have evaluated the efficiency of the immediate postextubation direct laryngoscopy. In group II (n = 100), one anesthesiologist has compared the direct, indirect, and flexible laryngoscopies in every patient in a fixed and timed fashion. In group III (n = 100), the four examiners have evaluated the flexible laryngoscopy at a different timing so as to eliminate the possible temporal relationship of the ease of visualization in group II. In group IV (n = 1208), the four examiners have evaluated flexible laryngoscopy, on a large scale, at any time during the 1-h stay in the recovery room. Special attention was directed to the patients with known cardiovascular diseases. Direct and indirect laryngoscopies were only effective in 76 and 73%, respectively, of the patients, whereas flexible laryngoscopy was effective in 99.6% of them. Flexible laryngoscopy was easy to perform in 96.5% of the patients versus 65 and 55% with direct and indirect laryngoscopies. Finally, variations in monitored cardiovascular parameters were significantly lower with flexible and indirect laryngoscopies than with direct laryngoscopy. These mild variations induced by flexible laryngoscopy were well tolerated by patients with known cardiovascular diseases. Flexible laryngoscopy is the best method for an immediate laryngoscopic examination after thyroidectomy.

Fiber Optic Technology↗
PubMed1996

Delayed forced air warming prevents hypothermia during abdominal aortic surgery.

We have evaluated the efficacy of the delayed forced air warming during abdominal aortic surgery in 18 patients. Patients were allocated randomly to one of two groups: the control group (n = 9) received no intraoperative warming device; the Bair-Hugger group (n = 9) had active skin surface warming with an upper body cover. The device was activated when core temperature decreased to less than 36 degrees C. The reduction in core temperature was 0.6 degrees C during the first hour after induction and 0.4 degrees C during the second hour in both groups. In the control group, core temperature continued to decrease until the end of surgery, whereas in the Bair-Hugger group, the reduction in core temperature stopped after 1 h of warming, and then rewarming began. At the end of surgery, core temperature in the Bair-Hugger group was similar to core temperature before induction, and was higher than core temperature in the control group (P < 0.003).

Adult↗
PubMed1996

Ventilatory effects of laparoscopic cholecystectomy.

BACKGROUND: During laparoscopic cholecystectomy the arterial-end-tidal CO2 gradient (Fa-ETCO2) has been variously shown to be unchanged, increased, decreased or even negative. The goal of this study was to evaluate Fa-ETCO2, and to determine the proper contribution of VECO2 and VA in regard to the increase of FETCO2. METHODS: Ventilatory patterns were studied in 15 ASA 1-2 patients (mean age +/- SD: 48.5 +/- 15.0) undergoing laparoscopic cholecystectomy, with intraperitoneal CO2 insufflation limited to 12 mmHg, 15 degrees head-up position, during general anaesthesia and controlled ventilation. The following were studied before, during and after the pneumoperitoneum: FaCO2, FETCO2, nasopharyngeal temperature; dead space ventilation, and expired volumes using the Single Breath Test for CO2. VA was calculated as the alveolar fraction of expired VT multipled by the respiratory frequency. RESULTS: During pneumoperitoneum it is shown that: 1) Fa-ETCO2 either decreases and becomes even negative (n = 8) (P < 0.01), or stays unchanged (n = 7), but never elevates; 2) VECO2 increases (peak value: +22.6%) (P < 0.01); 3) VA is unchanged, and 4) dead space ventilation, determined in 7 patients, remains unchanged. CONCLUSION: We conclude that only exogenous CO2 loading, and not VA, can explain such increase in FETCO2 and FaCO2, in cases of limited CO2 insufflating pressure in ASA 1-2 patients.

Adult↗
PubMed1996

Pharmacokinetics of lidocaine with epinephrine in piglets following epidural anaesthesia.

The time course of arterial plasma lidocaine concentration, following an epidural anaesthesia via the sacrococcygeal or the S4-S5 trans-sacral approach, was studied in nine healthy piglets (7.8 +/- 1.3 weeks). Plasma lidocaine concentrations were measured for up to six hours after administration (5 mg/kg). Peak plasma concentration was 1.83 +/- 0.17 mg/l. Pharmacokinetic parameters determined from an independent compartment model were not different from those observed after an epidural administration of lidocaine via the sacrococcygeal space in children, except for a wide variability in the time taken to reach the maximum concentration (27.3 +/- 7.4 min) and a shorter half-life of elimination (82.8 +/- 7.0 min). The total body clearance of lidocaine was similar in piglets (17.3 +/- 1.6 ml/min/kg) to that in children. The shorter half-life of elimination was therefore attributed to a smaller volume of distribution in piglets (2.0 +/- 0.2 l/kg).

Anesthesia, Epidural↗