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Biomedical subjects

J L Bourgain

Publications and source records attributed to J L Bourgain.

At least 19 recordsLinked to original sources
PubMed2006

Pressure support ventilation during fibreoptic intubation under propofol anaesthesia.

GOAL OF THE STUDY: To assess the benefit of pressure support ventilation during fibreoptic intubation performed under propofol anaesthesia in patients having an anticipated difficult intubation. PROCEDURES: Thirty-two patients with ENT cancer, and having at least two criteria for anticipated difficult intubation were prospectively included. All patients received topical lidocaine 2% and propofol by plasma target control infusion (initial target concentration 3 microg ml(-1), then adjusted to maintain loss of consciousness without apnoea). They were randomly assigned between two groups: spontaneous breathing (SB) or pressure support ventilation (with a support level set at 10 cm H(2)O) both using Fi(o(2))=1. Conditions for fibreoptic intubation, respiratory parameters (pulse oxymetry, ventilatory frequency, tidal volume and PetCO2 after intubation) and haemodynamic parameters were recorded. RESULTS: Patient characteristic data and intubation conditions were similar between both groups. All patients had a successful fibreoptic intubation and none needed a rescue procedure because of desaturation. In spite of a longer duration of intubation, PE'CO2 after intubation was lower and tidal volume during intubation was higher with pressure support ventilation than in SB patients [38.1 (4.2) vs 42.3 (4.7) mm Hg and 371 (139) vs 165 (98) ml, respectively]. Desaturation episodes were observed in two SB patients conversely to no episode during pressure support ventilation, probably because of the higher minute ventilation. CONCLUSION: Pressure support represents a useful method to improve ventilation during fibreoptic intubation under propofol anaesthesia in patients with an anticipated difficult intubation.

Aged↗
PubMed2006

Pressure-controlled ventilation is superior to volume-controlled ventilation with a laryngeal mask airway in children.

BACKGROUND: This prospective, randomized, crossover study had two purposes: first, to determine whether pressure-controlled ventilation (PCV) is safer than volume-controlled ventilation (VCV) by preventing gastric insufflation in children ventilated through an laryngeal mask airway (LMA); second, to assess whether the measurement of LMA leak pressure (P(leak)) is useful for preventing leakage during positive pressure ventilation (PPV). METHODS: Forty-one, 2 to 15-year-old children underwent general anesthesia with an LMA. The expiratory valve was set at 30 cmH(2)O and P(leak) was measured using constant gas flow. Children were randomly ventilated using PCV or VCV for 5 min in order to reach a P(ET)CO(2) not exceeding 45 mm Hg, and then they were ventilated with the alternative mode. If the target P(ET)CO(2) could not be obtained in one mode, we switched to the other. If both modes failed, children were intubated. Tidal volumes, P(ET)CO(2) and airway pressures were noted and compared between modes. Gastric insufflation was checked by epigastric auscultation. RESULTS: PCV provided more efficient ventilation than VCV, as targeted P(ET)CO(2) was obtained without gastric insufflation using PCV in all cases except one, whereas VCV failed in three cases. No gastric insufflation occurred when ventilating below peak. CONCLUSIONS: These findings suggest that in the age group studied, PCV is more efficient than VCV for controlled ventilation with a laryngeal mask. Gastric insufflation did not occur with this mode.

Adolescent↗
PubMed2003

Laparoscopic total pelvic exenteration for cervical cancer relapse.

BACKGROUND: Laparoscopy classically reduces morbidity and invasiveness. To decrease the operative morbidity associated with exenteration, we considered the possibility of performing a total pelvic exenteration by the laparoscopic approach. CASE: A 34-year-old woman presented with a cervical cancer relapse. The bladder, uterus, vagina, ovaries, and rectum were mobilized en bloc from the pelvic sidewall. We used vascular endoscopic staplers for the control of sigmoid vessels and anterior branches of internal iliac vessels. The specimen was removed through the vulva. A colo-anal anastomosis and an ileal-loop conduit for urinary tract diversion were made. The operative time was 9 h. The postoperative course was uneventful. Specimen margins were free of disease. CONCLUSION: With laparoscopic surgical knowledge and new endoscopic staplers, laparoscopic pelvic exenteration procedure is feasible.

Adult↗
PubMed2003

[Preoxygenation and upper airway patency control].

During preoperative assessment, risk factors of upper airway obstruction should be evaluated: respiratory insufficiency, low O(2) reserve, preoxygenation failure or difficult face mask ventilation. In healthy subjects, spontaneous breathing O(2) for 3 min is the reference method. Apnoea duration is longer after preoxygenation than after denitrogenation, even if FEO(2) and SpO(2) do not change during the two last minutes of preoxygenation. The apnea time is longer after 3 min spontaneous breathing than after four deep breaths for 1 min in most of the literature. Maximal breathing during 2 min can produce values comparable to those obtained with tidal volume breathing for 3 min. FEO(2) monitoring is helpful in the assessment of preoxygenation quality: In case of oxygenation impairment during anaesthesia induction, algorithm use is helpful. Because desperate emergencies will occur in association with anaesthesia, every location should have the immediate availability of Fastrach and trans tracheal ventilation. Every anaesthesiologist should be familiar with and well practised in a variety of airway management techniques. Teaching programs are organised in order to develop anaesthesiologist sensitisation and skill.

Anesthesia, Inhalation↗
PubMed2003

[Survey and budgetary impact of anaesthesia machines failures].

OBJECTIVE: To assess the incidence and the causes of failures of anaesthesia machines in relation to aging. Study design. - Prospective survey from january 1996 to july 2000. MATERIAL AND METHODS: The causes (mechanical or electronic), the moment of identification (checklist, maintenance operation or quality-control operation) of each anaesthetic machine failure, the repair cost and the maintenance cost of 14 anaesthetic machines have been collected and entered into a database. RESULTS: Over 31,948 anaesthesia delivered during the period of the study, 614 failures have been declared: 53% were related both to mechanical problems or monitoring failure and 40% were identified during the pre-operative checklist. In half of the cases, a specially trained anaesthetic nurse was able to correct the failure in the operating theatre. The annual rate of anaesthetic machine failure remained stable over the study period and the annual maintenance cost is approximatively 10% of the initial machine value. No procedure was cancelled because of a machine technical failure. CONCLUSION: Anaesthetic machine failure rate change according to the time should not be criteria for remplacement if rigorous quality control and maintenance operation are used.

Anesthesia, Inhalation↗
PubMed2001

[Pharmaceutical traceability integrated with the patient file. Development of a computerized hospital application].

The Clinical Pharmacy Department (CPD) of the Gustave Roussy Institute, has developed a traceability software package that is integrated with the patient file. The Traceability & Medical Devices Functional Unit manages the Blood Derivative Medicinal Product traceability circuits, the circuits of over 400 Sterile Medical Devices and, generally speaking, those for all pharmaceutical goods for which traceability is imperative. The SIMBAD-TRACE software package has been developed in situ and was first open for access in March 1999. It enables pharmaceutical traceability data to be accessed from 500 networked workstations. The references tracked generated about 10,000 movements per year. In terms of performance, the system achieves three complementary objectives: 1) reporting traceability scores which reflect the ability of CPD and the establishment to pertinently respond to a complex regulatory requirement on a daily basis; 2) the contribution of the tool to cost containment with respect to allocating rare goods; the contribution of the software package to the implementation of medical device vigilance inquiries, particularly descending inquiries. Finally, SIMBAD-TRACE is one of the pillars of our Quality Assurance Program (QAP).

Equipment and Supplies↗
PubMed2001

Mechanisms and risk factors for infection of pulmonary artery catheters and introducer sheaths in cancer patients admitted to an intensive care unit.

Pulmonary artery catheters (PACs) are typically inserted for short periods, and the extra-luminal route is assumed to be the overriding source of contamination and/or infection. Our aim was to assess the incidence of PAC and introducer colonization in cancer patients, and to study the mechanisms and risk factors for infection. Patients with a Swan-Ganz catheter admitted to an intensive care unit were prospectively analyzed over 14 months. As soon they were no longer necessary, PACs and introducer sheaths were removed and cultured. We recorded the mean duration of placement, the number of times PACs were handled and the site of insertion. Seventy-nine catheters were inserted in 68 patients. The median (range) duration was three days (0-10) for PACs, and 3.6 days (0-18) for introducers. PAC and/or percutaneous introducer sheath colonization was diagnosed in seven patients (8.9%), but in only one case were both colonized. Colonization rates were 15.5 per 1000 days for PACs and 14.1 per 1000 days for introducers. Introducers were mainly colonized before the 5th day, while PACs were mainly colonized after the 5th day. No PAC or introducer-related local infection or bacteraemia was diagnosed. Colonization was more frequent on catheters inserted into the internal jugular vein. The colonization rate was 5% for PACs and introducers. Our findings suggest that contamination of introducers and PACs may be dissociated and could result from either extraluminal or endoluminal colonization. As three of four PAC colonizations occurred after 5 days, the duration of catheter placement should be considered important. There was little clinical impact of microbial colonization.

Bacteremia↗
PubMed2001

Transtracheal high frequency jet ventilation for endoscopic airway surgery: a multicentre study.

Serious complications during high frequency jet ventilation (HFJV) are rare and have been documented in animals and in case reports or short series of patients with a difficult airway. We report complications of transtracheal HFFJV in a prospective multicentre study of 643 patients having laryngoscopy or laryngeal laser surgery. A transtracheal catheter could not be inserted in two patients (0.3%). Subcutaneous emphysema (8.4%) was more frequent after multiple tracheal punctures. There were seven pneumothoraces (1%), two after laser damage to the injector, one after difficult laryngoscopy, four with no clear cause. Arterial desaturation of oxygen was more frequent during laser surgery and in overweight patients. Transtracheal ventilation from a ventilator with an automatic cut-off device is a reliable method for experienced users. Control of airway pressure does not prevent a low frequency of pneumothorax.

Adolescent↗
PubMed2001

Comparison of the intubating laryngeal mask airway with the fiberoptic intubation in anticipated difficult airway management.

BACKGROUND: The intubating laryngeal mask airway (ILMA; Fastrach; Laryngeal Mask Company, Henley-on-Thames, UK) may provide an alternative technique to fiberoptic intubation (FIB) to facilitate the management of the anticipated difficult airway. The authors therefore compared the effectiveness of the ILMA with FIB in patients with anticipated difficult intubation. METHODS: One hundred patients, with at least one difficult intubation criteria (Mallampati class III or IV, thyromental distance < 65 mm, interincisor distance < 35 mm) were enrolled (FIB group, n = 49; ILMA group, n = 51) in this prospective randomized study. Anesthesia was induced with propofol and maintained with alfentanil and propofol after an efficient mask ventilation has been demonstrated. The success of the technique (within three attempts), the number of attempts, duration of the successful attempt, and adverse events (oxygen saturation < 90%, bleeding) were recorded. RESULTS: The rate of successful tracheal intubation with ILMA was 94% and comparable with FIB (92%). The number of attempts and the time to succeed were not significantly different between groups. In case of failure of the first technique, the alternative technique always succeeded. Failures in FIB group were related to oxygen desaturation (oxygen saturation < 90%) and bleeding, and to previous cervical radiotherapy in the ILMA group. Adverse events occurred significantly more frequently in FIB group than in ILMA group (18 vs. 0%, P < 0.05). CONCLUSION: The authors obtained a high success rate and comparable duration of tracheal intubation with ILMA and FIB techniques. In patients with previous cervical radiotherapy, the use of ILMA cannot be recommended. Nevertheless, the use of the ILMA was associated with fewer adverse events.

Adult↗
PubMed2000

Biting the laryngeal mask: an unusual cause of negative pressure pulmonary edema.

PURPOSE: To describe negative pressure pulmonary edema due to biting of the laryngeal mask tube at emergence from general anesthesia. CLINICAL FEATURES: A healthy patient underwent general anesthesia using a laryngeal mask airway and mechanical ventilation. During recovery, the patient strongly bit the laryngeal mask and made very forceful inspiratory efforts until the mask was removed. Five minutes later, the patient developed dyspnea and had an hemoptysis of 50 ml fresh blood. Chest radiograph showed bilateral alveolar infiltrates. Pharyngo-laryngeal examination was normal. Bronchoscopy revealed no injury but diffuse pink frothy edema fluid. Clinical examination and chest radiograph became normal after 12 hr of nasal oxygen therapy confirming airway obstruction as the most available cause of this pulmonary edema. CONCLUSION: Airway obstruction due to biting of a laryngeal mask tube may result in negative pressure pulmonary edema.

Adult↗
PubMed1999

[The breakdown of anesthesia equipment survey].

OBJECTIVE: To assess the incidence and the causes of failures of anaesthesia machines. STUDY DESIGN: Prospective survey from August 1995 to September 1997. MATERIAL: Check-list and machine failure forms. METHODS: Failures of anaesthetic machines have been collected and entered into a database. Causes and treatment of each failure have been analysed. RESULTS: Of 5,096 foreseen forms, 3,926 (77%) have been completed after check-list or anaesthesia machine failure. Overall, 233 incidents have been declared (4.5%). Failures identified during the preoperative check-list (n = 96) were mainly related to mechanical problems, especially the gas proportioning device (35%). Perioperative failures (n = 137) were mostly related to electronic problems (ventilator: 27% and monitor: 57%). In more than half of the cases, a specially trained anaesthetic nurse was able to correct the failure in the operating theatre. Using 14 anaesthetic machines for 12 operating rooms, no procedure was cancelled because of a technical failure of a machine. CONCLUSIONS: This study emphasizes the value of the check-list and the failure report. The presence of a specially trained anaesthetic nurse allows immediate correction of the majority of technical problems.

Anesthesiology↗
PubMed1999

[Accessory anesthetic breathing systems: verification before use].

Accessory or ancillary anaesthesia breathing systems can be defined as all those connected to the fresh gas outlet of the anaesthetic apparatus and used instead of the circle system associated with the ventilator, which is the main circuit. They include: the Mapleson systems, the systems with a nonrebreathing valve and the disposable systems with a carbon dioxide absorber. They can be a cause of major accidents when not checked before and monitored during use. This technical note describes techniques of preanaesthetic checking and monitoring during anaesthesia.

Anesthesia, Closed-Circuit↗
PubMed1998

[Pros and cons of adding an accessory breathing system to the main circle circuit. II. Arguments against their use].

When compared to the circle system alternative breathing systems (ABS) are of no benefit. When the only indication of an ABS is emergency oxygen administration it should be connected to the O2 pipeline upstream from the flowmeter bank and the vaporiser. The use of an ABS for anaesthesia maintenance is no longer justified because of the difficulties in monitoring pressure, flow and concentrations of the gas mixture, the cost of gas and vapour administered at a high flow and the resulting pollution. The use of an ABS for very short anaesthetics is only acceptable if the administered gas mixture is monitored.

Anesthesia, Closed-Circuit↗