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J L Pourriat

Publications and source records attributed to J L Pourriat.

At least 19 recordsLinked to original sources
PubMed2002

[Myocardial infarction in AIDS].

We report two cases of myocardial infarction, in young HIV positive patients seen in the Emergency Department. These patients were under treatments: for one, an association of nucleosidic inhibitors, and for the other one, the combination of nucleosic analogue inhibitor with a non nucleosic analogue; in the last case, the patient underwent, few months before, a treatment containing a protease inhibitor. In both cases, the pain wasn't typical and didn't refer to a coronary heart disease. Lipid tests were normal. The diagnosis has been made quickly and allows a coronary angioplasty with a favourable issue. Authors are arguing the characteristics of this cardiac pathology, recently discovered in HIV positive patients, and do insist on the need to think at a coronary heart disease in front of any chest pain symptom even unusual.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Complication profiles of adult asthmatics requiring paralysis during mechanical ventilation.

OBJECTIVE: To assess the characteristics and the incidence of morbidity of intubated asthmatic patients who received long-term paralysis. DESIGN: Retrospective cohort study. SETTING: Five intensive care units (ICUs) in Paris and the surrounding suburbs. PATIENTS AND PARTICIPANTS: The NMB group consisted of patients who received neuromuscular blocking agents for more than 12 h (NMB group) versus sedation alone (SED). INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The incidence of post-extubation muscle weakness and/or myopathy was 18% in the NMB group compared to 2% in the SED group ( p=0.01). The occurrence of ventilator-associated pneumonia was higher in the NMB group (42% versus 4%; p<0.0001). The duration of ICU stay and of mechanical ventilation were significantly greater in the NMB group. Multiple logistic regression analysis showed that inclusion in the NMB group was the only independent predictor of the presence of the overall morbidity [odds ratio 6.4 (2.09; 19.64)]. CONCLUSION: While greater initial severity of respiratory compromise in the NMB group may explain part of the difference, use of NMB agents appears to be strongly related to the presence of significant complications among mechanically-ventilated asthmatic patients.

Adult↗
PubMed2001

[Immediate evaluation of continuous medical education].

OBJECTIVES: To analyse the results of the immediate evaluation of an European teaching session using a questionnaire provided by the French College of anaesthesiologists. STUDY DESIGN: Open evaluation. MATERIAL: Questionnaires completed after each topic by 50 participants of an European course including 15 lectures were collected. METHODS: The types of professional exercise and the medical practise reliable to the different topics were pointed out. The evaluation included 4 items noted from 1 to 10: new information for medical practise, definition of pedagogic objectives, quality of means used for teaching, interest for the treated subject. The global mean score for each item and for each speaker was calculated. Results were compared according to the professional mode of exercise, the own medical practise and the project to modify it in the future. RESULTS: Scores affected to items were significantly lower for participants exercising in PSPH compared to general and university hospitals and private clinics (p < 0.001). New information was better found in case of poor or absence of practise, but interest was improved when medical practise was frequent. 2/3 of the participants projected to modify their practise after the session. CONCLUSION: The analysis of medical evaluation should allow to determine an acceptable zone of quality which may be useful for accreditation. However, distorting results according to the professional mode of exercise and the own medical practise should encourage the development of adapted continuous medical education. Delayed evaluation may be necessary to objective the putative benefits of CME on medical practise.

Education, Medical, Continuing↗
PubMed2001

[Tetraplegia in the course of coma from drug intoxication].

It is reported a case of quadriplegia occurring in a 67-year-old women after she commits suicide with flunitrazepam. The patient stayed during around twenty hours unconscious, in the sitting position, with an extreme flexion of the neck on the left side. After injection of flumazenil the patient's consciousness was restored. Nevertheless a complete sensitive and motor deficit at the C4 and C5 level was then observed. Several diagnosis such as peripheral neuropathy, infectious disease, or arterial occlusion were eliminated and we finally postulated that the regulation of the spinal blood flow had likely been disturbed by the prolonged flexion of the neck, the hypotension and the putative respiratory depression. The fact that the patient suffered from cervicarthrosis would have already impaired the spinal blood flow regulation and consequently had probably damaged the spinal cord. No clinical improvement of the quadriplegia was noticed and the patient died in the intensive care unit thirteen days after admission. Such an exceptional complication after a toxic coma remind us the necessity to avoid long lasting vicious position of the cervical spine in anaesthesia and emergency practice.

Aged↗
PubMed2000

[Meningitis after locoregional spinal anesthesia].

OBJECTIVE: Meningitis is a severe and an uncommon complication of both spinal and epidural anaesthesia. This review summarizes the knowledge on epidemiology, clinical and microbiological diagnosis and the ways to prevent them. DATA SOURCES: Articles published in English and French language since 1989 has been collected on Medline database, using "meningitis", "spinal anaesthesia" and "epidural anaesthesia" as keywords. DATA SYNTHESIS: Bacterial meningitis are usually in relation with Gram positive bacterias which is a clue for an exogenous contamination. Another unusual ways of contamination are blood circulating bacterias and spreading of local infection. Aseptic meningitis has been described, in relation to introduction of irritant agents in subarachnoid space. Lumbar puncture must be done each time meningitis suspected so that it can assert the diagnosis and guide antibiotherapy. Easy hygienic guidelines has been widely published to prevent meningitis. Usually, antibiotherapy alone is sufficient to treat meningitis but with an unjustified cost and sometimes severe persistent neurologic sequelae. CONCLUSION: The unexpected appearance of meningitis during the wearing-off of a spinal anesthesia is exceptional; the possibility of death or serious sequela must be taken into account. The sources of contamination are quite frequently exogenous, the germs coming most often from the patient's cutaneous flora or the anesthetist's ENT flora. Prevention of this risk involves a rigorous respect for cutaneous disinfection and hygiene procedures. The anesthetist's medico-legal responsibilities will be called upon in case of exogenous contamination.

Adolescent↗
PubMed2000

Effects of isoflurane on bacterial growth.

Anaesthetic agents have been implicated in the development of postoperative pneumonia, but the direct effect of volatile anaesthetics on bacterial growth has given contradictory results. The effects of isoflurane on the growth of Staphylococcus aureus and Escherichia coli were investigated under conditions similar to those of clinical practice, using standardized microbiological methods. An open anaesthetic circuit was adjusted to the normal ventilatory settings of an adult patient. A spray, installed on the inspiratory side of the circuit, ensured the delivery of isoflurane at 1.5 minimal alveolar concentration. The bacterial strains studied were both wild-type and reference strains. Bacterial inoculums were prepared to obtain a bacterial exponential growth of 10(3) colony-forming units per mL in 10 mL of nutritive broth. Each strain was studied with and without exposure to isoflurane and measured by the usual criteria of bacterial growth, and by bacterial regrowth after exposure to isoflurane. Under experimental conditions close to clinical practice, exposure to isoflurane did not alter bacterial growth of S. aureus and E. coli, or their bacterial regrowth when isoflurane exposure is over.

Anesthesia, Inhalation↗
PubMed2000

[Meningitis after spinal anesthesia].

The occurrence of meningitis after spinal anaesthesia is a very rare event. We report a case of Streptococcus sanguis meningitis following spinal anaesthesia for orthopaedic material removal. The presence of Gram positive cocci (Streptococcus sanguis) in the cerebrospinal fluid was in favour of an exogenous contamination, originating either from the patient's skin or the anaesthesiologist's oropharynx. The outcome was uneventful. The responsibility of the latter can result in legal consequences. The scrupulous compliance with guidelines prevents this risk.

Adult↗
PubMed1999

Cost-effectiveness analysis of the terlipressin-glycerin trinitrate combination in the pre-hospital management of acute gastro-intestinal haemorrhage in cirrhotic patients.

OBJECTIVES: To assess the cost-effectiveness of an early treatment of upper gastro-intestinal haemorrages in cirrhotic patients. DESIGN: Utilization data linked to the results of a double-blind, placebo-controlled trial demonstrating the efficacy of the terlipressin-glycerin trinitrate combination (TER-GTN) in the reduction of mortality at day 42 for haemorragic patients due to rupture of oesophageal varices. SETTING: Hôpital Jean Verdier, Bondy, Assistance Publique-Hôpitaux de Paris, France. SUBJECTS: Eighty-four patients included over 2 years by emergency services and hospitalized in an intensive care unit (ICU) for haemorrage, 41 in the "treated" group and 43 in the "placebo" group. MAIN OUTCOME MEASURES: Mortality at day 42, cost per death avoided. RESULTS: The mortality rate in the placebo group was 46.5% versus 27.5% in the treated group. The mean length of stay was 5 days longer in the treatment group. The excess cost per death avoided was 25,849 FF. Of this extra cost 27% was due to treatment and 24% was due to increased length of stay. The excess cost per case treated was FF 5,097, 10% of the total cost per stay for rupture of oesophageal varices (ROV). CONCLUSIONS: Our results are of the same magnitude as those published by Mac Cormick et al. in the United Kingdom for similar treatment. The extra cost appears to be moderate, and much lower than monoclonal antibody therapy for sepsis. The impact on the study hospital budget did not exceed 1.7 10(-4).

Acute Disease↗
PubMed1999

[Drug expenses from anesthesiologists].

OBJECTIVES: To assess expenses generated by prescriptions from anaesthesiologists in the operating theatre, recovery rooms, surgical intensive therapy units, postoperative care on surgical wards (digestive surgery, orthopaedics, gynaecology, obstetrics, paediatric surgery). METHODS: Prospective study (one year) with evaluation of the costs induced by intravenous and volatile anaesthetics, morphinic and non morphinic analgesics, neuromuscular blocking agents, crystalloids, antibiotics, intravenous nutrient solutions, blood substitutes, anticoagulants, vitamins and vasoactive drugs. RESULTS: The expenses resulting from these prescriptions reached the quarter of the total drug hospital budget. They were equally distributed between anaesthesia and intensive therapy units on the one hand and postoperative care on surgical wards on the other hand. Intravenous anaesthetic agents, antibiotics, crystalloids, represented each one more than 10% of the total cost. CONCLUSIONS: This study demonstrates the weight of prescriptions by anaesthesiologists in the hospital budget. At our hospital, it was mainly due to their activity outside the operating theatre, especially on surgical wards. Therefore anaesthesiologists are essential partners for the elaboration of a cost containment policy.

Anesthesiology↗
PubMed1999

A multicentre comparison of the costs of anaesthesia with sevoflurane or propofol.

Day-case anaesthesia requires rapidly eliminated anaesthetics which are relatively expensive. This multinational, multicentre European study assessed the relative costs of propofol or sevoflurane anaesthesia in 211 patients. Anaesthesia was induced and maintained with propofol in group 1, with propofol and sevoflurane in group 2, and with sevoflurane in group 3. Drug and delivery costs were calculated in US$. Induction of anaesthesia was fastest in groups 1 and 2, although spontaneous ventilation resumed earliest in group 3. Emergence times and times at which patients were fit for discharge were similar in all groups. Group 2 had the lowest costs based on actual drug use (mean $14.2 (SEM 0.8) vs $18.7 (0.8) and $17.3 (0.8) in groups 1 and 3, respectively). Anaesthetic drug wastage and disposable costs were highest in group 1 and lowest in group 3. Consequently, total costs were highest in group 1 ($31.9 (0.9)) compared with groups 2 ($19.7 (0.9)) and 3 ($18.8 (0.9)). Although we observed increased nausea and vomiting in groups 2 and 3 and reduced patient satisfaction in group 3, these differences should be balanced against the greater cost of propofol anaesthesia.

Adolescent↗
PubMed1998

Quality of perioperative antibiotic administration by French anaesthetists.

Antibiotics are the most prescribed drugs in hospitals in France and approximately one-third of prescriptions are for antimicrobial prophylaxis. Although the principles of prophylaxis have been defined over the years, there is still widespread misuse of antimicrobials for that purpose. The aim of this survey was to determine whether prescription of prophylactic antibiotics by French anaesthetists complies with the French Guidelines on Surgical Antibiotic Prophylaxis. Information was sought concerning the agent(s) recommended, the timing of the first dose and the duration of prescription. A total of 1473 French anaesthetists was studied. For the great majority (93%), the first antibiotic dose is administered at time of induction of anaesthesia, as recommended by the guidelines. First- and second-generation cephalosporins are frequently selected, as well as co-amoxiclav. In contrast to the guidelines, third-generation cephalosporins (3GCs) are widely prescribed in digestive and urological surgery and quinolones in urological surgery. Duration of prescription is limited to 48 h by most anaesthetists (94%), however there is a strong tendency to prescribe prophylaxis for longer periods in the immunocompromised and patients undergoing major surgery. This survey indicates discrepancies between the French Guidelines on Surgical Antibiotic Prophylaxis and the current practice of French anaesthetists. Major concerns are the use of antibiotics such as 3GCs or fluoroquinolones and prescription for periods exceeding 48 h. In conclusion, compliance with guidelines for prophylactic antimicrobial administration should be more strict in surgical patients.

Anesthesiology↗