PubMed Health⌕ Search

Biomedical subjects

J P Carpentier

Publications and source records attributed to J P Carpentier.

At least 19 recordsLinked to original sources
PubMed2006

[Ketamine: drug facts, uses in anesthesia, and new applications for analgesia].

Ketamine is an anesthetic drug of choice in tropical zones. In addition to excellent pharmocologic properties and low cost, it offers the possibility of using a variety of administration routes and of performing invasive procedures with spontaneous ventilation. Adverse psychodysleptic effects can be prevented by association with midazolam or propofol. Hypersalivation can be prevented with atropine. Recent experience has shown that thanks to its antihyperalgesic effects ketamine can be used for postoperative analgesia at doses ten times lower than for anesthesia.

Analgesia↗
PubMed2005

How we do it: adjunctive intravenous midazolam: diagnosis and treatment of therapy-resistant muscle tension dysphonia.

Dysphonic patients with muscle tension are common at voice clinics. The majority respond to intensive vocal therapy. A small number of cases remain resistant to intensive vocal therapy. We have used intravenous midazolam to enhance therapy-resistant dysphonic patients' self-monitoring, their self-awareness and to change fixed patterns. Six of seven patients were discharged with restoration of normal voice 1 month after treatment.

Anti-Anxiety Agents↗
PubMed2005

[Assessment of transfusion requirements: a way to in improve perioperative management of blood products?].

Autogenic blood transfusion is indispensable in emergency surgery situations involving severe blood loss. It may also be required in some non-emergency surgical and obstetrical situations. The use of blood-sparing techniques as an alternative to autogenic blood transfusions blood loss can be especially beneficial in tropical settings where the risk of viral transmission is high. The combined use of blood-sparing and autogenic transfusion techniques requires preoperative assessment of transfusion requirements. The expected amount of preoperative blood loss must be determined and compared with the acceptable amount of blood loss for the patient in function of transfusion threshold. Various techniques to reduce the need for autogenic blood transfusion can be used depending on locally available resources. Blood-sparing techniques include treatment to increase the patient's baseline hemoglobin rates, use of cell saving systems for autologous blood transfusion, and/or perioperative transfusion of recuperated blood. In this article these techniques are illustrated in two practical clinical cases.

Blood Transfusion, Autologous↗
PubMed2003

[Surgical emergencies at Libreville hospital center].

OBJECTIVE: To estimate the waiting times of surgical emergencies and identify causes of delay. Study design. - Prospective study over 36 months. MATERIAL AND METHOD: From January 1996 to December 1998, surgical emergencies arriving to the Libreville Hospital Center have been classified in absolute emergencies (AE) and relative emergencies (RE). Five parameters have been measured: waiting before the first contact with the resident (T1); waiting time for making the decision of operation (T2); waiting time for the admission in the operating block (T3); waiting before the surgical intervention (T4); total duration of waiting between admission in the operating block and the beginning of the surgical intervention (TT). Concerning each one of those stages, the abnormal lengthening causes of time for surgical emergencies have been identified. RESULTS: During that period, 325 surgical emergencies have been received. The mean duration of surgical emergency management has been 504.3 +/- 613.7 min. Among those emergencies, 114 have been classified AE (35.1%) and 211 RE (64.9%) with mean durations of 421.2 +/- 347.0 min for AE and of 549.3 +/- 722.5 min for RE. Some delays in the management of emergencies have been found among 176 patients (54.2%). Their frequency has been 58.8% for AE and 51.7% for RE. The most current cause of delays has been the waiting of complementary medical tests results (44.4%), followed by difficulties in supplying (31.1%) and by technical or staff problems (24.1%). CONCLUSION: This study has permitted to show that the waiting times of surgical emergencies management are abnormally long in Libreville hospital center. There is an important frequency in delays as well for RE as for AE. Socio-economic problems are very important. It seems necessary to organize surgical emergencies management in a specific structure and codify the prescription of complementary medical tests.

Adolescent↗
PubMed2002

[Does tropical environment influence morbidity and mortality?].

Despite enormous progress in medical science, health care coverage in poor countries remains incomplete, uncertain and minimal. The probability of death is higher in Africa. Life expectancy is only from 50 to 55 on the African continent in comparison with over 70 years in North America and Europe. The African population is predominantly young but malnutrition, deficiencies, anemia, parasitism and genetic defects (drepanocytemia) are widespread. In general treatment of acute trauma and illness is straightforward and vital or functional prognosis is good provided that proper elementary care is administered rapidly. However due to difficult field conditions and limited medical facilities, care is often delayed. Most patients are admitted with advanced, complicated disease to facilities that are often poorly equipped, undersupplied and lacking in qualified personnel, basic medication and blood products. This combination of factors accounts in part for the fact that prognosis of the same disease is poorer in tropical areas than in other areas of the world. Rational use of human resources and better organization of international cooperation would allow short-term improvement in health care in tropical areas. It is only at this price that people in the Northern and Southern hemisphere in this time of globalization can have the same chance of survival for the same disease.

Acute Disease↗
PubMed2002

[Natural selection and medical triage: everyday realities].

Most emergency care facilities in tropical areas are inefficient, underequipped, and quickly overwhelmed by the ever-growing attendance. As a result, mortality is higher than in developed countries. To speak in terms of natural selection would be tantamount to a fatalistic admission of powerlessness to deal with the situation. In Africa, the gross imbalance between supply and demand makes it necessary to make hard choices in order to make the most effective use of available staff and equipment. The objective of medical triage is to allocate scarce facilities to those patients with the greatest chance of survival. However it is difficult to define precise rules for making such choices since they are strongly dependent on available resources, type of pathology, and level of medical skill. Prognostic indicators are ill-suited to emergency situation since they require not only clinical data but also and above all, in most cases, laboratory data which is not always available or justifiable. Experience is probably the best guarantee for reliable triage, which is philosophically difficult to accept but often unavoidable in everyday practice.

Developing Countries↗
PubMed2001

[Practice and complications of spinal anesthesia in African tropical countries].

OBJECTIVE: To evaluate the risk of the practice of spinal anaesthesia (SA) in African tropics. STUDY DESIGN: Prospective study in multiple centres over a two years period. PERSONS: Twenty-one anaesthesiologists and anaesthetist nurses covering ten African countries. METHODS: Two anonymous questionnaires; the first, filled in each anaesthetic problem occurred, to define the type of incident or accident, and its circumstances; the second was designed to define the position occupied, to quantify the global anaesthetic activity, the number of SA, and to value the number of complications or deaths linked to SA. RESULTS: Six anaesthesiologists and one anaesthetist nurse replied to the study, covering six sites in five different countries (Senegal, Chad, Central African Republic, Niger and Madagascar). On the 18,432 anaesthetic acts collected, 2,703 (14.7%) were SA. In the well-equipped centres, general anaesthesia was predominant with a frequency of over 75%. However in the not so well equipped centres or those which supplies were more problematical, SA technique was used with a frequency varying from 48.9 to 68.7%. Forty incidents and accidents were reported (1.5%), five led to the death of the patient (0.2%). Among the seven cardiac arrests (0.3%), four were fatal (0.1%). Eight of the ten accidents and all of the deaths occurred in the least equipped centres. Eight of ten accidents happened during emergency caesarean sections. All cardiac arrests were preceded by a severe hypovolemia. For the four deaths after cardiac arrest, an anaesthetist nurse with isobaric bupivacaine 0.5% carried out SA. CONCLUSIONS: This study showed that the practice of SA in African tropics was performing in different practice conditions and people qualification than they were in France. The frequency of cardiac arrests and deaths was respectively five and 20 times more important, in those conditions. The first conclusion that can be drawn from this study is that it is questionable to use SA for emergency Caesarean section under hypovolemic condition. The second is the necessity for specific training on the local anaesthesia for anaesthetist nurses but also training to choose the anaesthesia best adapted to the surgery, the condition of the patient and the means available.

Adolescent↗
PubMed2000

Effects of sevoflurane on hypoxic pulmonary vasoconstriction in anaesthetized piglets.

In vitro, halogenated agents reduce the pulmonary vasoconstrictor response to alveolar hypoxia in isolated perfused lungs. However, studies in intact animals have been less convincing. The aim of the present study was to assess the effect of sevoflurane on hypoxic pulmonary vasoconstriction (HPV) in anaesthetized piglets using the pressure/cardiac index relationship (P/Q). Ten large white piglets were anaesthetized and mechanically ventilated, alternately in hyperoxia (FIO2 = 0.4) and hypoxia (FIO2 = 0.12). Multipoint plots of pulmonary arterial pressure (PAP) or differences between PAP and left atrial pressure (LAP) against Q were generated by gradual inflation of a balloon introduced into the inferior vena cava. P/Q relationships were established in hyperoxia and hypoxia at baseline, and then with sevoflurane. In hypoxia, pressure gradients (PAP-LAP) increased at every level of Q, thus demonstrating active pulmonary vasoconstriction. Sevoflurane at 1 MAC did not affect these P/Q relationships in hyperoxia or hypoxia as compared with baseline. Sevoflurane at a clinically relevant concentration (1 MAC) has no significant effect on HPV in anaesthetized piglets.

Anesthesia, Inhalation↗
PubMed1998

[Oxygen in the field hospitals: current experience in the military health service].

A fifty per cent oxygen ratio locks quite sufficient for putting at sleep war wounded patient. After the present time, every french field surgical structures are equipped with oxygen extractors. Furthermore, those teams have at heir disposal for several years, oxygen generators, working with sodium chlorate candels. Those one can fill oxygen cylinders (3.5 l at 90 or 150 bars), providing pure oxygen, which will ever be essential under exceptional conditions. During war period, the supply difficulties demand to have at disposal two different production capabilities for oxygen administration.

France↗
PubMed1993

[A comparative study of recovery following maintenance of anesthesia with propofol or isoflurane. An attempt to synthesize current data].

Quality of recovery is a means to improve anaesthetic safety during postoperative time, in post-anaesthesia recovery room and especially when the patient returns to his unity. The comparison of recovery after maintenance of anaesthesia with propofol or isoflurane shows that, for 50 to 60 min surgical procedures, results are significantly better with isoflurane. Review of literature shows that, for less than 30 min operations, propofol seems to give best recovery. For more than 30 min operations, isoflurane enables better quality recovery.

Adolescent↗
PubMed1992

[Lyme's disease, a possible cause of isolated acute myocarditis].

The frequency of cardiac lesion in patients with other signs of Lyme disease has been estimated at 8 percent. The usual manifestation of myocardial involvement is a varying degree of atrioventricular block or more diffuse signs of myocarditis. Autopsy or intramyocardial biopsy provides a histological diagnosis of myocarditis. Microscopy shows a diffuse lympho-plasmocytic infiltrate with presence of macrophages in the myocardium, associated with a varying number of necrotic myocytes. Structures resembling spirochetes have been found in some cases. Exceptionally, the cardiac lesion may be isolated, presenting as an acute atrioventricular block and/or an acute myocarditis; in such cases the diagnosis of cardiac lesion caused by Lyme disease is made on serological grounds. We report the case of a 30-year old man admitted for acute myocarditis which turned out to be totally regressive. Intramyocardial biopsy showed interstitial congestion associated with inflammatory lympho-histiocytic infiltrates and eosinophilic polymorphonuclears; the myocardial fibres in contact with these infiltrates appeared to be altered. The diagnosis of Lyme disease was subsequently confirmed by serological tests. Patients with myocarditis caused by Lyme disease must be treated with antibiotics. Recent reports have demonstrated the presence of spirochetes in the myocardium of patients with dilated cardiomyopathy, suggesting that the spirochete Borrelia burgdorferi might be associated with, or play a part in, the subsequent occurrence of dilated cardiomyopathy.

Acute Disease↗
PubMed1991

[A rare cause of difficult intratracheal intubation: Langenbeck's disease].

A case of difficult tracheal intubation due to insufficient mouth opening once anaesthesia had been induced is described. At the pre-anaesthetic visit, the 47-year-old female patient had painless restricted mouth opening (two fingers' breadth), dental malpositions, and slight lateral mandibular deviation. Cervical spine movements were normal. She was ranked 3 on the Mallampati scale. The anaesthetic technique preserved spontaneous breathing (induction with propofol 1.5 mg.kg-1 and alfentanil 15 micrograms.kg-1). Manual ventilation was impossible. An oral cannula could not be inserted. As intubation by the normal route was impossible, the retromolar approach had to be used. Several attempts were required for successful intubation by this route. At the end of surgery, the patient was extubated without any difficulties. Postoperative investigations revealed hypertrophic coronoid processes. In this condition, the mandible is jammed by hitting the maxilla, especially when mandibular lifting manoeuvres are used to facilitate manual ventilation and tracheal intubation. Clinical and paraclinical predictors of difficult tracheal intubation seem to be unreliable in such dynamic abnormalities of mouth opening.

Female↗
PubMed1991

[Formation of a knot in a J spiral metallic guide: a complication of the Seldinger method].

Central venous catheter insertion by Seldinger's technique uses a wire guide which could be cause of complications. This case reports a blocked wire guide of which J tip was responsible for knotting. Utilization of vessel dilator of central venous catheterization set (Arrow) permitted to liberate and withdraw the wire guide without surgical operation. A larger use of this wire guide could increase the frequency of such complications.

Aged↗
PubMed1987

[Rupture of an intracranial aneurysm after spinal anesthesia].

A case is reported of an intracranial aneurysm which ruptured after spinal anaesthesia. A 36-year-old man underwent several locoregional anaesthesias for the surgical treatment of an infected lower limb fracture (8 epidural blocks and 1 spinal anaesthesia). After a further spinal anaesthesia, he suffered violent headaches, a meningeal syndrome, restlessness, left hemiplegia and coma. The relationship between such an accident and the anesthesia is discussed in the light of similar cases previously published.

Adult↗