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Biomedical subjects

J du Cailar

Publications and source records attributed to J du Cailar.

At least 19 recordsLinked to original sources
PubMed1979

[Blood and urinary cyanide concentrations during long-term sodium nitroprusside perfusion].

Five deeply comatose neurological patients were administered a continuous perfusion of sodium nitroprusside (SNP) at the rate of 3 microgram.kg-1.min-1. The levels of blood cyanide (CN-) were measured two hours after the start, then every 12 hours during, and 12 and 24 hours after the end of perfusion. The urinary output of CN- was also studied. The results show that total blood CN- stabilized after 36 hours to a mean value of 0.11 mg/l. When perfusion was stopped, CN- blood levels dropped but did not reach pre-perfusion values at the 24th hour. Urinary excretion of CN- which reached a maximum value of 0.050 mg/24 h represents a negligible amount and does not explain the fall of blood CN- and the occurrence of a concentration plateau. The results showing lower values obtained on non-anesthetized patients during the first hours of perfusion compared to those of a previous study done under neuroleptanaesthesia are discussed. These results suggest that prolonged perfusions at SNP at the rate of 0.177 mg.kg-1.h-1 do not produce toxic blood level of CN-.

Adult↗
PubMed1979

[Effects of diazepam on oxygen consumption].

Oxygen consumption (VO2) was measured in ten patients before and after the administration of 0.28 mg.kg-1 of diazepam, using a spirometer placed in the circuit of an MA1 respirator functioning on a closed circuit basis. The results showed a significant decrease in VO2 OF 8 p. 100. The differences seen in comparison with previous studies may be explained by differences in the methods of study used. It would appear that this hypometabolic effect is not an intrinsic property of diazepam but rather a consequence of the neurodepressive properties of the drug, on the gamma system in particular.

Adult↗
PubMed1979

[Peridural anesthesia and cesarean section. Apropos of 117 cases].

One hundred and seventeen caesarean sections performed under epidural anesthesia are reported. Following localization by air myelography, catheterization of the epidural space was performed in all cases. The estimated level of injection was L 1.76 +/- 0.82. The local anesthetic used was: lignocaine 2 p. 100 with adrenalin 1/160,000 (N = 13) in a dose of 388 mg +/- 81.4; bupivacaine 0.5 p. 100 with adrenalin 1/2000,000 (N = 77) in a dose of 106.6 mg +/- 20; or a mixture of bupivacaine 0.5 p. 100 with adrenalin 1/200,000 and lignocaine 2 p. 100 without adrenalin (N = 27) at doses of 91.0 mg +/- 23.9 and 238 mg +/- 53.4 respectively. The failure rate was 5.97 p. 100 and the operative conditions were satisfactory in 91.5 p. 100 of cases. Apgar scores were greater than 7 in 87 p. 100 of cases at one minute and 99 p. 100 of cases at 5 minutes. The proportion of minor incidents was 30 p. 100, and of complications 3.5 p. 100. Their prevention and treatment and the anesthetic protocol are discussed.

Adolescent↗
PubMed1979

[Postoperative analgesia by constant flow injection of lignocaine in obstetrical and gynecologic surgery].

154 surgical patients were given post-operative analgesia by peridural injection at a constant flow in the post-operative period after obstetric or gynecological surgery. These patients received 536.2 +/- 105.3 mu mol.h-1 (145.2 +/- 28.5 mg.h-1) of lignocaine for 46.97 +/- 15.56 h through a catheter omserted between L1-L2. The drug was given in concentrations which varied between: 27.7 to 18.5 m mol.l-1 (0.75 to 0.50 p. 100) depending on the age; and the volume varied between 17.5 to 30 ml.h-1 depending on the height. Satisfactory analgesia in 87 p. 100 of cases allowed all supplementary analgesia to be stopped. The only significant hemodynamic effect was a slight tachycardia (+ 15 p. 100). Two undesirable side effects were noted: a transitory but well-defined (type 2 or 3) motor paralysis, and an accumulation of plasma lignocaine (40 mu mol.l-1 (1.1 microgram.ml-1) at 48 h).

Analgesia↗
PubMed1979

[Nature and antibiotic resistance of bacteria encountered in an intensive care unit. Computerized study based on 422 antibiograms].

A computer analysis of 422 sheets of data from antibiograms performed on 146 patients in a resuscitation unit of multipurpose type, was performed. The study comprises the investigation of the nature of the isolated bacteria and the resistance of the organisms to antibiotics alone or in combinations. The results obtained show on the one hand, that there is a development over time of resistance to antibiotics and a change in the nature of the bacteria, and on the other, that a precise knowledge of the bacteriological data concerning a given department enables the intiation of treatment before having the antibiogram results with an increased chance of efficacy. The importance of such a study is controversial.

Anti-Bacterial Agents↗
PubMed1979

[Comparison of postoperative blood cortisol levels after neuroleptanalgesia and extradural anesthesia].

Postoperative plasma cortisol levels were measured in two series of surgical patients who had undergone a gynaecological operation, with respectively 17 and 16 subjects. Samples were drawn on D0 6pm, D1 8am, D2 8am and D3 8 am. A reference sample had been taken before the premedication on D0 at 8 am. The first series had been anaesthetised using a dextromoramidedroperidol type neuroleptanalgesia followed by postoperative analgesia by a noramidopyrine compound. The second series required epidural anaesthesia followed by postoperative analgesia by the injection of lidocaine at constant rate, interrupted between the last two samples. In the neuroleptanalgesia group: from a basal level of 470 nmol.l-1, plasma cortisol rose to 800 nmol.l-1 (p less than 0.01) on D0 at 6 pm to subsequently remain on a plateau between 500 and 550 nmol.l-1 (NS) within the normal physiological limits for the laboratory. In the epidural group, from a basal level of 420 nmol.l-1, plasma cortisol rose to 1000 nmol.l-1 (p less than 0.01) to return to basal levels only on D3: 450 nmol.l-1 (NS) with intermediate values of 700 and 630 nmol.l-1 (respectively: p less than 0.001 and p less than 0.05). Statistical comparison between the two groups showed that the increase in cortisol in the epidural group in relation to the other was significant throughout the period of administration of lidocaine at constant flow rate: p less than 0.05 on D0 at 6pm, D1 and D2. The results are discussed.

Adult↗
PubMed1979

[Changes in physicochemical parameters and coagulation factors in hemodilution with dextran of molecular weight 60,000].

In 18 subjects undergoing aorto-bifemoral by-pass, pre-operative isovalaemic hemodilution was carried out (using a dextran of molecular weight 60,000) at the same time as venous section of a mean value of 1087 ml reducing the hematocrit to 0.30. The following were studied before, immediately after and 24 hours after hemodilution: blood viscosity (at variable shearing rates), oncotic pressure, sedimentation rate, clotting factors, plasma electrolytes. These results showed that at the end of hemodilution, oncotic pressure was maintained and even increased despite the fall in blood protein levels, with also a decrease in blood viscosity, a tendency to dynamic hypocoagulability (thrombocytopenia, fall in fibrinogen and increase in cephalin kaolin time and Quinck time) without any increase in lytic activity. 24 hours later, these parameters tended to return to normal. Discussion on the basis of a study carried out in vitro, seeks to demonstrate which of these changes were related to the dextran molecule and which were related to the hemodilution.

Adult↗
PubMed1978

Nitroprusside, its metabolites and red cell function.

The effects on metabolism and red cell function of blood levels of thiocyanate (SCN-) and cyanide (CN-) were studied in 42 patients undergoing surgery under controlled hypotension (CH) induced by sodium nitroprusside (SNP). The mean dosage of SNP administered was 21.38 mg (SD = 12). The durating of perfusion was 121 minutes (SD = 11). All operations were performed under neuroleptanalgesia without complications. No tachyphylaxis was encountered. Under SNP a slight increase of blood SCN- (from 13.9 mg/l +/- 1.1 to 23 mg/l +/- 2.6) was found. Blood levels of CN- are increased mostly in the red cell, the mean value being 0.300 mg/l +/- 0.10 for whole blood after two hours of perfusion. This value decreased when perfusion was stopped. All blood samples were negative for methaemoglobin and cyanmethaemoglobin. Carbonic anhydrase activity was not modified, CN- toxicity levels for this enzyme being 50 times higher than those found during our study. 2,3-DPG levels did not vary. Blood gases, acid-base balance and Davo2 did not change significantly, although a slight increase in blood lactate was measured. As shown by this study, appreciable amounts of CN- are detected in blood during SNP perfusion while SCN- stays at relatively low levels. Fortunately most of the CN- released from SNP moves into the red cell and does not alter its functions at clinical concentrations. The low plasma concentration of CN- is not sufficient to cause important metabolic disturbances. However, dosages of SNP higher than those administered during this study could increase the blood and tissue CN- to toxic levels. A toxicity study shows that, during a relatively short period of time, SNP dosage should not exceed 1.16 mg/kg or a maximum of 10 microgram/kg/min for a period of two hours.

Adolescent↗
PubMed1978

[The use of naloxone in neuroleptoanalgesia].

Naloxone was used in 20 patients divided into two series: series A consisted of 10 adults with an average age of 50.6 years (+/- 12.03) and series B 10 children with an average age of 8.5 years (+/- 5.16). Naloxone was given in the treatment of postoperative respiratory depression related to persistence of morphine impregnation, the patients having received either fentanyl (mean dose 0.04 mg/kg/h) or dextromoramide (mean dose 1.15 mg/kg/h). The mean dose of naloxone was 0.26 mg +/- 0.10, i.e. 3.9 microgram/kg in series A, and 0.13 mg +/- 0.11, i.e. 5.3 microgram/kg in series B. In both series, study of ventilatory function showed correction and stabilisation of the various parameters (F/min, Vt and V) up to 180 minutes after the injection. Recovery was rapid in both groups (7 to 10 min) and of good quality. Whilst it was accompanied in a number of cases by the recurrence of pain, the latter never required specific relief. The administration of naloxone was associated with an increase in heart rate (non-significant) at 10 min in series A and 30 min in series B. Apart an episode of nausea in one case of series A, no disagreeable side effects were observed.

Adolescent↗
PubMed1978

[Constant flow anesthesia using a combination of etomidate and fentanyl].

In 35 orthopaedic surgery patients (33 adults and 2 children), anaesthesia was obtained using an association of etomidate and fentanyl. Induction was obtained by injection from a syringe of a mixture of etomidate and fentanyl in an average dose of 21 mg for etomidate and 0,08 mg for fentanyl. Anaesthesia was maintained by constant dose of etomidate was 1.29 mg/kg/h and 4.96 microgram/kg/h for fentanyl. The mixture used for both induction and maintenance contained 1.3 mg of etomidate and 5 mg of fentanyl per ml. The results, value, indications and contraindications of this technique are described.

Adolescent↗
PubMed1978

[Osmotic colloidal pressure: measurement and clinical importance].

Knowledge of osmotic pressure has long existed and its practical use in the treatment of patients under intensive care has been widely developed over the past few years following the introduction of simple electronic osmometers. It is related more to plasma albumin than to globulins. It varies in relation with a certain number of physiological factors and in different pathological circumstances. The value of OP and above all of the difference OP--PCP in the prevention, diagnosis, treatment and prognosis of pulmonary oedema has been clearly demonstrated in several recent studies. Its value in relation to total serum proteins is that it takes into account any possible dysproteinaemia and that it is directly expressed in units of pressure which makes possible the calculation of the OP--PCP difference which represents the difference between the only OP--PCP difference which represents the difference between the only two intravascular forces which participate in fluid exchanges at the level of the pulmonary capillary.

Age Factors↗
PubMed1978

[Plasma concentration of fentanyl during and after its administration at constant flow].

Using the technique of the radio-immunological estimation with fentanyl-H3, a study was made in sixteen adults anaesthetised by the administration at a constant rate of alfadione and fentanyl, of plasma concentrations of fentanyl during and after anaesthesia. Anaesthesia was induced by the administration of 4.2ml of alfadione and 0.084mg of fentanyl. The maintenance dose was 0.147 ml/kg/hour of alfadione and 2.95 microgram/hg/hour of fentanyl. Five minutes after induction, the concentration of fentanyl was 2.7 microgram/l. The level fell significantly to 2.56 microgram/l at the 45th minute. From this point onwards, it increased regularly up to the 120th minute, when it reached a level of 3.7 microgram/l. When the infusion was stopped, the level first decreased rapidly, the excretion curve then becoming flattened out. At the 120th minute, a level of 1 microgram/l persisted. This study indicates that the administration of fentanyl at a constant rate is not accompanied by a constant blood concentration up to the 120th minute, the point at which the study was terminated. The residual level found after administration and in the absence of any clinical effect implies the need for a reduction in dose at the time of any complementary administration of fentanyl during the postoperative period.

Adult↗
PubMed1977

[Anesthesia with continuous infusion of alfatesine and phenoperidine. Uses in anesthesia of aged subjects in visceral surgery].

Anaesthesia was administered to one hundred and fifty eight patients by continuous infusion of a mixture of Alfatesine and phenoperidine. The patients were divided on two groups: group A consisted in 96 patients undergoing abdominal surgery and group B of 62 cases of various types of surgery, mainly orthopedics. The average age was 63 years (range 16-96). The operative risk scored 6 or more in 71 cases. The length of operation averaged 151 minutes (S.D. +/- 15). The mixture made of alfadione 25 ml and phenoperidine 5 mg in a glucose 5 per cent 250 ml solution was administered by mechanical pump. The induction dose was 50 ml of the mixture for patients under 50 years (rate 10 ml per minute), 40 ml per patients from 50 to 70 years (5 ml per minute), and 30 ml for patients over 70 years (5 ml per minute). The maintenance dose was adjusted to weight and age and ranged from 0,11 to 0,15 ml/kg/h for alfadione and from 0,022 to 0,030 mg/kg/h for phenoperidine. Routine tracheal intubation and artificial ventilation were performed in group A. The results are studied in relation to the effectiveness of the anaesthesia mixture, its side effects and influence on recovery. Generally, the results are good and emphasize the value of the technic in abdominal surgery for elderly patients. The methods of application are discussed in terms of medical background.

Adult↗
PubMed1977

[Atypical pulmonary embolism associated with inter-auricular communication].

A case of massive pulmonary embolism at a patient with undetected atrial defect is reported. The authors discuss the difficulties of establishing a proper diagnosis when the right heart pressure is not raised and when a large emboliser is well tolerated. Angiography confirmed the diagnosis and the patient was successfully treated with embolectomy followed by ligation of the inferior vena cava.

Heart Septal Defects, Atrial↗