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L Tiret

Publications and source records attributed to L Tiret.

At least 109 records · Page 6Linked to original sources
PubMed1988

Complications related to anaesthesia in infants and children. A prospective survey of 40240 anaesthetics.

A prospective survey of anaesthesia-related mortality and morbidity in infants and children was carried out in a representative sample of anaesthetics performed in 440 institutions chosen at random in France. A total of 40240 anaesthetics were administered to patients younger than 15 yr, 2103 (5%) involving infants (younger than 1 yr). Twenty-seven major complications related to anaesthesia occurred during or within 24 h of the anaesthesia--an incidence of 0.7 per 1000 anaesthetics. Nine, of which four were associated with cardiac arrest, were observed in infants, whereas in children there were 18 complications of which eight were associated with cardiac arrest, one with fatal outcome. The risk of complications was significantly higher (P less than 0.001) in infants (4.3 per 1000) than in children (0.5 per 1000). Accidents observed in infants mainly occurred during maintenance of anaesthesia and were the result of respiratory failure. In children, circulatory failure was as frequent as respiratory failure and complications were observed almost equally during induction and maintenance and on recovery. The rate of complications increased significantly with the ASA score and the number of co-existing diseases. The incidence was also higher when a previous history of anaesthesia was present, when the procedure was an emergency, and when the duration of preoperative fasting was less than 8 h.

Adolescent↗
PubMed1988

[Digestive surgery in France. A national epidemiologic survey (1978-1982)].

An epidemiological survey, carried out from 1978 to 1982 in 460 public and private institutions randomly selected from all parts of France, provided an assessment of the activity performed in digestive surgery. The sample included 37,967 patients, yielding an annual estimation of 700,000 patients operated on in the entire country. Digestive surgery was the first surgical domain (20 p. 100 of the entire surgical activity); 51.5 p. 100 of the patients were males and 53 p. 100 were under 35 yr of age. The annual incidence of these operations was 1.3 per 100 population. The first reason for operation was appendicitis (43 p. 100), followed by hernia (17.2 p. 100), gallbladder and biliary tract (10 p. 100), and anal diseases (7.7 p. 100). Digestive cancers led to 32,000 operations each year, with a majority of colonic cancers (40 p. 100). Except for appendectomy and operations on the gallbladder and biliary tract, most procedures were more frequent in males, especially operations on the stomach and esophagus. Incidences of appendectomy, cholecystectomy, inguinal hernia repair and operations for digestive cancers were assessed by sex and age. Incidence of appendectomy was 3 to 4 times greater than in other countries. Intraoperative and immediate postoperative (less than 24 h) mortality was higher for digestive operations (4.7 p. 1000) than for surgery as a whole (2 p. 1000). It increased with age and was higher in males.

Adolescent↗
PubMed1987

[Injuries requiring anesthesia. An epidemiologic survey].

An epidemiological survey carried out in 460 public and private institutions chosen at random country-wide in France made it possible to study injuries whose treatment had necessitated an anaesthetic. For 1980, the total number of anaesthetics administered for injuries was estimated at 450,600, among which 22% were applied in public teaching hospitals, 40% in non teaching hospitals, and 38% in private institutions. Of the total number of anaesthetics given, 41% were emergencies and 10% were repeat operations. The proportion of anaesthetics applied in treatment of injuries increases in the summertime and on weekends. There was a majority of male patients (61%), the most important group being those 15 to 24 years of age. Among females, the highest proportion of injuries was observed among those between 75 and 84 years of age. Fractures accounted for 58% of the injuries, open wounds for 20%, dislocations, sprains and strains for 10%. The incidence of injuries varied according to sex and age. Those exposed to the highest risk were males between 15 and 24, and females over 75. Incidence rates by sex and age were also assessed for fractures of the skull and face, upper limb, neck of the femur and lower limb.

Adolescent↗
PubMed1987

[Femoral neck fractures after age 65: morbidity, mortality, lethality].

In 1984, in France, 7,916 deaths of persons over 65 yr were due to femoral neck fracture (national statistics of mortality). In the same age group, the annual number of surgical procedures performed for this reason was estimated from a national survey to be 36,300 in 1980. The proportion of deaths and surgical procedures due to this condition increases with age and is always higher in females. The same result is observed concerning the annual incidence of deaths and the incidence of operations (2 p. 1000 in males, 6 p. 1000 in females over 65 yr). Lethality was assessed by relating figures of mortality and surgical morbidity (1 death p. 4.6 operations). It was higher in males (1 death p. 3.5) than in females (1 death p. 4.9). The difference between males and females was more marked in younger age groups (ratio of 3 in the 65-69 yr group) and decreased with age. This excess-lethality in males is partly due to a poorer preoperative condition, and especially to a greater frequency of coexisting respiratory failure.

Aged↗
PubMed1986

Complications associated with anaesthesia--a prospective survey in France.

A prospective survey of complications associated with anaesthesia was carried out in France from 1978 to 1982 in a representative sample of 198,103 anaesthetics performed in 460 public and private institutions chosen at random in the country as a whole. There were 268 major complications associated with anaesthesia occurring during or within 24 hours of anaesthesia (one per 739 anaesthetics), among which 67 were followed by death within 24 hours and 16 by coma persistent after the 24th hour. The incidence of death and coma was one per 2387 anaesthetics. The incidence of death and coma totally attributable to anaesthesia was one per 7924 anaesthetics. Fifty-eight per cent of complications occurred during anaesthesia while 42 per cent were observed during the recovery period. Mortality was lower following complications during anaesthesia than for those during the recovery period. Half of the deaths and cases of coma totally attributable to anaesthesia were due to postanaesthetic respiratory depression. The rate of complications appeared to be dependent upon several risk factors: the patient's age, the number of associated diseases, the preoperative status, whether the operation was an emergency and the duration of procedure.

Adolescent↗
PubMed1986

[Cardiac arrest during anesthesia and the recovery period. Data from the INSERM survey 1978-1982].

This report analyses rate, predisposing factors, causes and outcome of 458 cardiac arrests occurring during anaesthesia and the following 24 hours and collected in France by a national prospective survey between 1978 and 1982. The overall rate of cardiac arrests was 1 per 433 anaesthetics, resulting in death before the 24th postoperative hour in 79% of cases, i.e. 1 per 547 anaesthetics. Cardiac arrests not related to anaesthesia were three times more frequent than those related to anaesthesia. Among these, one half is partially related to anaesthesia and the other totally. The prognosis of cardiac arrests totally related to anaesthesia is six times better than that of not related arrests (64% of recoveries without sequelae vs 10%). The cardiac arrests not related to anaesthesia occur mainly at the end of surgery and the following 24 hours. The main causes are hypovolaemia, sepsis and severity of surgical illness. Among cardiac arrests related to anaesthesia, a quarter occurred during induction, another during maintenance and a half during recovery from anaesthesia. The first were mainly related to histamine release and had the lowest mortality rate. The last were mainly related to unrecognized postoperative respiratory depression and resulted in the highest mortality. The authors underline the necessity of better preoperative detection of high risk patients, smooth induction of anaesthesia, continuous clinical monitoring of the patient during surgery and the recovery period.

Age Factors↗
PubMed1986

[Anesthesia in gynecology and obstetrics: a national epidemiologic study].

A sample of 33,508 anaesthetics taken from a national enquiry between the years 1978 and 1982 and representative of the overall activity in this field in France made it possible to look at anaesthesia in gynaecology and obstetrics in France. This study has made it possible to estimate that the annual number of anaesthetics that are given in this filed in France come to about 600,000 of which 22% are in obstetrics. The means that 2.2% of all women have an anaesthetic for these reasons. The most common operations are induced abortion and curettage of the uterus. Epidural anaesthesia was used in 12% of obstetric manoeuvres and 0.8% of gynaecological procedures. 70% of the women who were anaesthetised were aged between 20 and 40 and 64% had already had an anaesthetic in the past. 91% were in satisfactory health before the operation. One in 4 interventions were emergencies. University departments performed 21% of the cases, non-university hospitals 34% and private clinics 45%. In 30% of the cases, the anaesthetic was given by a nurse or a midwife. The risks of major complications while under anaesthetic or in the 24 hours after the operation were higher in obstetrical manoeuvres (2.4 p. 1,000) than in gynaecological procedures (1.1 p. 1,000). 78% of the complications in gynaecology could be attributed to anaesthesia as compared with 44% in obstetrics.

Abortion, Induced↗
PubMed1985

[Contraception and the use of care systems].

A study has been made of the frequency of the use of contraceptive methods and the methods used (oral contraception, intra-uterine device and other methods). This was carried out on 2000 women aged between 20 and 44 who had not been sterilised, were not pregnant, who lived in towns and in the country. The following variables were studied: the age, the socio-professional class, the zone in which they lived, the way antenatal care had been carried out (the number of antenatal visits and preparation for labour), the number of times they had seen a gynaecologist during the pregnancy, how the baby had been looked after in its first year of life and how often it had seen a paediatrician. A statistical analysis made it possible to categorise the variables that were studied in their relationship to medical contraception. This shows that as regards age, educational level and social status medical contraception was always better in towns than in the country. On the other hand, when women in the country do use medical contraception they go to the gynaecologist much more often than their town sisters do without any particular result from these consultations. Finally, medical contraception is not linked to other medical attention. This tends to confirm that contraception can be used as a prognostic element to show how well the woman will be looked after in pregnancy.

Adult↗
PubMed1984

[Anesthesia and intensive care in cardiac surgery. Activity at the French centers in 1982].

A national survey was carried out to inquire about the practice of anaesthesia and surgical intensive care in cardiac surgery in French hospitals. In 1982, 15,797 surgical procedures with cardiopulmonary bypass were collected; 1,360 and 555 were performed in children and infants respectively. Coronary surgery accounted for 46% of the total. For the same time interval, 2,554 operations without cardiopulmonary bypass were done. Postoperative care was supervised by anaesthesiologists in most of the French centres. The duration of stay of patients in intensive care units increased as the unit's activity decreased. With the exception of arterial blood pressure monitoring, there was no consensus on the method or the extent of monitoring of patients undergoing cardiac surgery. A Swan-Ganz catheter was only used in 18% of cases. Neuroleptanalgesia was the anaesthetic technique most often used.

Adult↗
PubMed1984

[Multifactorial index of the risk of complications related to anesthesia].

Anaesthetic risk has been studied until now only in terms of mortality rates, and by single factor analysis. A multifactorial index of anaesthetic risk, taking into account all major complications related to anaesthesia that occur during--or within 24 hours of--surgery is proposed. Data were collected in a prospective survey among a representative sample of anaesthesias. The logistic model included a sample of 232 complications and a control group of 1 642 anaesthesias with no complications. Eight factors related to the patient's condition, and to the kind of surgery performed, were considered. Only six were found to have prognostic value, and--among them--the "previous complications" factor stood out. There was a good concordance between predicted and observed risk. The index may be used for a preoperative estimate of anaesthetic risk.

Adolescent↗
PubMed1984

Cardiac arrest related to anaesthesia: a prospective survey in France (1978-1982).

This report analyses the rate, predisposing factors, causes and outcome of 119 cardiac arrests related (totally or partially) to anaesthesia which were collected in France by a national prospective survey performed between 1978 and 1982. The overall rate of cardiac arrests occurring during anaesthesia and recovery was 1 per 1665 anaesthetics, resulting in death, before the 24th postoperative hour, in 56% of cases, i.e. 1 per 2900 anaesthetics. Approximately a quarter of cardiac arrests occurred during induction, another quarter during maintenance and a half during recovery from anaesthesia. The first were mainly related to anaesthesia and had the lowest mortality rate. The last were mainly related to unrecognized postoperative respiratory depression and resulted in the highest mortality. Cardiac arrests were less frequent in private hospitals than in teaching hospitals but the mortality rate was higher.

Adolescent↗
PubMed1980

[Causes of death of children at the Hôpital des Enfants-Malades. Statistical study of 1 098 pathologic and clinical records collected from 1966 to 1975 (author's transl)].

The clinical and histopathologic records of 1 098 children under 15 years of age, deceased at the hôpital des Enfants-Malades from 1966 to 1975 were studied. This material represents 44% of the total deaths of the same period. This study uses both the international classification of diseases and W.H.O.'s criteria, for distinguishing in causes of death between the principal cause, the immediate cause and associated causes. A higher mortality rate was observed in boys (58%), during the first year of life (80%), during the first 12 hours following admission (13%) and during the night. Causes of death are rarely isolated (10%), more often multiple: double (50%), or even triple or more (40%). Malformations represent 40% of the main causes of death, infections 14%, perinatal mortality 11%. Among immediate causes, infectious diseases are responsible for 23% of the deaths, respiratory disorders for 15%. Among associated causes are seen, in decreasing order of frequency: surgical procedures, prematurity, known or unrecognized associated malformations. Infections occurring during hospitalization represent the principal iatrogenic disorders. Anatomico-clinical examination failed to find an immediate cause of death in 25% of the cases and a principal cause in 7%.

Adolescent↗
PubMed1980

[The adolescent today. Medical and demographic questions (author's transl)].

Medical and demographic aspects of adolescence are described. These include: statistics concerning medical causes of death, data obtained in special medical or social communicaties, especially hospital morbidity and chronic disease statistics; lastly, the results of sample surveys, such as that concerning morbidity breakdown in general practice. All these data can serve as a basis for an intelligent approach to the medical problems of adolescence.

Adolescent↗