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P Adnet

Publications and source records attributed to P Adnet.

At least 19 recordsLinked to original sources
PubMed1999

[Caffeine skinned fiber tension test: application to the diagnosis of susceptibility to malignant hyperthermia].

OBJECTIVE: To assess the reactivity of sarcoplasmic reticulum to caffeine, using the skinned muscle fibre tension test and to compare it with the reference in vitro contracture test in the diagnosis of malignant hyperthermia (HM) susceptibility. STUDY DESIGN: Laboratory investigation. MATERIAL: Muscle biopsies from 63 patients, including 29 classified as susceptible to MH (MHS) and 34 classified as non-susceptible (MHN) according to criteria of the European and the North American MH groups. METHOD: The reactivity to caffeine and halothane of skinned muscle fibres was compared, according to the type of fibres, with the data of the in vitro contracture test. The type of fibres (type I: oxidative, slow; type II: glycolytic, fast) were determined with strontium dose-response curves. RESULTS: The reactivity to caffeine was significantly lower in the MHS group, for both type I and type II skinned fibres. However, in comparison with the data of the in vitro contracture tests, using the ROC curve analysis, the best sensitivity-specificity compromise was 90%-71% and 74%-84% for type I and type II skinned fibres respectively. CONCLUSION: The skinned muscle fibre tension test cannot be used instead of the in vitro contracture test for the diagnostic of MHS. However, it may strengthen the data of the latter.

Caffeine↗
PubMed1999

[Anesthesia practice by nurse anesthetists in French speaking Sub-Saharan Africa].

OBJECTIVE: To evaluate the practice of anaesthesia in French-speaking subsaharian countries. TYPE OF STUDY: Prospective survey. PERSONS: Two hundred seventeen nurse anaesthetists, from 11 different countries. METHODS: Anonymous questionnaire. RESULTS: One third of nurses were practising anaesthesia since less than five years and 1/3 since more than 10. Only 39 (18%) were working in the country side. Thirty seven (17%) had been trained outside subsaharian Africa (in Cuba 6%, France 5%, Morocco 5% and Germany 1% respectively). Two hundred thirteen (98%) were performing general anaesthesia and 169 (78%) regional anaesthesia. Hundred sixty eight (97%) used spinal anaesthesia, 57 (33%) epidural, 31 (18%) intravenous regional anaesthesia, 24 (14%) axillary block, 17 (10%) caudal block and 10 (6%) peripheral block respectively. For regional techniques, disposable devices were available in 50% of cases. For general anaesthesia, thiopental was administered by 193 (89%) and ketamine by 156 (72%) nurse anaesthetists respectively. In 50% of cases, these drugs were used alone. An ECG was available in 40%, a pulse oximeter in 14% and a capnographe in less than 2% of cases. A ventilator was present in 66% of the places, but used only in 30% of them because of the lack of maintenance and training. CONCLUSIONS: In this study, 50% of nurse anaesthetists were working alone. However, this rate is probably under-estimated, as the questionnaire did not consider anaesthesia practice in the country side.

Africa South of the Sahara↗
PubMed1999

[Evolution of the demography of anesthesia practitioners in French speaking Sub-Saharan Africa].

OBJECTIVE: To assess the course of the demography of anaesthesia providers in French-speaking subsaharian countries. TYPE OF STUDY: Retrospective survey. PERSONS: Doctors trained in anaesthesia and nurse anaesthetists registered in West African medical societies. METHODS: Countries, hospitals, anaesthesia manpower, seniority and place of training were analysed. RESULTS: In the 13 French-speaking subsaharian countries including 97.5-M inhabitants, 122 doctors and 868 nurses were registered as anaesthetists in 1998. Mean ratios were one doctor trained in anaesthesia for 799,180 inhabitants and one nurse anaesthetist for 112,327 inhabitants. From 1980 to 1998, these figures increased by a factor 11 for doctors (+1100%) and by a factor two for nurses (+100%). Most doctors were working in the chief town, in both public and private health care institutions. CONCLUSIONS: In all French-speaking subsaharian countries, a major shortage of doctors trained in anaesthesia is existing.

Africa South of the Sahara↗
PubMed1999

[Chloroquine poisoning with respiratory distress and fatal outcome].

Chloroquine poisoning can cause life threatening cardiovascular disturbances. We report three cases of suicide with chloroquine causing acute respiratory insufficiency from pulmonary oedema with lethal outcome, despite a treatment with diazepam, epinephrine and mechanical ventilation.

Adolescent↗
PubMed1998

Myofilament calcium sensitivity is decreased in skinned cardiac fibres of endotoxin-treated rabbits.

OBJECTIVE: The aim was to determine whether myofilament Ca2+ sensitivity is altered in skinned cardiac fibres from endotoxin-treated rabbits. METHODS: Endotoxin was injected i.v. in conscious New-Zealand White rabbits at a dose of 0.5 mg/kg (groups I, II, and III) or 1 mg/kg (group IV). A fifth group was used as control. Hearts were excised 4 h (groups I and IV), 24 h (group II), or 5 days (Group III) after injection. Skinned fibres were obtained with chemical (EGTA + Brij 58) treatment of bundles isolated from papillary muscles. RESULTS: The maximal Ca(2+)-activated force (F0) of skinned cardiac fibres was not different between groups. However, [Ca2+] required to evoke 50% of F0 (Ca50) was higher in the fibres from group I than in controls (1.78 +/- 0.05 vs. 1.53 +/- 0.03 microM; P < 0.05). This effect was dose-dependent (group IV: Ca50 = 2.08 +/- 0.12 microM; P < 0.05 vs. group I), larger after 24 h (group II: Ca50 = 2.12 +/- 0.05 microM; P < 0.05 vs. group I). By 5 days, myofilament Ca2+ sensitivity had returned to normal (group III: Ca50 = 1.54 +/- 0.05 microM). CONCLUSION: Myofilament Ca2+ sensitivity is decreased in skinned fibres taken from rabbit myocardium after i.v. endotoxin injection. This effect is dose- and time-dependent, and reversible with time.

Actin Cytoskeleton↗
PubMed1998

-Secondary cerebral stress of systemic origin in children with severe craniocerebral injuries-.

OBJECTIVE: To assess incidence of secondary brain insults of systemic origin (SBISOs) such as arterial hypotension, hypoxaemia, hypercarbia, and anaemia in severely head injured children; to assess their impact on mortality and morbidity in the short- and long-term. STUDY DESIGN: Prospective, open study covering a 24-month period. PATIENTS: Seventy-one children, under 15 years of age, admitted to a trauma centre for severe brain injury. METHOD: Analysis of SBISOs and outcome. RESULTS: Twenty-five children were admitted with SBISOs. The mortality rate was 37%. After hospitalization, 84% of the children with SBISOs vs 46% without SBISOs had severe disability (Glasgow outcome score = 1, 2 and 3). After 1 year, 20 out of the 45 children still alive were contacted. One of the four with SBISOs communicated a bad recovery. Fifteen children without SBISOs presented good recovery: GOS = 4-5, paediatric overall performance category (POPC scale) = 1-2. CONCLUSION: Hypotension was associated with significant increase in mortality (x 3.6) in children with severe head injury. The consequences were worse when anaemia was associated.

Adolescent↗
PubMed1998

[Brachial plexus anesthesia via an axillary route for emergency surgery: comparison of three approach methods].

OBJECTIVES: To compare three techniques of brachial plexus blockade for emergency surgery of the upper limb. STUDY DESIGN: Prospective, randomised study. PATIENTS: One hundred eleven patients admitted to an emergency surgical service, randomly assigned to three groups. METHODS: The patients were given 2% lidocaine with epinephrine 20 mL and 0.5% bupivacaine 20 mL. The three groups were as follows: brachial plexus block using a peripheral nerve stimulator (group St, n = 38); transarterial brachial plexus blockade with injection of 2/3 of the anaesthetic in back of and 1/3 in front of the artery (group TAP, n = 36); transarterial brachial plexus blockade with one single injection in back of the artery (group TP, n = 37). The success rate, time required to perform the technique, latency of analgesia, quality of motor blockade, and adverse effects were compared between the three groups. Analysis of variance was used to compare quantitative data and chi 2 test were used for qualitative data. RESULTS: Rates of success varied between 65 and 75%. Success rates, latency of analgesia and quality of motor blockade were not significantly different between groups. Time to perform the technique was longer when using a nerve stimulator. CONCLUSION: As these three techniques for brachial plexus block in emergency surgery are comparable, no one can be recommended instead of the others.

Adolescent↗
PubMed1998

Malignant hyperthermia.

Malignant hyperthermia is a rare autosomal dominant trait that predisposes affected individuals to great danger when exposed to certain anaesthetic triggering agents (such as potent volatile anaesthetics and succinylcholine). A sudden hypermetabolic reaction in skeletal muscle leading to hyperthermia and massive rhabdomyolysis can occur. The ultimate treatment is dantrolene sodium a nonspecific muscle relaxant. Certain precautions should be taken before anaesthesia of patients known to be susceptible to malignant hyperthermia. These include the prohibition of the use of triggering agents, monitoring of central body temperature and expired CO2, and immediate availability of dantrolene. In addition, careful cleansing of the anaesthesia machine of vapours of halogenated agents is recommended. If these measures are taken, the chances of an MH episode are greatly reduced. When malignant hyperthermia-does occur in the operating room, prompt recognition and treatment usually prevent a potentially fatal outcome. The most reliable test to establish susceptibility to malignant hyperthermia is currently the in vitro caffeine-halothane contracture test. It is hoped that in the future a genetic test will be available.

Anesthesia↗
PubMed1997

[Cerebral fat embolism after closed leg injury].

A 21-year-old man sustained a closed fracture of the leg from an industrial accident, without associated head trauma. The orthopaedic treatment consisted of immediate immobilization by setting leg in plaster. Two hours after admission, the Glasgow coma scale score was 10. Four hours after admission he developed a coma (Glasgow coma scale score = 7) with repetitive seizures. No lesion was visible on cerebral CT scan. Chest X-ray was unremarkable. Petechiae on the anterior chest wall and abdomen with bilateral mydriasis occurred. Thrombocytopenia with prothrombine time increase were observed. Magnetic resonance imaging, 27 hours after admission, showed high-intensity areas on T2 weighted views due to fat embolism. Retinal haemorrhages were observed. The bronchoalveolar lavage showing fat staining of tracheal aspirates confirmed the diagnosis of fat embolism. This case report emphasizes the possibility of predominant neurologic manifestations of a fat embolism and the diagnostic help of cerebral magnetic resonance imaging.

Accidents, Occupational↗
PubMed1997

[Benzodiazepine withdrawal presenting as pseudo-surgical abdominal pain].

A 39-year-old patient was admitted to the emergency department for acute abdominal pain. Physical examination showed a peritoneal syndrome. However, CT-scan, Doppler and blood analysis were unremarkable. As the patient had a history of auto-medication with benzodiazepines at high doses, a withdrawal syndrome was considered. An intravenous administration of 3 mg of midazolam determined the relief of all symptoms in a few minutes.

Abdomen, Acute↗
PubMed1997

[Malignant hyperthermia and appendicular sepsis. Can they be differentiated during surgical procedure?].

OBJECTIVE: To assess the possibility to differentiate clinically intraoperative malignant hyperthermia (MH) and sepsis. STUDY DESIGN: Comparative retrospective study of clinical cases. PATIENTS: Sixteen patients operated on for acute appendicitis and developing clinical signs of MH confirmed or not by in vitro caffeine halothane contracture tests (IVCT). METHOD: To isolate the patients' characteristics with regard to the diagnosis of sepsis and MH crisis. To compare both groups of clinical features with results of IVCT. RESULTS: The diagnosis of MH sensitivity has been excluded in ten hyperthermic patients and confirmed in four others with IVCT. No correlation was existing between the importance of perioperative sepsis, MH features and IVTC results. CONCLUSIONS: This study confirmed the difficulty to differentiate clinically MH and sepsis during surgery. Considering the severe outcome of MH crisis, it is recommended to start the specific therapy even in case of appendicular sepsis.

Adolescent↗
PubMed1997

Identification of heterozygous and homozygous individuals with the novel RYR1 mutation Cys35Arg in a large kindred.

BACKGROUND: Malignant hyperthermia (MH) is a potentially fatal, often autosomal dominant, disorder of skeletal muscle and is triggered in susceptible people by all commonly used inhalational anesthetics. In this article, the authors describe a malignant hyperthermia susceptible (MHS) kindred in which both parents of the proband are MHS and are first-degree cousins. Haplotype analysis in this kindred with chromosome 19 linked markers revealed that the proband and another sibling were homozygous for the affected RYR1 allele. METHODS: Eighteen members of this large pedigree were investigated, with a clinical examination for signs of a myopathy, a caffeine halothane contracture test, a histo-enzymologic study on the muscle biopsies, and linkage analysis on genomic DNA isolated from family blood samples. RYR1 cDNA was amplified by polymerase chain reaction and was cloned and sequenced, facilitating mutation detection. RESULTS: Linkage analysis demonstrated linkage between RYR1-linked markers and MH susceptibility in this family. DNA sequencing identified a T to C transition at nucleotide position 103, resulting in the substitution of an arginine for cysteine 35, representing the most N-terminal mutation reported to date in the RYR1 gene. This mutation segregates fully with the MHS trait, generating a lod score of 4.65 in favor of linkage to MHS at a recombination frequency of 0.0. CONCLUSIONS: The proband in this kindred is the first reported homozygote to have presented with an MH episode. The homozygotes in this pedigree do not have an overt myopathy. The sensitivity of muscle samples to caffeine clearly distinguished the two homozygotes from other heterozygous-susceptible individuals. No clear differentiation was observed with the halothane contracture results.

Adolescent↗
PubMed1995

[Detection of gas embolism in neurosurgery by capnography. Apropos of 32 patients surgically treated in seated position].

Hitherto dreaded and dreadful, air embolism has since the past few years a better prognosis owing to new techniques of early detection. The present study concerns a series of 32 neurosurgical patients who were operated in the sitting position under continuous capnography. This method not only provides global monitoring (metabolic, haemodynamic and respiratory) but also allows early detection of any significant migration of air or gas into the blood vessels. The incidence of air embolism in this series was 31% (10 patients out of 32). The onset of air embolism was diagnosed on a rapidly progressive fall in the expired fraction of CO2 (FECO2), in spite of a normal blood pressure. Early treatment prevented further complications. Therefore capnography is a sensitive and reliable method of air embolism detection intraoperatively. Its use in the operating room and intensive care unit should be systematic whenever air embolism may occur.

Adolescent↗