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Biomedical subjects

P Courrèges

Publications and source records attributed to P Courrèges.

17 recordsLinked to original sources
PubMed2006

[Regional organization for intensive care in children, need for maintenance of competence in paediatric anaesthesia and intensive care].

The recent French text concerning the medical care both of the child and the teenager classifies the establishments either in specialized centers or in proximity centers according to their level in the management of children and teenagers, the competences of their medical teams, their organization in permanence of care and the volume of acts they carry out and pathologies they treat by class of age. This grid of the paediatric activities implies a new organization both in paediatric surgery and in paediatric ENT and consequently in the anaesthetic organization. Anaesthetic competences necessary to the achievement of this mission and the means of maintaining these later are analyzed and compared with some foreign experiments.

Adolescent↗
PubMed2005

Inadvertent epidural infusion of paracetamol in a child.

An 11-year-old boy underwent lumbar epidural anesthesia under general anesthesia to provide intra- and postoperative analgesia for a severe burn of his lower limb. A dural tap at the L4-L5 space occurred during the epidural approach. A second attempt through the upper intervertebral space was successful. Postoperatively, the boy was given both continuous epidural analgesia and intravenous (i.v.) infusions. These latter were provided using two similar double track pumps. At the 36th postoperative hour a nurse injected paracetamol using inadvertently the epidural instead of the i.v. pump. The mistake was repeated 6 h later. The boy experienced both headache and vomiting. Symptoms seemed to be a mechanical rather than a toxic complication. They disappeared for 48 h under treatment including saline and caffeine. Neurological examinations stayed normal. No sequelae were noted. The frequency of this type of medication incident is probably underestimated. The literature notes a large list of injected drugs, but paracetamol had never been described.

Acetaminophen↗
PubMed2003

Anaesthetic management for Edward's syndrome.

We report the anaesthetic management for a Cohen procedure in a girl with Edward's syndrome (trisomy 18). Information in the literature about anaesthetic management in trisomy 18 patients is poor. The patients are dysmorphic, have severe mental retardation and multiple organ malformations of which congenital heart disease is the most important. Our patient was a 7 year-old girl, such a survival being exceptional with trisomy 18. Anaesthesia is high risk and pain assessment is difficult. Establishing good relations with the family and appraising the need for surgical procedures are the main other difficulties.

Abnormalities, Multiple↗
PubMed1998

[Extramucosal pylorotomy via the umbilical route under general anesthesia and para-umbilical cord: evaluation of intra- and postoperative analgesia].

OBJECTIVE: To assess both intra- and postoperative analgesia in infants undergoing extramucosal pylorotomy via a circumumbilical incision under general anaesthesia with neither opioid nor muscle relaxant, associated with a paraumbilical block. STUDY DESIGN: Open prospective study covering a 1-year period. PATIENTS: The study included 32 infants (age = 1.1 +/- 0.7 months, body weight = 4,427 +/- 876 g). METHOD: General anaesthesia was induced with either thiopentone or halothane and, after tracheal intubation, maintained with halothane in a N2O-O2 50 vol% mixture. Para-umbilical block was obtained using 0.5 mL.kg-1 of 1% lidocaine with epinephrine. Pain was assessed using time course of respiratory rate, heart rate and mean arterial pressure. A change of more than 20% in one of these variables was considered as criterion for poor analgesia. RESULTS: Intraoperative analgesia was adequate in all patients but one, 3 minutes after incision. Surgical conditions were considered as being good or satisfactory in 76% and 24% of cases, respectively. Postoperative analgesia, assessed 1 and 6 hours after completion of surgery, was convenient in 90% of infants, the end of the action of the local anaesthetic resulting in a poor analgesia at the 6th hour in four of them. CONCLUSION: Provided a short bevel needle is used and basic safety rules of local anaesthesia are followed, the para-umbilical block provides adequate intra and postoperative analgesia in infants undergoing extramucosal pylorotomy via circumumbilical route.

Analgesia↗
PubMed1996

[Cystic ectasia of the rete testis: apropos of a case].

We report a case of a simple testicular cyst developing on the rete testis. Nine cases have been reported in children. In our patient, the cyst was associated with aplasia of the homolateral kidney and termination of the left ureter in the left deferens. According to the literature, the diagnosis is usually fortuitous at histology examination. The cause is probably embryonic malformation. Castration is the therapeutic solution. In our case, simple enucleation allowed preservation of the deferens since the controlateral tree was damaged. There have been no complications with a 6-year follow-up.

Cysts↗
PubMed1996

[Value of ilio-hypogastric block in appendectomy in children].

This prospective study aimed to evaluate the efficiency of ilio-hypogastric nerve block for control of post appendicectomy pain in children. Forty-two children aged 3-15 years scheduled for appendicectomy were anaesthetized in the same way. After randomization, a preoperative ilio-hypogastric nerve block was performed in 21 patients. Twenty one were not blocked. The postoperative pain assessment showed a better analgesia in the blocked children group. Analgics were required less in group. Five inefficient blocks were recorded. No complications were noted. Ilio-hypogastric block was found to be safe and efficient for control of post-appendicectomy pain in most children.

Adolescent↗
PubMed1996

[Epidural anesthesia in children under 3 months of age. Apropos of 49 cases].

This retrospective study includes 45 patients (age: 32 +/- 28 days; weight: 4,077 +/- 988 g) who underwent epidural analgesia with a catheter for various surgical operations. Epidural space was detected by the loss of resistance to air technique. The anaesthetic solution administered was bupivacaine 0.25% with 1/200,000 epinephrine. Four technical failures were recorded; intraoperative analgesia was adequate for all other patients. In 17 patients, postoperative analgesia was maintained by continuous infusion (0.125% bupivacaine or 0.25% lidocaine: 0.2 mL.kg -1.h-1). In 18 patients, it was managed by iterative injections (0.25% bupivacaine with epinephrine: 0.25 mL.kg -1.h-1). In 10 patients, a single shot was sufficient. Postoperative analgesia was found to be inadequate in four patients. No incidents or accidents were recorded. A benefit-risk analysis with the support of the literature attempts to define the main indications of this method.

Anesthesia, Epidural↗
PubMed1995

[Epidural anesthesia and esophageal atresia. Apropos of a case].

We report the good results of a thoracic epidural analgesia for oesophageal atresia repair in a 3-day old girl. Surgery was performed under light general anaesthesia combined with a single epidural injection of bupivacaine 0.25% (0.5 ml.kg-1) with epinephrine through a 19 G catheter (T7 space, descending to T5). During the three following days, a continuous epidural infusion was used (0.2 ml.kg-1.h-1 bupivacaine 0.125%). Intraoperative analgesia and postoperative analgesia were adequate, the latter being assessed by the Barrier-Amiel-Tison pain scale. Thus heavy postoperative care could be avoided, namely mechanical ventilation. Recovery was uneventful.

Anesthesia, Epidural↗
PubMed1994

[Evaluation of the Hotline perfusion warmer in infants with body weight under 10 kg].

This randomized study assessed the efficacy of the Hotline fluid warner in 42 children under 10 kg, undergoing surgery of more than 1 h of duration. In all a heating mattress and a heating humidifier were also used. The decrease in core temperature was more important in children without warner (1.1 +/- 1.4 degrees C vs 0.1 +/- 0.3 degrees C in those with a warner). Efficiency of this device is demonstrated even at the low perfusion flows requested for surgery in newborns and infants.

Body Temperature↗
PubMed1994

[Evaluation of laryngeal masks].

The size 1 laryngeal mask (LMA1) was studied prospectively in a series of 37 infants (weight less than 6.5 kg) undergoing 42 routine surgical procedures. LMA1 insertion was successful at first attempt in 80.9% of all cases and a good airway control was obtained in 93%. The most frequent cause of insertion failure was an insufficient depth of anaesthesia. Only one incident occurred peroperatively. The recovery incidents rate, higher than in other studies, was mainly due to the laryngeal hyperreactivity of infants. LMA1 provides high safety for infant anaesthesia woith food working conditions for bot anaesthetist and surgeon. However, an accurate determination of the anaesthesia level and a close monitoring of recovery are strongly recommended.

Equipment Safety↗
PubMed1994

[Laryngeal masks in pediatric anesthesia. Apropos of 251 cases].

A series of 251 anaesthesias with a laryngeal mask (LM) in a paediatric surgery unit is studied retrospectively. After some short training, using LM is most often easy and allows a good airway control without any frequent or severe complications. Therefore this technique should quickly supplant the facial mask and many endotracheal intubations.

Adolescent↗