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Biomedical subjects

P Maurette

Publications and source records attributed to P Maurette.

At least 19 recordsLinked to original sources
PubMed1992

Clinical and pharmacokinetic aspects of the combination of meperidine and prilocaine for spinal anaesthesia.

The aim of this study was to determine whether the addition of a small dose of prilocaine could augment the spinal block induced by meperidine and affect intrathecal meperidine pharmacokinetic behaviour. Spinal anaesthesia was performed in 60 men scheduled for endoscopic resection of a prostatic adenoma or bladder tumour under spinal anaesthesia. They were allocated randomly to receive either 1 mg.kg-1 meperidine (Group 1, n = 30), or 1 mg.kg-1 meperidine plus 0.5 mg.kg-1 prilocaine (Group 2, n = 30). Blood samples were collected prior to and for 24 hr after spinal injection in 24 patients (12 in each group). Plasma meperidine levels were assayed by gas chromatography. Complete motor block was achieved in all Group 2 patients, but was incomplete in seven of Group 1 (P less than 0.05). The onset of both motor and sensory blocks was shorter (P less than 0.01) in Group 2 and the duration was longer (P less than 0.05). Coadministration of prilocaine modifies meperidine pharmacokinetic behaviour. The area under curve was 48% greater (P less than 0.01) and Cmax was higher in Group 2 than in Group 1, 145.8 +/- 42.2 vs 107 +/- 20.5 ng.ml-1 (P less than 0.001). No evidence of respiratory depression was noted in any of the patients. Despite the increase in plasma meperidine concentrations, no side effects were observed. The plasma concentrations remained at one third to one sixth the levels reported to induce a respiratory depression. It is concluded that the addition of prilocaine to meperidine improves motor and sensory block during surgery and alters meperidine kinetics without producing major side effects.

Aged↗
PubMed1992

Posttraumatic disablement: a prospective study of impairment, disability, and handicap.

This study was designed to evaluate both the frequency and the course of impairments, disabilities, and handicaps resulting from trauma. It was conducted in Aquitaine, France, on a sample of 1005 trauma patients (mean ISS, 10.5 +/- 0.3) in which severe trauma (ISS > 25) was rather overrepresented (169 of 1005). A prospective follow-up of disablement according to the WHO classification was based on medical examinations performed 6 and 12 months after the trauma. Of 664 survivors reviewed at 6 months, the findings were cross tabulated with Injury Severity Score (ISS) and age. There was a good relationship between ISS and the mean length of stay in the hospital (r = 0.46; p < 0.001), the duration of rehabilitation, and the time away from work or school. Out of this sample of 1005 patients with rather major injuries, 73% of the survivors suffered from at least one impairment, with a consistently lower frequency in children whatever the severity. At least one disability was encountered in 52.3% of these patients depending on both ISS and age. Handicap was noted in at least 26% of the cases. Between the sixth month and the end of the first year, the minimal handicap regression was 35.8%, whereas the minimal regression of the disability rate was 19.5%. The best improvement was observed essentially in the low ISS categories. Whereas for minor trauma the course of disablement seems to be fixed 1 year after the injury, such is not the case for severe trauma.

Absenteeism↗
PubMed1990

Thyroid function in brain-dead donors.

Twenty brain-dead potential organ donors were studied prospectively to establish thyroid function. Two or three consecutive blood samples were obtained during brain death. Seven times a sample was available before brain death occurred. Free triiodothyronine (FT3) fell in most patients (80%). Very low (less than 1.6 pmol/l) and subnormal levels (between 2 and 3 pmol/l) were found in 65% and 15% of the patients, respectively. Serum reverse total triiodothyronine (rT3) was inversely correlated with FT3. Free thyroxine (FT4) was less often decreased (mean 14.68 +/- 1.42 pmol/l) and 35% of the patients had normal levels. Mean thyroid stimulating hormone (TSH) remained normal (0.71 +/- 0.15 microU/ml). The study of consecutive samples during brain death did not show a constant, progressive decrease in hormonal levels. There is no statistical difference between values observed before and after brain death. No correlation was found between FT3 levels and hemodynamic data or immediate allograft function. The pattern of thyroid function in these patients was typical of the sick euthyroid syndrome with a low T3 or low T3 and low T4 serum levels. This syndrome usually does not need to be treated. However, many experiment findings and some clinical data argue in favor of T3 therapy in donors and possibly in recipients. The dosage regimen must be adjusted to be effective without causing harm to multiorgan donors before it can be widely used. It remains to be proved that low FT3 serum indicates low intracellular FT3 and worse metabolic function in clinical conditions.

Adolescent↗
PubMed1990

[Resuscitation in the elderly: prognostic factors].

High medical environment in our society is linked up with an increase of intensive care in geriatric patients. Such a situation can seem to be inappropriate, especially when it results in a trial to obtain the survival of patients who are finishing their life. Therefore an appropriate medical evaluation and management are required in order to quantify as fairly as possible both prognosis and specific risks. Mortality factors in elderly patients are multiple and additive. Two groups of risks can be distinguished: intrinsic risk factors depending on the patient (age, neurologic impairment, severity of acute illness, previous health status), and extrinsic risk factors, related to medical environment (i.e. length of stay in intensive care unit, care quality...). These latter are improvable. In the elderly, the mortality rate is twofold higher (about 35%) than in young patients. Evaluation of intensive care unit outcome on 6 month survival makes this rate worse, as 10% to 20% more patients die secondarily. However, most of the studies demonstrate that duration of stay in intensive care units is similar, whatever the age and outcome. It must also be underlined that quality of life after intensive care is similar in young and old patients. It is concluded that individual's and society's views concerning cost and effectiveness of intensive care in elderly patients do not always coincide with objective results. If medical motivation has to be preserved, specific care strategy remains to be established.

Age Factors↗
PubMed1990

The epidemiology of head trauma in Aquitaine (France), 1986: a community-based study of hospital admissions and deaths.

This paper reports the findings of a study of head trauma conducted over a one-year period within a defined region with a population of 2.7 million (Aquitaine, France). It includes cases resulting in death prior to hospitalization or requiring hospitalization. During the one-year period, 391 deaths and 8549 hospital admissions due to head trauma occurred, yielding an annual estimate of 8940 head-injured people. The immediate case-fatality rate was 4.4%. Among non-fatal cases, 80% were mild, 11% moderate and 9% severe. The overall annual incidence was 281/100,000 in both sexes (384 and 185/100,000 in males and females respectively). The annual death rate was 22/100,000 (33 and 12, respectively). Patterns of incidence by age and sex were in general agreement with earlier studies. The main causes of head trauma were traffic accidents (60%) and falls (33%). One-third of hospitalized patients had no injury other than the head trauma. The most frequently associated injuries were those involving extremities, whereas the most severe were those involving the abdomen. The Injury Severity Score (ISS) ranged from 4 to 66, with a mean of 9 and a median of 5. At the eighth day following injury, 25% of hospital-treated patients were still hospitalized and 2% had died. The outcome correlated well with the ISS.

Accidental Falls↗
PubMed1990

[Between therapeutic life support care and passive euthanasia: objective factors of intensive care in aged patients].

High medical environment in our society is related to an increase of intensive care in old patients. This situation could be looked unappropriate trying to survive people who are finishing their life. An appropriate medical evaluation and management is thus necessary in order to quantifie as fairly as possible both prognosis and specific risk. Factors at the source of mortality in elderly patients are multiple and additive. However two classes of risk can be distinguished. On the one hand some of the risk factors are intrinsic depending on the patient (i.e., neurologic impairement, age, severity of acute illness, previous health status). On the other hand some of the risk are extrinsic related to medical environment (i.e. length of stay in intensive care units, care quality...). This latter risks are improveable and thus are important to be pinpointed. Time is also powerful to assess the best prediction of outcome in old patient. Unlikely mortality rate in elderly is twofold higher (about 35%) as compared as young patients. Evaluation of intensive care unit outcome on 6 months survival make this rate worse as 10% to 20% secondary died. However most of the published studies show that duration in intensive care is similar undepending of age and outcome of the patient. It is also noted that quality of live after intensive care is the same in young or old patient. It is concluded that individual's and society's views concerning cost and effectiveness of intensive care in old patient do not always coincide with objective results. If medical motivation has to be preserved, specific care strategy remained to be established.

Age Factors↗
PubMed1989

Arterial and ventricular CSF pharmacokinetics after intrathecal meperidine in humans.

In order to investigate the mechanisms leading to respiratory depression after lumbar administration of opioids, plasma and ventricular CSF pharmacokinetics of intrathecal meperidine (1 mg.kg-1) were studied in five head-injured patients undergoing surgery for lower limb fracture. Meperidine was detected both in the plasma (arterial catheter) and in the ventricular CSF (intracranial catheter) soon after intrathecal administration: 45 +/- 17 min and 100 +/- 14 min, respectively. The maximal plasma concentration was 341 +/- 133 ng.ml-1, whereas, in ventricular CSF, it was 64.5 +/- 14.9 ng.ml-1. The ventricular CSF-plasma ratio increased with time (r = 0.82) from 0.18 +/- 0.04 at the first hour to 0.38 +/- 0.1 at 16th hour. It is concluded that the putative risk of respiratory depression appears to be mainly related to the absorption into the systemic circulation and to redistribution back into CSF.

Adolescent↗
PubMed1989

Incidence, causes and severity of injuries in Aquitaine, France: a community-based study of hospital admissions and deaths.

This paper reports the results of a study of injuries conducted during a one-year period within a defined geographic population of 2.7 million persons (Aquitaine, France). Cases were defined as unintentional or intentional injuries, either resulting in immediate death before reaching hospital or requiring hospital admission. During the one-year period, 1,181 deaths were registered and 8,190 hospital admissions occurred during the sample periods. The three leading causes of injury were falls (40 per cent), traffic accidents (27 per cent), and poisonings (15 per cent). The overall incidence of injuries was 136 per 10,000 person years. Incidence by sex and age was assessed for the main external causes. The ratios of nonfatal to fatal cases were calculated by sex and age and by external cause. The origin of the injury was suicide in 14 per cent of cases and assault or homicide in 3 per cent. The severity of injuries, assessed using an automatic computation of the Injury Severity Score (ISS), ranged from 1 to 66 with a mean of 6.9. Substantial variations of ISS were observed according to external cause. At the 8th day following admission, 31 per cent of hospital-treated patients were still hospitalized and 0.8 per cent had died in hospital. The outcome correlated well with the ISS.

Accidental Falls↗
PubMed1988

[Comparative repercussions of general and spinal anesthesia on the psychological functions of the aged subject].

Although worsening cerebral function in the elderly is often said to be due to anaesthesia, it still remains to be proved that anesthesia acts on an elderly patient's psychological make-up. This study aimed to compare the psychological effects of general or spinal anaesthesia on 35 patients more than 70-yr old under repair of a subcapital femoral fracture, after having excluded 63 patients. They were randomly divided into two groups, the first receiving a spinal anaesthetic with 1.5 mg.kg-1 prilocaine (RA; n = 19), and the others a general anaesthetic with 5 mg.kg-1 thiopentone, dextromoramide, nitrous oxide and enflurane (GA; n = 16). None of the patients wer given a premedication. They underwent a battery of six psychological tests before and 36 h after surgery, all carried out by the same physician. Six patients in GA group and three in RA group developed a transient fall in mean blood pressure just after anaesthetic induction (not significant). There were no significant differences between the two groups in age, sex distribution, ASA class and performance in the tests, both before and after surgery. Individual psychological scores did not differ either. In the RA group, the postoperative tests were even better carried out than before surgery (p less than 0.05). It could therefore be concluded that anaesthesia alone has little impact on the psychological status of elderly patients.

Aged↗
PubMed1988

[Changes in intracranial pressure in severe head injured patients in hemodialysis].

Two cases of acute post-traumatic renal failure in severely head injured patients are reported. An increase in intracranial pressure (ICP) was shown up by continuous monitoring during haemodialysis: it was more important during conventional haemodialysis than during continuous arteriovenous haemofiltration. Although this effect is well known experimentally, few cases of continuous ICP pressure monitoring have been reported in head injury patients undergoing haemodialysis. The increase in ICP is explained in the dog as a result of blood-brain differences in urea concentration and osmolality leading to an increase in cerebral spinal fluid volume and cerebral tissue swelling. If dialysis is necessary in these patients, it should be carried out early and progressively, the patient's ICP being monitored continuously.

Acute Kidney Injury↗
PubMed1988

[Post-traumatic cerebral fat embolism].

A seventeen year old boy sustained pelvic, femoral shaft and malleolar fractures in a road traffic accident. Six hours after admission, the patient became comatose (Glasgow coma score = 7); the coma worsened such that, 24 h later, the coma score was 4. Petechiae were present on the conjunctiva and anterior chest wall. Computed tomography revealed diffuse brain swelling. The diagnosis of cerebral fat embolism was made. There were multiple episodes of severe intracranial hypertension. After 23 days of traction, the femoral fracture was internally fixed. The patient returned home after five months of hospital, with just a few memory and writing problems. Ten months after the accident, magnetic resonance imaging showed a small ventricular dilatation due to subcortical atrophy. Residual ischaemic lesions and demyelination could be seen in the right centrum ovale and temporal lobe. The cerebral lesions contrast with the reversibility of the clinical state.

Adolescent↗
PubMed1988

Propofol anaesthesia alters somatosensory evoked cortical potentials.

This study evaluated the effects of propofol on somatosensory evoked cortical potentials in 20 ASA grade 1 or 2 patients who underwent spinal surgery. Anaesthesia consisted of propofol, dextromoramide, 50% nitrous oxide and oxygen mixture. The induction dose of propofol was 2 mg/kg and was followed by an infusion of 6 mg/kg for the first hour and 3 mg/kg subsequently. Somatosensory evoked cortical potentials were recorded on the scalp and compared to pre-operative values using Student's paired t-test. We observed a significant depression of evoked potential 10 minutes after induction, which continued until the early phase of recovery. Because of its short and quickly reversible action, propofol is an acceptable agent when clinical monitoring of the spinal cord is indicated but is not satisfactory when monitoring has to be based on somatosensory cortical evoked potentials.

Adult↗
PubMed1987

[Propofol versus methohexital in the surgery of the spinal canal].

The aim of this study was to compare the quality of postanaesthetic recovery after anaesthesia with methohexitone (M) or with propofol (P). Thirty patients undergoing spinal surgery were randomly assigned to either group. The induction dose was 2 mg . kg-1 for both M and P. Anaesthesia was maintained by continuous infusion. The rate was 0.15 mg . kg-1 . min-1 for P and 0.07 mg . kg-1 . min-1 for M. Analgesia was obtained with fentanyl with the same doses in both groups. The maintenance doses were subsequently decreased by 50 and 75% of the initial values. This work compared the quality induction and the criteria of recovery (Aldrete score, Newman test). In two patients in each group, sensory evoked potentials (SEP) were recorded to monitor neurological integrity. The quality of induction was similar in both groups. Awakening was significantly more rapid in group P. The SEP were much decreased in group P, whilst there were few changes in group M. Monitoring of medullar integrity is mandatory in spinal surgery, requiring a rapid recovery. This objective was obtained with shorter delays in patients anaesthetized with propofol than in those who had received methohexitone. However, the former, at the doses used, seemed to depress the SEP.

Adult↗
PubMed1987

[Results of resuscitation in injured elderly patients].

This study assessed the results of intensive care in elderly trauma patients and quantified the different factors involved in the final outcome. It included 116 patients, aged 65 years or more, and covered a two year period. The following parameters were obtained for each patient: age, severity of trauma (ISS and SAPS), head injury (GCS), prehospital health status (ESA), survival after three months and quality of survival. Three months after trauma, overall mortality was 45.7%. Survivors were 72.8 +/- 4.9 year old, while those that died were 75.3 +/- 7.5 year old (p = 0.01). Mean ISS was 19.7 +/- 8 and mean SAPS was 9.4 +/- 3.2. The risk of death was 3.6 (1.6 to 8.1) times greater if ISS was over 15. The same risk was 4.7 (2.1 to 11.1) times greater if SAPS was over 9. GCS was 8.8 +/- 4.4 in dead patients and 12.5 +/- 2.4 in survivors (p = 0.001). The risk of death was 10.4 (4.2 to 26.2) times greater if GCS was under 8. The final prognosis could be assessed with the following exponential model: Survival = 1/(1 + exp - (8.7 - 0.07 X age - 0.07 X ISS - 2.9 X GCS*), where GCS is equal to 0 if the real GCS was under 8, and equal to 1 otherwise. The ESA did not affect mortality. Three months after trauma, the degree of independence was the same as before in 87% of survivors. It was concluded that age and the severity of trauma were the most important factors in determining prognosis in geriatric trauma patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗