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Biomedical subjects

P Morisot

Publications and source records attributed to P Morisot.

At least 19 recordsLinked to original sources
PubMed1992

[Is posterior lumbar epidural space partitioned?].

The anatomy of the posterior lumbar epidural space (PLES) has been extensively studied. Besides the anatomists, surgeons, radiologists and anaesthetists have taken an interest in this. However, because each one has considered the PLES from his own specialist field, descriptions are not always concordant. In particular, the reality of a medial partition in the PLES has been suggested by epidurography and intraoperative observations. Lewit and Sereghy and Luyendijk opened the debate by reporting, on antero-posterior epidurographic films, a clear-cut, medial, vertical and narrow picture which partitioned the PLES. However, this was not constant. Savolaine et al. also recognized this partition on epidurographic CT scans. During laminectomies, Luyendijk has taken photographs of a medial fold of the dura mater which appeared to hold it to the posterior vertebral arch, being collapsed on either side of the midline. He named it "plica mediana dorsalis durae matris" (PMD). Several anaesthetists considered that this could explain why epidural analgesia sometimes acted on one side only. Husemeyer and White, and Harrison et al., have tried to confirm this experimentally by making casts with polymerizing resins in cadavers. They did not get very convincing results. Blomberg also tried to see this space by epiduroscopy in the cadaver. Unfortunately, for technical reasons, his photographs were of poor quality. He, however, reported having seen each time the PMD and a band of connective tissue fixing it to the vertebral arch in the midline. However, all these anatomical studies used methods which alter the natural structures. Their results are therefore questionable. The PLES is a virtual space. Histological studies have shown that it is filled with fatty tissue between the dura and the vertebral arch. It is therefore conceivable that any liquid injected into the PLES, such as contrast medium or local anaesthetic, must push back the dura, the only tissue which can move to give it any room. The fatty tissue could therefore be compressed and take any of the shapes which have been described on epidurography. On the other hand, should it be torn, it seems this fatty tissue could make up these haphazard fibrous tracts tensed between the dura and the vertebral arch, such as described in classical anatomy, as Bonica recalled. These can be clearly seen during surgical and anatomical dissections, and during endoscopies carried out on cadavers with sufficient optical means, as opposed to the medial fibrous band fixing the dura to the vertebral arch.(ABSTRACT TRUNCATED AT 400 WORDS)

Endoscopy↗
PubMed1991

[Evaluation of obstetrical pain by a questionnaire of adjectives. Comparison of 2 epidural analgesia protocols].

A French version of the McGill pain questionnaire, the "Questionnaire Douleur Saint Antoine" (QDSA), was assessed prospectively by comparing two epidural analgesia protocols using bupivacaine. One hundred women in labour who asked for epidural analgesia were randomly allocated to two groups and received either 0.25% or 0.5% bupivacaine (mean initial doses 32.5 and 50 mg respectively) with adrenaline 1 in 200,000. All the patients were then instructed to trigger a patient controlled analgesia (PCA) device for top-up doses of 0.25% bupivacaine with adrenaline 1 in 400,000 once they became aware of pain returning. This PCA device was preset to give on-demand injections of 12.5 mg with a lockout interval of 20 min, together with a continuous infusion rate of 10 mg.h-1. Pain was evaluated using four rating scales: QDSA, visual analogue scale (VAS), verbal rating scale (VRS) and behavioural scale (BS). Pain was measured at least four times: before analgesia (T0), 20 min after the initial injection (T20), before starting PCA (TRe), and immediately after delivery of the newborn (TEx). In addition, the level of anxiety was ranked at the beginning of labour with the Spielberger state trait anxiety inventory (STAI). In the 396 questionnaires completed by the patients, there was a significant correlation between the QDSA and the other scales (p less than or equal to 0.05), but at T0, BS was mostly correlated with the affective index of QDSA (p = 0.01), as well as with the STAI (p = 0.0001). At T20, in the group of women who had been given 0.5% bupivacaine initially, the decrease in QDSA score was significantly greater for the sensory index (p = 0.04); the first re-injection interval was longer than in the other group of women (p = 0.05). At TRe, the total QDSA score of all the patients was half that at T0, indicating the good sensitivity of this score. These results are in agreement with those reported by Melzack with the McGill pain questionnaire. The QDSA varies in the same direction as the other scales. On the other hand, the affective part of the score was only correlated with the level of anxiety and behaviour. The sensory part of this score was the only one to show a difference between the different initial doses given to the patients. The results obtained with this series of patients underline the value of a multidimensional assessment of labour pain.

Analgesia, Epidural↗
PubMed1991

[Complications of local and regional anesthesia. An analysis of closed files of insurance companies].

We report a review of closed insurance claims for local and regional anaesthesia mishaps in the main private professional insurance companies. Twenty eight cases with extensive written documentation were discovered, spanning a 6 years interval between 1983 and 1989, involving 21 epidural, 6 spinal and 1 caudal anaesthesias, half with surgical and half obstetrical indication, and excluding all other blocks. Twenty four out of the 28 patients were relatively healthy. ASA I or II, only 4 ASA III. They fitted 4 items of our taxonomy of known complications: 15 cardiac arrests, 10 neurological damages, 1 systemic toxic reaction to local anaesthetic drug and 1 allergic reaction to dextran. The cardiac arrests resulted primarily from the 3 following or contributing factors: hypovolemia (in 3 cases), added sedation (7) and high or total spinal block following reinforcing doses (8). Twenty two had a poor outcome: 8 deaths, 7 severe neurological injuries, a baby was dead and another child had severe neurobehavioral sequellae. The author points out the limitation of this study--a biased sample of all adverse events and inability to derive an incidence. However some of these events reveal patterns of anaesthetic management which lead to poor outcomes.

Adult↗
PubMed1989

Ventilatory response to carbon dioxide during extradural anaesthesia with lignocaine and fentanyl.

Twenty-seven patients undergoing extracorporeal shock-wave lithotripsy or knee arthroscopy received extradural anaesthesia with 2% lignocaine plus adrenaline 1 in 200,000. They were allocated randomly to three groups, one receiving no fentanyl (n = 6), the two others receiving fentanyl 50 micrograms either extradurally (n = 15) or i.v. (n = 6). Three tests of sensitivity to carbon dioxide (Read's method) were performed successively on each patient: before operation and at 1 and 2 h after the extradural injection. Whereas lignocaine and adrenaline alone had no significant effects on basal ventilation and the ventilatory response to carbon dioxide, extradural fentanyl caused a slight reduction in resting ventilatory rate and ventilation at 1 and 2 h with no change in resting end-tidal carbon dioxide concentration. In addition, the slope of the ventilatory response to carbon dioxide was reduced slightly at 1 h and ventilation at end-tidal PCO2 of 7.3 kPa was reduced also at 1 and 2 h. Conversely, the same dose of fentanyl i.v. had lesser and shorter effects on ventilation at rest and during carbon dioxide rebreathing. Our results show that fentanyl 50 micrograms given extradurally caused slight ventilatory depression which is probably clinically unimportant.

Adult↗
PubMed1987

[Thoracic epidural anesthesia for extracorporeal lithotripsy. Comparison of 4 anesthetic solutions].

Extracorporeal shock-wave lithotripsy (ESWL) is a new non-invasive procedure allowing disintegration of upper urinary tract calculi, usually carried out in epidural anaesthesia (EA). The patient strapped to a stretcher is immersed in a bath. At the bottom of the tube is the shock-wave generator. The release of shock waves (1,000 to 2,000 for each treatment) is triggered by the R-wave of the patient's ECG. Arrhythmias and extrasystoles (ES) may occur. In the investigational trial, the preferred anaesthesia was continuous lumbar EA with a large volume of 2% lidocaine extended to the level of T6. This study was conducted to assess continuous thoracic EA at the T12 interspace with a lesser dose (12 ml) of 2% lidocaine (XT, comparing it with single dose EA with the same volume of three other agents: bupivacaine 0.5% (Ma) and mixtures of 2% lidocaine-0.2+ tetracaine (XT), and 2% lidocaine-fentanyl 50 micrograms (XF), all with 1/200,000th adrenaline. Eighty patients (ASA class I or II) were assigned randomly to receive one of the four types of EA. All were monitored with Holter's method. The demographic distribution was similar for the four groups. Mean duration of the procedure was 32 +/- 15 min. Premedication was given only in 16 patients, very anxious. The results were excellent in 68 patients; 11 had to be supplemented with one or two doses of intravenous agents: diazepam and/or fentanyl: one failure was given an intravenous general anaesthesia. Mild hypotension occurred in four patients. 242 ES occurred in 48 patients (60%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1976

[Disorders of hemostasis during partial hepatectomies. Study of 20 cases].

Changes in blood coagulation have been studied during and after 20 elective hepatic lobectomies, most of them for tumors necessitating extensive resection (17 right lobectomies, 10 of which were extended to the medial segment of the left lobe). In addition, 9 unresectable tumors, as proved by exploratory laparotomy, were taken for controls. Before operation, hemostasis in essentially normal except a hyperfibrinogenemia and a slight increase of fibrinogen split products in half the cases. Factor VIII antigen levels are consistently increased. During mobilization of the liver an increased fibrinolytic activity and soluble complexes are frequently observed. Fibrinolysic activity spontaneously returns to normal at the end of the operation, except in cirrhotic patients. No bleeding disthesis is observed and haemorrhage appears to be related to technical problems. On the other hand, there is no clinical evidence of thromboembolism after operation. Therefore any specific therapy either pro or anti-coagulant, appears unjustified, apart from the eventual and transient administration of antifibrinolytic drugs in cirrhotic patients. In the post operative period, blood clotting factors synthetized by the liver (prothrombin complex and antithrombin III) slowly return to normal. Rapid correction of hypo-accelerinaemia reflects the onset of liver regeneration. A simplified method for surveying hemostasis during and after liver resection is proposed.

Adolescent↗
PubMed1975

[Effects of postoperative decurarization with neostigmine on digestive anastomoses].

A prospective study was undertaken to assess the influence of neostigmine, a reversal agent for curarimimetic myorelaxants, on the incidence of postoperative disruption of anastomotic sites. Over a period of one year, 400 patients had surgery, including anastomosis, on the digestive tract for a variety of surgical conditions (Table II). At the end of anaesthesia, 200 patients received doses of atropine and neostigmine, usually 1 mg and 2.5 mg of each, as indicated on clinical basis and neuromuscular stimulation. The other patients did not recieve these drugs and were ventilated till the myorelaxation vanished spontaneously. During the postoperative period of incidence of anastomotic breakdown was assessed by the surgeon, unaware of the use or the omission of neostigmine in his patients. Anastomotic leakage was classified in four groups, namely: proved, absent, likely and unlikely. In this series and according to these clinical criteria, both groups had an incidence of anastomotic breakdown which was not significantly different (Table III). Neostigmine as used in this work does not seem to compromise the normal healing of anastomotic sites on the digestive tract.

Adolescent↗