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P Narchi

Publications and source records attributed to P Narchi.

27 records · Page 2Linked to original sources
PubMed1992

Serum concentrations of local anaesthetics following intraperitoneal administration during laparoscopy.

The present study is a comparison of the pharmacokinetics of four local anaesthetics injected double blind in the right subdiaphragmatic area during outpatient laparoscopy performed under standard general anaesthesia in 28 young women. 80 ml of one of the following solutions was injected: Group A 0.5% plain lidocaine (n = 7), Group B 0.5% lidocaine with 1/320.000 adrenaline (n = 8), Group C 0.5% lidocaine with 1/800.000 adrenaline (n = 7), and Group D 0.125% bupivacaine with 1/800.000 adrenaline (n = 6). Blood samples were collected over 360 min from an iv catheter and serum concentrations were measured by gas chromatography. No adverse effects occurred in the study period. In Group A (plain lidocaine), Cmax was significantly higher and tmax significantly earlier than in Groups B and C (lidocaine with adrenaline). A toxic level was not found after either solution in any patient. The intraperitoneal use of doses of 400 mg lidocaine or 100 mg bupivacaine for perioperative analgesia was safe and solutions of lidocaine containing adrenaline appeared to pose even less risk than plain solutions.

Adult↗
PubMed1992

Ventilatory effects of epidural clonidine during the first 3 hours after caesarean section.

Many authors have shown the analgesic efficacy of 150-800 micrograms of epidural clonidine in the postoperative period. Its use as an analgesic after caesarean section has recently been studied with higher dosages (400-800 micrograms). Our study aimed at assessing the analgesic and ventilatory effects of two smaller doses of epidural clonidine (150 and 300 micrograms), which were compared to the effects of 10 mg of parenteral morphine (M) during the first 3 h after caesarean section. The duration of the analgesic effect was longest with 150 micrograms of epidural clonidine. Arterial blood pressure decreased from 30 min after the injection to the end of the study in both epidural clonidine groups. A marked sedation was observed in patients receiving 300 micrograms of epidural clonidine and was frequently associated with snoring, obstructive apnoea and episodes of arterial oxygen desaturation. We conclude that 150 micrograms of epidural clonidine provides better and longer analgesia after caesarean section than 10 mg of parenteral morphine, and seems preferable to higher doses (300 micrograms) in this setting, since 300 micrograms of epidural clonidine may produce unacceptable respiratory obstructive disturbances.

Analgesia, Epidural↗
PubMed1991

Heart rate response to an i.v. test dose of adrenaline and lignocaine with and without atropine pretreatment.

In order to evaluate the sensitivity of an adrenaline test dose for detecting intravascular injection and the effect of atropine pretreatment, 90 ASA physical status I and II patients were allocated randomly to two groups, to receive i.v. saline 1 ml (n = 46) or i.v. atropine 0.5 mg (n = 44). Five minutes later, all patients received an i.v. test dose of 2% lignocaine 3 ml with adrenaline 15 micrograms at a rate of 1 ml s-1. The groups were similar with respect to basal heart rate (HR). HR remained unchanged after saline injection, but increased slightly 5 min after atropine injection (mean 78 (SD 15) beat min-1 vs 87 (20) beat min-1 (P less than 0.05). After the test dose of lignocaine with adrenaline, HR increased significantly in both groups at 30 s, 1 and 2 min, and remained increased at 3 min in the atropine group. The maximum increase in HR was greater in the atropine group than in the saline group (31 (4) beat min-1 vs 26 (11) beat min-1 (P less than 0.05). However, when individual maximum HR changes are considered, five patients in the saline group and four in the atropine group had an increase less than or equal to 10 beat min-1, and three patients in the saline group had no change or a decrease in HR. Defining a positive result to a test dose as an increase in HR of greater than 10 beat min-1, the sensitivity of the adrenaline test dose was 83 (5.5)% in the saline group and 91 (3.5)% in the atropine group (ns).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Ventilatory effects of premedication with clonidine.

Clonidine has been proposed as a premedication before surgery because of its beneficial effects on hemodynamics, especially in patients with a high cardiovascular risk. However, reports on the effects of clonidine on ventilation are conflicting. Accordingly, eight fasting ASA physical status I volunteers received in a double-blind randomized order 300 micrograms of oral clonidine, the effects of which were compared with placebo given in a crossover design. Hypotension, bradycardia, and sedation were significantly more profound and of longer duration after clonidine. Clonidine did not decrease minute ventilation more than the placebo, and separate analysis of tidal volume and respiratory rate changes also showed the absence of a significant difference between the two groups. However, clonidine produced episodes of obstructive pattern associated with moderate decreases in oxygen saturation, which were not observed with placebo. We conclude that the potential detrimental effects of these obstructive airway patterns of clonidine should be taken into account when prescribing this drug for premedication.

Administration, Oral↗
PubMedDate not supplied

Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy.

Laparoscopy is frequently associated with postoperative shoulder pain that may last several days. We have assessed the analgesic effect of intraperitoneal local anaesthetics during day-case diagnostic laparoscopy. 80 young women were randomly assigned to one of four groups of 20 patients each: group 1, no peritoneal administration; group 2, 80 ml saline injected under direct vision in the right subdiaphragmatic area at the start of the procedure; group 3, 80 ml 0.5% lignocaine with adrenaline (320,000 dilution); group 4, 0.125% bupivacaine with adrenaline (800,000 dilution). Scapular pain was assessed with a visual analogue pain scale, and information about nausea, vomiting, abdominal pain, and analgesic requirements during the first 48 h was sought. Both local anaesthetics were more effective in reducing postoperative shoulder pain than either control or saline. Analgesic requirements were greater in the non-treatment groups than in the local anaesthetic groups. Intraperitoneal local anaesthetic administration during laparoscopy is both a non-invasive and an efficient method of reducing the intensity of scapular pain.

Adult↗
PubMedDate not supplied

Survey of regional anesthetic practice among French residents at time of certification.

BACKGROUND AND OBJECTIVES: A survey of anesthesia practice was conducted among French residents in anesthesia at the end of their training. This study was performed mainly to evaluate the residents' experience in peripheral nerve blocks. METHODS: Two short clinical cases were proposed to all French residents during a telephone interview immediately before their certification. The first described the case of a young asthmatic patient admitted for an elbow fracture. The second described an elderly woman with severe aortic stenosis admitted for a supracondylar fracture of the femur. A questionnaire had been prepared and was filled in during the interview. Each resident was asked to answer according to the actual choice he or she would have made. For both cases, when general anesthesia was chosen first, the next question was to discuss which regional anesthesia would be used if general anesthesia had to be discarded. In that way, the practical knowledge about most common peripheral nerve blocks learned during residency was investigated. RESULTS: Of 77 residents registered as being at the end of their residency, 8 were on either sabbatical or maternity leave. Regional anesthesia was the first choice in 78% and 57% of cases for the first and second clinical cases, respectively. The regional anesthetic techniques chosen were axillary block (66%), interscalene block (31%), and intravenous regional anesthesia (3%) for case 1 and combined lumbar plexus and sciatic block (36%), epidural anesthesia (30%), single-shot spinal anesthesia (18%), and continuous spinal anesthesia (16%) for case 2. Throughout the residency of the group, 32 +/- 2 axillary blocks, 12 +/- 2 interscalene blocks (axillary vs interscalene, P < .0001), 21 +/- 3 femoral blocks, and 10 +/- 2 sciatic blocks (femoral vs sciatic, P < .0001) had been performed (mean +/- SEM). They had also performed 2.5 +/- 0.5 continuous spinal anesthesias and 17 +/- 3 intravenous regional anesthesias respectively. Upper extremity blocks were more often used during residency than lower extremity blocks (44 +/- 3 vs 31 +/- 4, P < .01). A peripheral nerve stimulator was routinely used by 83% of residents. CONCLUSION: French residents in anesthesiology at time of certification are better trained for peripheral nerve blocks of the upper extremity than for those of the lower extremity. Axillary plexus and femoral nerve block are the most widely used blocks, probably reflecting the techniques the most mastered among teachers. Finally, the extensive use of a peripheral nerve stimulator by residents is probably the result of the widespread use of this device by teachers in France.

Adult↗