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Biomedical subjects

P Schoeffler

Publications and source records attributed to P Schoeffler.

At least 19 recordsLinked to original sources
PubMed1999

[Laryngoscope. Evaluation of a device for preventing blade contamination].

OBJECTIVE: To evaluate the efficacy and the difficulty of use of a disposable sheath which prevents the contamination of blades. STUDY DESIGN: Prospective bacteriological, virological and clinical evaluation. MATERIAL: A translucid cover sheath, made of polyethylene enclosing the blade of the laryngoscope, and delivered in clean, non-sterile packaging (Prolam, Péters). METHOD: 1) A control of sterility performed by setting-up a culture derived from the solution used for rinsing the device before its use. 2) An in vitro study of the effectiveness of preventing contamination of the blades by a polio virus/RT-PCR technique. 3) Clinical evaluation: after 200 orotracheal intubations by 12 anaesthesiologists and 15 nurse anaesthetists, a questionnaire on the ease of use was completed. RESULTS: The bacteriological study of the sheats before use showed an acceptable level of contamination. The sheath was an effective barrier against poliovirus, even after 12 h of immersion. Clinically, the sheath was easily adapted over the blade of the laryngoscope in 98% of the cases. Insertion in the mouth was considered as easy in 94% of the patients. The visualization was good or excellent in 83% of the cases and in 16% of the patients, the users experienced difficulties to intubate. CONCLUSION: The laryngoscope blade sheath is simple and easy to use, efficient and not expensive.

Bacterial Infections↗
PubMed1999

Antiemetic activity of the NK1 receptor antagonist GR205171 in the treatment of established postoperative nausea and vomiting after major gynaecological surgery.

In this double-blind, randomized, parallel group study, we have investigated the antiemetic activity of the potent and selective NK1 receptor antagonist GR205171 25 mg i.v. compared with placebo in the treatment of established postoperative nausea and vomiting (PONV) in patients after major gynaecological surgery performed under general anaesthesia. The incidence of PONV in the study population was 65%. Thirty-six patients were treated with placebo or GR205171 (18 patients per group). GR205171 produced greater control of PONV than placebo over the 24-h assessment period. The stimuli for emesis after PONV are multifactorial and the efficacy of GR205171 in this study supports the broad spectrum potential for NK1 receptor antagonists in the management of postoperative emesis. GR205171 was well tolerated and no adverse events were reported that would preclude the further development of this agent.

Adolescent↗
PubMed1999

Lidocaine plus ropivacaine versus lidocaine plus bupivacaine for peribulbar anesthesia by single medical injection.

UNLABELLED: This study was designed to compare the effects of ropivacaine and bupivacaine, each combined with lidocaine, during peribulbar anesthesia by single medial injection for cataract surgery. One hundred patients were included and randomly divided into two groups of 50, given a mixture of 50% bupivacaine (0.5%) and 50% lidocaine (2%) or 50% ropivacaine (1%) and 50% lidocaine (2%), and 25 U hyaluronidase per mL with each combination. After the first injection, patients given ropivacaine exhibited significantly better akinesia than those given bupivacaine, and significantly fewer were reinjected (19/50 vs 31/50). Among the patients reinjected, peroperative akinesia and analgesia proved satisfactory in both groups. We observed three cases of diplopia caused by retraction of the internal rectus muscle and two cases of moderate ptosis after superonasal reinjection. Hemodynamic profiles were similar in the two groups, and no major side effects were noted during the observation. One percent ropivacaine may be a more appropriate agent than 0.5% bupivacaine for peribulbar anesthesia by single medial injection. IMPLICATIONS: One percent ropivacaine may be a more appropriate agent than 0.5% bupivacaine for peribulbar anesthesia by single medial injection. Combined with lidocaine, it provides better akinesia and similar analgesia.

Aged↗
PubMed1998

Combined nitric oxide inhalation, prone positioning and almitrine infusion improve oxygenation in severe ARDS.

PURPOSE: To determine the efficacy and side effects of prone positioning (PP) and nitric oxide (NO) inhalation, alone, associated, or combined with i.v. almitrine for the treatment of hypoxaemia in severe acute respiratory distress syndrome (ARDS). METHODS: Over a period of 20 months, 27 consecutive critically ill patients with severe ARDS (Murray score > 2.5, PaO2/FiO2 < 170 after alveolar recruitment) were prospectively and randomly included. They inhaled NO for two hours at concentrations of 5 and 10 ppm for one hour each (H0-H2). One hour later, they were returned to the prone position for four hours (H3-H7). During the last two hours in this position (H5-H7), they were assigned to further inhalation of 10 ppm NO (Group B, n = 9) or to no further inhalation (Group A, n = 9). In group C (n = 9), the procedure for group B was combined with perfusion of 16 mg.kg-1.min-1 almitrine throughout the study. RESULTS: Compared with control values, two hours NO inhalation improves PaO2/FiO2 and shunt effect by +28% and -9%, PP by +88% and -27%, PP + almitrine by +132% and -28%, NO + almitrine by +153 and -28%, PP + NO by +94% and -29%, NO + PP + almitrine by +327 and -48%. NO inhalation reduces pulmonary vascular resistance. Other haemodynamic parameters remain unchanged, whatever the treatment. NO inhalation improves PaO2/FiO2 by over 20% in 50% of the patients and PP is effective in 78% of the cases. CONCLUSION: Prone Position improves PaO2/FiO2 significantly more than NO alone but less than PP + almitrine or NO + almitrine. The best results are obtained with the association of NO + Prone position + Almitrine.

Administration, Inhalation↗
PubMed1998

[Catabolic aspects of cranial trauma].

During their stay in the intensive care unit, head-trauma patients develop a hypermetabolic and a hypercatabolic status. Their nitrogen balance is highly negative and the muscular proteolysis is largely increased. The nitrogen losses originate mainly in muscles, resulting in muscle wasting and weakness. The whole protein synthesis remains quite normal, but this does not reflect the reality, as muscular protein synthesis is decreased, while hepatic protein synthesis is increased. The increased proteolysis seems to be due to the activation of the three proteolytic pathways, particularly the ATP-ubiquitin-dependent pathway. The causes of the increased muscle proteolysis in head trauma patients remain unclear. The increased glucocorticoid release, which is integrated in the acute phase response to injury, could be one of them. Glutamin, vitamin or zinc supplementation has been proposed in head trauma patients. The use of glucocorticoid antagonists, recombinant growth hormone or anti-cytokines are our fields of research.

Craniocerebral Trauma↗
PubMed1998

The effects of volume and speed of injection in peribulbar anaesthesia.

We have evaluated the effects of the volume and speed of administration of local anaesthetic during peribulbar anaesthesia. One hundred and forty patients scheduled for cataract surgery were randomly allocated to one of four groups of 35. Each patient received an injection of the same mixture of lignocaine, bupivacaine and hyaluronidase. Patients in group A were given 9 ml at a speed of 5 ml.min-1, group B were given the same volume at 12 ml.min-1, group C were given 13.5 ml at 5 ml.min-1 and group D were given 13.5 ml at 12 ml.min-1. A significantly higher incidence of satisfactory akinesia was found in group D, whose pain score at injection was no higher than for the other groups. Large volumes of local anaesthetic significantly affected intra-ocular pressure. The incidences of early and late ptosis or diplopia were not affected by either the rate of injection or the volume of local anaesthetic.

Aged↗
PubMed1997

[Brachial plexus block: effect of the addition of sufentanil to local anesthetic mixture on postoperative analgesia duration].

OBJECTIVES: To compare the quality and the duration of analgesia produced by a supraclavicular brachial plexus blockade obtained with a mixture of lidocaine and bupivacaine when supplemented or not with sufentanil. STUDY DESIGN: Prospective, randomized, double-blind study. PATIENTS: The study included 40 patients undergoing osteosynthesis of the upper limb under brachial plexus block, randomly assigned to two groups. METHODS: The patients of the control group were given 0.5% bupivacaine 1 mg.kg-1 and 1% lidocaine 2 mg.kg-1. Those of the sufentanil group, received the same mixture supplemented with sufentanil 0.2 mg.kg-1. During the postoperative period, the characteristics of analgesia were blindly evaluated every hour for 48 h with a visual analogic scale graduated from 0 to 100. Analgesia was considered satisfactory when the score was below 30. Adverse effects of opiates (drowsiness, pruritus, nausea and vomiting) were also assessed. Oxygen saturation was continuously monitored. Blood pressure, heart and respiratory rates were measured at the same intervals than analgesia. Duration of analgesia are expressed as medians (range) and compared using a Mann and Whitney's U test. RESULTS: The respective durations of satisfactory analgesia were significantly different: 12.5 h (8-17) in the control group versus 24 h (8-48) for the sufentanil group. The adverse effects in the sufentanil group were nausea (2), vomiting (1) and pruritus (1). No respiratory depression was noted. CONCLUSION: Sufentanil added to a mixture of lidocaine and bupivacaine increases twofold the duration of postoperative analgesia following branchial plexus blockade.

Analgesics, Opioid↗
PubMed1997

Intravenous dolasetron mesilate in the prevention of postoperative nausea and vomiting in females undergoing gynecological surgery.

STUDY OBJECTIVE: To evaluate a range of doses of intravenous (i.v.) dolasetron mesilate, in preventing postoperative nausea and vomiting (PONV). DESIGN: Double-blind, placebo-controlled, randomized, multicenter trial. SETTING: Ten hospitals and/or surgical centers. PATIENTS: 281 women undergoing gynecologic surgery with general anesthesia. INTERVENTIONS: Patients received one of four single, i.v. doses of dolasetron mesilate (12.5 mg, 25 mg, 50 mg, and 100 mg) or placebo administered following cessation of anesthesia. MEASUREMENTS AND MAIN RESULTS: Patients were monitored for 24 hours following study drug administration. The antiemetic efficacy of each dolasetron mesilate dose was evaluated by recording the number and timing of emetic episodes, and the effects on nausea were assessed by use of visual analog scales (VAS). Safety was assessed by adverse event reports, clinical laboratory tests, electrocardiographic (ECG) measurements, and monitoring vital signs. Complete responses (patients with no emetic episodes and no escape antiemetic medication requirements in 24 hours) were achieved by 54% in the 12.5-mg, 67% in the 25-mg, and 59% in both the 50-mg and 100-mg dolasetron mesilate dose groups, and by 43% in the placebo group. Nausea VAS assessments demonstrated that dolasetron-treated patients were significantly (p = 0.048) more likely to report no nausea (VAS score < 5 mm) than those in the placebo group. Adverse events reported generally were mild in intensity, and there were no clinically significant changes in laboratory tests, vital signs, or ECG parameters. CONCLUSIONS: Dolasetron was effective and well tolerated for the prevention of PONV in female patients undergoing gynecologic surgery with general anesthesia.

Adolescent↗
PubMed1997

Haemodynamic conditions enhancing gas embolism after venous injury during laparoscopy: a study in pigs.

This study was designed to determine the conditions that promote carbon dioxide embolism after venous injury during laparoscopy in pigs. Injury to an iliac vein was filmed during laparoscopy in the presence of a pneumoperitoneum created at increasing pressures from 0 to 30 mm Hg in 5-mm Hg increments. At intraperitoneal pressures less than 20 mm Hg, there was a parallel increase in femoral venous pressures, resulting in haemorrhage, with persistent blood flow to the inferior vena cava. At intraperitoneal pressures of 20-30 mm Hg, there was collapse of the femoral vein, occurring earlier in the presence of hypovolaemia. Between these two states (haemorrhage and collapse), there was a point of equilibrium which allowed retrograde venous penetration of carbon dioxide bubbles. During release of the pneumoperitoneum, these bubbles were exteriorized through the area of the injury, but some passed into the inferior vena cava where their presence was detected by an oesophageal Doppler probe.

Animals↗
PubMed1997

The addition of opioids to local anaesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine and sufentanil.

We compared the duration of analgesia produced by a mixture of lignocaine and bupivacaine, either alone or combined with morphine (75 micrograms.kg-1), buprenorphine (3 micrograms.kg-1) or sufentanil (0.2 microgram.kg-1) in 80 patients after brachial plexus block for orthopaedic surgery of the upper limb. The characteristics of analgesia were evaluated hourly using a visual analogue scale. The analgesia was considered satisfactory for scores of 30 or less. The median duration (range) of satisfactory analgesia was: 11.5 (8-15) h without an opioid, 21 (9-27) h with morphine, 20 (14-34) h with buprenorphine and 24.5 (11-38) h with sufentanil. We conclude that the addition of an opioid to a local anaesthetic mixture lengthens the duration of analgesia.

Adult↗
PubMed1997

Albumin and fibrinogen syntheses increase while muscle protein synthesis decreases in head-injured patients.

The effect of trauma on protein metabolism was investigated in the whole body, muscle, and liver in severely head-injured patients presenting an acute inflammatory response by comparison to fed control subjects receiving a similar diet. Nonoxidative leucine disposal (an index of whole body protein synthesis) and muscle, albumin, and fibrinogen synthesis were determined by means of a primed, continuous infusion of L-[1-13C]leucine. Nonoxidative leucine disposal increased by 28% in the patients (P < 0.02). Fractional muscle protein synthesis rate decreased by 50% (P < 0.01) after injury. Fractional and absolute fibrinogen synthesis rates were multiplied by two and nine, respectively, after injury (P < 0.001). Albumin levels were lower in patients (25.2 +/- 1.2 g/l, means +/- SE) than in controls (33.7 +/- 1.2 g/l, P < 0.001). However, fractional albumin synthesis rates were increased by 60% in patients (11.4 +/- 1.0%/day) compared with controls (7.3 +/- 0.4%/day, P < 0.01). Therefore, 1) head trauma induces opposite and large changes of protein synthesis in muscle and acute-phase hepatic proteins, probably mediated by cytokines, glucocorticoids, and other stress hormones, and 2) in these patients, hypoalbuminemia is not due to a depressed albumin synthesis.

Blood Proteins↗
PubMed1996

Increased mRNA levels for components of the lysosomal, Ca2+-activated, and ATP-ubiquitin-dependent proteolytic pathways in skeletal muscle from head trauma patients.

The cellular mechanisms responsible for enhanced muscle protein breakdown in hospitalized patients, which frequently results in lean body wasting, are unknown. To determine whether the lysosomal, Ca2+-activated, and ubiquitin-proteasome proteolytic pathways are activated, we measured mRNA levels for components of these processes in muscle biopsies from severe head trauma patients. These patients exhibited negative nitrogen balance and increased rates of whole-body protein breakdown (assessed by [13C]leucine infusion) and of myofibrillar protein breakdown (assessed by 3-methylhistidine urinary excretion). Increased muscle mRNA levels for cathepsin D, m-calpain, and critical components of the ubiquitin proteolytic pathway (i.e., ubiquitin, the 14-kDa ubiquitin-conjugating enzyme E2, and proteasome subunits) paralleled these metabolic adaptations. The data clearly support a role for multiple proteolytic processes in increased muscle proteolysis. The ubiquitin proteolytic pathway could be activated by altered glucocorticoid production and/or increased circulating levels of interleukin 1beta and interleukin 6 observed in head trauma patients and account for the breakdown of myofibrillar proteins, as was recently reported in animal studies.

Adult↗
PubMed1996

Effect of injection pressure on the success rate of peribulbar block.

The aim of this prospective double-blind study was to evaluate the effect of the pressure on injection of local anaesthetic during peribulbar anaesthesia. Fifty patients scheduled for cataract surgery under peribulbar anaesthesia, with a two injection site technique, were randomly assigned to receive a mixture of 5 ml of etidocaine 1%, 4 ml of bupivacaine 0.5% and hyaluronidase 50 IU, injected under a constant pressure of either 140 g.cm-2 (group 1) or 250 g.cm-2 (group 2). After orbital compression, the degree of akinesia of the extra-ocular and orbicular muscles was graded by clinical assessment. A significantly higher rate of satisfactory akinesia of the extra-ocular muscles was found in group 2 (72% vs 28% in group 1) (p < 0.01). No significant relationship was found between the time taken to administer the anaesthetic mixture at constant pressure and the quality of the block.

Aged↗
PubMed1995

Anaesthesiology.

Because of the extension of laparoscopic surgery to older patients with more complicated medical histories, anaesthetists increasingly have to face the problem of haemodynamic and respiratory tolerance of the technique. The management of such problems requires the understanding of the mechanisms involved, and their implications in terms of patient selection. Protocols where the maintenance of anaesthesia is provided using halogenated agents like isoflurane or desflurane have been shown to blunt the increase in systemic vascular resistances induced by CO2 insufflation and therefore enhance the haemodynamic tolerance of this procedure.

Anesthesia, General↗
PubMed1994

[Insufflators for endoscopy].

Operative laparoscopy needs a space to be made inside the abdominal cavity. This can only be achieved by suspension or by positive pressure. The endoscopic insufflator makes it possible to create this positive pressure, and does indeed enable the operating space to remain open. But it would be too limiting to consider these devices from the visibility point of view only, for they can also be exploited for their action on hemostasis and dissection. With this in mind we feel that the endoscopic surgeon ought to be perfectly familiar with his apparatus and not simply limit himself to adjusting the pressure and flowrate at the beginning of the operation. This hyper pressure in the abdomen is not without consequences for the patients' homeostasis and can indeed require an operation to be halted or converted to laparotomy. So knowledge of the biomedical aspects of his equipment will also enable the surgeon to increase the safety of his operations.

Endoscopes↗