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Biomedical subjects

P Viars

Publications and source records attributed to P Viars.

At least 19 recordsLinked to original sources
PubMed1979

Cardiovascular response to the i.v. administration of morphine in critically ill patients undergoing IPPV.

The haemodynamic changes following the administration of morphine 0.15 and 0.30 mg kg-1 i.v. were studied in 11 patients, free from known cardiac disease. All patients were acutely ill and their lungs were being ventilated mechanically. In those patients receiving 0.15 mg kg-1, the only haemodynamic change was a slight and transitory decrease in the systolic arterial pressure. In contrast, several changes were observed in patients receiving 0.30 mg kg-1: an immediate and prolonged decrease in the cardiac index was noted along with transient decreases in heart rate, stroke volume index, arterial pressure and left stroke work index. These results suggest that the haemodynamic cost of morphine 10 mg is negligible but could be significant when 20 mg has been administered and must be weighed against its beneficial effects in the critically ill patient.

Adult↗
PubMed1979

Early anuria prevention in human kidney transplantation. Advantage of fluid load under pulmonary arterial pressure monitoring during surgical period.

In human kidney transplantation, a high blood flow established through the graft immediately upon clamp release is usually associated with immediate satisfactory renal function. One hundred consecutive kidney transplant patients were thus provided with a large volume of fluid during surgery. To avoid pulmonary edema, fluid load was given under mean pulmonary arterial pressure (PAP) monitoring, and controlled ventilation was maintained during the early postoperative period. Whether initial PAP value was within normal range or elevated, all patients required an equivalent fluid load to reach the best hemodynamic condition upon clamp removal. The mean intraoperative fluid load consisted of 2406 +/- 968 ml of water with 22.8 +/- 9.4 g of sodium chloride, 5.9 +/- 1.8 units of albumin, and 2.6 +/- 1.8 units of packed red blood cells. Immediately before clamp release patients were given furosemide and mannitol. During the postoperative period, i.v. infusions consisted of water and sodium chloride (6 g/liter) to match urine output, provided that diuresis was equal to or above 400 ml/hr. If diuresis remained or decreased below this level, diuresis replacement was associated with PAP-controlled infusion of saline, albumin, and red blood cells if needed. Furosemide was eventually given if diuresis did not increase above 400 ml/hr with fluid loading. With this protocol a good early diuresis was established in 95% of the cases. Ten patients required dialysis before the 5th postoperative day, one of them because of fluid overload and anuria. Concurrently, a decreased mortality rate and an increased graft survival rate were observed.

Adolescent↗
PubMed1978

[The use of Marcaine in obstetrical analgesia].

Bupivacaine (Marcaine) is being used increasingly in obstetrics for epidural analgesia, by virtue of the good sensory block obtained and the minimum of side-effects on the mother and newborn infant. At a concentration of less than 0.5 p. 100, analgesia is excellent with a minimal effect on motor fibres. Side-effects and toxicity are limited by the use of fractionated doses from the beginning of labour or of a single dose during or at the end of labour calculated in relation to the effect sought. Any action on the newborn infant would appear to be exceptional, if dose recommendations are respected, the high percentage of Marcaine bound to proteins limiting its transplacental passage.

Anesthesia, Epidural↗
PubMed1976

Central venous pressure and pulmonary wedge pressure. A comparative study in anesthetized surgical patients.

To determine the reliability of central venous pressure (CVP) as a guide to fluid therapy during an operation, repeated and simultaneous CVP and pulmonary wedge pressure (PWP) measurements were made with a Swan-Ganz catheter in 13 relatively elderly patients without obvious cardiac or respiratory disease- Overall correlation between CVP and PWP was highly significant (P less than .001); there was, however, an important variation of the correlation for each patient. For values of CVP greater than or equal to 8 mm Hg, the correlation was not significant. The disparity between right and left ventricular filling pressures was confirmed by the relationship between serial changes in CVP and PWP. These data strongly suggest that in relatively elderly patients undergoing surgery without evidence of cardiac or respiratory disease, CVP may be misleading index for appreciating PWP.

Aged↗
PubMed1976

[Anesthesia and pre- and postoperative resuscitation in massive maxillofacial destruction].

Severe facial injuries are becoming more and more common, -either facial injuries alone or associated with other injuries, -or facial deformities due to cancer which has required radical surgical operation. The authors analyse the cases of 26 patients with trauma and 24 with neoplastic radical surgical modifications. In the first group, pre-operative resuscitation is often an emergency, e.g. tracheotomy to restore or maintain vital respiratory functions. In the second group, the patients are often elderly and undernourished and they require intensive care before operation. In both groups there are common problems: -feeding by gastric catheter is generally required, -many re-operations with their problems: -avoid nutritional disorders, -and avoid morphine addiction.

Adolescent↗
PubMed1976

[Problems posed by difficult intubations].

The difficulties of tracheal intubation are mainly encountered in facial surgery and E.N.T. surgery, but they may nevertheless, occur in any form of surgery. The indications for nasal intubation, without visible glottis, the problems raised and the means of solving them, whilst respecting safety precautions, are briefly recalled.

Cicatrix↗