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Biomedical subjects

P Yazbeck

Publications and source records attributed to P Yazbeck.

13 recordsLinked to original sources
PubMed2006

Effect of vital capacity manoeuvres on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery.

BACKGROUND: Arterial oxygenation may be compromised in morbidly obese patients undergoing bariatric surgery. The aim of this study was to evaluate the effect of a vital capacity manoeuvre (VCM), followed by ventilation with positive end-expiratory pressure (PEEP), on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery. METHODS: Fifty-two morbidly obese patients (body mass index >40 kg m-2) undergoing open bariatric surgery were enrolled in this prospective and randomized study. Anaesthesia and surgical techniques were standardized. Patients were ventilated with a tidal volume of 10 mL kg-1 of ideal body weight, a mixture of oxygen and nitrous oxide (FiO2 = 40%) and respiratory rate was adjusted to maintain end-tidal carbon dioxide at a level of 30-35 mmHg. After abdominal opening, patients in Group 1 had a PEEP of 8 cm H2O applied and patients in Group 2 had a VCM followed by PEEP of 8 cm H2O. This manoeuvre was defined as lung inflation by a positive inspiratory pressure of 40 cm H2O maintained for 15 s. PEEP was maintained until extubation in the two groups. Haemodynamics, ventilatory and arterial oxygenation parameters were measured at the following times: T0 = before application of VCM and/or PEEP, T1 = 5 min after VCM and/or PEEP and T2 = before abdominal closure. RESULTS: Patients in the two groups were comparable regarding patient characteristics, surgical, haemodynamic and ventilatory parameters. In Group 1, arterial oxygen partial pressure (PaO2) and arterial haemoglobin oxygen saturation (SaO2) were significantly increased and alveolar-arterial oxygen pressure gradient (A-aDO2) decreased at T2 when compared with T0 and T1. In Group 2, PaO2 and SaO2 were significantly increased and A-aDO2 decreased at T1 and T2 when compared with T0. Arterial oxygenation parameters at T1 and T2 were significantly improved in Group 2 when compared with Group 1. CONCLUSION: The addition of VCM to PEEP improves intraoperative arterial oxygenation in morbidly obese patients undergoing open bariatric surgery.

Adult↗
PubMed2004

[Spinal anaesthesia and Moya Moya disease].

Moya Moya is a rare disease of uncertain origin, characterised by stenosis of one or both of the internal carotid arteries and responsible of several neurological signs. We present the case of a boy with Moya Moya disease who was scheduled for an epiphisiodesis of the lateral malleola and had a spinal anaesthesia with hyperbaric bupivacaine 0.5% 10 mg without any perioperative complications. Any anaesthetic method could be used, provided special attention is given to avoid changes of capnea and blood pressure to preserve cerebral blood flow and palliate to cerebral flow steal.

Adolescent↗
PubMed1997

[Intraoperative malignant hyperthermia: apropos of a case].

Malignant hyperthermia (MHS) is a rare potentially fatal complication of general anesthesia. Anesthetic agents most frequently incriminated are succinylcholine and halogenated agents. Respiratory acidosis is the most specific and sensitive sign. Hyperthermia per se may occur secondarily or may stay totally absent. Tachycardia and/or arrhythmias often develop due to hyperkalemia and metabolic acidosis. Muscle rigidity whenever present is pathognomonic The "gold standard" test for the diagnosis of MHS is the halothane-caffeine contracture test. Dantrolene is the treatment of choice and prognosis depends on the early administration of this agent.

Dantrolene↗
PubMed1995

[Duplication of the vena cava].

Bilateral superior vena cava is a congenital anomaly of which the anaesthesiologist and intensivist should be aware in order to not mistake catheters placed in the left superior vena cava as being malpositioned outside of the venous circulation. These malpositions generally require catheter removal and reinsertion. This anomaly although rare is not-so-unusual. It is generally well tolerated.

Aged↗
PubMed1995

Hemodynamic effects of pressure support ventilation following cardiac surgery.

Hemodynamic effects of pressure support ventilation (PSV) were assessed in 33 patients, after cardiac surgery. The patients, selected for their stable left ventricular and respiratory functions, underwent uncomplicated coronary artery bypass grafting. They all underwent the same anesthetic protocol, and an invasive hemodynamic monitoring. Eight to ten hours postoperatively, while all patients were fully awake, normothermic and hemodynamically stable, controlled ventilation (CV) was replaced by 3 levels of PSV (20, 10, 5 cm H2O). These levels were applied consecutively for 20 minutes each, before extubation. Hemodynamic and gas exchange data were recorded on CV, on each level of PSV, and on spontaneous breathing. The results were analyzed using ANOVA and Bonfferoni methods. No statistical significance could be noted between the five modes of ventilation as to hemodynamic parameters, arterial and mixed venous blood gases, and oxygen consumption (VO2). The only 2 parameters that reached statistical significance were central venous pressure and respiratory rate. Our study demonstrates that patients with stable cardiovascular and respiratory function can adapt to different levels of PSV without hemodynamic modifications or an increase in their VO2.

Adult↗
PubMed1994

[Complications and outcome of implantable infusion pumps: apropos of 60 cases].

The aim of this study was to analyse the complications and the outcome in 59 patients with 60 implantable ports for cancer chemotherapy. Perioperative complications included: subcutaneous haematoma (n = 6), wrong position of the catheter tip (n = 2), accidental intravascular injection of lidocaine with adrenaline (n = 1), vagal reflex (n = 1) and pneumothorax (n = 1). Late complications included extravasation of drugs (n = 4), wound dehiscence (n = 1), spontaneous migration of the catheter tip (n = 2), venous thrombosis (n: = 2), septicaemia (n = 6), local discomfort (n = 6) and ports' obstruction (n = 15). In 11 cases, repermeabilization was possible with heparin or streptokinase. Patients were followed up to 40 months, 37% died with a patent port, 6% died with an obstructed port and 45% are still alive with a functional port. Twelve percent of the ports were removed. The lack of life-threatening complications, the high rate of satisfied patients (85%) and the long mean period of use (11 months) in this study are similar to those published in the literature and confirm the value of implantable ports for chemotherapy.

Follow-Up Studies↗
PubMed1994

[Laryngeal mask: a new tool for the anesthetist].

The laryngeal mask airway avoids the need for laryngoscopy and for tracheal intubation which may be harmful to certain patients. It was used in 70 patients by anesthetists with no previous experience of its use. A clear and unobstructed airway was obtained in 97.2% of patients. An evident hemodynamic stability was observed following its insertion and few minutes later. Laryngospasm occurred in 8 cases during the course of anesthesia and it appeared to be a result of light anaesthesia or of a secondary displacement.

Adolescent↗
PubMed1992

[Anaphylactic shock due to modified fluid gels: 2 case reports].

UNLABELLED: Colloid solutions can give severe anaphylactic accidents. We are reporting two cases from our department. FIRST CASE: a sixty eight years old man perfused with Plasmion solution (Gelatin plasma substitute) before spinal anesthesia, presented sudden hypotension and diffuse skin rush. Second case: a twelve years old girl, receiving a Plasmion solution to correct a hypovolemic shock in I.C.U, presented a severe bronchospasm and a worsening of the hypotension. These accidents are explained by immunologic reactions or by direct histamine release. Their incidence is between 0.01 and 0.8 percent depending on the used solution. They are prevented by an antihistaminic premedication for the gelatin plasma substitutes and by an haptenic inhibition for Dextran (polysaccharide plasma substitutes). The new colloid solutions, based on hydroxyethylstarch, seems to give much less allergic reactions.

Aged↗
PubMed1992

[Secondary migration of a central venous catheter linked to an implantable port].

The secondary migration of the distal part of a central venous catheter with implantable port is rarely described. This study reports a case in which the distal part of a catheter with implantable port moved spontaneously, a month after its implantation in a branch of the internal jugular vein without any other complication. The discussion is about modalities, frequency and explanation mechanisms of the complications due to central catheters. The conclusion insists on systematical radiologic control of the position of implantable port with central venous access, and in case of bad working or any sign of thrombo-phlebitis.

Catheterization, Central Venous↗
PubMed1992

[Use of implantable chemotherapy reservoirs. Experience at the Hotel-Dieu of France].

We are presenting our experience with 70 deep venous catheters for long term chemotherapy. Despite the well known complications of these procedures, the implantation of subcutaneous injection sites has facilitated the management and brought much more comfort to cancer patients. Strict measures of survey and meticulous nursing care are essential for optimal use of the injection sites.

Adolescent↗