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Biomedical subjects

R Larbuisson

Publications and source records attributed to R Larbuisson.

At least 37 records · Page 2Linked to original sources
PubMed1996

The efficacy and safety of intravenous propafenone versus intravenous amiodarone in the conversion of atrial fibrillation or flutter after cardiac surgery.

OBJECTIVE: The primary objective was to evaluate the efficacy of propafenone compared with amiodarone in the reversion of atrial fibrillation or flutter. The secondary objective was the assessment of the tolerance of propafenone versus amiodarone. DESIGN: An open, randomized trial. SETTING: A single university hospital. PARTICIPANTS: Forty patients who gave their informed consent. INTERVENTIONS: These patients underwent cardiac bypass surgery or aortic valvular replacement. For treatment of postsurgical arrhythmias, they either received intravenous propafenone, 1 to 2 mg/kg in a 10-minute bolus, followed by an infusion of 420 mg in 24 hours, or amiodarone, 2.5 to 5 mg/kg, in a 10-minute bolus followed by an infusion of 900 mg in 24 hours. MEASUREMENTS AND MAIN RESULTS: Sinus rhythm was restored in 12 of 18 (67%) propafenone patients and in 17 of 22 (77%) amiodarone patients. If the early success time-limit had been fixed at 60 minutes, the proportion would have been 41% (7/17) for propafenone versus 14% (3/22) for amiodarone, and that difference is nearly significant (p = 0.07 Fisher's exact test). However, after 210 minutes, 50% of the propafenone patients regained sinus rhythm versus only 25% of the amiodarone patients. Hemodynamic parameters improved with time in both groups without showing any statistically significant difference. CONCLUSIONS: The results suggest that propafenone produces a more prompt effect in converting patients from atrial fibrillation or flutter to normal sinus rhythm.

Adolescent↗
PubMed1996

[Anesthetics].

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Anesthesia, Conduction↗
PubMed1995

Prophylaxis in cardiac surgery. A controlled randomized comparison between cefazolin and cefuroxime.

In a prospective randomized two center trial, short-term prophylaxis with cefuroxime (CFX) in 189 patients was compared with cefazolin (CFZ) in 196 patients submitted to elective cardiac surgery. A total of 3 g was administered over 24 h in both groups. One major adverse reaction with CFX was noted. Patients were prospectively screened by infectious disease nurses for surgical wound and secondary infections. Sternal wound infections occurred in eight patients treated with CFX and all were minor. One patient from this group eventually died of infectious causes. In the CFZ-treated patients two major and six minor wound infections occurred requiring extensive debridement in two. Secondary infections occurred less frequently in the CFX group (13.2 per 100) than in the CFZ group (16.8 per 100) with two infection-related deaths in the CFX and one in the CFZ group. The most commonly identified organisms were Staphylococcus aureus and a variety of gram-negative organisms. No major differences were observed between the CFX and CFZ groups. Short-term administration of 3 g CFZ or CFX in this study could not demonstrate the advantage of one of the antibiotics used over the other in terms of clinical outcome, incidence or site of infection or organisms identified. The 24 h administration of 3 g CFZ or CFX provided suboptimal prophylaxis for wound infection or secondary infections in patients undergoing elective open heart surgery.

Adult↗
PubMed1991

Myeloperoxidase and elastase as markers of leukocyte activation during cardiopulmonary bypass in humans.

To assess leukocyte activation during cardiopulmonary bypass, we measured white blood cell and neutrophil counts and lysosomal enzyme release, especially myeloperoxidase and elastase, throughout the operation and for 5 days postoperatively. A newly developed double antibody radioimmunoassay of myeloperoxidase and an enzyme-linked immunosorbent assay for detection of the polymorphonuclear elastase-alpha 1-proteinase inhibitor complex were used to determine their plasma levels in 15 patients undergoing elective aorta-coronary bypass grafting. Preoperatively white blood cell counts and plasmatic levels of myeloperoxidase and elastase-alpha 1-proteinase inhibitor were normal. Because no correlation has yet been established between levels of myeloperoxidase and elastase-alpha 1-proteinase inhibitor, the aim of this prospective study was to evaluate the use of these enzyme levels as markers for leukocyte activation in vivo. We addressed the clinical situation of cardiopulmonary bypass because it offered the possibility of monitoring the comparative evolution of blood levels of these enzymes in parallel to white blood cell counts through well-defined steps corresponding to known events. We document the advantages of myeloperoxidase blood levels over elastase measurement as reflecting more rapidly the in vivo activation of leukocytes. The time course kinetics of these three measurements were not parallel. White blood cell counts remained stable at the beginning of bypass, whereas myeloperoxidase levels increased sharply and continuously as soon as bypass was instituted until the end of bypass. Elastase levels also increased, but later than myeloperoxidase, beginning when the patients was rewarmed. High elastase plasma levels persisted later than myeloperoxidase after bypass, in parallel with white blood cell counts. It thus clearly appears that changes in myeloperoxidase levels more rapidly reflect the activation state of leukocytes induced by cardiopulmonary bypass and surgery, whereas peak levels of elastase were delayed and parallel to white blood cell counts. From this model, in which the evolution of leukocyte numbers could be followed in relation with known steps of stimulation, it appears that myeloperoxidase is a sensitive marker for monitoring in vivo activation of white blood cells.

Adult↗
PubMed1990

Plasma renin activity and urine beta 2-microglobulin during and after cardiopulmonary bypass: pulsatile vs non-pulsatile perfusion.

Fourteen patients with normal preoperative renal function underwent aortocoronary bypass graft using cardiopulmonary bypass (CPB) with pulsatile (P;n = 7) or non pulsatile (NP;n = 7) perfusion. In the two groups prebypass values of plasma renin activity (PRA) and urine beta 2-microglobulin (beta 2-M) were within normal limits. PRA increased significantly during CPB and the first 6 h after CPB only in the non-pulsatile group. In both groups, the urine beta 2-M level increased significantly during and after CPB; however, there was no significant difference in urine beta 2-M levels between the two groups. Also, the amount of beta 2-M excreted in urines per unit of time increased significantly in both groups during and after CPB; there was no significant difference between the two groups.

Aged↗
PubMed1989

Fluid management and plasma renin activity in organ donors.

Fluid management and assessment of organ perfusion in organ donors with hypotonic polyuria remain poorly investigated problems. In our protocol, urinary losses (565 +/- 202 ml/h) were replaced volume for volume by 3.3% dextrose/0.3% natrium chloride solution (Baxter) with 20 mmol/l potassium chloride. Concentrated red blood cells were administered to maintain hematocrit at about 30%, and volume expansion (central venous pressure above 6 mmHg) was obtained by gelatin (haemaccel) infusion. In all donors (n = 9), plasma electrolytes remained within normal limits despite hypotonic polyuria. Suppression of initial plasma renin activity (PRA: 9.7 +/- 3.6 ng/ml per hour) was obtained by subacute volume expansion. In eight donors the hemodynamic status improved, dopamine administration, when used, was discontinued, and PRA decreased (2.3 +/- 0.7 ng/ml per hour; P less than 0.05). The only donor who failed to respond to fluid therapy had increased PRA (24.2 ng/ml per hour). During fluid challenge, an inverse relationship was demonstrated between mean arterial pressure and PRA in all nine donors (r = -0.61; P less than 0.001), while there were no significant changes in blood urea. creatinine, or urine output. It is concluded that in organ donors, proper maintenance of the hemodynamic status and suppression of the renin stress response may be obtained by an adequate fluid management, involving both qualitative restoration and expansion of intravascular volume.

Adolescent↗
PubMed1989

Interest of face mask--CPAP in one case of severe accidental hypothermia.

We report one case of severe accidental hypothermia; rectal temperature was 25 degrees C. Hypoxemia unmodified by 100 O2 inhalation in an ordinary face-mask was easily corrected using a face-mask CPAP; a ventilation-perfusion mismatching could be implicated in the cold induced hypoxemia. Active rewarming (1.5 degrees C/h) was pursued from 25 to 37 degrees C, using non aggressive methods: warming blankets and a Bennett heated humidifier inserted in the CPAP system. Even in severe hypothermia successful results may be obtained without resort to sophisticated methods.

Acidosis, Lactic↗
PubMed1986

The value of serum CK-MB and myoglobin measurements for assessing perioperative myocardial infarction after cardiac surgery.

In 41 patients who underwent coronary bypass surgery, creatine kinase (CK)-MB mass concentration was repeatedly measured in serum during and after the intervention using a new two-site immunoenzymetric assay (IEMA). Serum CK-MB activity was determined with the use of four different techniques: immunoinhibition, immunoinhibition-immunoprecipitation, column chromatography and electrophoresis. Myoglobin (Mb) was also measured in each specimen by radioimmunoassay. In the 33 patients who followed a completely uneventful postoperative course, the cumulated CK-MB release was, on the average, 12.2-fold less than after acute myocardial infarction. The CK-MB peak concentrations using the IEMA were 33 +/- 3 micrograms/l (X +/- SEM) and occurred 6.4 +/- 0.5 h after the intervention was started; CK-MB levels had decreased to 2.9 +/- 0.4 micrograms/l at the end of the first postoperative day. The evolution of the CK-MB concentration was parallel to that of the enzyme activity. The serum Mb maximum concentrations (518 +/- 39 micrograms/l) were reached after 3.3 +/- 0.1 h. The other eight patients developed perioperative myocardial infarction (PMI); in this group, the cumulated CK-MB release was higher, and the serum CK-MB postoperative curves were of three different types. The patients with delayed CK-MB peaks (type I pattern) or sustained elevations (type III) of this isoenzyme also showed increased serum Mb levels at the end of the first postoperative day. The PMI patients with early (10 h) CK-MB elevations (type II) did not demonstrate abnormal serum Mb levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Prostaglandin E2, prostacyclin, and thromboxane changes during nonpulsatile cardiopulmonary bypass in humans.

To study the effect of lung bypass on the production of prostaglandin E2, prostacyclin, and thromboxane A2, we measured simultaneously arterial and venous plasma concentrations of prostaglandin E2, 6-keto-prostaglandin F1 alpha (stable metabolite of prostacyclin), and thromboxane B2 (stable metabolite of thromboxane A2) before, during, and after cardiopulmonary bypass. Seventeen patients (age range 46 to 69 years) undergoing aorta-coronary bypass grafts were investigated. The prostaglandin E2 production rose sharply immediately after the onset of bypass (baseline: 9.7 +/- 2.9 pg/ml to 85 +/- 16.6 pg/ml in venous and 87 +/- 12 pg/ml in arterial plasma, p less than 0.03) and rapidly decreased after pulmonary reperfusion (53 +/- 6.4 and 57 +/- 20 pg/ml, respectively, in venous and arterial plasma at the end of bypass). The increase in prostaglandin E2 was influenced by the heart-lung machine itself (as demonstrated by a closed "bypass" circuit) and by lung bypass. Pulmonary metabolism of prostaglandin E2 was maintained after bypass. The prostacyclin production rose significantly at the beginning of bypass (154 +/- 26 pg/ml venous prebypass level to 361 +/- 94 pg/ml after aortic clamping, p less than 0.03). Prostacyclin decreased progressively during rewarming of the patient, pulmonary reperfusion, and discontinuation of bypass. When prostacyclin decreased, thromboxane B2 production rose significantly and reached peak arterial levels when the lungs were reperfused (112 +/- 33 pg/ml prebypass levels to 402 +/- 101 pg/ml, p less than 0.01). Except for prostaglandin E2, there were no significant differences between arterial and venous plasma levels of these substances. The same prostanoids were also measured in five patients undergoing major orthopedic operations, and no significant changes in prostanoids were observed. Our data demonstrate significant production of prostaglandin E2 in the systemic circulation during cardiopulmonary bypass in humans. They further indicate that lung bypass disturbs the plasma prostaglandin/thromboxane balance.

6-Ketoprostaglandin F1 alpha↗
PubMed1985

Prevention by acebutolol of rhythm disorders following coronary bypass surgery.

Seventy-one patients submitted routinely to coronary artery bypass surgery were randomized into 2 groups. Group A (32 patients) received 24 hr after initiation of surgery an intravenous perfusion of 100 mg of acebutolol given over 24 hr (22 cases) or 600 mg administered orally (10 cases). On subsequent days, they received 1200 mg of acebutolol/day orally. Group B (39 patients) was used as control. The groups were comparable in terms of age, sex, severity of coronary disease, preoperative therapy, duration of extracorporeal circulation, aortic clamping time, and immediate postoperative haemodynamic findings. No patient received digitalis. During hospital stay (10 days), 1 group A patient (3%) and 13 group B patients (33%; P less than 0.001) developed a sustained episode of atrial arrhythmia (fibrillation, flutter or atrial ectopic tachycardia). The majority of these rhythm disorders developed between days 2 and 4. On Holter monitoring on days 7-10, malignant ventricular extrasystoles (grades IV and V of Lown's classification) were more frequent in group B (65.2%) than in group A (19.3%; P less than 0.001). Haemodynamic measurements taken at rest performed in 27 patients on days 7-10 (16 patients of group A; 11 of group B). No difference was observed between the two groups. Acebutolol is a safe and efficacious drug for the prevention of arrhythmias following coronary surgery.

Acebutolol↗
PubMed1983

[Serum activity of angiotensin converting enzyme during extracorporeal circulation in man].

Serum activity of angiotensin converting enzyme (ACE) were measured during extra-corporeal circulation in five patients undergoing aorto-coronary bypass surgery. We observed a significant decrease of serum ACE levels in the absence of pulmonary circulation, suggesting that in man the lungs were the major source of circulating ACE. An effective extra-pulmonary liberation of ACE could take place during cardiopulmonary bypass. The levels of serum ACE increased with pulmonary recirculation, but preoperative levels were not reached 24 h later.

Aged↗
PubMed1979

[Effect of drugs used in anesthesia on endocardial viability ratio (EVR) in cardiac surgery].

Endocardial viability ratio, arterial blood pressure, heart rate, central venous pressure and left ventricular diastolic pressure were examined in 50 patients undergoing one or more aorto-coronary grafts. General anaesthesia was obtained by morphine, diazepam, pancuronium and a mixture of oxygen and nitrous oxide. Morphine anesthesia did not effect EVR. Only mean arterial pressure showed a significant increase at the time of surgical stimulation. During sternotomy, EVR fell progressively in patients with hypertension. Tachycardia alone did not modify it. This hypertension was better treated by sodium nitroprussiate than by halothane or enflurane with regard to protection of the sub-endocardial layer against ischaemia. Under the influence of sodium nitroprussiate EVR rapidly reached values greater than those obtained under halothane or enflurane. In the hour following extra-corporeal circulation, endocardial viability ratio improved without any significant variation in classical haemodynamic parameters.

Anesthetics↗
PubMed1978

Measurement of endocardial viability ratio (E.V.R.) during anesthesia for cardiac surgery.

Since sub-endocardial ischemia is the consequence of a discrepancy between the blood demand and supply of oxygen at this level, the study of the myocardial performance by the measurement of the endocardial viability ratio (E.V.R.) is both useful and possible during anesthesia. E.V.R. is the ratio between the oxygen supply and demand of the myocardium. It is equal to the diastolic pressure time index (D.P.T.I.) over the tension time index (T.T.I.). Measurements are made at different times, by means of the arterial pressure and the left atrial pressure, as well as with the Datascope-E.V.R. Computer. During gradual morphine administration (0.5-1-1.5 mg/kg) and if no major surgical stress occurs, E.V.R. remains excellent and stable (1.46 - 1.48 - 1.43). It deteriorates more or less (1.29 - 1.09) during tachycardia or hypertension. Within the hour following the end of extracorporeal circulation, E.V.R. significantly improves (1.04 - 1.06 - 1.09 - 1.23). Although E.V.R. measurement is easy during cardiac surgery, it is impossible to carry out in case of arrhythmia. While morphine anesthesia induces no variation in E.V.R., tachycardia or hypertension require the addition of therapeutic drug. Within one hour following the end of extra-corporeal circulation, E.V.R. measurement shows improved endocardial viability, although the hemodynamic parameters undergo no significant change.

Anesthesia, General↗