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T Alouini

Publications and source records attributed to T Alouini.

7 recordsLinked to original sources
PubMed1995

[Comparison of extrapleural and intrapleural analgesia with bupivacaine after thoracotomy].

OBJECTIVE: To compare the analgesic and the ventilatory effects as well as blood concentrations of bupivacaine, administered either in the extrapleural or interpleural space after posterolateral thoracotomy. STUDY DESIGN: Randomized clinical trial. PATIENTS: Twenty ASA class I and II patients, scheduled for elective thoracic surgery were randomly allocated either in the IP group (catheter inserted into the interpleural space) or the EP group (catheter inserted in extrapleural position, paravertebrally above the posterior parietal pleura). METHODS: In the catheter, inserted at the Th4 level at the end of the surgical procedure, 20 mL of 0.5% bupivacaine were injected after full recovery from anaesthesia, with the thoracic drains clamped for 30 min. The injection was repeated every six hours. Pain was evaluated after a deep inspiration with a visual analog scale (VAS), before and 1.3 and 6 hours after the injection. Analgesia was considered as effective if the VAS score at the end of the first hour was less than 30 mm. Otherwise 0.1 mg.kg-1 of morphine was administered subcutaneously. The forced vital capacity (FVC) and the forced expiratory volume one second (FEV1) were measured preoperatively and on 1st (D1) and 2nd postoperative Day (D2). Blood samples for measurements of plasma bupivacaine concentrations were obtained at 5, 10, 20, 30, 60, 90, 120, 150, 180 and 250 min respectively after the first injection. RESULTS: Bupivacaine provided a more rapid, deep and prolonged analgesia by extrapleural than by interpleural route. Analgesia was effective in 9 patients in EP group vs 4 patients in IP group (P < 0.05). Morphine requirements were 4 +/- 8 mg in EP group vs 17 +/- 10 mg in the IP group (P < 0.05). The FVC and FEV1 values were similarly decreased on D1, but recovery was better in EP group on D2 (P < 0.05). Bupivacaine peak concentrations in plasma were lower in EP group (0.86 +/- 0.42 microgram.mL-1) than in IP group (1.63 +/- 1.44 micrograms.mL-1), however the difference was not significant. CONCLUSIONS: Extrapleural administration of bupivacaine provides better analgesia as the anaesthetic agent comes in closer contact with intercostal nerves and with lower risk of loss of agent through the pleural drainage. Therefore its use is recommended preferentially over the interpleural route for analgesia after posterolateral thoracotomy.

Adult↗
PubMed1987

[Surgical treatment of ventricular tachycardia].

We present our clinical experience with 37 patients presenting with ventricular tachycardia who, between 1980 and 1986, underwent subendocardial resection, guided by per-operative mapping in 34 cases. An aneurysm of the left ventricle was present in 23 patients (62%), and an akinetic area in the remaining 14 patients. In every case the cause of ventricular tachycardia was an ischaemic heart disease. Prior to surgery, the global isotopic ejection fraction was 27 +/- 11% and the left ventricular end-diastolic pressure was 21 +/- 8 mmHg. The most common site of origin of the arrhythmia was the septum (26 cases, 77%). The mean area of resection was 26 +/- 16 cm2. Resection of a ventricular aneurysm was also performed in 23 cases, and 22 patients underwent coronary bypass. There were 4 early deaths (operative mortality rate : 10.8%) and 4 late deaths. The actuarial survival rate was 89 +/- 5% at 6 months and 72 +/- 9% at 24 months. One-half of the deaths was due to recurrence of the ventricular tachycardia. A post-operative electrophysiological study conducted in 30 patients proved negative in 28 (93%). Altogether, there were 6 immediate or late failures (16.2%) after a mean follow-up period of 18 months. The probability of a relapse-free, medication-free life or sudden death was 86 +/- 6% after 6 months and 82 +/- 7% after 24 months. The quality of life of the survivors war remarkable, since 86% of them (25/29 patients) remained in functional class 1 or 2 after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1987

Left ventricular aneurysm with predominating congestive heart failure. A comparative study of medical and surgical treatment.

From 1979 to 1985, 109 patients were treated for congestive heart failure caused by postinfarction left ventricular aneurysm. Congestive heart failure was predominant in all patients at the time of diagnosis, 73% of whom were in Functional Class III or IV. Left ventricular end-diastolic pressure averaged 23.8 +/- 0.8 mm Hg (mean +/- standard error of the mean), total ejection fraction 29.7% +/- 1.0%, and telediastolic volume of the aneurysm 76.2 +/- 5.8 ml. Aneurysmectomy was performed in 49 patients (45%), whereas the remaining 60 patients were treated medically. The two groups did not differ in regard to clinical and hemodynamic data on admission, except for a more extensive coronary artery disease in the surgical group. Follow-up was obtained for all patients (100%) and averaged 48 +/- 3 months. Actuarial survival curves were similar, and the 5-year survival rates for surgical and medical groups were 70 +/- 7% and 64% +/- 7%, respectively (not significant). However, the 5-year complication-free rate was significantly (p = 0.05) higher among surgical patients (52% +/- 8%) than among the medical group (31% +/- 7%). Multivariate analysis showed the following variables to influence survival independently (p less than 0.05): contractile segment ejection fraction, right ventricular failure, antecedents of cardiac arrest or cardiogenic shock, and corrected contractile score. Independent variables decreasing the risk of cardiac-related complications and death (p less than 0.05) were as follows: surgical treatment, shorter interval between initial infarction and diagnosis of aneurysm, and absence of right ventricular failure. Functional improvement was directly related to surgical treatment and to residual segment contractile score (p less than 0.05). Thus, in patients with congestive heart failure caused by left ventricular aneurysm, surgical treatment improved the quality of life and prognosis for cardiac-related complications, but did not increase overall survival, compared to medical management of similar patients.

Adult↗
PubMedDate not supplied

Left ventricular aneurysm complicated by congestive heart failure: an analysis of long-term results and risk factors of surgical treatment.

The results of surgical treatment of post-infarction left ventricular aneurysms in 49 patients with congestive heart failure preoperatively were analyzed. Average patient age was 55 years. Preoperative total ejection fraction averaged 30.5 +/- 1.5% (mean +/- SEM), contractile segment ejection fraction was 42.5 +/- 1.1% and end-diastolic volume of aneurysm was 81.4 +/- 10.4 ml. Seventy eight percent of patients underwent coronary artery bypass grafting concomitantly with aneurysmectomy. Mean follow-up after operation was 41.5 +/- 3.5 months. Hospital mortality was 8.2%, the 5 year survival rate was 70 +/- 7% and the 5 year complication free rate was 52 +/- 8%. Mean functional class of dyspnea improved significantly from 2.9 +/- 0.1 preoperatively to 1.6 +/- 0.1 at late follow-up (p less than 0.001). Likewise, isotopic ejection fraction at rest increased from 13.7 +/- 1.3% preoperatively to 30.9 +/- 3.0% postoperatively (p less than 0.0001). Logistic regression analysis isolated two factors which influenced postoperative survival independently: contractile segment ejection fraction (p = 0.045) and myocardial score of left anterior descending coronary artery (p = 0.035). Combining these two risk factors, it was possible to identify a low risk group of patients with a 5 year survival probability of 93 +/- 6%, contrasting with a high risk group of patients having a 5 year survival of 57 +/- 9% (p less than 0.02). Thus, resection of left ventricular aneurysms complicated by congestive heart failure provides improvement in left ventricular function and clinical status.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗