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V Souron

Publications and source records attributed to V Souron.

12 recordsLinked to original sources
PubMed2005

Sedation with target-controlled propofol infusion during shoulder surgery under interscalene brachial plexus block in the sitting position: report of a series of 140 patients.

BACKGROUND AND OBJECTIVE: The aim of this study was to assess target-controlled propofol infusion as a technique of sedation for shoulder surgery under interscalene brachial plexus block in the sitting position and to evaluate the effect of sedation on hypotensive/bradycardic events during this procedure. METHODS: One hundred and forty patients undergoing elective shoulder surgery in the sitting position under interscalene brachial plexus block (with 30 mL of ropivacaine 0.75%) were prospectively enrolled. All patients were premedicated with hydroxyzine 1 mg kg(-1), none received beta-blockers. No patients were given atropine except for the patients who experienced a vasovagal event either during the block procedure or intravenous catheter placement. The target-controlled propofol infusion was started immediately after positioning the patient on the operating table. The initial target concentration was 1 microg mL(-1). The infusion rate was adjusted every 15 min by increasing or decreasing the target concentration by 0.2 microg mL(-1) steps to maintain the patient rousable to verbal commands (score of 3 on Wilson sedation scale). The following parameters were assessed: minimal, maximal, optimal target concentration, respiratory and haemodynamic parameters, total propofol dose, additional alfentanil needs, occurrence of hypotensive/bradycardic events, complications. Results are mean +/- SD. Statistical analysis used t-test and chi2-tests. RESULTS: The optimal propofol target concentration was 0.8 mug mL(-1). No respiratory complications or conversion to general anaesthesia was reported. Two patients experienced transient and inconsequential intraoperative agitation. The incidence of hypotensive/bradycardic events during the procedure was 5.7% (eight patients). CONCLUSION: Target-controlled propofol infusion (0.8-0.9 microg mL(-1)) following hydroxyzine premedication is a safe and effective technique for sedation when combined with interscalene brachial plexus block during shoulder surgery in the sitting position.

Adolescent↗
PubMed1999

[Dural taps in peridural analgesia for labor: management by French anesthesiologists in 1997].

OBJECTIVES: To assess prophylactic and curative managements of dural taps occurring during the setting of epidural analgesia (EA) for labour. STUDY DESIGN: Nationwide French retrospective survey. PATIENTS AND METHODS: From April to July 1997, a questionnaire was sent to 799 French obstetrical units located in both teaching and non-teaching public hospitals and private institutions. RESULTS: Answers were obtained from 267 units (response rate of 33%). Although management of dural taps was similar in 52% of the institutions, only 8% had produced a written protocol. After a dural puncture, EA was still performed in 95% of the units, but usually in another interspace (87%). Large oral fluid intake was the most frequent prophylactic measure (81%). To prevent postdural puncture headache (PDPH), bed rest was largely used (76%) and lasted 24 hours in 46% of the institutions. Prophylactic epidural blood patch (EBP) was performed in 14% of the units. To treat PDPH, a majority of anaesthesiologists performed an EBP (92%) and most of them after a delay of 48 hours (62%). Intravenous and oral caffeine was used in 31 and 24% of the units respectively. Prior to EBP, coagulation status was assessed in about 20% of the units and blood culture in less than 3%. In 65% of the units the injection of EBP was discontinued when the patients felt backache. A large range of volumes were injected, but usually less than 20 mL were administered (81%). In 60% of the units the patients were discharged home after an overnight stay in the hospital. If the first EBP failed, a second one was performed in 61% of the cases. CONCLUSION: Management of dural taps occurring after EA for pain relief in labour differs widely from one French obstetrical unit to another.

Anesthesia, Epidural↗
PubMed1998

[Assessment of cardiovascular perioperative risk in non-cardiac surgery].

Patients with cardiovascular disease undergoing non cardiac surgery are exposed to three cardiac risks: myocardial infarction, heart failure and death. To estimate cardiac risk, clinical predictors of perioperative cardiovascular risk are classified as major, intermediate and minor and non cardiac surgery is stratified in high risk (greater than 5%), intermediate (from 1 to 5%), minor (lower than 1%) procedures. Efficient perioperative assessment of cardiac patients is obtained by teamwork and usually, indications for further cardiac investigations are the same as those in the nonoperative setting. An simplified algorithm, easier to use than original algorithm given in the guidelines of the American college of cardiology and the American heart association, may be helpful for the indication of further investigations. Five questions must be answered before using algorithm: is it an emergency surgical procedure?, was a coronary revascularization required in the past five years? has the patient had a coronary evaluation in the past two years?, are there identified clinical predictors of cardiac risk?, is it major or minor surgery? Three tests evaluate the preoperative cardiac risk: exercise testing, dipyridamole thallium scintigraphy, dobutamine stress echocardiography. Their accuracy is similar, their negative predictive value is high, their positive predictive value is low. These guidelines may be helpful to indicate further cardiac investigations which will have an impact on patient's treatment, monitoring during or after surgery and outcome.

Cardiovascular Diseases↗
PubMed1997

Venous air embolism during orthotopic liver transplantation in a child.

PURPOSE: A first case of massive venous air embolism is reported as a complication of orthotopic liver transplantation in a 17-month-old child during the dissection phase. CLINICAL FEATURES: During the hepatic dissection phase, perforation of suprahepatic veins was responsible for an air embolism with a decrease of P(ET)CO2 (27 to 6 mmHg), hypoxaemia (SpO2 decreased from 100 to 88%), and haemodynamic instability (systolic blood pressure decreased from 85 to 50 mmHg, central venous pressure increased from 6 to 10 mmHg). Central venous aspiration of air was unsuccessful but immediate resolution occurred and neurological outcome was normal. CONCLUSION: Venous air embolism during the dissection phase of liver transplantation in children is a risk that should be considered

Carbon Dioxide↗
PubMed1997

[Evaluation of hemostasis before obstetrical epidural anesthesia: a survey in 435 French obstetric departments].

OBJECTIVES: To specify by which means French anaesthesiologists evaluate the haemostasis profile of pregnant women before epidural analgesia. STUDY DESIGN: Nationwide retrospective survey. MATERIAL: Questionnaire sent of 847 French obstetrical units. METHODS: Comparison of categorical qualitative parameters using a chi 2 test. RESULTS: Answers from 435 centres, including 1,834 anaesthesiologists, performing 227 x 10(3) epidurals for 411 x 10(3) deliveries/year were obtained. A preanaesthetic clinical assessment was performed systematically in two out of three units, and blood samples for PT, aPTT and platelet count were taken in more than 90% of the centres. These laboratory examinations were often made during the 9th month of pregnancy (74%). For more than one-third of the anaesthesiologists, biological data are not essential before epidural puncture. In addition, the lower limits considered as being safe before epidural puncture were highly variable between the teams. CONCLUSIONS: Coagulation laboratory tests are almost always ordered before epidural obstetrical analgesia in France. The rationale to perform them is not always related to pregnancy induced haemostatic changes. Therefore, this problem should be clarified by a consensus conference for both practical and economical reasons.

Adult↗
PubMed1995

[Blood-patch treatment of headache occurring after post-dural puncture at the thoracic level].

A 23-year-old woman experienced headache following a high thoracic epidural analgesia to control postoperative pain after thoracoscopic treatment of a recurrent pneumothorax. On fourth postoperative day, a blood patch has been sited with 17 mL of autologous blood, injected into the thoracic epidural space at T1-T2 level, which was immediately effective. Except a mild and transient cervical pain during the procedure, no other complication occurred. The technique of thoracic blood patch is similar to the lumbar one, except some minor modifications. According to this case of a thoracic epidural blood patch which is seemingly the first one reported in the literature and our expertise with two other unpublished cases, a volume of 10 mL of blood may be sufficient and free of adverse effects.

Adult↗
PubMed1995

[Secondary neuromuscular deficiencies in critical care patients].

The authors report three cases of neuromuscular deficits occurring after a variable time of mechanical ventilation in ICU patients suffering from acute respiratory failure requiring sedation and neuromuscular blockade by pancuronium bromide. The clinical features of these deficits were similar : flaccid quadriparesia slowly reversible without sensory loss and difficult weaning from ventilation for two patients. The paraclinical investigations (measurements of creatine kinase, electrophysiological examination) permitted to distinguish two diseases: critical illness polyneuropathy (in patient with ARDS) and acute myopathy (in other patients with severe asthma) caused by corticosteroids and potentiated by neuromuscular blocking agents. This myopathy differs from the chronic myopathy caused by long term corticotherapy. After a status asthmaticus treated with corticosteroids and mechanical ventilation under muscle relaxants, creatine kinases should be measured in plasma and a neurological examination be performed. The value of neuromuscular blockade monitoring for the prevention of this myopathy should be assessed.

Adult↗