Biomedical subjects
A Borgeat
Publications and source records attributed to A Borgeat.
Postoperative arrhythmias and risk factors after open heart surgery.
Cardiac arrhythmias were recorded during 24 hours in 40 consecutive patients requiring open-heart surgery, using continuous Holter monitoring. Most patients developed both supraventricular and ventricular arrhythmias. Complex ventricular arrhythmias were detected in 31 patients (78%) and 2 patients suffered an immediate postoperative myocardial infarction. The following risk factors were considered: age, sex, type of heart disease, preoperative left ventricular ejection fraction, cardiopulmonary bypass and aortic clamping duration, length of anesthesia, dopamine administration, and maximal level of CK and CK-MB. Only dopamine administration, even in low renal dose, was associated with the number and severity of ventricular arrhythmias.
Usefulness of propofol in torticollis.
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Analgesia with subhypnotic doses of thiopentone and propofol.
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Propofol and spontaneous movements: an EEG study.
Spontaneous movements during induction of anesthesia with propofol were studied in 21 children aged 6-12 yr. The children were randomly assigned to group A (propofol 3 mg.kg-1), B (propofol 5 mg.kg-1), or C (thiopental 5-7 mg.kg-1). A baseline electroencephalogram (EEG) was recorded during 10 min in children awake, supine with eyes closed and opened, and then from the beginning of induction until 5 min after tracheal intubation. Spontaneous movements were observed in all children in group A but only in 14% in groups B and C. The induction EEG sequences were similar for the three groups: after a mean latency of 12 s, the tracing showed an increase in frequency from 9 to 10 Hz (alpha waves) to more than 14 Hz (beta waves). This transition lasted approximately 2 s, followed by delta waves (2-3 Hz) that continued for 1-2 min. Finally, beta waves reappeared and progressively but incompletely replaced delta waves during the next 5 min. Neither spikes, spike-wave patterns, rhythmic theta waves, nor burst suppressions were observed. Spontaneous movements were recorded on videotape and analyzed after the completion of the study by a neurologist unaware of patient treatment. Videotape analysis of the periinduction period showed spontaneous movements to be dystonic and choreiform with flexion, twisting, or extension movements of all extremities. All movements occurred coincident with the appearance of delta waves on the EEG. Their dystonic nature and the absence of EEG abnormalities suggest a subcortical origin and argue against associated cortical epileptic activity.
Induction dose of propofol in infants and children.
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Efficiency of a continuous infusion of propofol in a patient with tetanus.
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Acute choreoathetoid reaction to propofol.
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[The Wolf-Parkinson-White syndrome and peroperative arrhythmias].
The influence of anaesthetic drugs or techniques on the development of arrhythmias in patients with the Wolff-Parkinson-White syndrome still remains controversial. Most of the literature is based on single case reports from which no clear-cut attitude can be defined. In this retrospective study we tried to evaluate if a particular drug or technique could be recommended. We also discuss on the basis of electrophysiology of the Wolff-Parkinson-White syndrome situations in which the potential for arrhythmias is enhanced.
Etomidate vs. propofol for suspension laryngoscopies.
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[Acute pancreatitis: evaluation of two years of a diagnostic and therapeutic protocol].
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[The value of epidural analgesia in acute pancreatitis].
We report on a patient with acute pancreatitis whose pain was resistant to simultaneous administration of morphine, procaine and Buscopan. This episode was complicated by development of hypertension, tachycardia, angina pectoris, ventricular arrhythmias and electrocardiographic modifications. Analgesia was provided by epidural administration of fentanyl and bupivacaine and brought about rapid resolution of all symptoms. The usefulness of epidural analgesia in acute pancreatitis is discussed.
[An unusual anaphylactic reaction following succinylcholine chloride in a 21-month-old child].
An anaphylactoid reaction occurring after the intravenous administration of succinylcholine in a 21-month-old child is reported. The clinical manifestations and signs were limited to the upper airways and eyelids. The child was not known to be allergic or atopic. The IgE level was normal. The search for specific anti-choline IgE antibodies was negative. The skin tests were strongly positive for succinylcholine. The physiopathological and immunoallergic differences between anaphylaxis and anaphylactoid reaction are briefly discussed.
Acute pulmonary oedema following administration of ornithine-8-vasopressin.
We report the case of a patient who developed acute pulmonary oedema following a short and uneventful surgical procedure. Among the differential diagnoses, the role of ornithine-8-vasopressin is emphasized.
Comparison of propofol and thiopental/halothane for short-duration ENT surgical procedures in children.
Experiences with propofol in pediatric anesthesia are limited. We undertook a study to evaluate the quality of induction and recovery from anesthesia with propofol compared to thiopental/halothane. Twenty children received 3 mg.kg-1.min-1 of propofol as a loading dose followed by a maintenance dose of 0.1 mg.kg-1.min-1 (+/- 10%). Twenty children received 5-7 mg/kg of thiopental, and maintenance was provided with halothane (0.5%-1.5%). The interval between the end of the administration of propofol or thiopental/halothane and extubation, as well to discharge to the ward, was significantly shorter with propofol (4.4 versus 13.5 min and 7.22 versus 30.4 min, respectively). Spontaneous movements and pain on injection were seen significantly more frequently with propofol, whereas laryngospasm and hiccup were only observed with thiopental. During the first 6 h after the surgical procedure, analgesics were needed significantly more often in the thiopental group. Nausea and vomiting also were observed more frequently in the thiopental group. In conclusion, propofol used as a single anesthetic is a satisfactory technique for ENT surgery of short duration in children.
[Posology of propofol in relation to age in pediatric ORL anesthesia].
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[Acute monoblastic leukemia complicated by fatal splenic rupture following initiation of chemotherapy].
Fatal chemotherapy splenic rupture is a rare event in acute leukemia. We report on a patient with acute monoblastic leukemia who developed splenic rupture 13 hours after the initiation of aggressive chemotherapy. Histologic studies of the spleen showed diffuse capsular infiltration and disseminated areas of subcapsular necrosis. Lysis of the leukemic cells and release of their enzymatic content, induced by the chemotherapy, probably led to proteolytic injury of the splenic capsule. We suggest that this mechanism may be an important pathogenetic factor in the occurrence of splenic rupture in patients with acute leukemia.
Prevention of arrhythmias by flecainide after noncardiac thoracic surgery.
Cardiac arrhythmias are a frequent complication after thoracic operations. The prophylactic value of flecainide administered as a constant-rate, intravenous infusion (0.15 mg/kg/h) after a loading dose (2 mg/kg) was tested in a randomized, placebo-controlled study in 30 patients using Holter monitoring during the first 72 hours after operation. A high incidence of atrial and complex ventricular arrhythmias was observed in the placebo-treated group, with a clear predominance in patients undergoing left thoracotomy. Antiarrhythmic drugs had to be added in 6 patients in the placebo-treated group (n = 16), but in none in the flecainide-treated group (n = 14) (p less than 0.01). The preventive effect of flecainide was observed at serum concentrations in the middle of the therapeutic range (409 ng/mL) without side effects. It is concluded that flecainide administration effectively reduced or prevented cardiac arrhythmias after thoracic operations.