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Biomedical subjects

A Cozian

Publications and source records attributed to A Cozian.

34 records · Page 2Linked to original sources
PubMed1987

[Effect of propofol on left ventricular function in the coronary patient. Combined isotopic and hemodynamic studies].

The present study investigated the effects of propofol (P) as sole anaesthetic agent of left ventricular (LV) function using gated radionuclide ventriculography (RNV) in unpremedicated patients with chronic coronary arterial disease (CAD). After informed consent, seven ASA 111 patients (51-74 yr) undergoing major urologic surgery took part in this study. All patients suffered from documented angina pectoris secondary to CAD. None gave a history of congestive heart failure or valvular heart disease. No patients were premedicated, but all received their chronic medications (nifedipine and isosorbide) up to and including the morning of surgery. The study was performed in the Nuclear Medicine Laboratory just before surgery. Heart rate (HR) was obtained from standard limb lead II of the ECG. A 7.5 F thermodilution Swan-Ganz catheter and a radial artery cannula were inserted under local anaesthesia. All patients were studied by RNV using red blood cells (RBC) labelled in vivo with 99m-technetium (Tc). A first RBC-Tc preparation containing 2-3 mCi f Tc was counted 10 cm from a gamma-camera. A first-pass study was carried out in the left anterior oblique position following the bolus i.v. injection of the source, allowing the evaluation of the isotopic dilution cardiac output (COiso) and the attenuation factor (F). Then, a second RBC-Tc preparation containing 20-25 mCi of Tc was injected intravenously. At equilibrium, 16 ECG-synchronized frames were acquired by computer for processing. Mean end-diastolic (ED) and end-systolic (ES) counts, left ventricular-end diastolic and systolic areas and ejection fraction (EF) were calculated every 1.5 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

[Curarization of the myasthenia patient by atracurium].

The use of atracurium, a new intermediate duration of action non depolarizing muscle relaxant, is described in a myasthenic patient undergoing abdominal surgery. The effective dose to 95% twitch suppression is 0.15 mg.kg-1. Following the first dose, the time from maximum twitch depression to 25% recovery is 32 min, and 33 min following the second dose. The recovery index (25-75% recovery time) and the 5-90% recovery time are respectively 33 and 83 min. The train-of-four ratio is greater than 0.7 within 90 min after the reinjection. The significance of the behaviour of atracurium is discussed. In reduced dosage and with careful neuromuscular monitoring, atracurium appears to be a reasonable and safe choice of myasthenic patients to provide surgical relaxation.

Aged↗
PubMed1987

Vecuronium and atracurium in patients with end-stage renal failure. A comparative study.

Twenty patients with end-stage renal failure, undergoing kidney transplantation, were assigned randomly to receive either vecuronium or atracurium under evoked twitch tension control. The cumulative-dose technique was used to obtain 95% twitch depression (vecuronium: initial bolus 15 micrograms kg-1, increments 6 micrograms kg-1; atracurium: initial bolus 100 micrograms kg-1, increments 40 micrograms kg-1). Using ED95 values derived from the log-probit dose-response curves, vecuronium was 4.6 times more potent than atracurium. The durations of action of the initial cumulative-doses (from end of injection of the last increment to 25% recovery) were 11.1 +/- 3.3 min for vecuronium and 16.2 +/- 3.9 min for atracurium (P less than 0.05). In terms of duration of action of the maintenance doses (vecuronium one-quarter of the total incremental dose; atracurium one-third) some cumulation was observed with vecuronium (interaction time X treatment; cumulation ratio 1.46 +/- 0.31 v. 0.98 +/- 0.10 for atracurium, P less than 0.001). After 2 h of surgery, the mean recovery times (25% to 75% twitch height) did not differ (18.5 +/- 2.8 min and 16.7 +/- 4.4 min). It is concluded that vecuronium might be less safe than atracurium in patients with end-stage renal failure undergoing prolonged operations.

Adult↗
PubMed1987

[Comparative study of first-line ceftriaxone and amikacin in the treatment of severe urinary tract infections in the adult].

After randomization in 2 groups of 20, 40 adult patients with a severe urinary tract infection (post-urologic surgery, pyelonephritis, prostatitis, neurologic bladder dysfunction, Foley catheter) received as first-line therapy, ceftriaxone (CFX) 1 g/24 h im or amikacin (AMK) 500 mg/24 h im during at least 5 days. The clinical and bacteriological efficiency and the tolerance of the 2 agents are equivalent. In the 2 groups, all patients but one are clinically cured. In the CFX group, 2 patients had resistant organisms (E. cloacae, strepto D) to first-line antibiotic. 48 hours after the beginning and at the end of the treatment, the percentage of urine sterilization was respectively 65 and 88 in the CFX group and 50 in the AMK group. In both groups, 60% of the patients showed negative first-month follow-up urine specimen. Underlying urinary tract pathology contributed to persistence of the original infecting organism, reinfection or relapse; the responsible isolate remained sensitive to the first-line antibiotic.

Adult↗
PubMed1985

Preoperative acute volume loading in patients with pheochromocytoma.

Ten patients with pheochromocytoma underwent preoperative acute volume loading to determine whether fluid infusion severely increased pulmonary capillary wedge pressure without improving forward flow, and to provide a guide for intraoperative volume replacement. In one patient, volume loading confirmed baseline pressure data suggesting a discrepancy between right and left ventricular filling pressures. In a second patient with normal baseline wedge pressure, volume loading revealed an unsuspected ventricular dysfunction. During subsequent surgery, both volume and speed of fluid infusion were adapted to the preoperative ventricular response.

Adrenal Gland Neoplasms↗
PubMed1985

[Preoperative vascular loading. A guide for the management of volume expansion in the surgery of pheochromocytoma].

The most acurate fluid replacement is needed for the operative management of patients with pheochromocytoma. Pulmonary capillary wedge pressure monitoring must be incorporated into routine practice for assessing left ventricular filling pressure because discrepancies between central venous pressure and left-sided filling pressure may occur, even in patients apparently free of cardiopulmonary dysfunction. The response to preoperative acute volume loading was used in 11 patients--to detect preoperatively patients in whom fluid infusion was associated with a dangerous increase in pulmonary wedge pressure without improvement in forward flow and--to provide a guide for intraoperative volume replacement. This method confirmed informations suspected from baseline pressure data in one patient: distorsion between right and left ventricular filling pressures. Furthermore it showed an unsuspected ventricular dysfunction in a second patient with normal baseline pulmonary capillary wedge pressure. Both volume and speed of operative fluid challenge were adapted to this preoperative ventricular response.

Adrenal Gland Neoplasms↗
PubMed1982

[Fluid loading in the surgical care of pheochromocytoma. Hemodynamic study].

Collapse following removal of pheochromocytoma can be usually prevented by fluid loading. Fluid infusion is administered at the early beginning of the surgical procedure and is accelerated just after removal. Some authors prefer to start the fluid infusion in the preoperative period. In every cases preload measurements are of primary importance for a safely fluid administration. Problems of fluid loading in course of pheochromocytoma surgery are studied in six patients. Hemodynamic data are collected during pre, per and postoperative periods. Pre and post operative rapid fluid loading was performed in three patients in order to obtain a left ventricular function curve. Before any fluid treatment, two groups of patients are distinguished: 1) five hypovolemic patients who are about to receive 1 000 +/- 300 ml to normalize pulmonary wedge pressure, 2) one patient with high pulmonary wedge pressure and with alterated myocardial performance observed during rapid fluid loading. Combined use of sodium nitroprusside and fluid loading allowed to control hypertensive accesses and preload elevations and to prevent collapse following tumor removal. Hypovolemia and myocardial lesions are not necessarily present in all cases of pheochromocytoma. The routine use of a pulmonary artery catheter is warranted to improve cardiac pump function by combined fluid and vasodilator management.

Adrenal Gland Neoplasms↗