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Biomedical subjects

A Steib

Publications and source records attributed to A Steib.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Problems posed by the inferior vena cava in liver transplantation].

On the basis of a 200-case series, we report about the problems posed by the inferior vena cava for liver transplantation, and about the means implemented to solve these problems. Before hepatic transplantation, agenesia of the vena cava, which was encountered once, did not prevent grafting. During transplantation, the inferior vena cava posed problems due to its size or to the approach. These were solved using an extracorporeal venovenous shunt, which we advocate to systematically use for liver transplantation. Following transplantation, in addition to hemorrhages, the problems posed by the IVC included supra- or infrahepatic anastomotic stenoses (2 cases) and infrarenal, retrohepatic or suprahepatic thromboses (2 cases). Their repair again resorted to a venovenous shunt, for which we specify the strategy of use.

Adult↗
PubMed1991

[Peroperative massive pulmonary embolism of tumoral origin. Value of extensive monitoring].

A case is reported of a 47-year-old female patient who suffered from massive tumour embolism during a nephrectomy for a renal carcinoma invading the inferior vena cava. Intraoperative monitoring consisted in direct blood pressure measurement (radial artery cannula), central haemodynamic monitoring (Swan-Ganz catheter), pulse oximetry and capnography. During the surgical manipulation of the suprahepatic vena cava, Petco2 suddenly decreased (from 25 mmHg to 14 mmHg), together with Spo2 (from 99% to 89%), and the mean pulmonary arterial pressure increased from 18 mmHg to 40 mmHg. The drop in arterial blood pressure to 50/30 mmHg, initiated an immediate sternotomy. After clamping the superior and inferior venae cavae, numerous tumour fragments were removed from the pulmonary artery. Cardiac activity restarted after internal cardiac massage, 1 mg adrenaline, 1 g calcium chloride and 150 mmol of molar sodium bicarbonate. The whole procedure lasted 30 min. Arterial blood pressure became stable at 110/50 mmHg, pulmonary arterial and wedge pressures at 20 and 5 mmHg. The Spo2 increased to 98%, and Petco2 to 25 mmHg. The nephrectomy was then carried out, the patient being given 5 micrograms.kg-1.min-1 dobutamine and 3 micrograms.kg-1.min-1 dopamine. At the end of surgery, systolic blood pressure was 120 mmHg, mean pulmonary arterial pressure 25 mmHg, and PaCO2 34 mmHg. The patient left the intensive care unit after twelve days. After one year of follow-up, no complication had occurred. The value of cardiopulmonary bypass in nephrectomy for renal carcinoma invading the vena cava, or the renal vein, is discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1991

[Effects of urapidil on the cardiovascular response to intratracheal intubation].

The effects of urapidil on the haemodynamic response to endotracheal intubation were compared to that of placebo in two groups of 25 patients scheduled for general surgery. Normal saline solution or 0.4 mg.kg-1 urapidil were injected 3 min before induction of anaesthesia with 3 micrograms.kg-1 fentanyl, 0.3 mg.kg-1 etomidate and 0.1 mg.kg-1 vecuronium. Blood pressure (Pasys, Padia, Pa) and heart rate were measured continuously by servoplethysmomanometry before giving the test drug (T0), at the time when the lowest blood pressure was recorded during the three minute period between giving the drug and induction (T1), at the time when the lowest blood pressure was recorded during the three minute period between induction and endotracheal intubation (T2), at the time when the highest blood pressure was recorded immediately after intubation (T3), three minutes after intubation (T4), five minutes after intubation (T5), and at the time when the lowest blood pressure was recorded after surgery had been started (T6). It was planned to give a 25 mg urapidil dose to any patient, from either group, who had a Pasys greater than 200 mmHg for more than 60 sec. Giving urapidil lowered Pasys (T1) by 16%, whilst heart rate increased by 12%. The blood pressure peak due to endotracheal intubation was lower in those patients who had been given urapidil than in the placebo group (T3; p less than 0.05). Six patients in the latter group required the 25 mg urapidil dose, versus 2 in the urapidil group. The preventive effects of urapidil seem to be similar to those obtained with other antihypertensive agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗
PubMed1990

[Cardiac arrest during anesthesia and recovery period].

Cardiac arrests (CA) occurring during anaesthesia and recovery can be classified into three groups: CA not related to anaesthesia (NACA), CA related to anaesthesia (ACA), whether partially (PACA) or totally (TACA). In the French survey, NACAs were three times more frequent than ACAs. Nearly 25% of ACAs occurred at induction and consisted mainly in TACAs. Another quarter of ACAs occurred during maintenance and consisted mainly in PACAs. About 50% of ACAs occurred after the end of anaesthesia and had the highest mortality rate. Cardiac arrest corresponds to the status of a heart unable to generate the minimum aortic blood flow required for functioning of vital organs. For the brain, a zero-blood flow of more than 4 seconds results in coma. Consequently CA exists when the time interval between two subsequent efficient systoles is greater than 4 seconds. Anaesthetic agents can result in CA by 1) overdose (absolute, relative), 2) anaphylactoid/anaphylactic reactions, 3) specific effects (acetylcholine-like effect, hyperkalaemia and malignant hyperthermia for succinylcholine; vagal effect of vecuronium and atracurium; cardiotoxicity of bupivacaine) and 4) drug interaction. In hypoxic CA, severe neurologic impairment often still exists at the time of onset of CA. The anaesthesia machine and controlled ventilation can induce CA by hypoxic ventilation, overdose of anaesthetic vapour, excessive CO2 reinhalation, hypoventilation, disconnection, excessive pressure in airways. Cardiac hypothermia can be a cause of CA as well as a cause of unsuccessful CPR. Massive infusion of unwarmed fluids and IPPV with unheated gases generate a temperature gradient within the heart which may result in severe arrhythmias and CA.(ABSTRACT TRUNCATED AT 250 WORDS)

Anaphylaxis↗
PubMed1990

[General anesthesia in the elderly].

Physiologic and pathologic changes due to ageing should be taken in account for the preoperative evaluation and peroperative management of geriatric patients. Pharmacokinetic changes ed to reduce the doses of intravenous agents by 50%. MAC of inhalational agents is decreased by 25 to 75%. Pharmacodynamic deleterious effects are limitative in the choice of some drugs. Cardiocirculatory and pulmonary functions need specific, if possible non invasive monitoring, during surgery, recovery and the early postoperative days.

Aged↗
PubMed1990

Recovery from total intravenous anaesthesia. Propofol versus midazolam-flumazenil.

The aim of this study was to compare recovery assessed with the Newman, deletion af a's and postbox tests after total intravenous anaesthsia for procedures lasting more than 90 min, with either propofol (PPF) or midazolam (MDZ), reversed or not by flumazenil (FMZ). Thirty patients scheduled for peripheral surgery were randomly allocated to 3 groups of 10, receiving by continuous infusion until the end of surgery either PPF (n = 10) or MDZ (n = 20) combined with alfentanil. FMZ was administered thereafter to 10 patients receiving MDZ until they opened their eyes on command or to a maximum dose of 1 mg. Recovery tests were performed 45, 90 and 180 min after the end of anaesthesia. Results were analysed with non-parametric tests. Recovery scores were significantly better in the PPF group at all times, reaching control values at 180 min for the three first tests. FMZ reversal did not improve the scores compared to those resulting from MDZ alone. This study provides further data in favour of PPF as far as rapid and complete recovery is concerned. The efficiency of FMZ is incomplete and only transient when administered in a single dose.

Adult↗
PubMed1989

[Hemodynamics and hepatic transplantation using a veno-venous shunt: influence of the preoperative hyperkinetic state].

The routine use of a veno-venous bypass is not accepted by all surgical liver transplantation teams. The putative benefits (maintaining haemodynamic stability during the anhepatic phase, reducing blood losses, avoiding renal failure) are counterbalanced by the real risks of air embolism or thromboembolism. A severe preclamping hyperkinetic haemodynamic status represents an elective indication for some authors, whilst it is a reduced cardiac function for others. Two groups of ten patients undergoing liver transplantation, with a porto-femoro-axillary venous bypass (flow rate 2 to 2.5 l.min-1), were studied retrospectively. They differed by their pre-clamping cardiac index (CI), greater than 5 l.min-1.m-2 in group A and less than 4.5 l.min-1.m-2 in group B. The same anaesthetic protocol was used in all patients consisting in fentanyl, thiopentone, pancuronium, and midazolam. The use of blood products and biological parameters did not differ between the two series of patients. The CI decreased by 30% and systemic vascular resistances (Rsa) increased by 48% in group A after clamping, without any deleterious effects on oxygen delivery; similarly, in group B, CI fell by 15% and Rsa increased by 20%. After unclamping, CI rose by greater than 50%, and Rsa decreased in both groups. No differences were seen between the two series 5 min after revascularisation. The release of vasoactive agents by the cold ischaemic graft could explain this. These results suggest that veno-venous bypass could be beneficial in the 2 different preoperative haemodynamic profiles studied. The low decrease in CI in hyperkinetic patients allowed tissue oxygenation to be maintained at adequate levels during the anhepatic phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Accelerating and retarding effects of dexamethasone on the development of the avian lung.

Fertile eggs from Bovans hybrid were treated with dexamethasone on day 17 of incubation. This treatment resulted in a stimulation of the surfactant synthesis as recorded by the increased uptake of 14C-choline into the pulmonary phosphatidylcholine and the accumulation of lipoid vacuoles. On the other hand, dexamethasone caused a delay in pulmonary fluid absorption till day 19. This delay seems to be caused by a retarded onset of lung circulation. This conclusion has been derived from the lowered pulmonary hemoglobin content at this developmental stage. On the basis of the activities of ornithokallikrein and the angiotensin converting enzyme, ornithokinin may be involved in the retarded onset of circulation.

Animals↗
PubMed1989

[Is the ultrasonic dissector an advance? Apropos of 70 hepatectomies].

The aim of this retrospective study was to determinate whether the ultrasonic dissector (U.S.D.) is a major advance over existing methods in hepatic surgery. Between 1983 and 1989, we performed 70 hepatectomies "réglées". Twenty seven patients were operated because of benign lesions and 43 patients because of malignant tumours. Transparenchymal approach using "Kellyclasy" or digitoclasy with control of the hilar vessels was carried out 39 times. U.S.D. was used 31 times. No mortality was observed during operating time or post-operative period. The postoperative morbidity was not attributable to the use of the U.S.D. On the whole, U.S.D. has modified neither the amounts of blood loss nor the duration of hilar clamping. However the use of U.S.D. presents 3 advantages: it allows sometimes to perform hepatectomy without pedicular clamping, it makes easy the transparenchymal approach of the large vascular and biliary structures, and it is useful in hydatic cyst surgery. Although the U.S.D. is not indispensable to carry out hepatectomy, it improves intraparenchymal control of vessels and biliary ducts, making therefore hepatic resection easier.

Constriction↗
PubMed1988

[Perforation of the pulmonary artery during the insertion of a Swan-Ganz catheter].

An accidental rupture of the pulmonary artery in a 77 year old female patient is reported. She was admitted for total mastectomy, but her past medical history revealed an old myocardial infarct, treated arterial hypertension and asthma. She was under heparin as well for her varicose veins. Her clinical examination revealed a patient in mild chronic heart failure. It was therefore decided to carry out invasive monitoring during surgery and the recovery period. A Swan-Ganz catheter was put up. Its progression was controlled by looking at the pressure curves. Several attempts were made to obtain a wedge pressure, with no success. During these attempts, the patient developed a cough followed by massive haemoptysis. Despite adequate resuscitative measures, the patient died before a surgical procedure could be attempted. Postmortem examination showed the rupture to be 9 cm away from the origin of the pulmonary artery. This unfortunate accident confirmed that the following three factors, all present in this patient, should call for extreme care in the setting-up of Swan-Ganz catheters: age greater than 60 years, pulmonary arterial hypertension and anticoagulant therapy.

Aged↗
PubMed1988

[Perforation of the pulmonary artery following Swan-Ganz catheterization].

Pulmonary arterial rupture due to the use of a Swan-Ganz catheter is a rare accident, with an estimated 2% incidence rate. It is fatal in almost 50% of cases. Predisposing factors are age greater than 60 years, pulmonary arterial hypertension and anticoagulant treatment. In patients older than 60 years, changes in the arterial wall increase the risk of rupture; pulmonary hypertension leads to too distal a movement of the catheter, and a concomitant treatment with anticoagulant drugs increases the amount of blood lost. Handling errors when setting up the catheter are often the cause of these accidents, especially a balloon too blown up and a catheter pushed too far. A subsequent movement of the catheter can be a cause of rupture during cardiac surgery. Haemoptysis is the major symptom of this accident, being found in 90% of cases. It can however be of minor importance; if it is ignored, this can lead to a secondary overwhelming haemorrhage. The haemorrhage can be life-threatening because of the cardiovascular collapse and acute respiratory failure by asphyxia. The treatment can only be carried out in intensive care. It will depend on the severity of the accident. It can go from an expectant wait after partial or total removal of the catheter, to an emergency thoracotomy for vascular suture, segmentectomy or even lobectomy. Intermediate measures include turning the patient onto the healthy side, injecting adrenaline or a clot of the patient's blood by the distal end of the catheter, placing a Fogarty catheter in the affected bronchus, or tracheal intubation with a double-lumen catheter and using mechanical ventilation with PEEP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Propofol in elderly high risk patients. A comparison of haemodynamic effects with thiopentone during induction of anaesthesia.

Twenty elderly patients of ASA grade 3 or 4, received either propofol 1 mg/kg or thiopentone 2 mg/kg for induction of anaesthesia. These doses provided a convenient level of anaesthesia for all patients. There were no significant intra- or intergroup haemodynamic changes, with the exception of a decrease in diastolic pressure and rate-pressure product after propofol. It is concluded that propofol 1 mg/kg can be used to induce anaesthesia in elderly high risk patients without deleterious cardiovascular effects.

Aged↗