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Biomedical subjects

B Dureuil

Publications and source records attributed to B Dureuil.

At least 55 records · Page 3Linked to original sources

[Selenium deficiency favors the appearance of heart failure after multiple injury].

A 47-year-old multiple trauma patient, experiencing a C. Difficile colitis with diarrhoea, developed diffuse oedema with peritoneal and pleural effusion due to global heart failure. Selenium deficiency, reported in trauma patients, may explain the occurrence of cardiomyopathy. The role of selenium in cardiac dysfunction and the various situations inducing a selenium deficiency are discussed.

Clostridioides difficile↗

[Heart injury following closed thoracic injury].

A 60-year-old man, was admitted in the emergency ward, following a motor vehicle accident. At the time of arrival his clinical state was stable. The initial investigations showed a moderate left haemopneumothorax and fractured ribs. After insertion of a thoracostomy tube into the left pleural cavity he had to undergo surgery for an open fracture of the left arm. Following induction of anaesthesia, a cardiovascular collapse occurred rapidly. An emergency thoracotomy was performed which showed a right ventricular perforation by a rib fragment. The authors discuss the role of possible changes in heart position produced by induction of general anaesthesia. Indeed the decrease in functional residual capacity following induction of anaesthesia with a cephalad diaphragmatic shift may have secondarily exposed the right ventricle to the bevel of a fractured rib.

Arm Injuries↗

Role of prostaglandins and nitric oxide on halothane-induced arteriolar dilatation in rat diaphragm.

The effects of anaesthetics on the microcirculation of the diaphragm are incompletely understood. Therefore, we assessed by in vivo intravital microscopy in rats the action of halothane on diaphragmatic arteriolar diameter and the role of nitric oxide and prostaglandins on halothane-induced diaphragmatic arteriolar diameter. We studied 54 rats anaesthetized with thiopentone. Dose-response curves to topically applied Krebs' solution saturated with halothane at increasing concentrations of 0%, 1%, 3% and 5% were carried out in the presence of an inhibitor of nitric oxide synthesis (N omega-nitro-L-arginine (LNA), 300 mumol litre-1) or inhibitors of prostaglandin synthesis (mefenamic acid 20 mumol litre-1 or indomethacin 20 mol litre-1) or in the absence of any inhibitor. We found dose-dependent arteriolar dilatation which was abolished by mefenamic acid and indomethacin. In contrast, the effect of halothane was not modified by LNA. These data demonstrated that halothane-induced arteriolar dilatation in the diaphragm of the rat was mediated by prostaglandins but not by nitric oxide.

Anesthetics, Inhalation↗

[Severity scores underestimate the seriousness of acute renal failure after emergency surgery].

OBJECTIVES: The predictive value of APACHE II and SAPS severity scores were evaluated in a group of patients with acute renal failure admitted in ICU after emergency surgery. The criteria of poor prognosis identified in the 24 hours following admission were also evaluated. STUDY DESIGN: Open prospective study. PATIENTS AND METHODS: During 22 months, we included every patient admitted in ICU after emergency surgery with a serum creatinine concentration > or = 130 mumol.L-1. Clinical and biological parameters were collected in the first 24 hours following admission and the severity scores were calculated. Prediction of hospital outcome, based on APACHE II score, was calculated. The standard mortality ratio (observed mortality/predicted mortality) was calculated. Accuracy of SAPS and APACHE II score was compared using ROC curves and comparison of the areas under the curves. RESULTS: Death in ICU occurred in 44% of the patients while hospital mortality was 51%. The standard mortality ratio for APACHE II score was 1.35. The areas under the curves for SAPS and APACHE II scores were not statistically different. The criteria of poor prognosis, identified in the first 24 hours following admission, were cardiovascular failure, oliguria and sepsis. CONCLUSION: Conventional severity scores are inaccurate for prediction of mortality in patients with acute renal failure following emergency surgery.

Acute Kidney Injury↗

[Effects of midazolam on respiratory drive in healthy volunteers].

OBJECTIVE: To compare the effects of a sedative dose of midazolam on mean inspiratory flow (VT/TI = index of central respiratory activity), known as being decreased by midazolam and the intercostal muscle activity, known as being increased by this agent. STUDY DESIGN: Laboratory study. PATIENTS: Seven healthy volunteers. METHODS: After assessment of baseline values of ventilatory variables and intercostal electromyographic activity (in arbitrary units), midazolam 0.1 mg.kg-1 was administered by iv route. The measurements were repeated after 5 and 10 min, and finally 2 min after the i.v. injection of flumazenil 1 mg. RESULTS: Midazolam decreased VE and VT. Similarly VT/TI ratio decreased from 0.44 +/- 0.04 (baseline value) to 0.26 +/- 0.03 (5 min) and 0.3 +/- 0.03 L.s-1 (10 min later) respectively (P < 0.05). Conversely, midazolam increased the intercostal electromyographic activity from 4.0 +/- 0.7 (baseline value) to 26.5 +/- 16.6 (5 min) and 28.4 +/- 16.6 U (10 min later) respectively (P < 0.05). Within 2 min after flumazenil administration all variables returned to baseline values. CONCLUSIONS: The decrease of VT/TI ratio is probably linked to increased resistances in the upper airways. This ratio cannot act as an indicator of respiratory drive during sedation or anaesthesia. The assessment of the ventilatory effects of benzodiazepines must be based simultaneously of the various other indicators of the ventilatory drive, as these agents act on the different stages of the ventilatory cycle and therefore cannot be characterized by a unique variable.

Adjuvants, Anesthesia↗

Alteration in swallowing reflex after extubation in intensive care unit patients.

OBJECTIVES: To assess the swallowing reflex after prolonged endotracheal intubation and to assess the influence of age and duration of intubation on this reflex. DESIGN: Prospective, observational, clinical study. SETTING: The intensive care unit of a university teaching hospital. PATIENTS: The swallowing reflex was studied after extubation in 34 patients and compared with the deglutition in 30 nonintubated patients with a nasogastric tube and 15 nonintubated patients without a nasogastric tube. INTERVENTIONS: Four volumes of normal saline (0.25, 0.50, 0.75, and 1 mL) were injected at the epipharynx level. Swallowing efficiency was assessed by the latency between instillation and the first swallow, as identified on a submental electromyogram. The tests were performed immediately (day 0), and at 1 (day 1), 2 (day 2), and 7 (day 7) days after extubation in the intubated group. Nonintubated patients were tested once. MEASUREMENTS AND MAIN RESULTS: On day 0, the latency was increased for each bolus in the extubated group when compared with the control groups. Significant shortening of latency after 0.50, 0.75, and 1 mL injections of normal saline occurred on days 1 and 2 when compared with day 0, whereas no change was observed after 0.25 mL of normal saline was injected. On day 7, a significant improvement was observed, regardless of the volume injected. There was no correlation between swallowing latency and either the age of the patients or the duration of endotracheal intubation. CONCLUSIONS: These data indicate that prolonged endotracheal intubation impairs the swallowing reflex, with improvement within 1 wk. This phenomenon could contribute to microinhalations and aspiration pneumonia after extubation.

Aged↗

[Diprivan and asthma].

Propofol is probably a safe agent in asthmatic patients. In clinical practice, its efficacy in reducing the incidence of peroperative bronchospasm is deemed possible, but has not yet been totally established. With respect to the regression of bronchospasm in a patient receiving propofol, it is not possible to accurately differentiate between the beneficial effects related to the depth of anaesthesia and a specific effect of this agent on bronchial tone. Finally, its haemodynamic effects in case of severe bronchospasm remain to be assessed.

Airway Resistance↗

[Changes in the deglutition reflex during the perioperative period].

The swallowing reflex is one of the major mechanisms protecting the lungs against aspiration of foreign material. Its complex time course requires a perfect coordination with ventilation, as the aerodigestive crossroads are common for both functions. Physiological factors as ageing, as well as mechanical and pharmacological agents, may contribute to swallowing reflex alterations. Moreover, endotracheal intubation and most anaesthetic agents may impair the swallowing function and favour the occurrence of aspiration. This review discusses the normal swallowing process and its alterations by agents currently used in anaesthesia. Furthermore, the effect of intubation as well as changes related to co-existing diseases are considered.

Aged↗

Effects of halothane on surfactant biosynthesis by rat alveolar type II cells in primary culture.

BACKGROUND: Pulmonary surfactant, which is synthesized by alveolar type II cells (ATII cells) almost exclusively, plays a major role in maintaining alveolar homeostasis by reducing surface tension at the fluid-gas interface. Phosphatidylcholine (PC), the main surfactant lipid component, is largely responsible for this surface activity. The effects of halothane on the phospholipid metabolism of the pulmonary surfactant by ATII cells are unknown, even though these cells are exposed directly to volatile anesthetics during anesthesia and even though any alteration in surfactant biosynthesis by anesthetics may have deleterious effects on lung function and thereby facilitate postoperative pulmonary complications. In the current study, the effects of halothane exposure on surfactant synthesis by rat ATII cells in primary culture were investigated. METHODS: ATII cells were isolated from adult rat lungs and used for the experiments after 24 h in primary culture. The ability of ATII cells to synthesize surfactant was assessed by the incorporation of radioactive precursors in PC. Cytotoxicity was measured by the rate of lactate dehydrogenase release into the culture medium, and the lactate metabolism was taken as an index of glycolytic metabolism. All metabolic measurements were made after 24 h in primary culture. Effects of various halothane concentrations (1, 2, 4, and 8%) exposure for 4 h were studied, as were the effects of 2% halothane for various durations of exposure (2, 4, 8, and 12 h). The reversibility of halothane effects on PC synthesis was assessed after a 2% halothane exposure for 4 h. PC secretion and adenosine triphosphate cellular content were also measured for 4 h exposure at the various halothane concentrations. RESULTS: During a 4-h exposure, PC synthesis was reduced by 10, 24, 29 and 36% for 1, 2, 4, and 8% halothane respectively when compared with control values. At 2% halothane concentration, the observed decreases in PC synthesis were 12, 24, 31 and 34% for 2, 4, 8, and 12 h exposure, respectively. The inhibitory effect of halothane was completely reversed 2 h after the end of exposure. PC secretion was unaffected by increasing halothane concentrations during a 4-h exposure. Halothane did not produce cell damage except for the longest exposure durations (8 and 12 h) at 2% vapor concentration. Whatever the exposure conditions, lactate production by ATII cells exposed to halothane was greater than production by unexposed cells. CONCLUSIONS: These results indicate that halothane decreases the biosynthesis of pulmonary surfactant by ATII cells in primary culture and alters the high energy phosphate metabolism of these cells.

Adenosine Triphosphate↗

Effects of intravenous midazolam on the work of breathing.

Midazolam at sedative doses induces an increase in upper airway resistance, but its effects on the work of breathing have not been established. The flow-resistive work of breathing and pulmonary resistance (RL) of eight healthy volunteers were measured, with either midazolam 0.1 mg/kg or placebo in a random order. Esophageal pressures were measured using a balloon-tipped catheter, airflow using a pneumotachograph. Total resistive work expressed per minute (WTOT) and per liter of ventilation (WTOT/VE), and their inspiratory (WI) and expiratory (WE) components were determined. No change was observed after placebo injection. Five minutes after midazolam injection, an increase was observed in WTOT (from 3 +/- 0.4 J/min [mean +/- SEM] at control to 6.3 +/- 1.1 J/min; P < 0.01) and in WTOT/VE (from 360 +/- 30 mJ/L at control to 1250 +/- 120 mJ/L; P < 0.01), involving both WI and WE components. An increased inspiratory RL was observed from 13.7 +/- 2.6 cm H2O.L-1.s-1 at control to 32.8 +/- 3.9 cm H2O.L-1.s-1 after midazolam. Changes in inspiratory RL were correlated to changes in WI and WI/VE (r = 0.574, P < 0.001; and r = 0.762, P < 0.001, respectively). Our results suggest that airway obstruction plays a major role in the increased work of breathing observed during sedation with midazolam.

Adult↗

[Effects of acute alcoholic intoxication on the upper respiratory tract function].

Acute alcohol intake may be of potential hazard in anaesthesia emergency procedures because of consciousness alterations. Alcohol ingestion alters indeed the functions of upper airway muscles and increases the risk of obstructive sleep apnea. However, no data are available on the effects of alcohol on the swallowing reflex (SR), which is a major protective mechanism against pulmonary inhalation and on upper airway resistances (UAR) following external inspiratory load application. This study was designed to investigate the effects of acute alcohol intake on SR and UAR in healthy volunteers. After informed consent, 8 male volunteers (29 +/- 3 years) were studied in the supine position. The tip of a catheter was placed through the naris at the epipharynx level for injection of 3 series of 2 volumes of distilled water (0.25 and 1 ml respectively). Swallows were identified by a submental electromyogram. SR efficiency was assessed by recording 1) the latency (L) between injection and the first swallow, and 2) the number of swallows (N) elicited by each bolus. The subjects were breathing through a facial mask connected to a pneumotachograph. Supraglottic airway pressures (UAP) were recorded using a small balloon catheter placed at the tip of the epiglottis. UAR were calculated as the ration of UAP (cmH2O) on air-flow (l.s-1) at the airflow's peak. After a control set of measurements (TC), including SR assessment and UAR at rest (UARo) and during application of an external inspiratory resistive load (12 cmH2O.l-1 x s-1) (UARr) to sensitize the experiment, the subjects ingested 1 ml.kg-1 of alcohol as 40 degrees vodka.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Effects of midazolam on respiratory muscles in humans.

Midazolam at sedative doses alters the breathing pattern; however, its effects on respiratory load and respiratory muscle activity have not been established completely. Therefore, the effects of midazolam (0.1 mg/kg) on total pulmonary resistances and on diaphragmatic, intercostal, and abdominal muscle patterns were studied in nine volunteers. Measurements were performed during control, 5 and 10 min after midazolam, and then 2 min after 1.0 mg of intravenous flumazenil. After midazolam, total pulmonary resistance increased from 6.3 +/- 0.65 to 36.6 +/- 8.1 cm H2O-L-1 x s-1 (P < 0.01), a pattern associated with an increased intercostal electromyographic activity (peak and slope; P < 0.05). By contrast, the ratio of gastric pressure on esophageal pressure changes decreased from 65.5% +/- 6.2% to 16.3% +/- 3.9% (P < 0.01), indicating reduced diaphragmatic activity. In 7/9 subjects, there was expiratory abdominal muscle activity. Flumazenil reversed all these effects. We conclude that midazolam 0.1 mg/kg increases total pulmonary resistance and elicits a compensatory load response characterized by an increase in inspiratory intercostal and expiratory abdominal muscle activities whereas diaphragmatic contribution is reduced.

Abdominal Muscles↗

[Impairment of deglutition reflex after prolonged intubation].

This study was designed to assess the swallowing reflex after an endotracheal intubation of more than 24 h, as well as the influence of age and duration of intubation on swallowing. Twenty patients (aged 58 +/- 17 years) who had been intubated for more than 24 h were compared with fifteen others (63.1 +/- 16.7 years), who had never been intubated. All had a nasogastric tube. Swallowing was assessed after administration of 0.25, 0.5, 0.75 and 1 ml volumes of normal saline, in a random sequence, into the epipharynx through a thin catheter passing through the nostril after extubation (E0), and then at 1 (E1), 8 (E8), 24 (E24) and 48 h (E48) in the extubated patients, and once in the control patients. Swallowing responses were identified by an electromyogram of the floor of the oral cavity. The efficiency of the swallowing reflex was assessed by the delay between instillation and the first swallowing response obtained, and the number of swallows recorded during the first 15 seconds following each injection. There was a significant increase in swallowing delay in intubated patients for volumes less than 1 ml during the first three measurements. Recovery occurred for 0.5 and 0.75 ml at E24 and E48, when compared with the control group. However, delay remained increased throughout the study for 0.25 ml. The number of swallows was the same in both groups for each volume tested. There was no correlation between increased delay and age or duration of intubation. These data confirmed that prolonged endotracheal intubation impairs the swallowing reflex.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Effects of i.v. midazolam on upper airway resistance.

We have measured changes in supraglottic airway resistance (Rsg) produced by midazolam. Ten subjects were studied on two occasions, receiving in a random order either midazolam 0.1 mg kg-1 or placebo. Supraglottic pressures were measured using a balloon-tipped catheter and air flow with a pneumotachograph. Rsg were calculated at a flow rate of 0.3 litre s-1 during inspiration. No changes in Rsg and no apnoeic events were noted following placebo injection. Mean Rsg increased from 0.23 (SEM 0.07) kPa litre-1 s to 1.29 (0.38) kPa litre-1 s 5 min after injection of midazolam (P less than 0.01), and remained increased significantly for 20 min. Twenty-two apnoeic events were recorded in six subjects, including 11 obstructive events. We conclude that midazolam in sedative doses increases Rsg markedly and induces central apnoea during the first few minutes after i.v. administration and this is followed by obstructive apnoea.

Adult↗

Does a subparalysing dose of vecuronium enhance diaphragm fatigue?

We have examined, in six healthy volunteers, the effect of a subparalysing dose of vecuronium on the development of diaphragm fatigue. Vecuronium was given as a 0.5-mg bolus i.v. followed by 0.5 mg infused over 30 min; as a control, saline was given in random order. Diaphragm strength was assessed by measuring transdiaphragm pressure and by electromyography. Diaphragm fatigue was induced by breathing against an inspiratory resistance. The plasma concentration of vecuronium varied between 15 and 30 ng ml-1 15 min after administration of vecuronium was started. Peripheral neuromuscular block was not detected in any subject. Diaphragm fatigue developed within the same period in both groups: mean 334 (SD 166) s after saline and 345 (190) s after vecuronium. The electromyographic pattern of diaphragm fatigue and the time constant of relaxation of transdiaphragm pressure after fatigue were similar in both groups. We conclude that, at low plasma concentrations of vecuronium, similar to those present in the postoperative period, there was no predisposition to diaphragm fatigue.

Adult↗

Effects of endotoxic shock on diaphragmatic function in mechanically ventilated rats.

Diaphragmatic function was investigated in mechanically ventilated rats during endotoxic shock (group E, n = 18) and after saline solution injection (group C, n = 8). Endotoxic shock was produced by a 1-min injection of Escherichia coli endotoxin (10 mg/kg iv) suspended in saline. Diaphragmatic strength was assessed before (T0) and 15 (T15) and 60 (T60) min after injection by measuring transdiaphragmatic pressure (Pdi) generated during bilateral phrenic stimulation at 0.5, 10, 20, 30, 50, and 100 Hz. Diaphragmatic neuromuscular transmission was assessed by measuring the integrated electrical activity of the diaphragm. Diaphragmatic endurance was assessed 75 min after injection from the rate of Pdi decline after a 30-s continuous 10-Hz phrenic stimulation. In 16 additional animals, diaphragmatic glycogen content was determined 60 min after inoculation with endotoxin (n = 8) or 0.9% sodium chloride solution (n = 8). Diaphragmatic resting membrane potential (Em) was measured in 16 additional animals 60 min after endotoxin (n = 8) or saline injection (n = 8). Mean blood pressure decreased from 74 +/- 3 to 53 +/- 6 mmHg at T60 in group E, whereas it was maintained in group C. At T60 Pdi was decreased in group E for frequencies of 50 and 100 Hz and was associated with a decreased diaphragmatic electromyographic activity of 25.3 +/- 2.5 and 26.5 +/- 5.2% for 50- and 100-Hz stimulations, respectively, in comparison with T0 values.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Diaphragmatic microcirculation during halothane and isoflurane exposure in pentobarbital-anesthetized rats.

We investigated the effects of halothane and isoflurane on diaphragmatic microcirculation in pentobarbital-anesthetized rats by in vivo video microscopy. After a baseline period, rats were randomly allocated into three groups according to administration of 0.5, 0.75, and 1 minimal alveolar concentration (MAC) of either halothane (group Hal, n = 16), isoflurane (group Iso, n = 14), or no halogenated agent (group C, n = 20) in three succeeding steps of 15 min. Mean arterial blood pressure (MAP), arteriolar diameters, and functional capillary density were analyzed in the last 3 min of each step. MAP remained unchanged in group C but decreased in a dose-dependent manner in both halogenated receiving groups. MAP was significantly lower in rats breathing Hal compared with those breathing Iso. Arterioles were classified in second (A2, n = 39), third (A3, n = 24), and fourth (A4, n = 30) order according to their relative location in the network. No changes in A2 and A3 diameters were noted in either group. A4 diameters remained unchanged in groups C and Iso, whereas a significant reduction was found in group Hal at 0.75 and 1 MAC exposure (P < 0.05 compared with baseline and with groups C and Iso, respectively). During Iso exposure, functional capillary density was not significantly different when compared with baseline and group C, whereas in group Hal it decreased significantly at 0.5, 0.75, and 1 MAC, amounting to 61.1 +/- 9, 30.7 +/- 10.3, and 22.8 +/- 6.3%, respectively, of baseline (P < 0.01 vs. baseline and P < 0.05 vs. groups Iso and C for 0.75 and 1 MAC).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗