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C Blery

Publications and source records attributed to C Blery.

11 recordsLinked to original sources
PubMed1988

Prospective assessment of a protocol for selective ordering of preoperative chest x-rays.

Routine preoperative chest x-rays are still widely employed worldwide, although results of many studies do not support their broad utilization. A protocol for selective ordering of preoperative chest x-rays, according to the patient's clinical status, medical history and scheduled surgery, was developed and implemented in a teaching hospital in Paris. The utilization of the protocol during a one-year period was evaluated. Eleven hundred and one chest x-rays were ordered in 3866 patients (28 per cent). Five hundred and sixty-eight x-rays (52 per cent) were abnormal. One hundred and sixty-six (15 per cent) were considered useful by the anaesthetists, who took into account the entire hospital course, although only 51 (5 per cent) had an impact on the surgical plan or anaesthetic management. Among the 2765 patients who did not have a preoperative chest x-ray, two patients could have benefited from the chest x-ray, in the view of anaesthetists. Chart review for these two patients and for patients who had perioperative complications in the absence of a preoperative chest x-ray revealed that no complications could be linked to the lack of preoperative chest x-ray ordering. This study shows that the abandonment of routine ordering of preoperative chest x-rays does not produce adverse effects on patient care.

Adult↗
PubMed1988

Usefulness of selectively ordered preoperative tests.

The authors prospectively evaluated the usefulness of 12 preoperative tests (including blood type and screen) ordered selectively according to clinical status and importance of scheduled surgery. Two methods of assessing usefulness of tests were used, taking into account not simply their abnormality yield, but also their impact on patient care during the entire hospitalization: first, usefulness was assessed by anesthetists involved in care; second, usefulness was assessed by an automated analysis of specific clinical situations in which tests were a priori considered useful. In 3,866 patients 15,920 tests were performed; 30% of performed tests were abnormal. As a consequence of test results, surgery was delayed or cancelled in 19 patients and modified in 1, and a treatment was instituted or anesthetic management influenced in 347 (9%). Blood component therapy was instituted in 652 patients (17%). Anesthetists and automated analysis found at least one preoperative test useful in 931 patients (24%) and 890 patients (23%), respectively, whereas on a per-test basis 17% and 9% of tests were found useful. The discrepancy in usefulness assessment was mainly due to differences in evaluation of the usefulness of normal results. This study shows that the usefulness of selectively ordered preoperative tests may be high, but better criteria for their indications are needed, because tests other than those recommended by protocol were found useful.

Adult↗
PubMed1986

Evaluation of a protocol for selective ordering of preoperative tests.

A protocol for selective ordering of 12 preoperative tests, according to clinical status and type of surgery, was prospectively tested for one year in a teaching hospital. 3866 consecutive surgical patients had an average of about 4 tests each. The possible value of tests that were omitted was assessed in the light of events during and after operation. According to predetermined criteria, 0.4% of non-ordered tests would have been potentially useful; but in the opinion of the anaesthetists, only 0.2% would actually have been useful. The protocol therefore had little adverse effect on patient care and was acceptable to clinicians.

Adult↗
PubMed1984

Effect of epidural morphine on post-operative pulmonary dysfunction.

The effect of post-operative epidural morphine analgesia on pulmonary function was assessed after abdominal surgery and compared to conventional analgesia. In a control group, ten patients received a parenteral analgesic, non-narcotic drug. In a second group of 11 patients, epidural morphine was injected after the operation and continuous analgesia was prolonged until the 3rd post-operative day by means of repeated injections through an epidural catheter. Analgesia was tested on a visual pain scale. Pulmonary function was evaluated by measurements of blood gases, pulmonary volumes (vital capacity, by spirometry, and functional residual capacity by helium dilution technique) and forced expiratory volume in one second. Measurements were performed on the day before the operation and on the first, third and sixth post-operative days. Pain scoring documented a better analgesia in the epidural group during the post-operative period. By contrast, epidural morphine was unable significantly to improve VC, FEV1 and FRC during the post-operative course. The results suggest that pain is not an important factor of decreased post-operative pulmonary function.

Adult↗
PubMed1980

[Giant hemangioma of the liver (author's transl)].

This case is reported because of the technical problems raised when excision of very large tumors of the liver is required. A patient was found to have a hemangioma of the right lobe of the liver. A right hepatectomy to include Spiegel's lobe was performed by a subcostal approach extended to a right thoracophrenotomy. After clamping the vascular pedicle of the right liver, the section of the liver was removed and a tumor weighing 3.420 g discovered. Postoperative recovery was uneventful. During right hepatectomies for very large tumors, excellent control of the inferior vena cava and right superior hepatic vein can be maintained by the use of thoracophrenotomy associated with laparotomy. Though the possibility of complexe vascular exclusion of the liver has to be considered during hepatic sectioning, this aves not appear to be essential, and the use of manual dissection after clamping the vascular pedicles of the right liver is a rapid and certain procedure.

Female↗
PubMed1978

[Allergy to suxamethonium. Case report].

The authors describe a clinical case of an allergy to suxamethonium (succinylcholine) chloride which prompted--a posteriori--an allergological work-up. This, in turn, demonstrated all the factors favoring histamine-release: atopic predisposition, tendency of nonspecific histamine-release, and real allergy to the muscle relaxant. This study has enabled the induction of anaesthesia without any problems, by avoiding the allergens through preventive therapy.

Adult↗