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Biomedical subjects

C Conseiller

Publications and source records attributed to C Conseiller.

At least 19 recordsLinked to original sources
PubMed1992

[Effects of nifedipine premedication on peroperative hypothermia].

The intraoperative time-course of core temperature in patients premedicated with nifedipine (n = 30) was compared to that of control patients (n = 30). Distal oesophageal temperature (TCORE) was recorded every five minutes during total hip replacement in 60 adults ranked ASA 1 to 2. Patients in the control group were only premedicated with 100 mg of oral hydroxyzine. The treatment group consisted of 30 patients taking nifedipine for blood pressure control or coronary insufficiency. They were given 10 mg sublingual nifedipine as well as the hydroxyzine premedication. Anaesthesia was induced with thiopentone, fentanyl and vecuronium, and maintained with nitrous oxide in oxygen and halothane in a semi-closed circuit. The slopes of the time-course for TCORE were established for each patient, using two linear regressions, between 0 and 0.5 h and from 1 to 2 h. The two groups did not differ in age, weight, ambient temperature, blood pressure, heart rate, and volume of unwarmed blood transfused. TCORE differed significantly from the 25th minute on until the end of the study period. Contrary to all expectation the TCORE at 2 h was higher in the nifedipine group (34.85 +/- 0.09 degrees C) than in the control group (34.01 +/- 0.14 degrees C, p < 0.001). TCORE decreased more rapidly in the control group during the first study interval (0 to 0.5 h), -1.50 +/- 0.60 degrees C.h-1 vs -2.34 +/- 1.02 degrees C.h-1 (p < 0.001). The second slopes did not differ particularly (-0.96 +/- 1.32 degrees C.h-1 vs -0.90 +/- 0.42 degrees C.h-1 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Comparison of effects of Elohes and albumin on hemostasis in orthopedic surgery].

A prospective study was carried out to determine the effects of Elohes, a low molecular weight hydroxyethylstarch, on haemostasis. Sixteen patients due to undergo total hip replacement were randomly assigned to one of two groups: group A, who were to receive up to 21 of 4% albumin to replace blood loss, and group E, 1.51 of Elohes. Patients were then given concentrated red cell packs (RCP) and lactated Ringer's solution so as to have a haematocrit value of 30%, up to the fifth postoperative day. The amount of blood lost intraoperatively was calculated by weighing the swabs and measuring the volume aspirated. Haemostasis was investigated on the eve of surgery, 3 hours afterwards, and then every second day (days 1, 3 and 5). Total blood loss and the number of RCP transfused were similar in both groups: 1,517 +/- 425 ml and 3.5 RCP, and 1,428 +/- 250 ml and 3.25 RCP in groups A and E respectively. Blood albumin concentrations fell in group E as expected, the starch diluting blood proteins. Bleeding time (Simplate), activated partial thromboplastin time, prothrombin time changed in the same way in both groups throughout the study period after infusion of either Elohes or albumin. The concentrations in factors II, V, VII and X fell by 30% three hours after surgery. Values returned to normal between days 1 and 3, the concentrations of some factors rising to values greater than preoperative values because of the postoperative inflammatory process (fibrinogen, factor VIII von Willebrand). However, there were no significant differences between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Albumins↗
PubMed1990

[Alkalization of bupivacaine in the combination fentanyl-bupivacaine in epidural obstetrical analgesia].

A randomized double blind study was carried out to determine whether alkalization of a 0.25% bupivacaine solution in a fentanyl-bupivacaine mixture hastened the onset, and increased the duration and quality, of extradural analgesia during labour. The study included 120 women with uncomplicated full-term gestation. Prior to the extradural injection, 0.1 ml of either 8.4% sodium bicarbonate or normal saline was randomly added to 20 ml of 0.25% bupivacaine. The patients were given 75 micrograms fentanyl with 12 ml of either alkalized or unaltered bupivacaine. Data for analysis were obtained in 106 parturients (bicarbonate group n = 54; control group n = 52). The pH of alkalized and unaltered bupivacaine were 7.07 +/- 0.01 and 5.56 +/- 0.01 respectively. There were no statistically significant differences between the bicarbonate and control groups with regard to the speed of onset of analgesia (7.08 +/- 0.7 min vs. 6.78 +/- 0.6 min), its duration (123.6 +/- 10.7 min vs. 113 +/- 6.6 min), and the number of cases of inadequate pain relief (6 and 3 respectively). The rate of maternal adverse effects, and neonatal status, were similar in both groups. It can be concluded that alkalizing a 0.25% bupivacaine solution in a fentanyl-bupivacaine mixture for epidural analgesia in labour has no clinical value.

Analgesia, Epidural↗
PubMed1989

[Liver transplantation in adults: postoperative management and development during the first months].

Recent improvements in the results of orthotopic liver transplantation (OLT) have made this a well-accepted treatment for patients with severe hepatic failure. Current problems encountered following OLT are discussed. Immediate complications comprise surgical bleeding, primary graft non-function, and graft failure due to hepatic artery occlusion. Secondary complications are frequent. Surgical ones include biliary and vascular (hepatic artery thrombosis most often) problems, as well as intra-abdominal abscesses associated with gastrointestinal perforation, biliary leak, graft ischaemia or an infected haematoma. 40% of patients having undergone OLT will be reoperated on, 2/3 of them within 3 months. Non-surgical complications are mostly pulmonary. The risk of pneumonitis is increased by prolonged mechanical ventilation; it is always potentially disastrous in the immunosuppressed, transplanted patient. Hypertension is also often seen in the early postoperative period; it requires prompt treatment. Early renal impairment after OLT is common, and of better prognosis than late onset renal failure, which is generally associated with shock, graft failure, sepsis or use of nephrotoxic agents. Seizures, usually only one, occur in about 10% of patients; recovery is complete. Encephalopathy with intracranial oedema related to fulminant hepatitis has a worse prognosis, but survival figures are quite encouraging. Three type of rejection are described after OLT: 1) severe accelerated rejection (very rare), 2) acute rejection encountered in about 70% of patients over the first 3 months, and 3) late rejection, which can lead to the vanishing bile duct syndrome (VBDS). Diagnosis of rejection is made by liver biopsy. Prophylactic immunosuppression includes cyclosporin, methylprednisolone and azathioprine. Cyclosporin toxicity and drug interactions are reviewed. Treatment of acute rejection episodes comprises an initial bolus of high doses of corticoid drugs; if there is no response, antilymphocyte globulin or monoclonal antibodies may have to be used. Infection is the main cause of death following OLT. Early infections, mostly intra-abdominal and pulmonary, are bacterial or fungal. Vital (especially CMV) and other opportunistic infections occur generally after the second week. Retransplantation, carried out in 10 to 25% of patients, may be urgent in case of primary graft failure, or hepatic artery thrombosis associated with graft failure, or hepatic artery thrombosis associated with graft failure. Other indications are early graft rejection with severe hepatic dysfunction, chronic rejection with severe VBDS, and recurrence of the initial disease.

Actuarial Analysis↗
PubMed1989

[A combination of sufentanil and 0.25% bupivacaine administered epidurally for obstetrical analgesia. Comparison with fentanyl and placebo].

The study reported was designed to determine whether 15 micrograms sufentanil would provide analgesia comparable in duration and quality with that given by 75 micrograms fentanyl, when associated with plain 0.25% bupivacaine for extradural analgesia for labour. Patients (n = 124) in labour and at full term were randomly divided into 3 groups. Group 1 (n = 41) were given 12 ml of 0.25% plain bupivacaine with saline, group 2 (n = 41) 12 ml of 0.25% plain bupivacaine with 75 micrograms fentanyl and group 3 (n = 42) 12 ml of 0.25% plain bupivacaine with 15 micrograms sufentanil. 11 cases were excluded from the study (8 Caesarean sections, 3 technical failures). The duration of analgesia obtained with the two opioids was similar (group 2: 126.7 +/- 6.5 min, p less than 0.01; group 3: 114.9 +/- 5.8 min, p less than 0.01; group 1: 93.6 +/- 5.4 min) as well as the quality of pain relief. There were no differences between the three groups with regard to Apgar scores. The only side-effect seen with sufentanil and fentanyl was pruritus (group 2: 21.9%, p less than 0.05; group 3: 21.4%, p less than 0.05; group 1: 2.4%). These results showed that 15 micrograms sufentanil could replace 75 micrograms fentanyl for extradural pain relief of labour with plain 0.25% bupivacaine. However, the use of opioids with local anaesthetics would seem to be of interest only if labour is likely to be prolonged.

Adult↗
PubMed1989

[Peroperative anaphylactic shock caused by latex].

A case is reported of severe anaphylactic shock occurring in a 32 yr old woman after foetal extraction during caesarean section. The agent responsible was the latex from the surgical gloves used. This was proved by the different allergological tests carried out: positive prick-tests to the latex, positive human basophil degranulation test and the finding of specific anti-latex IgE. All the tests carried out using the anaesthetic drugs were negative.

Adult↗
PubMed1989

[Oral administration of sodium citrate before general anesthesia in elective cesarean section. Effect on pH and gastric volume].

A study was carried out to assess the effects of oral sodium citrate on the pH and volume of gastric content in 52 unpremedicated women undergoing elective Caesarean section under general anaesthesia. The patients were randomly assigned to two groups: group T (n = 26) without antacids and group C (n = 26) receiving orally 30 ml of 0.3 M sodium citrate solution 5 min before induction of anaesthesia. After tracheal intubation, a size 18 double lumen naso-gastric tube was introduced. The gastric content was sampled 10 min (n = 52), 50 min (n = 52) and 80 min (n = 24) later. Before extubation, the stomach was completely emptied and the naso-gastric tube removed. On each sampling time, the pH was measured with a digital pHmeter; a search for biliary salts (pyloric reflux) was carried out with thin layer chromatography; the volume of the gastric content was measured using the phenol red dilution method. At 10 min, none patient in group C had a gastric pH less than 2.5, in the opposite to 92% of patients in the control group T. The alkalinizing effect of the citrate lasted throughout the evaluation time. The mean pH was respectively 5.3 +/- 1.07, 5.23 +/- 1.2 and 5.53 +/- 1.3 at 10, 50 and 80 min in group C (controls: 1.9 +/- 0.7; 2.49 +/- 1.3; 2.40 +/- 0.61). However, the citrate solution increased significantly the volume of the gastric content. It was respectively 51.1 +/- 29.9 ml, 79.15 +/- 70.9 ml and 32.9 +/- 22.1 ml; 29.6 +/- 28.5 ml; 26.6 +/- 10.9 ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1989

Controlled trial of extradural bupivacaine with fentanyl, morphine or placebo for pain relief in labour.

In a prospective, randomized double-blind study carried out on 255 parturients, fentanyl 80 micrograms (n = 81), morphine 4 mg (n = 83) or placebo (n = 85) was added to 0.25% bupivacaine administered extradurally for pain relief during labour. Fentanyl increased the mean duration of bupivacaine analgesia by 30% and did not reduce the rate of inadequate pain relief. Morphine did not increase the mean duration of bupivacaine analgesia significantly, but increased the rate of inadequate pain relief. It was concluded that morphine 4 mg added to extradural 0.25% bupivacaine was of no value.

Analgesia, Epidural↗
PubMed1989

Intravenous propofol during cesarean section: placental transfer, concentrations in breast milk, and neonatal effects. A preliminary study.

Placental transfer and neonatal effects of propofol were investigated in 21 women undergoing elective cesarean section under general anesthesia. This study was conducted in two separate phases according to the use of propofol. In both phases, anesthesia was induced with an iv bolus of 2.5 mg/kg of propofol. In phase 1 (n = 10), anesthesia was maintained with 50% nitrous oxide in oxygen and halothane. In phase 2 (n = 11), a continuous infusion of propofol at a rate of 5 mg.kg-1.h-1 was started after the induction dose. Maternal venous and umbilical cord arterial and venous samples were obtained at delivery. The propofol concentration in whole blood was measured with a high performance liquid chromatography method. Where possible, breast milk/colostrum was expressed for both phases postoperatively and a sample of blood was collected during phase 2 from neonates via a heel prick 2 h after birth. Propofol crossed the placenta, as demonstrated by concentrations found in umbilical venous blood in phase 1 (0.13-0.75 micrograms/ml) and in phase 2 (0.78-1.37 micrograms/ml). At delivery, the ratio of the drug concentration in umbilical venous blood to that in maternal blood was 0.70 +/- 0.06 for phase 1 and 0.76 +/- 0.10 for phase 2. The ratio of propofol concentration in the umbilical artery to that in the umbilical vein was 1.09 +/- 0.04 for phase 1 and 0.70 +/- 0.05 for phase 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Neonatal effects of propofol administered to the mother in anesthesia in cesarean section].

Propofol, 2-6 diisopropylphenol ("Diprivan", ICI) has been shown to be safe and effective for induction and maintenance of anesthesia when injected intravenously. Its pharmacological profile suggests that it may prove to be a useful agent in obstetric anesthetic practice. But, obstetrics is a specialized field in which the acute effects of the anesthetic agent on the fetus must be considered. This open non comparative study was therefore designed to investigate the neonatal assessments when propofol was used either for induction of anesthesia or for induction and maintenance of anesthesia during elective cesarean section. This study was conducted in two separate phases according to the use of propofol. In both phases, anesthesia was induced with an intravenous bolus of 2.5 mg.kg-1 of propofol. In phase 1 (n = 10), anesthesia was maintained with 50% nitrous oxide in oxygen and halothane. In phase 2 (n = 11), a continuous infusion of propofol at a rate of 5 mg.kg-1.h-1 was started after the induction dose. At time of delivery, blood samples were taken from maternal artery, umbilical vein and artery for acid-base and blood gas status. The condition of the infant was evaluated using Apgar score at 1, 5 and 10 min, time to sustained spontaneous respiration and the Neurologic and Adaptative Capacity Score was assessed at 30 min, 2 hours and 24 hours after birth. Maternal and neonatal blood gas tensions and acid-base status at delivery were within the normal clinical limits in both phases and compared favorably with results published by others workers using established methods of anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Propofol].

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Anesthesia, Intravenous↗