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Biomedical subjects

C Ecoffey

Publications and source records attributed to C Ecoffey.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Pharmacodynamics and safety of mivacurium in infants and children under halothane-nitrous oxide anesthesia].

OBJECTIVES: To determine pharmacodynamic effects and safety of mivacurium in paediatric patients. STUDY DESIGN: Multicentric, prospective, open, non-randomized study. PATIENTS: Forty-eight three-month-old to eight-year-old physical class ASA I or II children. METHOD: Anaesthesia was induced and maintained with halothane and nitrous oxide. Tracheal intubation was performed without a neuromuscular blocking agent. Neuromuscular blockade was measured with a strain force transducer after train-of-four stimulation of the ulnar nerve at the wrist every ten seconds. A single bolus dose of mivacurium (0.2 mg.kg-1) was injected during 15 seconds in patients allocated into three groups. Group 1: three to 12-month-old infants (n = 15), group 2: one- to three-year-old children (n = 16) and group 3: three- to eight-year-old children (n = 17). Onset and recovery parameters were measured in each patient. Heart rate and noninvasive arterial blood pressure were recorded every minute for five minutes after mivacurium injection. RESULTS: Following halothane administration for 29 and 32 min, and a FEThalothane = 1 vol%, mivacurium (0.2 mg.kg-1) determined a 100% neuromusmcular blockade in all patients. The onset time was 71 +/- 34 s (mean +/- SD) in all patients and did not differ between groups. Time to 25% and 95% recovery of the first twitch and recovery index for all the patients were 12 +/- 3 min, 19 +/- 5 min and 4 +/- 2 min respectively and did not differ between groups. No prolonged paralysis was observed. No significant changes of HR and BP occurred. CONCLUSIONS: Following 0.2 mg.kg-1 of mivacurium in patients aged between three months to eight years, a complete blockade occurs with a rapid onset time and a short duration of action, without significant cardiovascular effect.

Anesthetics, Inhalation↗
PubMed1999

[Treatment of severe cardiogenic pulmonary edema with continuous positive-pressure ventilation using a cuffed cannula Copa].

We report the use of a cuffed oropharyngeal airway (Copa), in a patient with an acute respiratory failure from a cardiogenic pulmonary oedema, for continuous positive pressure ventilation. Considering the ease of use and the lack of laryngeal stimulation, this device can be considered for mechanical ventilation in selected cases with acute cardiac failure. There are two contra-indications: prolonged mechanical ventilation, because of the lack of airway protection from gastro-oesophageal reflux, and normal consciousness, as the patient cannot swallow. This device can be considered when starting intensive therapy including mechanical ventilation in patients with acute respiratory failure of foreseen short duration.

Aged↗
PubMed1999

Haemodynamic effects of propofol vs thiopental in infants: an echocardiographic study.

Rapid i.v. induction of general anaesthesia is indicated in infants at risk of vomiting or regurgitation to reduce the risk of aspiration of gastric contents. Propofol is an alternative to thiopental in infants, and we have compared cardiovascular changes when propofol or thiopental was used for induction of anaesthesia in infants. Twenty infants, ASA I or II, aged 1-11 months, undergoing elective surgery were allocated randomly to receive either thiopental or propofol for i.v. induction. Cardiovascular and echocardiographic data were recorded in both groups before, during and for 5 min after induction of anaesthesia. Doses required to induce anaesthesia in each group were mean 10.3 (SD 0.9) mg kg-1 of thiopental and 6.1 (0.6) mg kg-1 of propofol. Thiopental did not alter significantly systolic or mean arterial pressure, afterload indices, rate-corrected velocity of circumferential fibre shortening or cardiac index, but decreased shortening fraction at 1 and 5 min after induction compared with awake values. Propofol did not alter heart rate, shortening fraction, rate-corrected velocity of circumferential fibre shortening or cardiac index at 1 and 5 min after i.v. induction compared with awake values. After induction, systolic and mean arterial pressures and afterload indices decreased more after induction with both agents, but did not become abnormal. Thus propofol decreased arterial pressure more than thiopental because of an effect on afterload. Cardiac output remained unchanged with both agents.

Anesthesia, General↗
PubMed1998

Cardiac output during liver transplantation.

PURPOSE: Measurement of cardiac output is an essential part of anaesthetic practice in patients undergoing major operative procedures. A thermodilution technique, using a pulmonary artery catheter is currently accepted as the gold standard in clinical practice. However its use is associated with several limitations. METHOD: In this prospective randomised controlled study measurement of cardiac output, an oesophageal Doppler monitor (ODM) was compared with the thermodilution technique in 18 patients undergoing orthotopic liver transplantation. Measurements were taken during the three phases of liver transplantation, i) dissection phase (three measurements), ii) anhepatic phase (four) and iii) reperfusion phase (six). RESULTS: There were no differences observed between the two measurements at any of the times studied and a strong correlation was observed (r = 0.714; P < 0.00001). However, when the data was analysed using Bland and Altman analysis, while the mean difference was small (0.07 l.min-1) it was > 2 l.min-1 in one third of measurements recorded i.e., the bias was near zero but the precision was large. No consistent differences were seen using the two methods in individual patients. CONCLUSION: The use of the ODM results in cardiac output measurements which are considerably different from those obtained using thermodilution and its use cannot be recommended in patients undergoing orthotopic liver transplantation.

Adult↗
PubMed1998

[Sever acute pulmonary edema after peri-anesthetic laryngospasm in a newborn infant].

Severe acute pulmonary oedema following peranaesthetic laryngospasm in a newborn. The authors report a case of severe acute pulmonary oedema secondary to a laryngeal spasm in a 3-week-old neonate, immediately after induction of anaesthesia with halothane. After emergency tracheal intubation, the infant experienced a severe, life-threatening pulmonary oedema requiring prolonged intensive care. Such a secondary time course is unusual. Usually pulmonary oedema has a favourable outcome after oxygen administration and maintenance of positive expiration pressure, except in the neonate.

Acute Disease↗
PubMed1998

[Postoperative pain. Particularities in the child of less than 5 years, neonatology excluded].

For many years, postoperative pain has been undertreated in children less than 5 years old in comparison to adults. The assessment of pain is indeed difficult in this range of age, and only the scales of hetero-evaluation are used. The guidelines for treatment are similar as in adults: systematic administration, balanced analgesia, evaluation of pain and potential adverse effects. Non opioid analgesics used are mainly paracetamol, niflumic acid and ibuprofen. Morphine remains the drug of choice among opioids; however the risk of respiratory depression in higher in infants less than 3 months old. Nalbuphine is also widely used in paediatrics. In addition, regional anaesthesia, either in single shot for minor surgery, or in continuous administration through epidural catheter for major surgery, has changed the management of postoperative pain in paediatrics.

Analgesia↗
PubMed1998

[Comparative hemodynamic effects of sevoflurane and halothane at tele-expiratory concentration in intubation of infants].

OBJECTIVE: To compare the cardiovascular changes at the end-tidal concentrations of sevoflurane versus halothane required for tracheal intubation in infants (intubation MAC). STUDY DESIGN: Prospective randomized study. PATIENTS: Thirty-two infants, ASA physical status 1 or 2, scheduled for elective surgery, randomized to receive either halothane or sevoflurane for anaesthetic induction by inhalation. METHODS: Cardiovascular and echocardiographic data were recorded in both groups at baseline, and at the end-tidal concentrations needed for intubation. RESULTS: Intubation MAC was significantly less with sevoflurane than with halothane in infants. Sevoflurane did not change heart rate (HR) and cardiac index (CI) compared to values when awake. Sevoflurane significantly decreased blood pressure, systemic vascular resistance (SVR) and shortening fraction (SF). Myocardial contractility assessed by stress-velocity index (SVI) and stress-shortening index (SSI) decreased significantly at the intubation MAC, but did not fall into the abnormal range. Halothane caused a greater decrease in HR, SF, SSI, and CI than sevoflurane. CONCLUSIONS: Sevoflurane decreases cardiac output less than halothane in infants at the intubation MAC, due to a lower end-tidal concentration at intubation MAC and to less effects on haemodynamic variables.

Anesthetics, Inhalation↗
PubMed1998

Transcutaneous CO2 tension effects of clonidine in paediatric caudal analgesia.

In adults, clonidine when added to bupivacaine, results in no detectable respiratory depressant effect except when carbon dioxide challenge is performed. However, to date no investigations have quantified this in children. Twenty-four children (nine months to seven years) were randomized in a double-blind study into two groups. After induction, a caudal block was performed with 1 ml.kg-1 0.25% bupivacaine. Clonidine 1 microgram.kg-1 was added in the clonidine group, and 1 ml normal saline in the placebo group. Patients were monitored in the recovery room for three h from arrival to discharge with continuous pulse oximetry, respiratory rate, a transcutaneous CO2 tension (tcPCO2) every 15 min, and a four point sedation score every 30 min. Mean tcPCO2 and respiratory rate values were not different between the two groups. Apnoea and desaturation less than 97% were not observed. The sedation score decreased with time in both groups, and the score time interval was significantly higher in the clonidine group (P < 0.05). All the patients left the recovery room with a sedation score of 1, excepting four in the clonidine group with a sedation score of 2. Clonidine 1 microgram.kg-1 with 0.25% bupivacaine mixture in caudal analgesia in children did not induce an increase in tcPCO2 despite prolonged sedation.

Adrenergic alpha-Agonists↗
PubMed1998

Gastric mucosal oxygen delivery decreases during cardiopulmonary bypass despite constant systemic oxygen delivery.

UNLABELLED: Previous studies report a decrease in gastric mucosal oxygen delivery during cardiopulmonary bypass (CPB). However, in these studies, CPB was associated with a reduction in systemic oxygen delivery (DO2). Conceivably, this decrease in DO2 could have contributed to the observed decrease in gastric mucosal oxygen delivery. Thus, in the present study, we assessed the effects of the maintenance of DO2 (at pre-CPB values) during hypothermic (30-32 degrees C) CPB on the gastric mucosal red blood cell flux (GMRBC flux) using laser Doppler flowmetry. In 11 patients requiring cardiac surgery, the pump flow rate during CPB was initially set at 2.4 L x min(-1) x m(-2) and was adjusted to maintain DO2 at pre-CPB values (flow 2.5-2.7 L x min[-1] x m[-2]). Despite a constant DO2, the GMRBC flux was decreased during CPB. These decreases averaged 50% +/- 16% after 10 min, 50% +/- 18% after 20 min, 49% +/- 21% after 30 min, and 49% +/- 19% after 40 min of CPB. The rewarming period was associated with an increase in GMRBC flux. Thus, maintaining systemic DO2 during CPB seems to be an ineffective strategy to improve gastric mucosal oxygen delivery. IMPLICATIONS: In the present study, we tested the hypothesis that gastric mucosal red blood cell flux assessed by laser Doppler flowmetry could be improved by maintaining baseline systemic flow and oxygen delivery during hypothermic cardiopulmonary bypass. Despite this strategy, gastric mucosal red blood cell flux decreased by 50% during hypothermic cardiopulmonary bypass.

Animals↗
PubMed1998

Respiratory effects of desflurane anesthesia on spontaneous ventilation in infants and children.

UNLABELLED: Volatile anesthetics depress spontaneous ventilation in a dose-dependent manner with variations in effects among different drugs. The goal of this prospective study was to assess respiratory changes during spontaneous ventilation using desflurane/O2/N2O anesthesia in two groups of children. Both groups were undergoing minor surgery and consisted of children < 2 yr old (Group I) and children > 2 yr old (Group II). They were examined at 0.5, 1, and 1.5 minimum alveolar anesthetic concentration desflurane anesthesia. Induction of anesthesia was performed via a face mask and a mixture of O2/N2O (40:60) with halothane. At lease 20 min after stopping halothane, the respiratory variables were recorded on desflurane anesthesia. Tidal volume and minute ventilation decreased significantly (P <0.05) as desflurane increased from 0.5 to 1.5 MAC in both groups. At 1.5 MAC, the respiratory rate was greater in Group II than in Group I (P <0.05). In both groups, the increase in end-tidal CO2 was significant at 1.5 MAC versus 1 and 0.5 MAC (P <0.05). Apnea, i.e., no respiratory movement for 20 s, occurred at 1.5 MAC in one patient in each group. The respiratory duty cycle did not change in any of the groups. Both indices of paradoxical respiration--amplitude index and delay index--did not change. IMPLICATIONS: Desflurane induces respiratory depression at concentrations higher than 1 minimum alveolar anesthetic concentration mainly due to a decrease in tidal volume. Therefore, desflurane at high concentrations should be used cautiously in infants and children with spontaneous ventilation.

Anesthesia, Inhalation↗
PubMed1998

Capillary refilling time and hemodynamics in neonates: a Doppler echocardiographic evaluation.

OBJECTIVE: To evaluate the correlation of the capillary refilling time measured in neonates with the hemodynamic parameters obtained by Doppler echocardiography. DESIGN: Prospective study. SETTING: Neonatal intensive care unit (ICU) in a university hospital. PATIENTS: Neonates without congenital cardiac disease admitted to the neonatal ICU (n = 100). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The clinical parameters obtained were: heart rate; blood pressure; mean airway pressure; cutaneous temperature; and capillary refilling time. The echocardiographic data included the measurement of aortic diameter, left atrial diameter, and shortening fraction. Pulsed-Doppler echocardiography was used to measure flow velocity values in the ascending aorta, in the pulmonary artery trunk, and in the patent ductus arteriosus. Cardiac index was calculated secondarily from the volumetric equation, including measured flow velocity in the ascending aorta, aortic diameter, and body weight. Shunt severity at this level was measured by analysis of the descending aortic flow. Thereafter, three groups were defined for analysis: group 1 with obliterated ductus arteriosus; group 2 with patent ductus arteriosus without a retrograde flow in the subdiaphragmatic aorta; and group 3 with patent ductus arteriosus and a retrograde flow in the subdiaphragmatic aorta. There was no correlation between the capillary refilling time and the following parameters: shortening fraction; mean airway pressure; body weight; left atrial diameter/ aortic diameter ratio; blood pressure; and heart rate. In group 1, the capillary refilling time was significantly linked to cardiac index (r2 = .54, p < .001). A lower correlation coefficient between capillary refilling time and cardiac index was found in groups 2 (r2 =.31, p < .001) and 3 (r2 =.41, p < .001). CONCLUSION: The capillary refilling time was significantly linked to cardiac index in neonates.

Aorta, Thoracic↗
PubMed1997

Venous air embolism during orthotopic liver transplantation in a child.

PURPOSE: A first case of massive venous air embolism is reported as a complication of orthotopic liver transplantation in a 17-month-old child during the dissection phase. CLINICAL FEATURES: During the hepatic dissection phase, perforation of suprahepatic veins was responsible for an air embolism with a decrease of P(ET)CO2 (27 to 6 mmHg), hypoxaemia (SpO2 decreased from 100 to 88%), and haemodynamic instability (systolic blood pressure decreased from 85 to 50 mmHg, central venous pressure increased from 6 to 10 mmHg). Central venous aspiration of air was unsuccessful but immediate resolution occurred and neurological outcome was normal. CONCLUSION: Venous air embolism during the dissection phase of liver transplantation in children is a risk that should be considered

Carbon Dioxide↗
PubMed1997

Monitoring orbicularis oculi predicts good intubating conditions after vecuronium in children.

PURPOSE: The aim of the study was to compare visual estimation of onset of neuromuscular blockade at both the adductor pollicis (AP) and the orbicularis oculi (OO) in children and to determine if monitoring the OO could predict good intubating conditions during vecuronium-induced neuromuscular blockade. METHODS: Thirty ASAI--II children (1.5-9 yr) were studied. Anaesthesia was induced with 6-8 mg.kg-1 thiopentone. The ulnar nerve at the wrist and the temporal branch of the facial nerve were stimulated every 10 sec using train-of-four (TOF) stimuli. Vecuronium, 0.15 mg.kg-1, was administered as a bolus. The responses at both the OO and the AP were evaluated visually. Patients were randomly divided into two groups. In the AP group (n = 15), the trachea was intubated when the AP was completely blocked. In the OO group (n = 15), intubation was performed when the OO was completely blocked. Intubating conditions were scored on a scale of 1 to 4. RESULTS: All the patients had complete blockade at both the orbicularis oculi and the adductor pollicis. In the two group, time from injection of vecuronium to complete neuromuscular blockade was shorter at the orbicularis oculi than at the adductor pollicis, 1.5 +/- 0.5 min vs 2.3 +/- 0.7 min, respectively, (P < 0.05; mean +/- SD) in the AP group, 1.7 +/- 0.3 min vs 2.3 +/- 0.8 min, respectively in the OO group (P < 0.05). Intubating conditions were excellent in all patient except one, where it was rated as good. They did not differ between groups. CONCLUSION: Following administration of 0.15 mg.kg-1 vecuronium in children, monitoring of the OO can detect good intubating conditions 0.7 min earlier than with monitoring of the AP.

Child↗