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C Ecoffey

Publications and source records attributed to C Ecoffey.

At least 91 records · Page 5Linked to original sources
PubMed1995

Spontaneous ventilation with halothane in children. A comparative study between endotracheal tube and laryngeal mask airway.

BACKGROUND: It has been reported that, in children breathing spontaneously via an endotracheal tube, halothane depresses ventilation with paradoxic inspiratory movement. Endotracheal tubes have a higher airflow resistance than do laryngeal mask airways (LMAs). Therefore, the aim of this study was to compare spontaneous ventilation via the LMA with that via the endotracheal tube in children anesthetized with halothane. METHODS: The authors studied two groups of 6-24-month-old children with no cardiorespiratory and neurologic disorders, undergoing elective minor surgery with halothane anesthesia: one group breathing via LMA (n = 10) and one group breathing via endotracheal tube (n = 10). They measured tidal volume, respiratory rate, minute ventilation, and end-tidal CO2. They assessed paradoxic inspiratory movement using amplitude index and phase delay index. RESULTS: Age and weight were similar in both groups. Mean +/- SD tidal volume (7.5 +/- 1.9 ml/kg in the LMA group vs. 5.3 +/- 1.1 ml/kg in the endotracheal tube group; P < 0.05) and minute ventilation (325 +/- 105 ml.min-1.kg-1 in the LMA group vs. 246 +/- 38 ml.min-1.kg-1 in the endotracheal tube group; P < 0.05) were lower in the endotracheal tube group. The phase delay index (18 +/- 11% in the LMA group vs. 41 +/- 19% in the endotracheal tube group; P < 0.05) and the amplitude index (25 +/- 43% in the LMA group vs. 74 +/- 72% in the endotracheal tube group; P < 0.05) were significantly smaller with the LMA than with the endotracheal tube. CONCLUSIONS: In 6-24-month-old children anesthetized with halothane, paradoxic inspiratory movement is less when breathing through an LMA than through an endotracheal tube.

Anesthetics, Inhalation↗
PubMed1995

[Arguments for conduction anesthesia in children].

Regional anaesthesia is more and more popular in pediatrics. Many arguments plead for its use. The efficient diffusion of local anaesthetics through the nerve roots sheet and the epidural space improves success in children. The lack of deleterious haemodynamic effect of sympathetic block following spinal and epidural blocks is a factor for their use. So is the quality of intra- and postoperative analgesia. In addition, the few number of complications is also an advantage of regional blocks in children.

Age Factors↗
PubMed1994

Clonidine in pediatric caudal anesthesia.

Extradural clonidine produces analgesia in adults. To assess its efficacy in children, we randomized 45 pediatric patients aged 1-7 yr presenting for a subumbilical surgery into three groups of 15 each. After halothane and N2O/O2 induction, and with a double-blind protocol, caudal anesthesia was performed with 1 mL/kg of 0.25% bupivacaine. Epinephrine 1/200,000 was added in one group (EG), 1 microgram/kg of clonidine in another group (CG), and no additional medication in the last group (BG). Postoperative analgesia was evaluated using the Broadman "objective pain/discomfort scale" (OPS) at 1-h intervals until the first analgesic administration. There were no differences among the groups in age, weight, duration of surgery, baseline systolic arterial pressure, and heart rate. The mean (+/- SD) duration of analgesia was longer in the CG (987 +/- 573 min) than in the EG (377 +/- 341 min) and BG (460 +/- 439 min); P < 0.01. The maximal OPS scores were lower in the CG than in the EG and BG (2.3 +/- 1.6 vs 3.4 +/- 1.4 and 3.4 +/- 1.8, respectively; P < 0.05). More patients in the CG (n = 7) than in the EG (n = 1) and BG (n = 2) required no postoperative analgesia; P < 0.05. No differences were found among the groups for the minimal respiratory rate and minimal Spo2 values in the postoperative phase, and there were no differences among the groups for heart rate and systolic arterial pressure during the 3 h after caudal anesthesia. We conclude that the duration of postoperative analgesia with caudal bupivacaine was significantly increased by the addition of 1 microgram/kg of clonidine.

Anesthesia, Caudal↗
PubMed1994

Preoperative analgesia with epidural morphine.

In a prospective double-blind study, we examined the effects of preoperative epidural morphine associated with general anesthesia (GA) on intra- and postoperative analgesic requirements over a 3-day postoperative period. Twenty patients scheduled for major intraabdominal surgery were randomly assigned to two groups: a control group (n = 10) and an epidural group (n = 10) which received an epidural injection of 5 mg of preservative-free morphine in 10 mL of 0.9% saline. Afterward, both groups received the same GA. Postoperative pain relief was achieved with intravenous (IV) boluses of morphine using a patient-controlled analgesia device. We found smaller opioid requirements in the epidural group than in the control group for intraoperative fentanyl (465 +/- 179 micrograms vs 983 +/- 682 micrograms), for postoperative morphine at 12 h (3.1 +/- 3 mg vs 21.4 +/- 13.8 mg) and 24 h (9.1 +/- 6.4 mg vs 20.6 +/- 9.8 mg), and for the cumulated needs over the 3-day postoperative period (37 +/- 24 mg vs 86 +/- 42 mg). The consumption of IV morphine by the control group decreased over time (P < 0.001, r = 0.44), whereas, in the epidural group, consumption remained constant and small during the 3 days. The maximum pain score was significantly lower in the epidural group than in the control group at 24 h (0.65 +/- 2.4 vs 3 +/- 2), at 36 h (0.3 +/- 0.6 vs 3 +/- 2.7), and at 60 h (0.1 +/- 0.3 vs 1.8 +/- 1.2) after surgery. These results suggest that a single epidural injection of 5 mg of morphine before major surgery produces intra- and postoperative pain relief for at least 3 days.

Adult↗
PubMed1994

Pharmacokinetics of rocuronium bromide in paediatric patients.

Rocuronium 0.8 mg kg-1 was given to 22 children between the ages of 3 months and 8 years during anaesthesia with N2O/O2, 60:40, and halothane. Blood samples were collected for 360 min for determination of rocuronium concentrations. The pharmacokinetics were best described by a two-compartment model. Two models were fitted, one proportional to weight and the other adjusted for age. Using the first model, volumes and clearances were all proportional to weight: in the second model, only the volume of the second compartment and clearance from the central compartment were proportional to age. The results do not support the use of body surface area, rather than weight for the calculation of paediatric doses of rocuronium. In this study, the volume of the central compartment was larger than the figure obtained in an adult population.

Androstanols↗
PubMed1994

Whole body oxygen uptake is not a good indicator of liver allograft function following orthotopic liver transplantation.

Variations of whole body oxygen uptake (VO2) have been studied during orthotopic liver transplantation. Some authors have suggested that the increase in VO2 after revascularization of the graft could be an index of good function of the grafted liver and thus low VO2 an early sign of primary non-function. The purpose of our study was to assess the temporal course of measured respiratory VO2 and to compare the VO2 changes to indicators of hepatic function. We used a metabolic monitor (Deltatrac, Datex Corp. Finland) to measure VO2 in 18 patients during transplantation. Clotting factors II and V at 1, 3, 7, 14 and 21 days post-operatively and peak serum transaminases within the first 3 post-operative days were determined. Variations of VO2 were a decrease during the anhepatic phase and an increase following the reperfusion phase as compared to the VO2 value obtained at the beginning of the procedure. No correlation was found between the increase in VO2 after reperfusion of the graft and either factor II (r = 0.33-0.4), factor V (r = 0.23-0.43) or peak transaminases (r = 0.13). One patient developed a primary non-function of the graft. For this patient VO2 increased far above the pre-anhepatic values. The authors conclude that VO2 is not a reliable sign of graft function.

Adolescent↗
PubMed1993

[Respiratory response to carbon dioxide after brachial plexus block with fentanyl and lidocaine].

Respiratory parameters, ventilatory response to carbon dioxide and quality of anaesthesia were studied in patients undergoing upper limb surgery under axillary blockade. Thirteen patients were randomly assigned to two groups, group A (n = 6), who were given 35 ml of 1.5% lidocaine with 1 in 200,000 of adrenaline, and group B (n = 7), who received 1 microgram.kg-1 of fentanyl with the same dose of lidocaine. Quality of the sympathetic, sensory and motor blocks were tested at 15 min (T1) and 45 min (T2) after the injection (T0). The other parameters measured at these three times, both with the patient in a half-sitting position breathing room air, and after a rebreathing test with CO2 through Read's circuit, were respiratory rate (FR), tidal volume (VT), minute ventilation (VE), and PetCO2. Fentanyl provided a better sensory and motor blockade at T1, without any difference in sympathetic blockade. The quality of the blocks was similar in both groups at T2. There were no significant differences in the respiratory parameters between the two groups. Moreover, there was no untoward effect due to fentanyl (nausea, pruritus). It is concluded that 1 microgram.kg-1 fentanyl added to a local anaesthetic solution may be useful, at least during the first hour of an axillary block, without any respiratory side-effects.

Adult↗
PubMed1993

[Massive pulmonary embolism caused by thrombosis formed on a central catheter in a child].

A case is reported of a 9-year-old girl admitted with a subarachnoid haemorrhage. Her neurological recovery was favourable after the embolization of a cerebral arterio-venous malformation. She stayed in ICU with mechanical ventilation because of a bacterial pneumonia and a post-extubation laryngeal oedema. She required insertion of a polyurethane subclavian catheter, as a peripheral venous access was not available. Five days later, the child suffered a sudden respiratory distress without changes of the electrocardiogram and the chest X-ray. The diagnosis of pulmonary embolism was suspected because of the presence of the central venous catheter, a catheter dysfunction and a superior vena cava syndrome. A catheter tip thrombus was shown by angiography as well as a thrombus in the pulmonary artery, a 90% obstruction of the proximal valvular tree of the right lung, a 10 to 15% distal obstruction in the left lung, a complete obstruction of the superior vena cava (SCV). The thrombolytic therapy was contra-indicated in this case because of the neurological pathology. Heparin was given by continuous intravenous infusion. When heparin concentration was at an appropriate level, the catheter was removed. Its microbiological culture remained negative. The next day, another angiography showed a partial permeability of the SVC and a better right pulmonary perfusion. During this procedure, the haemodynamic assessment showed only moderate abnormalities. Therefore the surgical treatment was not indicated and the heparin continued. The child recovered gradually with a normalization of the lung scintigraphy.

Catheterization, Central Venous↗
PubMed1993

Ventilation and thoracoabdominal asynchrony during halothane anesthesia in infants.

To evaluate the ventilatory consequences of high chest wall compliance during anesthesia in infants, we assessed the effects of halothane at different fractions of minimal alveolar concentration (0.75, 1.0, and 1.5 MAC) on ventilation and movements of the rib cage and abdomen in infants < or = 12 mo of age (group I) and children (group II) > or = 12 mo of age. Minute ventilation decreased in group I, (20.6%, 0.75 to 1.5 MAC), but the change in group II did not reach the level of statistical significance. Tidal volume decreased with halothane level between 0.75 and 1.5 MAC, and its fall was greater in group I (32.7 +/- 11.2 vs. 22.6 +/- 9.3% in group II, P < 0.05). Duty cycle, or ratio of inspiratory to total time (TI/TT), increased in group II with halothane level but did not change in group I, resulting in a decreased TI in group I at higher halothane levels. Thoracic paradox increased with halothane level in group I but not group II. The increase in thoracic paradox in association with the fall in tidal volume between 0.75 and 1.5 MAC was greater in group I than group II (P < 0.05). We conclude that smaller infants depend more on inspiratory intercostal muscle activity to stabilize the thorax, leading to a greater degree of depression of ventilation during halothane depression of inspiratory intercostal activity.

Abdominal Muscles↗
PubMed1993

Complications and fiberoptic assessment of size 1 laryngeal mask airway.

In pediatric practice, complications due to the laryngeal mask airway (LMA) have been studied with size 2 LMA, but not with size 1 LMA. We, therefore, compared prospectively the complications induced by LMA size 1 and 2 in 141 children aged 21 days to 11 yr. Intraoperative and lowest SpO2 values after removal of LMA were recorded. The following complications were recorded: cough, laryngospasm, bronchospasm, apnea, and airway obstruction. In 14 patients in the size 1 LMA group and 26 patients in the size 2 LMA group, pharyngolaryngeal structures were checked with fiberoptic examination. The number of attempts, complications, intraoperative SpO2, and lowest SpO2 values were similar when using size 1 and size 2 LMA. Fiberoptic examination of size 1 LMA showed a high incidence of impinging of the epiglottis in the LMA bars without airway obstruction. In conclusion, there was no difference in the complication rate between the two pediatric sizes of LMA when used in pediatric patients.

Airway Obstruction↗
PubMed1993

[The role of ambulatory locoregional anesthesia].

The use of regional anaesthesia in day care practice is discussed. Five criteria of discharge are described: the four "A"s: awake, ambulation, alimentation, analgesia plus micturition. Complementary sedation with the regional block, if needed, should be midazolam and fentanyl. These drugs should be titrated in order to administer the efficient minimal dosage. The main techniques of regional anaesthesia are as follows: for upper limbs, intravenous regional anaesthesia, axillary and interscalenic brachial plexus blocks; for the lower limbs epidural and spinal blocks. However, urinary retention and orthostatic hypotension can occur. Furthermore the risk of headache is not a contraindication to an ambulatory practice if some guidelines are observed. In addition, penile blocks and caudal blocks are widely used in pediatrics.

Ambulatory Surgical Procedures↗
PubMed1992

Continuous monitoring of mixed venous oxygen saturation during orthotopic liver transplantation.

Hemodynamic management is an important issue concerning anesthesia for orthotopic liver transplantation (OLT). Mixed venous oxygen saturation (SvO2) is considered a good index of tissue oxygenation, but controversy exists about the usefulness of monitoring this parameter in different types of surgery. Therefore, a prospective study was performed to determine changes in SvO2 during OLT and to study the correlation between SvO2 and hemodynamic measurements. Thirty patients undergoing transplantation for end-stage liver disease were divided into two groups: group 1 (n = 15, aged 42 +/- 11 years [mean +/- SD]) without venovenous bypass (VVB), and group 2 (n = 15, aged 43 +/- 10 years) with VVB. SvO2 was greater than 74% throughout the procedure and remained stable during dissection and the anhepatic phase. There was a significant increase in SvO2 after unclamping the portal vein in group 1, whereas a significant decrease was observed during the first hour following reperfusion in group 2. There was no correlation among SvO2 and oxygen consumption, arterial oxygen saturation, (SaO2), or hemoglobin concentrations. A statistically significant correlation was found between SvO2 and cardiac index in both groups (group 1: r = 0.58, P = 0.01; group 2: r = 0.51, P = 0.01), but the correlation was relatively poor. Continuous monitoring of SvO2 may be useful, but cannot substitute for intermittent determinations of other hemodynamic or oxygenation parameters.

Adult↗