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Biomedical subjects

C Ecoffey

Publications and source records attributed to C Ecoffey.

At least 127 records · Page 7Linked to original sources
PubMed1990

[Continuous block of the femoral nerve after surgery of the knee: pharmacokinetics of bupivacaine].

Ten ASA Class 1 and 2 patients, aged from 16 to 56 years (mean +/- SD: 37 +/- 17 years), scheduled for knee surgery were studied. At the end of the surgical procedure under general anesthesia, an epidural catheter was inserted in the femoral space. After X-ray opacification, a bolus of 2.5 mg.kg-1 of 0.5% bupivacaine with epinephrine was injected. A maintenance infusion was performed during 48 hours with 0.25 mg.kg-1.h-1 of 0.125% bupivacaine without epinephrine. Pain score recorded with an visual analogue scale was 5.0 +/- 1.9 before femoral block. Pain score decreased significantly from 6 to 48 hours. Plasma bupivacaine levels at 24, 36 and 48 hours were significantly higher than the levels obtained at 30 min, 1, 6 and 12 hours. Mean plasma bupivacaine level at steady state was 1.78 +/- 0.59 micrograms.ml-1. Clearance of bupivacaine was 2.59 +/- 0.91 ml.min-1.kg-1. No neurologic complications have been recorded.

Adolescent↗
PubMed1990

[Locoregional anesthesia in ambulatory patients].

The use of regional anaesthesia in ambulatory patients is discussed. Five criteria for discharge are described: the four 'A's (Awake, Ambulation, Alimentation, Analgesia) and micturition. Recommended agents for additional sedation with the regional block, if required, are midazolam and fentanyl. These should be titrated in order to administer the minimal efficient dosage. The main techniques for regional anaesthesia of upper limb are intravenous regional anaesthesia, axillary and interscalenic brachial plexus blocks and for the lower limbs epidural and spinal blocks. However, urinary retention and orthostatic hypotension can occur. The risk of headache is not a contraindication for day-case surgery if some guidelines are followed. Penile blocks and caudal blocks are widely used in pediatric surgery.

Ambulatory Surgical Procedures↗
PubMed1990

Efficacy of an epidural test dose in children anesthetized with halothane.

The effect of an intravenous (iv) injection of lidocaine with epinephrine was studied to determine if such a test dose would cause a reliably detectable increase in heart rate and systemic blood pressure in children anesthetized with halothane and nitrous oxide. The effect of the injection of atropine before the test dose on these parameters was also determined. Sixty-five children 1 month to 11 yr of age and weighing 3.9-35 kg were studied. The children were assigned to one of four groups, each of which was anesthetized with 1% halothane and 50% nitrous oxide. Group 1 (n = 20) received 10 micrograms/kg atropine followed 5 min later by an iv dose of 0.1 ml/kg 1% lidocaine with 1/200,000 epinephrine (0.5 micrograms/kg) to simulate an intravascularly administered epidural test dose. Group 2 (n = 21) was identical to group 1 but did not receive atropine prior to the simulated intravascular test dose. Groups 3 (n = 12) and 4 (n = 11) were identical to groups 1 and 2, but the simulated intravascular test dose did not contain epinephrine: group 3 received atropine prior to the test dose and group 4 did not. The simulated intravascular test dose increased heart rate in group 1 (with atropine) at each time period from 15 to 120 s, but only at 45 and 60 s in group 2 (without atropine). Following the iv test dose, 6 of 21 children in group 2 had an increase in heart rate of less than 10 beats/min, while only one child in group 1 had an increase in heart rate of less than 10 beats/min. Intravenous test doses that did not contain epinephrine (groups 3 and 4) had no effect on heart rate or blood pressure. Atropine, 10 micrograms/kg, improves the reliability of an epidural test dose in children anesthetized with halothane and nitrous oxide but does not ensure total reliability in detecting an intravascular injection.

Anesthesia, Epidural↗
PubMed1990

Effects of age on plasma protein binding of sufentanil.

The plasma protein binding of sufentanil has been studied in newborns, infants (0.5 +/- 0.3 yr), children (6.8 +/- 3.0 yr), and adults (39.5 +/- 9.0 yr). Binding of sufentanil was determined in vitro by equilibrium dialysis, and radioactive tritiated sufentanil was used for the determination of drug concentrations in plasma and buffer. The free fraction of sufentanil was significantly higher in the newborn (19.5 +/- 2.7%; P less than 0.01) than in the other age groups. The free fraction was also significantly higher in infants (11.5 +/- 3.2%; P less than 0.01) than in children (8.1 +/- 1.4%) or in adults (7.8 +/- 1.5%) but did not differ significantly between children and adults. The free fraction of sufentanil was strongly correlated with the alpha 1-acid glycoprotein plasma concentration (r = -0.73; P less than 0.001) whereas it was weakly correlated with albumin plasma concentration (r = -0.35; P less than 0.05). These data suggest that the lower concentration of alpha 1-acid glycoprotein in newborns and infants probably accounts for the decrease in protein binding of sufentanil in these age groups when compared with that in older children or adults. The increased free fraction in the neonate might contribute to the enhanced effects of lipophilic opioids in the neonate.

Adult↗
PubMed1990

Neonatal patterns of breathing after cesarean section with or without epidural fentanyl.

The pattern of breathing and lung mechanics were evaluated during the first 7 h of life in full-term healthy newborns delivered by cesarean section with bupivacaine epidural anesthesia, without (group 1) or with the addition of 100 micrograms of fentanyl (group 2). Respiration and oxyhemoglobin saturation (SpO2) were measured with calibrated inductive plethysmography and pulse oximetry, respectively, and recorded from 60-420 min following birth. Compliance of respiratory system (CRS) was measured using a multiple occlusion technique at 60 and 420 min. Pattern of breathing was compared during period I (60-240 min) and II (240-420 min) with the following results: 1) the number of apnea spells was similar in both groups during both periods; 2) in both groups, from period I to period II a significant decrease in apnea duration was observed (7.6 +/- 0.7 s-4.1 +/- 0.5 s in group 1 and 6.7 +/- 1.2 s-5.1 +/- 1.0 s in group 2, respectively (P less than 0.05); 3) respiratory rate (RR) and minute ventilation (VE) were similar in both groups during both study periods; and 4) both RR and VE significantly decreased in the two groups from period I to period II (i.e., 59 +/- 5-46 +/- 2 breath per min-1 and 313 +/- 60-248 +/- 24 ml.kg-1.min-1 in group 1, and 60 +/- 2-51 +/- 1 breath.min-1 and 318 +/- 12-290 +/- 12 ml.kg-1.min-1 in group 2, respectively; P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Spinal opiates.

Explore the source record for details and available documents.

Analgesia, Epidural↗
PubMed1990

[Criteria of recovery from caudal anesthesia in children].

The authors evaluated the return of sensory, motor, and sympathetic nervous system function following caudal block in children. Twenty children, ASA PS I, aged 5 +/- 4 yr (mean +/- SD), weighing 22 +/- 9 kg, scheduled for lower abdominal and urologic surgical procedures were studied. Anaesthesia was induced and maintained by halothane, N2O and oxygen. A caudal block was performed with 1 ml/kg of 0.25% bupivacaine. Analgesia assessed by Broadman's score was efficient in 18 out of the 20 children during the first 4 hours after the block. Upper level of cutaneous analgesia was T10 +/- 2 after the block. Two hours after the caudal injection an incomplete motor blockade was found in 14 of 20 children, and at 4 hours no block was found in any child. Heart rate was significantly increased in the upright position (122 +/- 12 to 131 +/- 26 bpm at 2 hours, and 110 +/- 21 to 118 +/- 28 bpm at 4 hours), whereas arterial blood pressure was unchanged in the upright position.

Ambulatory Surgical Procedures↗
PubMed1989

Ventilatory response to CO2 following intravenous ketamine in children.

The effects of intravenous ketamine (bolus of 2 mg.kg-1 followed by a continuous infusion at a rate of 40 micrograms.kg-1.min-1) on ventilatory response to carbon dioxide were studied in nine children ranging in age from 6 to 10 yr and in weight from 20 to 48 kg. Ketamine did not affect resting respiratory rate, tidal volume, end-tidal CO2 tension (PETCO2), or minute ventilation. Five minutes after the ketamine bolus, the slope VE/PETCO2 decreased significantly (P less than 0.05) from 1.71 +/- 0.47 to 1.05 +/- 0.23 1.min-1.mmHg-1 (mean +/- SD). After 30 min of continuous iv ketamine infusion, the slope returned to 1.65 +/- 0.44 1.min-1.mmHg-1, a significantly higher value (P less than 0.05) compared with the nadir and not significantly different from control. The minute ventilation at a PETCO2 of 60 mmHg decreased from 824 +/- 98 to 626 +/- 26 ml.kg-1.min-1 5 min after iv ketamine, and remained depressed (640 +/- 125 ml.kg-1.min-1 P less than 0.05) throughout the 30-min ketamine infusion. In addition, the slope VT/PETCO2 and the VT 60 did not change during the study; nonetheless, the slope f/PETCO2 and the f 60 decreased significantly following iv bolus ketamine, and the f 60 remained significantly decreased following ketamine infusion. The authors conclude that clinically useful doses of iv ketamine significantly alter ventilatory control in children.

Analysis of Variance↗
PubMed1989

Spread of analgesia and ventilatory response to carbon dioxide following epidural somatostatin.

The effects of somatostatin, injected into the epidural space, on analgesia and control of ventilation were studied in 25 patients aged 41 +/- 9 yrs (mean +/- SD). The patients were allocated to three groups to receive: Group I--1 mg of somatostatin in 2 ml saline (n = 13); Group II--1 mg of somatostatin in 10 ml saline (n = 6); and Group III--somatostatin in a loading dose of 250 micrograms followed by an infusion of 125 micrograms h-1 (n = 6). Segmental cutaneous analgesia, assessed by pinprick, without loss of thermal sensibility or motor blockade was found in all patients. Onset times and durations of analgesia were 15 +/- 2 min and 69 +/- 19 min (mean +/- SD) in Group I and 14 +/- 2 min and 68 +/- 11 min in Group II. The extent of dermatome analgesia at 30 min and 60 min after somatostatin injection, respectively, was: T6 +/- 2 to T12 +/- 1, T4 +/- 2 to L1 +/- 2 in Group I, and T7 +/- 3 to L1 +/- 3, T3 +/- 1 to T12 +/- 2 in Group II. Continuous analgesia with onset of 16 +/- 2 min and extending from T7 +/- 1 to T12 +/- 1 was observed in Group III. No side-effects were observed. The control of ventilation studies in eight patients in Group I by the Read's rebreathing method did not show any significant change.

Adult↗