Search PubMed⌕ Search

Biomedical subjects

C Ecoffey

Publications and source records attributed to C Ecoffey.

At least 145 records · Page 8Linked to original sources
PubMed1988

[Multiple laryngotracheal block for the biopsy of the base of the tongue and of the piriform sinuses during laryngoscopy].

Most laryngoscopies with diagnostic biopsies are usually carried out under general anaesthesia. Multiple laryngotracheal blocks were used in the patient reported; this 55 year old man presented with cachexia and a history of severe angina, myocardial infarction, arterial hypertension and chronic bronchitis. The different nerve blocks were carried out with a total of 2 mg.kg-1 lignocaine: the superior laryngeal nerve trunk, the internal laryngeal nerve, the trachea (by an intratracheal injection) and the tongue (using a lignocaine gel). The whole procedure was well tolerated by the patient. The advantages and disadvantages of this technique are discussed.

Biopsy↗
PubMed1988

Analgesia and ventilatory response to carbon dioxide after intramuscular and epidural alfentanil.

The analgesic and ventilatory depressant effects of epidural and intramuscular alfentanil (15 micrograms/kg) were compared in two groups of seven healthy unpremedicated subjects. Fifteen minutes after IM injection, the slope of the ventilatory response to CO2 decreased significantly (from 2.72 +/- 0.34 to 1.8 +/- 0.20 L.min-1.mmHg-1) while assessment of periosteal analgesia showed no change. After epidural injection, the slope of the ventilatory response to CO2 decreased significantly (from 2.32 +/- 0.42 to 1.61 +/- 0.29, 1.51 +/- 0.29, and 1.53 +/- 0.21 L.min-1.mm Hg-1) at 15, 45, and 90 minutes (x +/- SD, P less than 0.05), and there was significant periosteal analgesia of the tibia (15 and 30 minutes after injection) and of the radius (30 to 90 minutes after injection). Throughout the study, plasma alfentanil levels were similar after intramuscular and epidural injection. These results suggest that epidural alfentanil induces ventilatory depression due to the rostral spread of the drug rather than to systemic absorption.

Adult↗
PubMed1987

Bacterial cholangitis after surgery for biliary atresia.

We retrospectively studied the incidence of bacterial cholangitis in 129 infants operated on because of biliary atresia over 5 years. Forty-six of the 101 children who underwent hepatic portoenterostomy had a total of 105 episodes of cholangitis (range one to eight episodes per child). Most episodes occurred within 3 months of the operation. Factors associated with cholangitis included good or partial restoration of bile flow, abnormal intrahepatic bile ducts or cavities at the porta hepatis, and routine postoperative use of antibiotics. External jejunostomy was not effective in preventing cholangitis. In addition to fever and decreased bile flow, increased erythrocyte sedimentation rate and signs of shock were frequently observed. The responsible organisms, most often gram-negative bacteria, were identified in 79 (75%) episodes by blood or liver cultures. Most were susceptible to trimethoprim-sulfamethoxazole and third-generation cephalosporins during the first episode, but only to cephalosporins during later episodes. The incidence of signs of portal hypertension in children with normal serum bilirubin values at age 5 years was not higher in those who had previously experienced one or more episodes of cholangitis.

Biliary Atresia↗
PubMed1987

High frequency jet ventilation: the influence of different methods of injection on respiratory parameters.

Fourteen critically ill patients with ventilatory failure were ventilated with HFJV using a constant driving pressure of 3 atm and a constant I:E ratio of 0.43. In six (group I) HFJV, using a frequency of 100 b.p.m., was delivered via a proximal injector cannula. Four injector cannulae (i.d. 1.8, 1.6, 1.4 and 1.2 mm, respectively) were used at random. In eight patients (group II), HFJV using three frequencies (100, 300 and 600 b.p.m.) was administered either via a 1.8-mm i.d. proximal injector cannula (proximal injection), for via a Hi-Lo jet tracheal tube (distal injection). The following indices were measured in vivo: mean airway pressure (Paw), mean pulmonary volume above apnoeic FRC (delta V), mean alveolar pressure (clamps method) and arterial blood-gas tensions. Injected volume (Vinj), entrainment (E) and tidal volume (VT) were measured in vitro using a water-sealed spirometer. Operating pressure (the pressure in the connecting tube) was measured directly using a high pressure calibrated transducer. In group I, Paw, delta V, PaO2, Vinj and VT significantly decreased whereas operating pressure and E significantly increased when the internal diameter of the injector cannula was reduced. In group II, Paw, delta V, E, VT and operating pressure significantly decreased, whereas Vinj increased and PaO2 and PaCO2 remained unchanged, when proximal injection was switched to distal injection. In both groups, a significant relationship was found between operating pressure and E. At a constant driving pressure, operating pressure increased with narrow injector cannulae and increased frequency, and decreased when proximal injection was switched for distal injection.

Adolescent↗
PubMed1987

Pulsed Doppler ascending aortic, carotid, brachial, and femoral artery blood flows during caudal anesthesia in infants.

Hemodynamic effects of caudal bupivacaine anesthesia were studied in eight infants 6.5 +/- 0.5 months old (mean +/- SD), weighing 7.4 +/- 4.4 kg anesthetized with halothane 0.2% end-tidal and 60% nitrous oxide. Heart rate and systolic, diastolic, and mean arterial pressure remained unchanged. Cardiac index and stroke index assessed by pulsed Doppler and total vascular resistances were not altered by the caudal block. However, after caudal anesthesia, the authors observed a significant decrease (P less than 0.05) in brachial blood flow assessed by pulsed Doppler (from 49.0 +/- 28.3 to 31.7 +/- 24.6 ml-1.min) and a significant increase (P less than 0.05) in brachial vascular resistance (from 2.9 +/- 1.7 to 5.5 +/- 1.0 mmHg.min.ml-1). Blood flow and vascular resistance in both the femoral and carotid arteries did not change. This study suggests that, in supine position, caudal anesthesia in infants induces a blood pooling in the denervated lower extremities and a reflex vasoconstriction in innervated areas which maintains cardiac output. We conclude that volume loading is not necessary in normovolemic infants after caudal anesthesia with cutaneous analgesia below T5.

Anesthesia, Caudal↗
PubMed1987

Analgesia and ventilatory response to CO2 following epidural sufentanil in children.

The authors studied the effects of epidural sufentanil (0.75 microgram.kg-1) after urologic surgery in 15 children ranging in age from 4 to 12 yr, and in weight from 14 to 47 kg. The onset and duration of analgesia were 3.0 +/- 0.3 and 198 +/- 19 min, respectively (mean +/- SEM). Side effects included pruritus (3/15), nausea and vomiting (5/15), drowsiness (10/15), and urinary retention (1/11). No apnea was observed. Periosteal analgesia and ventilation were studied in eight of the children (mean age 8.6 +/- 0.8 yr). There was significant periosteal analgesia of the tibia (30, 60, 90, and 120 min after injection) and of the radius (60, 90, and 120 min after injection). Resting respiratory rate and tidal volume did not change during the study. Resting minute-ventilation decreased from 6.3 +/- 0.5 l.min-1 preoperatively to 5.6 +/- 0.6 l.min-1 (P less than 0.05) postoperatively, before epidural sufentanil injection; it did not decrease further after epidural sufentanil. Similarly, end-tidal CO2 tension increased significantly from 37.2 +/- 0.7 mmHg preoperatively to 39.9 +/- 1.2 mmHg (P less than 0.05) postoperatively, before epidural sufentanil; epidural sufentanil did not cause a further significant increase in end-tidal CO2 tension. The slope of the CO2 ventilatory response curve decreased significantly from 1.68 +/- 0.12 l.min-1. mmHg-1 preoperatively to 1.10 +/- 0.13 l.min-1.mmHg-1 (P less than 0.01) postoperatively. There were further significant decreases to 0.68 +/- 0.10 and 0.89 +/- 0.16 l.min-1.mmHg-1 30 and 60 min after epidural sufentanil.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesics, Opioid↗
PubMed1987

Ventilatory response to carbon dioxide after intramuscular and epidural fentanyl.

The authors compared the effects of administration of fentanyl 200 micrograms on the ventilatory response to carbon dioxide in two groups of nine healthy unpremedicated subjects: one group received fentanyl as an intramuscular injection; in the other group, fentanyl was injected into the epidural space. In the intramuscular group, the slope of the ventilatory response to CO2 did not decrease significantly. In the epidural group, the slope of the ventilatory response to CO2 decreased significantly from 2.48 +/- 1.05 to 1.77 +/- 0.7, 1.74 +/- 0.7, and 2.07 +/- 0.74 L X min-1 X mm Hg-1 at 30, 60, and 120 min after injection (chi +/- SD, P less than or equal to 0.05), respectively. At each time of the study, plasma fentanyl levels were significantly lower in the epidural group than in the intramuscular group (P less than or equal to 0.05). These results suggest that epidural fentanyl induces a nonsystemic ventilatory depression that may be due to the rostral spread of the drug.

Adult↗
PubMed1986

Epidural morphine in children: pharmacokinetics and CO2 sensitivity.

The effects of epidural morphine (50 micrograms X kg-1) after abdominal and urologic surgery were studied in 20 children ranging in age from 2 to 15 yr and weighing between 9 and 54 kg. The onset and the duration of analgesia were 30 +/- 12 min and 19.5 +/- 8 h, respectively (mean +/- SD). Side effects were pruritus (4/20), nausea and vomiting (8/20), and urinary retention (4/14). No apnea was observed. Ventilation control was studied in seven children. No significant change in resting respiratory variables occurred after both surgery and epidural morphine injection. However, the slope of the ventilatory response to CO2 was significantly (P less than 0.05) decreased after surgery but before morphine, as compared with its preoperative control value (0.84 +/- 0.44 versus 1.51 +/- 0.72 l X min-1 X mmHg-1), and remained low for 22 h after epidural morphine (0.90 +/- 0.57 l X min-1 X mmHg-1). Sixty minutes after morphine injection, the plasma morphine concentration was always less than 12 ng X ml-1 in the seven children studied. Pharmacokinetic parameters were similar to those observed after epidural injection of morphine in adults, except for a shorter terminal half-life (73.8 +/- 41.6 min) attributed to a greater total body clearance of morphine in the children (28.3 +/- 3.4 ml X min-1 X kg-1). It is concluded that epidural morphine provides effective and prolonged analgesia in children after abdominal and urologic surgery and that it is associated with prolonged respiratory depression that requires close monitoring for at least 24 h.

Adolescent↗
PubMed1985

Effects of epidural anesthesia on catecholamines, renin activity, and vasopressin changes induced by tilt in elderly men.

Mean arterial pressure, heart rate, plasma catecholamines, renin activity, and vasopressin changes induced by a 30-degree head-up tilt were studied before and during epidural anesthesia with bupivacaine in eight elderly patients (ages 58-82 yr). The tilt performed before epidural anesthesia did not modify mean arterial pressure, heart rate, plasma catecholamines, renin activity, and vasopressin at 5 and 15 min. During epidural anesthesia, the superior level of analgesia ranged from T4 to T10. Epidural anesthesia induced significant (P less than 0.05) decreases from control values in mean arterial pressure and plasma norepinephrine (from 85 +/- 6 to 67 +/- 8 mmHg and from 600 +/- 108 to 307 +/- 77 pg/ml, respectively, mean +/- SEM) without significant changes in heart rate, plasma epinephrine, renin activity, and vasopressin. However 5 and 15 min after tilt, significant decreases from pretilt values were measured in mean arterial pressure (from 67 +/- 8 to 57 +/- 6 and 55 +/- 6 mmHg, respectively) and in heart rate (from 70 +/- 8 to 63 +/- 7 and 62 +/- 7 beats/min). Simultaneously, an increase in plasma vasopressin (from 14.8 +/- 5.5 to 36.2 +/- 10.3 and 40.0 +/- 10.5 pg/ml) was recorded, whereas plasma norepinephrine and epinephrine remained unchanged. Posttilt plasma renin activity values at 5 and 15 min were increased significantly when compared with the preepidural values (2,752 +/- 1,168, 2,410 +/- 1,214 and 713 +/- 190 pg X ml-1 X h-1, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

Ventilatory response to CO2 following intravenous and epidural lidocaine.

The authors determined the effects of intravenous infusion and epidural administration of lidocaine on the control of ventilation in two groups of eight healthy unpremedicated subjects. In the intravenous group, an injection of 1.5 mg/kg lidocaine was followed by an infusion at a rate of 60 micrograms X kg-1 X min-1 for 30 min. The slope of the ventilatory response to CO2 was significantly increased (P less than 0.05) from its control value (2.65 +/- 1.22 1 X min-1 X mmHg-1 [mean +/- SD]) at the end of the infusion (58%), while plasma lidocaine level was at 3.14 +/- 0.82 microgram/ml. The correlation between individual plasma lidocaine levels and the changes in the slope of the ventilatory response to CO2 was significant (r = 0.58, n = 24, P less than 0.01). In the epidural group, after the administration of 5 mg/kg of lidocaine, the slope of the ventilatory response to CO2 increased significantly (P less than 0.05) from its control value (1.52 +/- 0.75 1 X min-1 X mmHg-1) at 15 (+22%) and 25 min (+42%), while plasma lidocaine levels were at 1.79 +/- 0.42 and 2.22 +/- 0.47 microgram/ml, respectively. In both groups, resting minute ventilation and end-tidal CO2 values remained unchanged. These results suggest that epidural lidocaine has a stimulating effect on the ventilatory control mechanisms that results from the systemic effect of the drug.

Adult↗
PubMed1985

[Caudal anesthesia in children: two-year retrospective study].

Caudal anesthesia has been used on a daily basis for two years in the Department of Anesthesia of Saint-Vincent-de-Paul Hospital. A retrospective study on 231 children was done to specify the procedures, the indication and the dosage of local anesthetics.

Anesthesia, Caudal↗
PubMed1984

Pharmacokinetics of lignocaine in children following caudal anaesthesia.

The time course of the plasma lignocaine concentration, following caudal anaesthesia, was studied in 11 healthy children (3.5-9 yr). Plasma lignocaine concentrations were measured for up to 6 h after administration (5 mg kg-1). Peak plasma concentration was 2.05 +/- 0.08 micrograms ml-1 and occurred at 28.2 +/- 2.9 min after administration. Pharmacokinetic parameters determined from a two-compartmental model were similar to those observed after the i.v. or extradural administration of lignocaine in adults, except for a longer half-life of elimination (155 +/- 32 min). Since the total body clearance of lignocaine was similar in children (15.4 +/- 1.2 ml min-1 kg-1) to that in adults, the longer half-life of elimination was attributed to a larger volume of distribution in the children (3.05 +/- 0.40 litre kg-1).

Anesthesia, Caudal↗