Search PubMed⌕ Search

Biomedical subjects

D Benhamou

Publications and source records attributed to D Benhamou.

At least 37 records · Page 2Linked to original sources
PubMed2005

[Prophylaxis of thromboembolic complications in obstetrics and gynaecology].

Venous thromboembolism is a leading cause of maternal mortality in many countries, including France. Most enquiries have repeatedly demonstrated that many deaths could be avoided, suggesting the need to update and ensure a wider diffusion of recommendations. Although thromboembolism-induced maternal death plays a major role, the absolute incidence of events remains low, reducing the ability to perform well-designed research and the level of recommendations presented. Many personal or pregnancy-related factors have been identified as increasing the risk of thromboembolism in pregnant patients but few of them have been associated with a significantly increased risk. A history of thromboembolic event and some thrombophilic factors (including antithrombin deficiency and antiphospholipid syndrome) carry the greatest risk. Pregnancy itself, caesarean delivery and the postpartum period, although associated with an increased risk play a minor role when not combined with other risk factors. Prophylactic treatment relies mainly on low molecular weight heparins which safety is now well established in pregnant patients. Dose and duration of treatment should be adapted to the perceived level of risk. The occurrence of a thromboembolic event is also increased after gynaecological surgery but major and cancer surgery carry the greatest risk. Here also, low molecular weight heparins play a leading role, although non pharmacologic means are useful. Dose and duration should be dependent on the level of risk.

Adult↗
PubMed2005

[Staphylococcus aureus: role and impact in the treatment of nosocomial pneumonia].

INTRODUCTION: Staphylococcus aureus (SA) has acquired a leading role in nosocomial pneumonia in terms of both frequency and severity, and poses therapeutic problems, namely antibiotic resistance and difficulties in the management of anti-staphylococcal drugs. STATE OF THE ART: Epidemiological data confirm that SA is implicated in almost a quarter nosocomial pneumonias, of which about a half are due to methicillin resistant SA (MRSA) in France. The pathophysiology of these infections most often involves inhalation following oropharyngeal carriage. In addition to the risk factors common to all nosocomial pneumonias there are the particular roles of head injury and coma, leading to an increased frequency of SA infection in neuro-surgical patients. PERSPECTIVES: The non-specific clinical picture, the grave prognosis of these pneumonias and the ineffectiveness against MRSA of the antibiotics used in the treatment of Gram negative infections make empirical treatment difficult. CONCLUSION: In addition to the antibiotics classically active against SA (notably methicillin for sensitive strains and glycopeptides for MRSA) new agents may allow improvement in the treatment of these patients, even if their place is not yet definitively established.

Anti-Bacterial Agents↗
PubMed2005

Dependency on mask ventilation after acute respiratory failure in the intermediate care unit.

The predictive factors for long-term dependency (LTD) on noninvasive ventilation (NIV) immediately after acute hypercapnic respiratory failure (AHRF) have not been identified. The present authors studied 42 patients with chronic obstructive pulmonary disease (COPD) and 58 non-COPD patients successfully treated by NIV for an AHRF episode. Parameters at stable state, at admission for AHRF and during a 1-yr follow-up were compared in patients with or without LTD-NIV at discharge. The incidence of LTD-NIV was 39% in non-COPD patients and 19% in COPD patients. Based on multivariate analysis with stepwise logistic regression, lower baseline pH values and noninfectious causes of AHRF were independently associated with LTD-NIV. Mutually adjusted odds ratios were found to be 1.316 (95% confidence interval (CI) = 1.127-1.536) for a 0.01 decrease of baseline pH value and 5.1 (95% CI = 1.8-14.0) for a noninfectious cause of AHRF. Outcome after 1 yr was poor in COPD patients. Long-term dependency on noninvasive ventilation is not an uncommon situation after resolution of an acute hypercapnic respiratory failure episode, especially in patients with non-chronic obstructive pulmonary disease causes of respiratory failure. The present study raises the need for prospective validation of a weaning protocol in patients managed by noninvasive ventilation for an acute hypercapnic respiratory failure episode.

Acute Disease↗
PubMed2004

Non-invasive assessment of cerebral perfusion pressure in brain injured patients with moderate intracranial hypertension.

BACKGROUND: A non-invasive estimation of cerebral perfusion pressure (CPP) using transcranial Doppler sonography was assessed in brain-injured patients by comparing conventional measurements of CPP (difference between mean arterial pressure and intracranial pressure) (CPPm) with the difference between AP(mean) and the critical closing pressure of the cerebral circulation (CPPe). METHODS: Twenty adults with bilateral and diffuse brain injuries were included in the study. CPPe was estimated using a formula combining the phasic values of flow velocities and arterial pressure. In group A (n=10) the comparison was repeatedly performed under stable conditions. In group B (n=10) the comparison was performed during a CO(2) reactivity test. Covariance analysis was used to assess the relationships. RESULTS: In group A, CPPe and CPPm were correlated (slope, 0.76; intercept, +10.9; 95% CI, -3.5 to +25.4). During the increase in intracranial pressure (group B) (+1.9 (sd 1.5) mm Hg per mm Hg of Pe'(co(2))) the relationship persisted (slope, 0.55; intercept, +32.6; 95% CI, +16.3 to +48.9) but the discrepancy between the two variables increased as reflected by the increase in bias and variability. CONCLUSION: Non-invasive estimation of CPP can be used for brain monitoring of head-injured patients, but the accuracy of the method may depend on the level of intracranial hypertension.

Adult↗
PubMed2004

[Anaesthesia and obstetrics: the role of the French 1998 laws in childbirth safety].

Introduction of new legal texts in 1994-1995 has certainly contributed to the improved safety of anaesthesia practice in France. More recently also legal texts have been published in this country to improve the practice of obstetrics. These two series of texts have had a significant impact on obstetric anaesthesia, improving care directly related to anaesthesia practice (such as visit with an anaesthetist during pregnancy for every patient) but also care of patients with maternal disease through the implementation of regionalisation and of perinatal networks. Significant problems however need to be solved if one wants that improvement in quality continues. Precise evaluation of practice patterns and of outcomes will become possible only when well-defined indicators will have been found and accepted. Also, regionalisation of obstetric services has led to a profound change in workload with an increase in both anaesthesic procedures and stress related to urgency situations in tertiary level perinatal units. Regionalisation has been introduced to reduce perinatal mortality and morbidity. However, maternal complications of obstetric or of pre-existing diseases may require specific competence that may not be available in perinatal centres specifically organized to improve neonatal outcome. High-level perinatal centres should thus be able to care for both the mother and the neonate. Alternatively, when not feasible, specific rules or protocols should be made available to optimize the transfer while taking into account the severity of maternal disease. All these continuing improvements will however be possible only if shortage of specialists of perinatal care stops.

Adult↗
PubMed2004

[Myasthenia gravis, pregnancy and delivery: a series of ten cases].

OBJECTIVE: To study the reciprocal interferences between pregnancy and myasthenia gravis (MG) and to describe obstetric and anaesthetic management during labour and the post-partum period. STUDY DESIGN: Retrospective, single centre study. METHODS: The files of 10 patients with MG, who delivered between October 1994 and May 2002, were examined. RESULTS: No stillbirth occurred and all pregnancies were brought to term. All patients were maintained on their long-term anticholinesterase medications during pregnancy. Seven exacerbations were detected and controlled, five by increasing the anticholinesterase treatment, one by using plasmapheresis and one by using intravenous immunoglobulins. No patient required admission to the intensive care unit during pregnancy. All patients had a pre-anaesthetic visit at/near 33 weeks of gestation. Delivery was induced for six patients. Regional analgesia was performed early in labour (epidural, n = 7; combined spinal-epidural = 2) using low concentrations of local anaesthetic and no complication was detected. Three patients required a caesarean section for an obstetrical indication. Seven patients delivered vaginally using instrumental extraction (n = 5). During the post-partum period, four patients were monitored in the intensive care unit during 48 h and close neurological follow-up disclosed no exacerbation during the first 6 post-partum weeks. CONCLUSIONS: MG has no significant effect on the course of pregnancy and delivery, but MG exacerbation can occur, especially in the first trimester. Regional analgesia is medically indicated and must be performed early in labour, using low concentration of local anaesthetic to lessen the risk of motor block.

Adult↗
PubMed2004

[Intraoperative arterial hypotension recorded by an anaesthesia information management system].

OBJECTIVES: In order to evaluate the benefits arising from regular recording of intraoperative adverse events, we extracted from our database all episodes of intraoperative hypotension and studied the risk factors of this event. STUDY DESIGN: Retrospective analysis of a large database from two university teaching hospitals evaluating the incidence and the risk factors of intraoperative hypotension by logistic regression. PATIENTS AND METHODS: A data collection chart describing the patient's characteristics, the anaesthetic technique and selected intraoperative incidents was filled for each anaesthetised patient in the operating room and then recorded in the computer database. Data collected in 2001 in patients undergoing general anaesthesia for orthopaedic and general surgery were reviewed and univariate and multivariate analysis were performed using Statview 5.0 and Stata 7.0. RESULTS: Among 11 820 patients who underwent anaesthesia, 2691 were selected. The incidence of intraoperative arterial hypotension was 16.8%. The associated factors were duration of surgery, age and ASA status of the patients. The use of etomidate for induction was not associated with a decreased risk of intraoperative hypotension. CONCLUSION: Systematic recording of intraoperative events in a database has been suggested as useful by many experts for quality-assurance and safety analysis purposes. Analysis of a frequent anaesthesia-related (i.e. hypotension) event did not disclose any relevant factor that might lead to improvement. Running such databases is time-consuming and may be expensive. This leads us to question the efficiency of such databases.

Adult↗
PubMed2004

[Regional anaesthesia for labor adn delivery in a parturient with neuropathy with liability to pressure palsy (tomaculous neuropathy)].

Tomaculous neuropathy (or hereditary neuropathy with liability to pressure palsy [HNLPP]) is a rare and hereditary disease which incidence has probably been underestimated. It is characterised by demyelination resulting in numbness and weakness after nerve pressure, injury or stretch. Despite a well-documented genetic pathophysiologic mechanism, implications for anaesthesia in patients with HNLPP are only speculative and the use of regional anaesthesia is debatable. We report here the case of a patient with HNLPP who was followed during two consecutive pregnancies in the same hospital and for whom an expert of the SOS-RA hotline service was consulted before each delivery. For the first delivery, epidural analgesia was performed for labour pain control but a caesarean section was necessary because of failure to progress (0.0625% bupivacaine with 0.2 microg/ml sufentanil for labour then 2% lidocaine with adrenaline for surgery). Two years later, the patient was again seen for a preanaesthetic visit because elective Caesarean section was planned. Spinal anaesthesia using hyperbaric bupivacaine and sufentanil was used. Both deliveries were uneventful and there were no neurologic complaints in the postpartum periods.

Adult↗
PubMed2004

[Recombinant activated factor VII as a life-saving therapy for severe postpartum haemorrhage unresponsive to conservative traditional management].

Postpartum haemorrhage remains the main cause of maternal morbidity and mortality. Treatment aims at maintaining hemodynamic circulation and preventing shock by stopping blood loss both medically and surgically. We report two cases of major postpartum haemorrhage due to uterine atony. Patients developed haemorrhagic shock and severe coagulation disorders (nadir values of PTT were <10% and fibrinogen was <0.1 g/l). Well-codified medical (ocytocin, sulprostone) and surgical management (ligation of both hypogastic arteries in the two cases completed by staged uterine ligation in one case) failed to stop bleeding. Recently, several case reports described successful use of recombinant activated factor VII (rFVIIa) in scheduled surgery, trauma and major postpartum haemorrhage. Thus, after transfusion of more than one blood mass and failure of surgical haemostasis to stop bleeding, rFVIIa (60 microg/kg) was given. A single iv bolus injection stopped ongoing diffuse haemorrhage in the two cases. No further transfusion was required afterwards in both patients. RFVIIa might thus be a strong complementary agent in the management of major postpartum haemorrhage. Optimal dose, timing and safety characteristics of rVIIa administration remain to be determined. One patient developed four weeks later thrombosis of both ovarian veins, a complication that can be related to either rFVIIa or to the staged uterine ligations performed during surgery.

Adult↗
PubMed2004

[Postoperative pain relief after gynecologic surgery].

Early administration of analgesics, generally before awakening from general anesthesia is useful to improve the patient's comfort in the post-anesthesia care unit (PACU). Multimodal analgesia includes administration of several analgesics from different pharmacological classes but in almost every combination, morphine or one of its derivatives is included. In the PACU, morphine is titrated using the intravenous route to obtain adequate and rapid pain relief. Analgesics are administered orally as soon as possible and in the vast majority of cases, immediate postoperative administration can be performed orally. After minor surgery (for example: diagnostic or operative laparoscopy) often performed in out-patients, a combination of acetaminophen and of a non-steroidal anti-inflammatory drug with or without an oral preparation of morphine is efficient and safe. Intraperitoneal administration of a local anesthetic can be a useful addition. When the postoperative surgical stress is expected to be of moderate intensity (for example: hysterectomy), the same combinations can be used but are initially administered intravenously. Nefopam, which is available only by intravenous administration in France, can be safely added. Morphine is often applied using a patient-controlled analgesia device (PCA). After major surgery (especially after radical surgery for malignant disease), intrathecal or epidural analgesia, using a local anesthetic and an opioid is extremely efficient and is combined with other analgesics. Finally, because the affective dimension is extremely important after gynecologic surgery (especially in mutilating interventions), psychologic preparation, patient information and communication are essential components of care.

Analgesia, Patient-Controlled↗
PubMed2004

[Labor pain and obstetric analgesia].

GOAL AND METHODS: Labor pain is of major concern since most parturients experience significant pain of extremely severe intensity for many. The purpose of this review was to provide an overview of the mechanisms and pathways of labor pain (including new insights on integration of the nociceptive signal) and to emphasize the need of effective labor pain relief. RESULTS: Labor pain can have deleterious effects on the mother, on the fetus and on labor outcome itself. Among the current methods of obstetric analgesia, regional analgesia (the most widespread technique being epidural analgesia) offers the best effectiveness/safety ratio thanks to pharmacological innovations. Systemic analgesia (parenteral opioids, nonopioid painkillers and inhaled anesthetic agents) provides an alternative to regional analgesia but remains less effective and more hazardous. Non-drug approaches (namely psychoprophylaxis and physical methods) may be effective when used with epidural analgesia but are often not potent enough when used alone. CONCLUSION: Despite its complex pathophysiology, labor pain can be efficiently managed. Thanks to multidisciplinary care, obstetric analgesia (mainly epidural analgesia) prevents deleterious effects of labor pain on the mother and fetus.

Analgesia, Epidural↗
PubMed2004

[Management of delivery in patients with Marfan's syndrome presenting aortic dilatation].

OBJECTIVE: We report the anesthesic and obstetrical management of two pregnant patients with Marfan's syndrome. An important dilatation of the root of aorta was established at the beginning of the pregnancy. Based on a review of the literature and our experience, we searched for clues to identify the ideal term and the best mode of delivery, and which type of anesthesia may be the more appropriate in patients with aortic dilatation. RESULTS: No consensus can be found in the literature as far as anesthesia and obstetric management of these patients is concerned. Pregnancy must be continued as long as possible to ensure adequate fetal growth but fetal extraction should not be delayed if the diameter of the aorta enlarges too much. A diameter of 40 mm is probably the higher limit to accept for vaginal delivery. Beyond, cautious cesarean section would be advisable. In the absence of dural ectasia or a technical problem, neuraxial anesthesia is a good option. CONCLUSION: According to the severity of the aortic dilatation and its evolution, specific management, based on good cooperation between obstetricians and anesthesiologists, is the key of a successful and safe childbirth.

Adult↗
PubMed2004

Acid aspiration prophylaxis in obstetrics in France: a comparative survey of 1998 vs. 1988 French practice.

BACKGROUND AND OBJECTIVE: To survey French anaesthetic practice regarding acid aspiration prophylaxis and compare it with an earlier survey. METHODS: A confidential questionnaire was sent to all 800 maternity units in France to assess three major topics: (a) drugs used for pharmacological prophylaxis; (b) regional anaesthesia for labour and Caesarean section and (c) techniques used for general anaesthesia and endotracheal intubation. RESULTS: Two-hundred-and-two units responded. Pharmacological prophylaxis was regularly used for labouring women in 78% of the responding units in 1998 (compared with 63% in 1988, P < 0.05). Antacid drug use before Caesarean section had increased from 75% in 1988 to 97% in 1998 (P < 0.05). General anaesthesia was used for Caesarean section by less than 2% of responding units (vs. 21% in 1988, P < 0.05). In contrast, there was little change in the use of endotracheal intubation for instrumental delivery (53% vs. 50%) or manual removal of the placenta (15% vs. 16%) between 1988 and 1998. The use of cricoid pressure increased significantly during the 10 yr period (50% vs. 88%, P < 0.05) and the technique was correctly described by 80% of the responding units (vs. 50%, P < 0.05). Similarly, the use of succinylcholine increased significantly from 25% (1988) to 479 (1998) (P < 0.05). CONCLUSIONS: There was a significant overall improvement of French practice regarding acid aspiration prophylaxis in obstetrics. However, the complete prophylaxis strategy is still not used in every patient emphasizing the need for continuing medical education.

Anesthesia, Conduction↗
PubMed2004

Postoperative nerve irritation syndrome after epidural analgesia in a six-year-old child.

Morbidity after paediatric epidural anaesthesia is unusual. We report a case of transient nerve root irritation occurring after epidural analgesia for radical nephrectomy in a 6-yr-old boy who received a continuous infusion of bupivacaine 0.1%. The epidural catheter was inserted within the L2-L3 interspace under general anaesthesia. Several possible causes are discussed. Mechanical irritation of nerve roots by the epidural catheter in the epidural space is the most likely cause. Br J Anaesth 2004: 92: 146-8

Abdominal Pain↗
PubMed2004

FEV1 reversibility does not adequately predict effect of formoterol via Aerolizer in chronic obstructive pulmonary disease.

Evaluation of patients with chronic obstructive pulmonary disease (COPD) often includes the use of post-bronchodilator reversibility testing to guide treatment decisions. Recommendations for reversibility testing differ and there is no universally accepted method or outcome criterion. A survey of recent clinical trials with beta2-agonists in COPD illustrates the diversity of methods used to assess reversibility and highlights the difficulty of comparing data from such trials. Two recent studies demonstrated the benefits of treatment with the long-acting beta2-agonist bronchodilator formoterol (Foradil Aerolizer) in patients with COPD. When patients were classified according to their degree of reversibility as partially or poorly reversible, improvements were observed in both groups irrespective of the definition applied. These results suggest that bronchodilator reversibility testing should not be used as a rigid basis for treatment decisions with beta2-agonists in COPD patients. There is a pressing need for the role of reversibility testing to be clearly defined.

Administration, Inhalation↗