Search PubMed⌕ Search

Biomedical subjects

D Benhamou

Publications and source records attributed to D Benhamou.

At least 55 records · Page 3Linked to original sources
PubMed2004

Propofol and remifentanil for intubation without muscle relaxant: the effect of the order of injection.

BACKGROUND: Common practice in intubation without muscle relaxant is to inject the opioid drug prior to the hypnotic drug. Because remifentanil reaches adequate cerebral concentration more rapidly than does propofol, we tested the hypothesis that injection of remifentanil after propofol might lead to better intubating conditions. METHODS: Thirty ASA I-II patients scheduled for elective surgery and with no anticipated difficult intubation were enrolled in the study. Five minutes after midazolam 30 microg kg(-1), patients were randomized into two groups: group PR received propofol 2.5 mg kg(-1) followed by remifentanil 1 microg kg(-1), and group RP received remifentanil 1 microg kg(-1) followed by propofol 2.5 mg kg(-1). Intubating conditions were compared using a well-validated score, and continuous arterial pressure was recorded non-invasively. RESULTS: Compared with group RP, intubating conditions were significantly better in group PR. The mean arterial pressure decrease was more pronounced in group RP. CONCLUSIONS: We therefore conclude that in premedicated healthy patients with no anticipated risk of difficult intubation, intubating and haemodynamic conditions are better when remifentanil is injected after propofol.

Adolescent↗
PubMed2004

[Non-invasive ventilation of elderly patients in the intensive care unit].

INTRODUCTION: An increasing number of elderly patients, with acute respiratory failure (ARF) due to e.g. COPD exacerbation or cardiac failure, are being referred to intensive care units for mechanical ventilation. STATE OF ART: NIV can be an effective ventilatory technique in ARF due to a variety of aetiologies. NIV has been shown to decrease endotracheal intubation rates, complication rates and median hospital length of stay. When managing acute-on-chronic respiratory failure, NIV is a first-line ventilatory technique, in the absence of criteria for immediate endotracheal intubation. The efficacy of NIV depends on the expertise of the medical and nursing staff (including physiotherapists) and should always be performed in an appropriate setting. There are very few data about NIV in the elderly but studies, which included patients over 75 years, did not identify different outcomes for this age group. PERSPECTIVES: Future clinical studies on NIV should allow us to better understand which patients will benefit the most from the technique. Certain specific settings in elderly populations, such as in palliative care or when an "non intubation order" has been given by the patient, his family or the medical/nursing staff, are under evaluation. CONCLUSIONS: NIV is effective and well tolerated and it has become a key ventilatory technique in the management of ARF, particularly for elderly patients.

Acute Disease↗
PubMed2003

[Is obstetric epidural anaesthesia technically possible after spinal surgery and does it work?].

OBJECTIVE: Previous spine surgery theoretically exposes the obstetric patient to a greater technical difficulty during regional analgesia for labour or during anaesthesia for caesarean delivery. Published experience suggests that epidural puncture is however technically possible in the majority of cases. STUDY DESIGN: Retrospective study. PATIENTS: Analysis of the files of parturients who gave birth in a maternity hospital during a six year period and who had previously undergone spine surgery. METHODS: Technical failures (during puncture), analgesic failures (complete block inefficiency and/or requirement of a general anaesthetic) and complications (important bleeding at the puncture site, dural tap, infection) observed during epidural analgesia/anaesthesia were recorded. RESULTS: Except for two paraplegic parturients who had been operated for dorsocervical traumatic injuries and who were excluded from the analysis, 31 parturients had undergone spine surgery and delivered during the period of analysis. Twenty patients underwent 22 epidural punctures. Technical failure were noted in two cases (9%) and analgesic failure in two other cases (9%). No significant complication was recorded. CONCLUSION: With an overall 18% failure rate, epidural anaesthesia is not contra-indicated in these patients but appears to be less reliable than in patients with normal spine. Psychological and technical preparation to the occurrence of failure is necessary.

Adult↗
PubMed2003

[Factors associated with laparoscopic approach for cholecystectomy, appendicectomy and inguinal herniorraphy in France].

OBJECTIVE: To determine on a national level the factors associated with the use of laparoscopy for digestive surgery. STUDY DESIGN: Nation wide study using a large representative sample (3 days of anaesthesia in France). METHODS: Univariate followed by multivariate analyses of data gathered in 1996 during the survey led by the French Society of Anaesthesia and Intensive care ("SFAR") including 2847 surgical procedures for cholecystectomy, appendicectomy or inguinal herniorraphy. RESULTS: Independent factors associated with the use of laparoscopy were: for cholecystectomy: age (less frequent when > or =71 years: adjusted Odds ratio [AOR] 0.4), sex (more frequent in female: AOR 1.7), ASA physical status (less frequent when > or =3: AOR 0.5), private hospital (AOR 2.0), procedure scheduled at least the night before (AOR 2.1), and use of closed circuit general anaesthesia (AOR 1.6); for appendectomy: age >15 years (AOR 1.9-2.2), female (AOR 2.1), private hospital (AOR 2.7), scheduled procedure (AOR 2.1), prolonged procedure (AOR 8.4), endotracheal intubation (AOR 16.7), and closed circuit (AOR 2.7); for inguinal herniorraphy: ASA physical status (less frequent when > or =3: AOR 0.4), private hospital (AOR 3.4), prolonged procedure (AOR 5.6), and endotracheal intubation (AOR 21.6). Association with a closed circuit was confirmed for general anaesthesia using a volatile agent (AOR 1.5). Overall, ambulatory surgery was rarely performed and used only for open procedures. Regional anaesthesia was used only for inguinal open herniorraphy. CONCLUSION: These data obtained from a large national survey confirmed the higher frequency of laparoscopy in middle aged patients, female (except for inguinal herniorraphy), without important comorbidity, in private hospitals. Laparoscopy was associated with prolonged procedures and with a change in the anaesthetic technique for appendicectomy and inguinal herniorraphy: tracheal intubation was almost constantly used. Whatever the procedure, closed circuit anaesthesia was more frequently used when surgery was performed under laparoscopy, reflecting newer equipment of the hospital, private or public.

Adolescent↗
PubMed2003

Side-effects of postoperative epidural analgesia in children: a randomized study comparing morphine and clonidine.

BACKGROUND: Morphine is widely used in association with local anaesthetics for postoperative epidural analgesia. There are no data on the prolonged use of clonidine for postoperative analgesia in children. The primary outcome of this randomized, double-blind trial was to compare the incidence of side-effects after epidural infusion of clonidine or morphine, in association with ropivacaine in children. METHODS: After institutional approval, 26 children, aged 3-12 years, who were scheduled for abdominal surgery, had an epidural catheter placed after induction of general anaesthesia. Patients were then randomized to two different groups. After an initial bolus of 2.5 mg x kg-1 0.25% ropivacaine with either 40 micro g x kg-1 morphine (group M, n = 14) or 1 micro g x kg-1 clonidine (group C, n = 12), an epidural infusion was started at a rate of 0.4 ml x kg-1 x h-1. The patients in the M group received an infusion of 0.08% ropivacaine with 10 micro g.ml-1 morphine, those in the group C an infusion of 0.08% ropivacaine with 0.6 micro g.ml-1 clonidine. RESULTS: The two groups were similar with respect to age, sex and weight. One patient in the C group was excluded for misplacement of the epidural catheter. The incidence of vomiting and pruritus was significantly higher in the M group compared with the C group (64% and 85% versus 0%, respectively). The incidence of pain was significantly higher in the C group compared with the M group (73% versus 29%) as well as the need for rescue analgesia medications. CONCLUSIONS: Epidural clonidine is followed by a significantly lower incidence of side-effects. However, its analgesic effects, at least at the doses used in this study, are less potent than those of epidural morphine.

Abdomen↗
PubMed2003

Efficacy of augmentation of epidural analgesia for Caesarean section.

BACKGROUND: Extension of a labour epidural for Caesarean delivery is thought to be successful in most cases and avoids the use of general anaesthesia. However, most previous studies that have estimated the failure rate of pre-existing epidural catheters were performed in small numbers of patients. METHODS: Therefore, we undertook to retrospectively measure the failure rate of indwelling epidural catheters in a large number of patients. RESULTS: The anaesthetic team was available at all times and was permanently led by a senior anaesthetist specialized in obstetrics. Extension was performed using lidocaine 2% with epinephrine (mean 18 (SD 6) ml), combined in most patients with sufentanil (9 (2.2) microg) and/or clonidine (75 microg). Among 194 consecutive extensions performed in a 1-yr period, general anaesthesia was required in five patients (2.6%) while sedation and/or i.v. analgesia were used in 27 patients (13.9%). In three cases where general anaesthesia was required, the interval between decision to incision was <10 min. No factor associated with failure could be identified. Addition of a lipophilic opioid or of clonidine did not modify the efficacy of the block (i.e. general anaesthesia or supplementation were required in a similar proportion). CONCLUSIONS: The augmentation of labour epidurals for Caesarean section using lidocaine 2% plus epinephrine is a reliable and effective technique. No factor associated with failure could be identified.

Adjuvants, Anesthesia↗
PubMed2003

[Non-invasive ventilation of elderly patients in the intensive care unit].

INTRODUCTION: An increasing number of elderly patients, with acute respiratory failure (ARF) due to e.g. COPD exacerbation or cardiac failure, are being referred to intensive care units for mechanical ventilation. STATE OF ART: NIV can be an effective ventilatory technique in ARF due to a variety of aetiologies. NIV has been shown to decrease endotracheal intubation rates, complication rates and median hospital length of stay. When managing acute-on-chronic respiratory failure, NIV is a first-line ventilatory technique, in the absence of criteria for immediate endotracheal intubation. The efficacy of NIV depends on the expertise of the medical and nursing staff (including physiotherapists) and should always be performed in an appropriate setting. There are very few data about NIV in the elderly but studies, which included patients over 75 years, did not identify different outcomes for this age group. PERSPECTIVES: Future clinical studies on NIV should allow us to better understand which patients will benefit the most from the technique. Certain specific settings in elderly populations, such as in palliative care or when an "non intubation order" has been given by the patient, his family or the medical/nursing staff, are under evaluation. CONCLUSIONS: NIV is effective and well tolerated and it has become a key ventilatory technique in the management of ARF, particularly for elderly patients.

Acute Disease↗
PubMed2002

[Factors associated with blood transfusion during anesthesia for scheduled hip or knee arthroplasty in France].

GOAL OF THE STUDY: To determine over a whole country what are the factors associated with an intraoperative homologous blood transfusion and with the use of autologous techniques (preoperative autologous blood donation: PABD; acute normovolemic hemodilution: ANVH; intraoperative red cell salvage: IRCS). STUDY DESIGN: National enquiry using a large representative sample (3 days of anaesthesia in France). METHODS: Univariate followed by multivariate analyses of data gathered in 1996 during the survey leaded by the French society of anaesthesia and intensive care (Sfar) and corresponding to 884 scheduled hip and knee prosthesis surgical procedures. RESULTS: Factors associated with a decreased use of PABD programme were: 1--old age and high ASA physical status; 2--procedures of short duration. By contrast, an increased use of PABD was associated with anaesthetics in which a closed circuit had been used. Except for a significant association with increasing age and with absence of PABD used, no additional factor was found to be linked with ANVH. No factor among those studied was found related to the use of IRCS. Homologous blood transfusion was more frequently used in ASA > or = 3 patients, in long duration surgeries while its use was decreased in patients with PABD (odds ratio--for reduction by PABD: 4.4 [95% confidence interval: 2.2-8.8]). Homologous blood transfusion was not related to the use of ANVH or IRCS. CONCLUSION: These data obtained from a large national survey confirm previously published studies and meta-analyses and are in agreement with current recommendations. An unexpected relation between PABD and closed circuit anaesthesia has been found.

Aged↗
PubMed2002

Continuous epidural analgesia with bupivacaine 0.125% or bupivacaine 0.0625% plus sufentanil 0.25 microg.mL(-1): a study in singleton breech presentation.

Epidural analgesia is the most efficient technique for labor pain relief. However, its resultant motor block might impair the mode of delivery, particularly in breech presentation where the risk of dystocia is high. In this trial, we compared bupivacaine 0.125% with a combination of a low concentration of bupivacaine (0.0625%) and sufentanil (0.25 microg.mL(-1)) both administered by continuous infusion. Analgesia, maternal and fetal/neonatal side effects and obstetric outcome were compared between group bupivacaine (n = 23) and group bupivacaine-sufentanil (n = 35). A greater number of patients in the bupivacaine 0.125% group required more than two top-ups (32 vs. 8% of patients, P = 0.03) while pain scores were similar. Motor block at delivery was more pronounced in the bupivacaine 0.125% group. Nausea and pruritus were more often encountered in the bupivacaine-sufentanil group. There was a trend toward a decreased rate of assisted or operative delivery in the bupivacaine-sufentanil group (92% vs. 74%, P = 0.09). Fetal/neonatal data did not differ between groups. Epidural analgesia with bupivacaine-sufentanil required fewer additional top-ups and produced less motor block than did bupivacaine 0.125%. However, there was no significant difference in mode of delivery between the two analgesic regimens.

Journal Article↗
PubMed2002

Improvement of information gained from the pre-anaesthetic visit through a quality-assurance programme.

BACKGROUND: Pre-anaesthetic evaluation is a fundamental component of anaesthetic practice. The aims of the present study were to assess the quality of the preoperative anaesthetic information gathered and to observe the quality profile after the introduction of a standardized form. This occurred through a four-step quality assurance programme over a 4-yr period. METHODS: The proportion of cases in which a complete recording of data was collected at the preoperative assessment was evaluated by searching in each patient's medical record for what was considered to be the minimum information required to provide satisfactory perioperative care. Fifteen criteria were selected. The recovery profile for each indicator and a global quality index (GQI expressed in %) for each patient's record were collected. In phase 1, the existing situation was assessed. Next, a standardized pre-anaesthetic form (PAF 1) was designed and its implementation evaluated (Phase 2). Phase 3 was performed 16 months after implementation of PAF 1 to assess the long-term value. The form was revised (PAF 2) and its use evaluated again 6 months later (Phase 4). For each evaluation, the records of a 1-month period were examined. Overall 1129 medical records were audited. RESULTS: The GQI increased significantly from 62 to 88% with similar changes for both elective and emergency cases. The recovery profile was improved for most indicators. CONCLUSIONS: We conclude that the quality of information recorded from the pre-anaesthetic visit is improved by using a standardized form. This will hopefully help to improve patient outcome and facilitate computerization of the anaesthetic record.

Anesthesia Department, Hospital↗
PubMed2002

Relaxation of proximal and distal isolated human bronchi by halothane, isoflurane and desflurane.

Volatile anaesthetics relax airway smooth muscle in vitro. The amount of relaxation might depend on the type and concentration of volatile anaesthetics, the calibre and precontraction level of the bronchi, and also on the species considered. These effects were investigated on isolated human bronchi. Isometric relaxations produced by halothane, isoflurane and desflurane bubbled on human bronchial rings precontracted with carbachol were recorded and compared with time controls. Volatile anaesthetics induced a concentration-dependent relaxation at 0.66, 1.33 and 2 minimum alveolar concentration (MAC). The relaxation was greater in mildly (carbachol 3x10(-7) M) than in highly (carbachol 2x10(-6) M) precontracted bronchi. Halothane was more potent in relaxing distal as compared to proximal bronchi; this differential effect was less pronounced with isoflurane and not observed with desflurane. While the three volatile anaesthetics induced similar relaxation on proximal bronchi, halothane was significantly more potent than desflurane on distal bronchi, with isoflurane being intermediate. The relaxation induced by 1.33 MAC of halothane, isoflurane and desflurane on moderately precontracted distal bronchi (carbachol 1x10(-6) M) was attenuated by pretreatment with glibenclamide 1x10(-5) M. In conclusion, halothane, isoflurane and desflurane exert direct but differential relaxant effects on human isolated bronchial smooth muscle. This may provide supplemental bronchodilation during anaesthesia. Although adenosine triphosphate-sensitive K+ channels are involved in these relaxant effects, they are unlikely to explain the observed differences between the three volatile anaesthetics.

Anesthetics, Inhalation↗
PubMed2001

[Epidemiology and management of suspected pneumonia in nursing home residents].

OBJECTIVE: We conducted a descriptive epidemiology study to examine the conditions of management of infectious lung disease in institutionalized elderly populations (population profile, diagnostic and therapeutic modalities) and to analyze the general and mental consequences in terms of independence (impact of the infectious event on the subject's life style). PATIENTS AND METHODS: A pragmatic survey was conducted by a multicentric observatory composed of 573 general practitioners, practicing in nursing homes. The series included 1790 patients aged over 70 years and residing in nursing homes who developed infectious lung disease over a 10-month period. The MMSE score was used to assess mental status and the Barthel index to assess functional handicap. Each patient was evaluated at the time of the final diagnosis (prescription of an antibiotic or decision for hospitalization) and at most 3 days after the end of this treatment or at discharge from hospital. RESULTS: The elderly population (84 +/- 7 years) was predominantly composed of women. The patients were treated for an acute respiratory infection considered in 30% of the cases to be acute lobar pneumonia. Subgroups of patients were identified for analysis: death (3.7%), x-ray confirmation of the diagnosis (11.5%), hospitalized patients (10.2%). In addition to major deterioration of the general health status, a consequence of the infection more than of the severity of the respiratory symptoms, the development of an acute episode coincided with reduced intellectual functions and onset of a state of confusion. In 70% of the cases, this resulted in a loss of independence of variable importance--simple difficulty for moving around to major functional handicap. The infectious episode was cured or improved (persistence of minor signs not requiring specific treatment) in 94.3% of the cases with appropriate antibiotics: single-drug regimen in 93.7% give per os (75%) or intravenously (25%) using aminopenicillin (with or without a beta lactamase inhibitor) in 80% of the cases. Antibiotic treatment was associated with physical therapy in more than half the cases, and with general conticosteroids in 40%. The treatment scheme was modified in 9.4% of the cases (change of antibiotic in 6%). CONCLUSION: This survey confirms the high risk related to general conditions in elderly institutionalized patients who develop respiratory infection. More than the infection itself, the rapid degradation of the general health status, or decompensation of comorbid states can create life-threatening situations or favor the development of irreversible handicaps.

Aged↗
PubMed2001

[Off-label prescriptions in an adult surgical intensive care unit].

OBJECTIVE: The aim of the study was to document off label prescribing in an adult surgical intensive care unit setting and to determine explanatory factors. METHOD: Medical prescriptions of 20 adult patients consecutively admitted in surgical intensive care unit were recorded, from the time of admission to the second day of hospitalisation. Concordance of each prescription to the different sections listed on the approved labeling was checked on the Vidal 1999 dictionary. French guidelines promoted by the two major intensive care societies were looked for to explain the most frequent reason of unapproved use of the 10 main therapeutic classes concerned by off label prescription. RESULTS: In this study, 465 prescriptions were analysed, representing 80 drugs and 35 therapeutic classes. Prescriptions were considered off label in 25.6%. Antibiotics, stress ulcer prophylactic drugs, vitamins, antiepileptic drugs were the main therapeutic classes used off label. The main cause of off label prescription was unapproved indication (66%), dosing schedule (27%) and method of administration (17%). For 5 therapeutic classes, representing 45% of off label prescriptions, a guideline supporting these prescriptions was available or was published in the year following the study. CONCLUSION: Off label prescription is frequent in the setting of adult surgical intensive care unit. Seldom medical situations and the gap between official labeling and medical knowledge are explanatory factors of these off label prescriptions.

Adolescent↗
PubMed2001

Laparoscopic surgery.

Explore the source record for details and available documents.

Cholecystectomy, Laparoscopic↗