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Biomedical subjects

D Benhamou

Publications and source records attributed to D Benhamou.

At least 127 records · Page 7Linked to original sources
PubMed1998

The effect of pneumoperitoneum on intraocular pressure in rabbits with alpha-chymotrypsin-induced glaucoma.

UNLABELLED: Increased intraperitoneal pressure is associated with physiological changes including alterations of intraocular pressure (IOP). We have previously shown that IOP is not adversely affected by increased intraperitoneal pressure up to 15 mm Hg in women with no preexisting eye disease. The aim of this study was to measure IOP changes associated with increased intraperitoneal pressure (up to 15 mm Hg) of 2 h duration in 12 rabbits with alpha-chymotrypsin-induced glaucoma. A reliable model of glaucoma was created by injecting alpha-chymotrypsin into the posterior chamber of the right eye in 12 rabbits. Thereafter, 5 of the 12 rabbits with glaucomatous eyes were treated with topical timolol. The left eye was used as a control. During pentobarbital general anesthesia, increased intraperitoneal pressure up to 15 mm Hg was created by intraperitoneal CO2 insufflation. Body temperature and expired CO2 were kept constant throughout the study. IOP measurements were made using an electronic pneumotonometer. IOP, mean arterial pressure, heart rate, and central venous pressure were recorded in head-up and head-down positions before, during, and after increased intraperitoneal pressure. The IOP of both eyes, in both treated and untreated rabbits, increased significantly from baseline only when increased intraperitoneal pressure associated with the head-down position resulted in a significant increase in central venous pressure. However, the IOP increase remained within the diurnal range. The major finding of this study is that, in a reliable model of glaucoma, CO2 pneumoperitoneum was associated with an increase in IOP when a head-down position was combined with pneumoperitoneum. IMPLICATIONS: In rabbits with alpha-chymotrypsin-induced glaucoma, increased intraperitoneal pressure (up to 15 mm Hg) resulted in a significant intraocular pressure increase when pneumoperitoneum was associated with the head-down position. However, the intraocular pressure increase remained within the diurnal range.

Adjuvants, Anesthesia↗
PubMed1998

Topical lidocaine-prilocaine cream (EMLA) versus local infiltration anesthesia for radial artery cannulation.

UNLABELLED: In a randomized trial, we compared topical anesthesia by a lidocaine-prilocaine cream (EMLA; Laboratorie ASTRA, Manterre, France) with subcutaneous local lidocaine infiltration for radial artery cannulation. Patients included 538 adults scheduled for coronary angiography using a radial approach. EMLA was applied 2 h before radial cannulation, and lidocaine infiltration was performed 5 min before cannulation. The primary end point was pain as assessed by a verbal numerical scale (0 = no pain, 10 = extreme pain). Pain was less severe in the EMLA group than in the lidocaine infiltration group (Score of 2 vs 7; P = 0.0001). Additional lidocaine infiltration was required significantly less frequently in the EMLA group (relative risk 0.19). The failure rate of cannulation was significantly lower in the EMLA group (relative risk 0.38), and insertion time was shorter (4 versus 6 min). We conclude that EMLA, compared with lidocaine infiltration, reduces pain associated with radial artery cannulation and improves the success rate of the procedure. Routine application of EMLA should be performed in awake patients 2 h before radial artery cannulation. IMPLICATIONS: In a randomized trial, we compared topical anesthesia by a lidocaine-prilocaine cream (EMLA) with subcutaneous local lidocaine infiltration for radial artery cannulation in 538 adults patients. EMLA reduced pain associated with radial artery cannulation and improved the success rate of the procedure.

Adult↗
PubMed1998

Intrathecal clonidine and fentanyl with hyperbaric bupivacaine improves analgesia during cesarean section.

UNLABELLED: Seventy-eight pregnant women at term, scheduled for elective cesarean section, were enrolled in this multicenter trial to compare the analgesic efficacy and side effect profile of a spinal block with hyperbaric bupivacaine alone (Group B) or combined with 75 microg of clonidine (Group BC) or with clonidine 75 microg and fentanyl 12.5 microg (Group BCF). Intraoperatively, clonidine increased the spread of the sensory block and decreased pain (pain scores 23+/-7 mm vs 17+/-6 and 2+/-1 mm for Group B versus Groups BC and BCF; P < 0.05) and analgesic supplementation. This improved analgesia was best with the clonidine-fentanyl combination (Group BC versus Group BCF; P < 0.05). Postoperative analgesia was prolonged only in Group BCF (215+/-79 min vs 137+/-35 and 183+/-80 min for Group BCF versus Groups B and BC; P < 0.05). Blood pressure and heart rate changes were not significantly different among groups, whereas sedation and pruritus were significantly more frequent in Group BCF. Nausea and vomiting were decreased in Groups BC and BCF. Apgar scores and umbilical artery blood pH were not different among groups. We conclude that adding a small dose of intrathecal clonidine to bupivacaine increases the quality of intraoperative analgesia and decreases pain during cesarean section. Combining clonidine with fentanyl further improved analgesia. IMPLICATIONS: In this study, we demonstrate improved intraoperative spinal analgesia by adding 75 microg of clonidine to bupivacaine; side effects were not increased. The combination of clonidine and fentanyl further improved analgesia but moderately increased sedation and pruritus.

Adrenergic alpha-Agonists↗
PubMed1998

The effect of adding a minidose of clonidine to intrathecal sufentanil for labor analgesia.

BACKGROUND: Preliminary studies have suggested that the addition of clonidine to intrathecal sufentanil prolongs analgesia without producing motor blockade. METHODS: Fifty-three nulliparous women in painful labor were included in this prospective, randomized, double-blinded study. Parturients at 2- to 5-cm cervical dilation received either 5 microg sufentanil plus 30 microg clonidine or 5 microg sufentanil intrathecally, followed by 5 mg bupivacaine epidurally. The primary outcome was time until first request for additional analgesia. Visual analog pain scores, sensory changes, blood pressure, heart rate, ephedrine requirements, motor blockade, sedation, pruritus, and nausea were also recorded. RESULTS: All parturients but one had effective analgesia in both groups, with similar sensory levels never exceeding T2. The duration (mean +/- SD) of analgesia was longer in the sufentanil-clonidine group: 125+/-46 versus 97+/-30 min (P = 0.007). The incidence of hypotension and the ephedrine requirements (median with range) were higher in the sufentanil-clonidine group: 63% versus 12% (P < 0.001) and 7.5 mg [range, 0-25.5 mg] versus 0 mg [range, 0-6 mg] (P < 0.0001). The incidence of fetal heart rate abnormalities during the first 30 min after intrathecal injection was similar in both groups (17% vs. 19%). No parturient had motor blockade. CONCLUSIONS: The addition of 30 microg clonidine to 5 microg intrathecal sufentanil extended the duration of labor analgesia without producing motor blockade. However, as previously reported with 100-200 microg clonidine, the incidence of hypotension and the ephedrine requirements were also increased, even when 30 microg clonidine only was added.

Adrenergic alpha-Agonists↗
PubMed1998

Epidural anaesthesia for caesarean delivery in triple and quadruple pregnancies.

BACKGROUND: Mechanical and/or hormonal factors may increase the spread of epidural anaesthesia in pregnancy, and hormonal changes are more pronounced in high-order pregnancies. However, no previous study has evaluated the dose requirements and haemodynamic effects of epidural anaesthesia for caesarean delivery in this latter situation. METHODS: The anaesthetic requirements to obtain a T4 upper sensory level were retrospectively compared in triple (n = 19) or quadruple (n = 2) pregnancies to 31 singleton pregnancies who received epidural anaesthesia for elective caesarean delivery using 2% lidocaine with 1/200,000 adrenaline. RESULTS: In high-order pregnancies, the gestational age at delivery was lower than in singleton pregnancies (34.9 +/- 1.9 weeks vs 38.2 +/- 1.1 weeks; P = 0.0001) whereas maternal body weight (76.5 +/- 8.7 kg vs 73.4 +/- 14.8 kg; NS) and lidocaine requirements (428 +/- 95 mg vs 426 +/- 98 mg; NS) were similar. Moreover, although the overall incidence of hypotension was not different (multiple pregnancy; 65% vs 58% in singletons), ephedrine (5.4 +/- 5.3 mg vs 10.7 +/- 13.8 mg; P < 0.05) and additional fluid requirements during onset of the block (4.3 +/- 1.7 mL/kg vs 5.3 +/- 2.6 mL/kg; P = 0.03) were less than in singletons. CONCLUSION: We found surprisingly similar anaesthetic requirements for epidural anaesthesia in high-order and singleton pregnancies. Mechanical factors may have played an important role. Moreover, the need for ephedrine and fluids was less in high-order pregnancies. This could be related to more pronounced physiological changes or to different physician attitudes.

Adult↗
PubMed1998

Dirithromycin concentrations in bronchial mucosa and secretions.

Since a high tissue penetration of dirithromycin (D) has been assessed in early studies, the aims of this study were to determine D concentrations in bronchial mucosa and secretions in patients suffering from an acute exacerbation of chronic bronchitis (AECB), to compare intra-individual bronchial mucosa and secretion concentrations and to relate bronchial concentrations of D and clinical efficacy. The main inclusion criteria were comprised of (1) AECB, defined by the presence of an increase in dyspnea, sputum production and change in sputum purulence, and (2) clinical indication of fiberoptic bronchoscopy allowing performance of bronchial biopsies. All patients were treated with a 500-mg once-daily D dose for 5 days. Patients were randomly divided into three groups, according to sampling times (24, 48 and 72 h after the last dose). Tissue concentration analyses were performed by one blinded microbiologist (microbiological agar diffusion assay). The results showed: (1) 37 out of the 46 patients (80.4%) had a favorable response to treatment at the time of fiberoptic bronchoscopy (14 cured, 23 improved); (2) bronchial mucosa concentrations were high in all groups, and (3) mean values at 24, 48 and 72 h after the last dose were respectively 6.51 +/- 1.44, 6. 61 +/- 2.7, 5.67 +/- 1.02 mg.kg-1; no statistical difference was observed between the groups. In bronchial secretions collected simultaneously, concentrations were lower, i.e. 1.26 +/- 0.3, 0.61 +/- 0.12, 0.84 +/- 0.12. Significant associations were observed between bronchial mucosa and secretion concentrations (r = 0.71, p = 0.0001), and between clinical response and bronchial concentrations (p = 0.03, Kruskall-Wallis test). In conclusion, these results may confirm the clinical significance of tissue concentrations measured in bronchial tissues of patients with AECB.

Anti-Bacterial Agents↗
PubMed1998

Risk factors for maternal condition at admission to an intensive care unit: does health care organisation play a role? Study Group of the Maternal Morbidity.

The objective of this study was to analyse the relation between severity of maternal condition at the time of intensive care unit (ICU) admission and various individual and institutional factors. This study analysed data from a retrospective population-based study in three French regions during 1991. The population study included 355 patients who were admitted to an ICU during pregnancy, delivery or within 42 days after delivery, for an obstetrical cause. The main outcome measure was the severity of maternal condition at ICU admission estimated from the level of consciousness and from the Simplified Acute Physiology Score (SAPS). The most severe maternal condition was associated with a change in hospital category (from the initially chosen hospital to the hospital referring for ICU) (OR 3.8, 95% CI 1.5-9.6) and with treatment in a private hospital at ICU referral (OR 3.3, 95% CI 1.3-8.3). Foreign nationality was the only individual factor related to very severe maternal condition. These results suggest that health care organisation during pregnancy affects the prognosis of severe maternal condition. The factors involved appear to include the management of unpredictable disorders, the conditions of maternal transfers before ICU admission, and antenatal care of foreigners.

Adult↗
PubMed1998

Mechanical ventilation in elderly patients.

Elderly patients are increasingly opting for intensive care unit (ICU) treatment with mechanical ventilation (MV). The aim of this study was to review specific aspects of MV in the older elderly (80-yrs-old and older). We retrospectively studied all patients who underwent MV during a 2-year-period in our respiratory ICU. Older elderly were compared with younger patients. Of 478 patients admitted to our unit, 58 underwent endotracheal ventilation (ETV) and 243 noninvasive ventilation (NIV). At the time of admission, older elderly patients (n = 106) were more severely ill than the younger ones, according to simplified acute physiology scores (SAPS). The history of older patients was characterized by a lower frequency of neurological abnormalities, and in the ETV group, a lower frequency of days previously spent in hospital. NIV was performed more often in older elderly (64%) than in younger patients (47%) and for a shorter time-period (8 compared to 10 days). The ICU mortality rate was higher in the older patients than in the younger ones in the overall population admitted to the unit (38 compared to 12%) and in the NIV population (21 compared to 9%) but not in the ETV population (40 compared to 44%). Long-term survival (2 yrs) was low (12%) in the older patients admitted to the unit. Several studies from the literature were reviewed. All authors agreed that age alone should not be a criterion to exclude the older elderly from intensive care, regardless of whether they found them to have the same or a poorer prognosis than younger patients. Selection biases are rarely studied. Our results indicate that some selection procedures on admission to the intensive care unit and before endotracheal ventilation are present despite the absence of any selection policy in our department. This selection enables us to obtain results from older populations which are as good as those from nonselected younger populations. When its use is practicable, noninvasive ventilation is associated with less discomfort, fewer complications and better short-term results than is endotracheal ventilation. In all cases, the long-term prognosis is poor.

Age Distribution↗
PubMed1998

Modalities of ventilation in obesity.

Obesity is nowadays the most frequently found health risk in the USA, where more than 1 in 3 adults have a weight > or = 20% over the ideal value. Obese patients are more prone to developing sleep apnoea syndrome and obesity hypoventilation syndrome as well as more frequent postoperative complications. Thus, acute and chronic respiratory failure episodes represent current presentations in clinical practice where noninvasive ventilation is very efficient and must be guided by polysomnographic data in order to decide on long-term respiratory treatment to avoid recurrence of acute on chronic decompensation.

Acute Disease↗
PubMed1997

Long-term efficiency of home nasal mask ventilation in patients with diffuse bronchiectasis and severe chronic respiratory failure: a case-control study.

The aim of this study was to evaluate long-term efficacy and tolerance of nasal mask ventilation (NMV) in a comparative case-control study. Fourteen patients with diffuse bronchiectasis and severe chronic respiratory failure (CRF), treated by long-term oxygen-therapy (LTO) and NMV, were case matched with 14 patients with diffuse bronchiectasis and severe CRF treated with only LTO. Patients and control subjects were compared based on the following parameters: blood gases, FEV1, vital capacity, hospitalizations, and survival. Symptoms, Karnofsky function score, and clinical evolution were also monitored in patients. Three subgroups may be identified according to outcome: two early deaths (subgroup 1), six patients with initial improvement and subsequent deterioration (subgroup 2), and six patients whose conditions remained improved for >2 years (subgroup 3). PaO2 decrease slope was slighter in this last subgroup than subgroup 2. The days of hospitalization were significantly reduced after institution of NMV in the patient group. Comparison between patients and control subjects did not show any difference on PaO2 evolution and on the overall median survival (46 and 40 months in NMV and control group, respectively). Long-term tolerance and compliance remained satisfactory for 11 patients. These results suggest that NMV is feasible as a long-term home treatment in patients with diffuse bronchiectasis. Although our results may have failed to prove a long-term efficiency on the course of blood gases and survival, a beneficial effect is observed with reduction of hospitalizations and improvement of functional status. This study warrants further investigation, in a prospective series, with a larger number of patients.

Adult↗
PubMed1997

[Evaluation of a checklist for anesthetic equipment before use].

OBJECTIVE: To describe and to assess the use of a checklist for anaesthetic equipment, the effects on the quality of care, as well as the difficulty to obtain a complete and permanent compliance of anaesthesia staff to the use of the checklist, in comparison with the practice patterns in other countries and of the recommendations by the French society of anaesthesia and intensive care for the anaesthetic machine checking. STUDY DESIGN: Prospective quality assurance study with two subsequent phases. METHODS: Both a detailed and a simplified checklist were initially tested over a 57-day-period to evaluate the incidence and severity of recognized abnormalities and to assess the compliance of the staff with this new procedure. Four months later, the same evaluation was performed again. The detailed checklist was used before the first anaesthetic in the morning and called "Theater opening form". The simplified list was used before the subsequent anaesthetics and called "Checking before induction form". RESULTS: During phase I, the detailed and simplified forms of the checklist were only used in 54% and 32% of cases respectively. They were more often completed in scheduled (93%) than in emergency cases (31%). The detailed checklist detected 5/165 potentially severe abnormalities in the breathing system that could be amended before use. After formal discussion with all members of the department, the simplified checklist was abandoned, as it did not detect any significant abnormality and was considered too time-consuming. During the phase II of the study, as the staff checked the anaesthetic machine more often in emergency cases (52%), the overall compliance increased (73%) but remained insufficient. However, no critical incident could be detected during the second evaluation period. DISCUSSION: This study demonstrated the safety benefits associated with the procedure of checking anaesthetic equipment, but also pointed out the difficulty to obtain a full participation of the staff in quality-assurance programmes.

Anesthesiology↗
PubMed1997

[Autotransfusion during caesarean section with blood containing p salbutamol without adverse effects].

We report the case of a patient presenting with a placenta praevia and who donated autologous blood while she had beta 2-agonist tocolysis. As the restitution of blood containing salbutamol at therapeutic concentration may induce uterine atony and cardiovascular symptoms, we monitored maternal clinical signs and plasma concentrations of salbutamol when autologous blood was retransfused after the end of Caesarean section. The maternal plasma beta 2-agonist levels during tocolysis were in agreement with the usual therapeutic concentrations. The beta 2-agonist infusion was discontinued 30 minutes before the subarachnoid blockade and the blood concentration measured at the time of skin incision was below the therapeutic threshold. The retransfusion of autologous blood neither raised the salbutamol concentration above the therapeutic threshold value, nor induced any clinical symptoms. After Caesarean section the retransfusion of autologous blood containing therapeutic concentration of salbutamol seems to be innocuous.

Adult↗
PubMed1997

Hyperthermia related to epidural analgesia during labor.

Although hypothermia has been reported during epidural anesthesia performed for nonobstetrical surgery or cesarean section, epidural analgesia for labor may lead to hyperthermia. Its incidence, time-course and intensity are influenced by multiple factors including site of measurement, duration of labor preceding epidural analgesia and perhaps ambient temperature and occurrence of shivering. During the first 2-5 h of epidural analgesia, a significant increase in temperature is not usually observed. Then, if labor is prolonged (mostly in primiparas), temperature may increase at a rate of 0.07-0.15 degrees C per hour. Imbalance between reduced heat loss during epidural analgesia and labor-induced heat production has been implicated but impairment of central temperature regulation cannot be excluded. This hyperthermia is usually of mild intensity (< 38 degrees C) and occurs in the absence of any infectious process; maternal and fetal consequences are also usually absent and treatment is probably unnecessary. However, fetal tachycardia may occur and the potential for a deleterious effect on the fetus remains controversial. Various measures for cooling the mother have been proposed but their efficacy has not been evaluated. The recognition that epidural analgesia may provoke hyperthermia may help to avoid inappropriate use of antibiotics or fetal extraction.

Journal Article↗
PubMed1997

Effect of intra-operative mechanical ventilation using 50% inspired oxygen on pulmonary oxygenation.

Forty-three ASA Grade I patients scheduled for elective abdominal surgery received at random either 25% or 50% inspired oxygen for intra-operative mechanical ventilation lasting 4-6 h. Pulse oximetry was monitored continuously. Venous admixture was assessed from the PaO2/FIO2 ratio and was measured twice intraoperatively: at the time of incision, and during surgical wound closure. PaO2 was measured 1 h after extubation having breathed room air for 10 min, if tolerated. The patients in the two groups were similar in regard to general characteristics, and had similar operations. Patients given oxygen 50% had operations that lasted longer, which made the trial more sensitive. The inspired oxygen did not affect pulmonary gas exchange either within each group or between groups under the conditions of the study. In no patient did pulse oximetry record an oxygen saturation below 95% intra-operatively.

Abdomen↗