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Biomedical subjects

D Benhamou

Publications and source records attributed to D Benhamou.

At least 163 records · Page 9Linked to original sources
PubMed1996

Comparison of high-performance liquid chromatography and polyclonal fluorescence polarization immunoassay for the monitoring of midazolam in the plasma of intensive care unit patients.

Midazolam (M) is used as an induction agent for anesthesia. The main metabolite is alpha-hydroxymidazolam (OM), which is pharmacologically active. Use of M for sedation is a recent application, rapidly gaining favor. Monitoring of the level of sedation is fundamental in that an excessive and prolonged effect is associated with the risk of complications. Thus, it was felt both necessary and useful to measure circulating M levels. We compared a high-performance liquid chromatography (HPLC) assay with fluorescence polarization immunoassay (FPIA) for the measurement of M in the serum of 138 sedated patients in the intensive care unit (i.e., 179 samples). Response of the OM was also assessed. The degree of crossover of the metabolite was between 76.8 and 32.7%. The equation of the regression line for sigma HPLC (i.e., the sum M + OM) versus FPIA was TDx = 1.1585 sigma HPLC + 143.42 (R = 0.966). The 95% confidence interval for the slope was 1.1551, 1.1619. The regression slope differed significantly from 1 (p < 0.001) and shows that FPIA measurements overestimated concentrations obtained by HPLC on the order of 19%. The discrepancy between the two techniques was all the more notable when concentrations were > 1,000 ng/ml. The relative selectivity of Abbott industrial reagent in terms of benzodiazepines leads to the identification of what might be called a midazolam-like (M-like) activity covering both M and OM. The development of a global FPIA method for measurement of this M-like activity in sedated patients provides a satisfactory solution to the question raised.

Adult↗
PubMed1996

Intra-ocular pressure changes during gynaecological laparoscopy.

Laparoscopic surgery carried out under general anaesthesia is associated with physiological changes, which also determine changes in intra-ocular pressure. We measured intra-ocular pressure at each phase of gynaecological laparoscopy, carried out under propofol-alfentanil-isoflurane general anaesthesia, in young women of ASA 1 status, with no pre-existing eye disease. Measurements were made with a Perkins applanation tonometer. Mean arterial pressure and end-tidal CO2 tension were kept constant throughout the study. Intra-ocular pressure decreased significantly after induction of anaesthesia, remained unchanged after a pneumoperitoneum of up to an intraperitoneal pressure of 15 mmHg had been created, increased significantly with head down tilt, but did not increase significantly above pre-induction values. Adequate depth of anaesthesia compensated for the intra-ocular pressure increase caused by head down position. Plateau airway pressure, considered as reflecting intrathoracic pressure, increased with intraperitoneal pressure elevation. However, such changes did not correlate with intra-ocular pressure changes.

Adult↗
PubMed1996

[Chronic tinnitus and hearing loss caused by cerebrospinal fluid leak treated with success with peridural blood patch. Apropos of 2 cases].

Hearing loss and tinnitus are frequently encountered in ENT patients and usually require complementary investigations such as audiogram, auditive evoked potentials, CT scan, MRI... One recent etiology, that is more and more discovered, is a decrease in spinal fluid pressure secondary to a dural fluid leak that occurs after a diagnostic lumbar puncture, a spinal anesthesia, an accidental dural puncture during an epidural technique or a lumbar myelography. Postural headache which are frequently present in such a setting, may mask these auditive symptoms. Epidural injection of autologous blood (blood patch) performed by anesthesiologists, which is usually indicated to treat such postural headaches, is efficient in relieving other symptoms related to spinal fluid leak after dural puncture. We report two cases of isolated auditive complaints (hearing loss and tinnitus) which have been dramatically improved after blood patch. In conclusion, ENT surgeons should seek for a recent or even a past history of spinal puncture whenever the etiology of auditive symptoms of their patient remains unclear.

Adult↗
PubMed1995

Epidural analgesia for labour in a parturient with neurofibromatosis.

The first report of epidural analgesia for labour in a 26-yr-old woman with von Recklinghausen's neurofibromatosis is described. Epidural anaesthesia is often considered as contraindicated because neurofibromas may involve spinal cord and nerve roots. However, general anaesthesia was considered at high risk for this parturient on the basis of her previous medical and surgical history and of physical findings. The present observation suggests that epidural analgesia may be used in such circumstances provided that spinal cord neurofibromas have been ruled out by clinical and CT scan (or magnetic resonance imaging) examination.

Adult↗
PubMed1995

Epidural analgesia during labor: continuous infusion or patient-controlled administration?

Patient-controlled epidural analgesia (PCEA) has several advantages over continuous epidural infusion of bupivacaine during labor: it produces a good analgesia with a limited sensory spread; generally, less bupivacaine is administered and maternal satisfaction with pain control is increased. However, the quality of analgesia is similar to that obtained with other forms of epidural administration. Moreover, PCEA is only a particular form of epidural and, as such, has the same safety requirements. PCEA does not appear to reduce the workload of the anesthetic team. The cost of the PCA pump will need to be included in future evaluation of the cost/benefit ratio.

Analgesia, Epidural↗
PubMed1995

Parturient's posture during epidural puncture affects the distance from skin to epidural space.

STUDY OBJECTIVE: To assess the factors affecting the distance from skin to epidural space. DESIGN: Prospective observational study of consecutive cases over a 2-year period. SETTING: Inpatient obstetric unit in a French university hospital. PATIENTS: 2,123 consecutive term parturients who received epidural anesthesia for cesarean section or epidural analgesia for labor and vaginal delivery. INTERVENTIONS: At the time of epidural puncture, the interspace used and the patient's posture (sitting or left lateral decubitus) were recorded, and the distance from the skin to the epidural space (DS-ES) was measured to the nearest 0.5 cm using a marked epidural needle. MEASUREMENTS AND MAIN RESULTS: The relationship between patient factors [height, weight, body mass index (BMI; weight/height2), presence of scoliosis] and technical factors (interspace, patient's posture at puncture) versus DS-ES was investigated using multiple regression analysis. DS-ES correlated positively with the parturient's weight and BMI. In addition, DS-ES was significantly greater when epidural puncture was performed in the lateral position as compared with the sitting position. CONCLUSION: Both the patient's weight and position during epidural needle placement are important factors influencing DS-ES. A change from the sitting to the lateral position may increase DS-ES, causing catheter dislodgment and consequent inadequate analgesia. Clinical studies relating DS-ES to inadequate analgesia must take these factors into account.

Adult↗
PubMed1995

Post partum headache after epidural analgesia without dural puncture.

In order to improve our knowledge of post partum headache, during a two-year period we studied a large population of pregnant patients of our institution using a four-stage process including two questionnaires (the first at 12-15 weeks' gestation and the second in the first week after delivery), a pre-anesthetic visit at 36 +/- 2 weeks' gestation and a computer printout obtained at delivery. Of 1058 patients for whom records were complete and who had epidural analgesia during labor not complicated by dural puncture, 128 (12.1%) complained of post partum headache. In patients who did not receive epidural analgesia, the incidence of post partum headache tended to be higher (15.2%). However, because of the low response rate (27.1%) and the low absolute number of patients with headache (27) in the non-epidural group, statistical comparison was not possible. Data from the medical history or from the current pregnancy as well as data obtained during delivery (maternal and fetal-neonatal) were not significantly different between those patients free of pain and those presenting with headache, except for a history of migraine and pregnancy-induced hypertension which were both associated with an increased risk of post partum headache. These risk factors should be considered in both clinical studies and obstetric malpractice claims.

Journal Article↗
PubMed1995

Lack of bronchodilator effect after administration of subanaesthetic concentration of isoflurane in mild asthmatic subjects challenged with methacholine.

Volatile anaesthetics used in high concentrations are potent bronchodilators. The effect of lower subanaesthetic concentrations is less documented, particularly in humans with provoked bronchial obstruction. We have studied seven mild asthmatic subjects twice, 1 week apart, during an asymptomatic period. A provocative test with methacholine was performed to produce a decrease in forced expiratory volume in 1 s (FEV1) of at least 20%. The subjects then inhaled either 100% oxygen or 0.75% isoflurane in oxygen for 8 min, via a face mask. During isoflurane inhalation, the subjects lost consciousness but recovered quickly. There was no significant improvement in FEV1 and maximum expiratory flow at 50% vital capacity (MEF50) recorded 3, 6, 9, 14 and 19 min after the end of isoflurane inhalation compared with time-control values. We conclude that lung function in mild asthmatic subjects challenged with methacholine was not improved after administration of a low subanaesthetic concentration of isoflurane. This may be important during recovery from general anaesthesia.

Adult↗
PubMed1995

[New routes for infiltration: surgical wound infiltration].

Wound infiltration with a local anaesthetic may be used either to provide anaesthesia for superficial surgery or for postoperative pain relief. In the latter situation, its efficacy is real but remains moderate and usually requires a combination with other analgesics. Ilio-iguinal and ilio-hypogastric block has been shown to have an analgesic efficacy close to that obtained with a wound infiltration but the duration of analgesia may be longer. These blocks remain unfrequently used in adults.

Administration, Topical↗
PubMed1995

[Mediastinal fibrosis associated with Riedel's thyroiditis. Apropos of a case].

The authors describe a case of mediastinal fibrosis in a 53 year old woman which presented with a superior venacaval syndrome ten years after the diagnosis of a Riedel's thyroiditis. The clinical and laboratory evidence did not reveal anything to suggest other fibrosing disorders (such as retroperitoneal fibrosis, extra-hepatic biliary fibrosis or orbital fibrosis) which could be associated either simultaneously or successively with this multi-focal fibrosis. The physiology of this disorder currently remains imprecise. A current hypothesis is that there is an immunological reaction in the periarterial area leading to lipid components make atheromatous plaques. The therapeutic means are limited and depend on the localisation of the fibrous tissue and of their functional repercussions. Currently, the benefit of corticosteroids on the mediastinal fibrotic lesions has not been demonstrated.

Adult↗
PubMed1995

[Comparative trial of the clinical efficacy and tolerance of cefatrizine (Cefaperos) and cefpodoxime proxetil (Orelox) in superinfections of chronic obstructive bronchopneumopathies in adults in urban practice].

In order to compare the clinical efficacy and safety of cefatrizine (Cefaperos) and cefpodoxime proxetil (Orelox) in the treatment of secondarily infected chronic obstructive pulmonary disease (COPD) in adults, a multicentre, randomized, open study was conducted by 60 general practitioners in two parallel groups of patient suffering from COPD complicated by an acute episode of superinfection (Anthoniesen stages 2 and 3). After verification of the eligibility criteria, written consent and randomization, the patients received, for 10 days, either cefatrizine at the dose of 1 g/day or cefpodoxime proxetil at the dose of 400 mg/day. A self-assessment form was given to the patient. A telephone visit was planned for D3. The final visit on D11 +/- 1 evaluated clinical efficacy (success or failure) and safety. The study population was composed of 250 patients with a mean age of 59.9 +/- 15.9 years (sex ratio M/F = 1.5). The principal etiology of COPD was chronic bronchitis in 67.5% of patients, longstanding asthma in 24.5% and emphysema in 6.8%. The mean history of the disease was 13.0 +/- 10.8 years. The Anthoniesen score was equal to 2 in 73.6% of patients, 3 in 8.8% of patients and 1 in 17.6% of patients. No significant difference concerning these criteria was observed between the two study groups. The clinical success rate was equivalent in the two groups. The time to regression of clinical signs tended to be shorter, up until the sixth day (mainly between D4 and D6) for patients treated with cefatrizine (p = 0.09; NS). The clinical safety was considered to be good and was comparable in the two study groups. This study concluded on the equivalent clinical efficacy of cefatrizine and cefpodoxime proxetil in the treatment of superinfections of COPD in general practice (97.5% and 99%, respectively), with a satisfactory and comparable safety, but with a much lower cost of treatment for cefatrizine. This conclusion is particularly important in the context of opposable medical references, as, although the treatment of superinfections of COPD by second and third generation cephalosporins is frequently proposed, the prescription of a less expensive cephalosporin appears to be more relevant.

Adolescent↗
PubMed1994

Ventilation during total intravenous anaesthesia with ketamine.

Total intravenous anaesthesia with ketamine (TIVAK) is widely used throughout the world especially in precarious conditions. Although ketamine is usually considered to provide good respiratory function and may be used with spontaneous ventilation, recent studies have shown that desaturations may occur. Seventy-six adults and 64 children scheduled for peripheral surgery were randomly allocated to breathe spontaneously room air or 40% oxygen during TIVAK. Pulse oximetry was continuously assessed during anaesthesia and recovery. Desaturation (SpO2 < 92%) occurred immediately after induction in 20 adults breathing air and in only three adults breathing oxygen (P < 0.05). Respiratory abnormalities were sufficiently severe to warrant tracheal intubation in two patients. Desaturations were not observed during the recovery period. Very similar results were observed in children although desaturations observed after induction in paediatric patients breathing room air were less frequent than in adults occurring in only nine patients. These desaturations were also less severe and never required tracheal intubation. The high incidence of arterial desaturation observed immediately after induction of anaesthesia with intravenous ketamine should prompt anaesthetists to provide oxygen in every adult patient at least for the first 15 min. The large decrease in SpO2 sometimes observed requires that trained personnel be present and that equipment for tracheal intubation be available.

Adult↗