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D Fletcher

Publications and source records attributed to D Fletcher.

At least 19 recordsLinked to original sources
PubMed2006

Evaluation of the pharmacokinetic profile and analgesic efficacy of oral morphine after total hip arthroplasty.

BACKGROUND AND OBJECTIVE: Oral morphine may be useful for postoperative pain relief, but few studies have tested its use after in-hospital surgery. METHODS: We evaluated clinical efficacy and the pharmacokinetic parameters of oral morphine after total hip arthroplasty. We recruited 60 patients who had total hip arthroplasty under general anaesthesia. The patients were randomized to receive placebo, 10 mg morphine sulphate or 20 mg morphine sulphate orally every 4 h for 24 h. The oral administration was started 3 h after the morphine-loading dose in the Post Anaesthesia Care Unit and then patients used intravenous morphine patient-controlled analgesia for 24 h. Pain score at rest (scored by patients on a visual analogue scale), sedation, nausea, vomiting and urinary retention were monitored. In 11 additional total hip arthroplasty patients, we determined the pharmacokinetics of morphine and its metabolites after oral administration of 20 mg morphine sulphate every 4 h for 16 h. RESULTS: The amount of morphine administered via patient-controlled analgesia over 24 h was reduced in the 20-mg group compared with that in the placebo group (19.0 +/- 2.7 mg vs. 33.0 +/- 5.5 mg; P = 0.03). No significant morphine-sparing effect was observed in the 10-mg group. Pain scores and side-effects were similar in all groups. The pharmacokinetic study revealed a limited and slow absorption of morphine. CONCLUSION: Despite a limited absorption of oral morphine postoperatively, high doses of oral morphine have a significant analgesic effect after total hip arthroplasty.

Administration, Oral↗
PubMed2006

[Evaluation of duration for direct admission dispatch process in an urban area].

OBJECTIVE: In France, when physicians in ambulances take care of patients, they report medical status to the dispatch centre. Then the dispatching physician search for the available and appropriate hospital service to agree in directly receiving the patient. We attempted to evaluate this direct admission dispatch, in a urban area, with many health care facilities. STUDY DESIGN: Prospective evaluation. PATIENTS AND METHODS: All the files for out of hospital interventions with a dispatch process were included. Data collected and analysed were: main pathologies, started time and end time of direct admission dispatch process and number of services called before finding the right place. RESULTS: 959 patients files were included, 849 could be analysed. The average duration of direct admission dispatch process is 10 (+/-13) minutes. Traumatology speciality shows a longer dispatch process than medicine disease (p < 0.001), and this time increased during summer (p < 0.05). The other parameters did not influence this duration. CONCLUSION: The average duration of direct admission dispatch process is acceptable. The increased duration of direct admission dispatch process in some pathology during summer may induce a risk for the patients. This problem will be improved only when the management of the available bed for emergency traumatology, will be implemented a regional coordination.

Adult↗
PubMed2005

Effect of neurolytic nerve block on systemic carrageenan-induced inflammatory response in mice.

BACKGROUND: Local tissue inflammation caused by injury or inflammatory processes may be reduced by section or local anaesthetic block of the nerve innervating the inflamed area. METHODS: Using a neurolytic nerve block, we assessed the systemic inflammatory response elicited by a local injection of carrageenan in mice. Sixty mice received a unilateral sciatic nerve block with 70% ethanol followed 5 days later by an injection of carrageenan on the ipsilateral or contralateral hind paw. Whole blood was sampled 15 h after carrageenan injection. RESULTS: Fifty-six animals had a complete nerve block. Tumour necrosis factor-alpha (TNF-alpha), interleukin 1beta (IL-1beta) and interleukin 10 (IL-10) concentrations were measured in the plasma of 20 mice (10 in the ispilateral group and 10 in the contralateral group). In the remaining 36 mice (18 in each group), blood was cultured for 24 h in the presence of lipopolysaccharide or Staphylococcus aureus extract. TNF-alpha and IL-1beta production in the supernatant were, on average, 30% lower in the ispilateral group than in the contralateral group. CONCLUSION: A prolonged nerve block decreases the systemic consequences of the local inflammatory reaction elicited by carrageenan injection.

Anesthetics↗
PubMed2004

[Benefit of pharmaceutical anti-oedematous treatment in acute adult epiglottitis].

Acute adult epiglottitis is a potentially life threatening infectious and respiratory emergency as it may result in airway obstruction. Endotracheal intubation, if needed, is a highly risky option in this situation and responsible for important morbidity and mortality rate. The option of a pharmaceutical anti-oedematous treatment, in order to avoid the risks involved in the endotracheal route has rarely been described. We here report the case of a 50-year-old man with a serious acute infectious epiglottitis who was treated at home by a Mobile Intensive Care Unit where a treatment of nebulized epinephrine and intravenous steroids was undoubtedly a successful option to the endotracheal route. So that, for adult patients and in the absence of any risk of an imminent respiratory arrest, this anti-oedematous treatment should be considered in order to avoid endotracheal route, an option which should be undertaken in case of complications. Nevertheless, this isolated case study concerning an adult is not transposable to children for which airway obstruction tolerance is lower.

Acute Disease↗
PubMed2003

Long term effects of oral sustained release morphine on neuropsychological performance in patients with chronic non-cancer pain.

Morphine is increasingly used in patients with chronic non-cancer pain, but a major concern associated with chronic use relates to possible cognitive side-effects. The aim of this long-term prospective study was to evaluate the cognitive impact of oral sustained release morphine in patients with non-cancer pain. A battery of neuropsychological tests to explore attention, psychomotor speed and memory was administered. The effects of morphine on pain, quality of life, mood, subjective memory impairment and side-effects were also investigated. Evaluations were performed at baseline in patients free from opioids and then after 3, 6 and 12 months. Twenty-eight patients were included: 18 received oral sustained morphine (range 40-140 mg/day), ten patients stopped morphine prematurely because of side-effects or insufficient pain relief and were followed as a control group. There was no impairment of any neuropsychological variable over time in the morphine treated patients in comparison with the control group. Two measures of information processing speed - the Stroop interference score and the digit symbol test were improved at 6 and 12 months and there were significant correlations with the pain relief and improvement of mood. Self-reported memory impairment improved notably in responders to morphine. Morphine induced persisting effects on pain, and to a lesser extent on quality of life and mood. The visual analog scale score for side-effects increased at 12 months and essentially consisted of gastrointestinal disorders. This study demonstrates that 12 months treatment with oral morphine does not disrupt cognitive functioning in patients with chronic non-cancer pain and instead results in moderate improvement of some aspects of cognitive functioning, as a consequence of the pain relief and concomitant improvement of well-being and mood.

Administration, Oral↗
PubMed2003

[Laboratory testing measurement of FIO2 delivered by Boussignac CPAP system with an input of 100% oxygen].

INTRODUCTION: CPAP (Continuous Positive Airway Pressure) is one of the treatments of the cardiogenic acute pulmonary edema (cAPE). Among the out-of-hospital used devices, Boussignac CPAP (Vygon) shows a good technical usability, but no analysis of delivered FIO2 is available. OBJECTIVE: To measure the FIO2 delivered to patient, using Boussignac CPAP with an input of 100 vol % oxygen. Type of study. - Measurement in a laboratory testing. MATERIAL AND METHOD: Measurement of delivered FIO2 in a three parameters environment: expiratory positive airway pressure (EPAP), respiratory rate (RR) and required oxygen flow (ROF). Laboratory test: 100 vol % oxygen input, with a ball-type flow regulator for oxygen 0-30 l x min(-1) (Mediline), Boussignac CPAP valve with manometer (Vygon), Michigan test lung, ventilator César (Taema), oxygen analysis (Servomex) with paramagnetic sensor, with a response time < 10 s, pneumotachographe (Fleisch v 2). RESULTS: Under 10 cmH2O EPAP, the required oxygen flow is < or = 30 l x min(-1). Measured FIO2 ranges from 70 to 100 vol %, for a volume per minute < or = 15 l x min(-1) except for a EPAP at 2.5 cmH2O with a rate = 10 c min(-1) and a tidal volume (VT) at 1500 ml where the measured FIO2 is 60 vol %. For a volume per minute > 15 l x min(-1) and < 20 l x min(-1), measured FIO2 ranges from 59 to 83 vol % depending on the variations of RR and VT. CONCLUSION: Boussignac CPAP with 100 vol % oxygen input, delivers high levels of FIO2, especially for volume per minute values usually met in cAPE. The needed oxygen flow is lower than what is usually required by other CPAP flow generators using the venturi effect that may be used in out-of-hospital medical care.

Manometry↗
PubMed2003

Randomized prospective study of the analgesic effect of nefopam after orthopaedic surgery.

BACKGROUND: Balanced postoperative analgesia combines non-narcotic drugs and opioids. We organized a large study to evaluate nefopam analgesia and tolerance in combination with morphine for patient-controlled analgesia (PCA) after orthopaedic surgery. METHODS: Two hundred and one patients scheduled to undergo hip arthroplasty were included in this multicentre (n=24), double-blind, randomized study comparing nefopam (20 mg every 4 h for 24 h) with placebo, the first dose being infused peroperatively. The primary outcome measure was the cumulative morphine dose received postoperatively by PCA over 24 h. Secondary outcome measures were the amount of morphine received as a loading dose in the postanaesthesia care unit (PACU) and during the 24-h observation period, and pain assessments using a visual analogue scale (VAS) and a verbal pain scale (VPS), patient's satisfaction with analgesia and treatment tolerance. RESULTS: The two groups were comparable with respect to their characteristics and preoperative pain assessment. PCA-administered morphine over 24 h was significantly less for the nefopam group than the control group (21.2 (15.3) and 27.3 (19.2) mg respectively; P=0.02). This morphine-sparing effect was greater (35.1%) for patients with severe preoperative pain (VAS>30/100). For the entire study period (loading dose and PCA), morphine use was less for the nefopam group (34.5 (19.6) vs 42.7 (23.6) mg; P=0.01). Pain VAS at PACU arrival and during the whole PACU period was significantly lower for the nefopam than for the placebo group (P=0.002 and 0.04 respectively). Patient satisfaction was similar for the nefopam and placebo groups. CONCLUSION: In combination with PCA morphine, nefopam gives significant morphine-sparing with lower immediate postoperative pain scores without major side-effects. This analgesic effect seems to be particularly notable for patients with intense preoperative pain.

Adult↗
PubMed2001

[Postoperative analgesia].

Postoperative analgesia is not adequate in France. An improvement is necessary for both the patient's comfort and the possible reduction of postoperative morbidity. The cornerstone of postoperative analgesia is regular evaluation of pain allowing adapted treatment. The organisation of postoperative analgesia requires teaching of medical and paramedical staff, the agreement on protocols with designation of a pain referent according to a quality insurance program. Available treatments include non-opioid and opioid drugs and local anaesthetic agents. Main difficulties include interindividual variability, and analgesia on movement. Patient-controlled analgesia allows adaptation of opioid treatment to patient's needs. The combination of drugs and techniques may allow a better analgesia, and a reduction of its side effects.

Analgesia, Patient-Controlled↗
PubMed2001

Resveratrol decreases hyperalgesia induced by carrageenan in the rat hind paw.

The effect of resveratrol, an aryl hydrocarbon receptor (AhR) antagonist, known to inhibit inducible cyclooxygenase-2 (COX2) and its transcription were examined in a model of hyperalgesia induced by carrageenan in the rat. Pretreatment with resveratrol did not reverse swelling and edema, but reversed the hyperalgesia induced by local tissue injury provoked by carrageenan. This reversal, occurring at resveratrol concentrations as low as 2 mg/kg, lasted for at least 48 hours. The link with COX2 activity inhibition and COX2 gene transcription, as well as a potential AhR inhibitory effect, remain to be established.

Animals↗
PubMed2001

[Quality assurance program for blood products in an out-of-hospital medical care unit].

INTRODUCTION: Transfusion of blood products is part of out-of-hospital medical activity. Despite rare use of transfusion and difficult environment, the rules of transfusion must be respected: follow up to detect blood products, security, and patient's information before and after transfusion, follow up of infectious and immunological consequences. However, the current law and usable documents were not conceived for out-of-hospital emergency care. OBJECTIVE: To improve follow-up of blood product transfusion in out-of-hospital medical care (Smur). STUDY DESIGN: Quality assurance programme. MATERIAL AND METHODS: a) Initial evaluation with a retrospective analysis based on the medical chart of patient for whom transfusion has been performed; b) corrective measures were proposed with creation of a specific document concerning transfusion and guidelines for blood product delivery in the out-of-hospital emergency care; c) evaluation of the impact of these correctives measures. RESULTS: Less than one per cent of patients treated by our Smur needed transfusion, mainly during interhospital transfer. Patients were in a life-threatening situation in 50% of cases. Follow-up improved after implementation of the programme from 25 to 83% of transfused patient (p < 0.001). Despite limitation due to the small number of patients, other parameters also improved. CONCLUSION: The use of specific guidelines and document improves the follow-up of transfusion in out-of-hospital medical care.

Adolescent↗
PubMed2001

Histochemical phenotypes of von Ebner's gland of ferret and their functional implications.

Von Ebner's gland of ferret was examined by means of light microscopy, protein, mucosubstance and enzyme histochemistry, and neurohistology. Acinar cells were replete with granules containing neutral mucosubstances and disulphides, and showed strong diffuse acid phosphatase activity and weak granular staining for peroxidase. Staining for cytochrome oxidase, succinate dehydrogenase, and NADH and NAD(P)H dehydrogenases was also seen. Basolateral plasmalemma of acinar cells showed weak, ouabain-sensitive Na+,K+-ATPase activity. Ductal cells were of a simple appearance, contained thiols and showed variable staining for acid phosphatase, dehydrogenases and cytochrome oxidase. Variable amounts of beta-glucuronidase reaction product were localized in the glandular parenchyma, being marked in atrophic areas. Prominent stellate myoepithelial cells embracing acini and also basal ductal cells were demonstrated by alkaline phosphatase. Thiamine pyrophosphatase reaction product was concentrated in blood vessels around parenchyma, with little Golgi-like staining in acinar cells. Acetylcholinesterase activity was associated with an extensive network of nerve fibres embracing parenchyma, whereas catecholamine fluorescence was not seen. The results suggest that the acini of von Ebner's gland of ferret synthesise neutral secretory glycoproteins and peroxidase. Water mobilization is inconspicuous. Lysosomal activities feature in the parenchyma, possibly a consequence of processing secretory products in acini, absorption in ducts and/or adaptation atrophy. The gland receives a rich cholinergic-type innervation, and has extensive myoepithelial and microvascular networks.

Animals↗
PubMed2001

Lack of peripheral analgesia mediated by intraplantar administration of neostigmine in carrageenan-injected rats.

BACKGROUND AND OBJECTIVE: The aim of the study was to test the peripheral analgesic action of neostigmine. Intraplantar administration of neostigmine was studied in carrageenan-injected rats. METHODS: After assessing baseline values (T0) for paw circumference and the paw withdrawal threshold on both hind paws, the right hind paw was injected with 0.2 mL of 1% carrageenan and the left hind paw with 0.2 mL of saline (0.9% NaCl). Two hours later (T1), both hindpaws were tested for inflammation (paw circumference) and for hyperalgesia (paw withdrawal threshold) and subsequently 20 microg of neostigmine was injected in the right hind paw. The paw withdrawal threshold was tested again 10 (T2), 20 (T3) and 60 min (T4) and paw circumference 60 min (T4) after neostigmine injection. RESULTS: Carrageenan injection in the right hindpaw was associated with a decrease in the paw withdrawal threshold reflecting mechanical hyperalgesia (P < 0.001) and an increase in paw circumference reflecting oedema (P < 0.001) in the right hind paw when compared with the left side from T1 to T4. Neostigmine had no effect on paw circumference and the paw withdrawal threshold at measuring points T2, T3 and T4 when compared with T1 in the right hindpaw. CONCLUSION: Our results support the lack of peripheral analgesic effect of neostigmine.

Analgesics↗
PubMed2001

Analgesic efficacy and safety of nefopam vs. propacetamol following hepatic resection.

In order to compare the morphine-sparing effect, analgesic efficacy and tolerance of nefopam and propacetamol given at their highest recommended doses, 120 patients undergoing elective hepatic resection were randomly assigned to receive postoperative intravenous patient-controlled analgesia with morphine alone, or in combination with nefopam (20 mg.4 h-1) or propacetamol (2 g.6 h-1). Compared with the control group (43 [7-92] mg), median [range] cumulative morphine consumption for 24 h after the study started was halved in the nefopam group (21 [3-78] mg, p <0.001) and 20% lower in the propacetamol group (35 [6-84] mg, p = 0.15). Analgesia was superior in the nefopam group despite the lower morphine consumption. Adverse effects were comparable in the three groups, except for significantly more nausea in the control group (39% vs. 17 and 26% in the nefopam and propacetamol groups, respectively) and more sweating in the nefopam group (17% vs. 0 and 3% in the control and propacetamol groups, respectively). Overall patient satisfaction was better (p < 0.001) in patients given nefopam (97%) than those receiving morphine alone (82%) or propacetamol (74%).

Acetaminophen↗
PubMed2001

More epidural than intravenous sufentanil is required to provide comparable postoperative pain relief.

UNLABELLED: The extent to which epidurally administered sufentanil acts directly on spinal opioid receptors remains controversial. We tested the hypothesis that small-dose boluses of sufentanil, given epidurally or IV, provide comparable analgesia at similar plasma sufentanil concentrations. The lipophilicity of sufentanil makes it likely to be absorbed into fat surrounding the epidural space. We therefore also tested the hypothesis that more epidural than IV sufentanil is required to produce comparable analgesia. Analgesia and plasma sufentanil concentrations were evaluated in 20 postoperative patients randomly assigned to patient-controlled epidural or IV sufentanil. Pain was evaluated with visual analog scales by blinded observers. Sufentanil doses and plasma concentrations were measured. Analgesia was similar with epidural and IV sufentanil administration. Plasma sufentanil concentrations were virtually identical in the two groups. However, significantly larger sufentanil doses were required with epidural administration: 238 +/- 50 microg vs 160 +/- 32 microg (P < 0.01). The primary mechanism by which small-dose boluses of epidurally-administered sufentanil produce analgesia seems to be systemic absorption of the drug with subsequent recirculation to the supraspinal opioid receptors. This study demonstrates that the cumulative dose of sufentanil, when administered as a small epidural bolus, is approximately 50% more than that administered IV to provide comparable analgesia. This indicates that the bioavailability of epidurally-administered sufentanil is reduced and suggests that a large proportion of the drug may be absorbed into the epidural fat. IMPLICATIONS: More epidural than IV sufentanil was required to provide comparable postoperative pain relief and similar plasma sufentanil concentrations. These data suggest that when sufentanil is administered in small-dose boluses, much of the drug is absorbed into the epidural fat and that the primary mechanism by which epidurally administered sufentanil produces analgesia is via systemic absorption.

Adolescent↗
PubMed2001

Intraoperative small-dose ketamine enhances analgesia after outpatient knee arthroscopy.

Ketamine may prevent postoperative hyperalgesia. In patients undergoing arthroscopic meniscectomy using general anesthesia, we tested whether a single intraoperative dose of ketamine enhanced postoperative analgesia and improved functional outcome compared with a typical multimodal analgesic regimen. After the induction of anesthesia, 50 patients were randomly assigned to ketamine (0.15 mg/kg IV just after the induction of anesthesia) or a vehicle placebo. Standardized general anesthesia included propofol, alfentanil, and nitrous oxide. Bupivacaine (0.5%) and morphine (5 mg) were given intraarticularly at the end of surgery. Postoperative analgesia was initially provided with morphine and subsequently with naproxen sodium (550 mg orally twice daily) and Di-Antalvic (400 mg acetaminophen and 30 mg dextropropoxyphene) as needed. Pain scores, analgesic requirements, side effects, and ability to walk were assessed in the ambulatory unit and at home for three postoperative days. Times to awakening and to discharge were similar in the two groups. However, the Ketamine group had significantly less postoperative pain at rest and during mobilization on Days 0, 1, and 2. Furthermore, they consumed significantly fewer Di-Antalvic tablets than the control group (13 [7-17] vs 27 [16-32], median [25%-75% interquartile range]). Patients given ketamine were also able to walk for longer periods of time on the first postoperative day. In conclusion, adding small-dose ketamine to a multimodal analgesic regimen improved postoperative analgesia and functional outcome after outpatient knee arthroscopy.

Adolescent↗
PubMed2001

Proinflammatory cytokine responses to P. aeruginosa infection in human airway epithelial cell lines.

A tendency toward excessive inflammation in cystic fibrosis (CF) patients often accompanies lung infections with Pseudomonas aeruginosa. We tested the cytokine response to P. aeruginosa in two pairs of human airway epithelial cell lines matched except for CF transmembrane conductance regulator activity. The 9/HTEo(-) CF-phenotypic cell line produced significantly more interleukin (IL)-8, IL-6, and granulocyte-macrophage colony-stimulating factor but not regulated on activation normal T cell expressed and secreted (RANTES) in response to Pseudomonas than the 9/HTEo(-) control line, and the differences widened over time. Similarly, a 16HBE cell line lacking transmembrane conductance regulator activity showed enhanced IL-8 and IL-6 responses compared with the control cell line. The pharmacology of the cytokine response also differed because dexamethasone reduced cytokine production to similar levels in the matched cell lines. The protracted proinflammatory cytokine response of the CF-phenotypic cell lines suggests that the limiting mechanisms of normal cells are absent or attenuated. These results are consistent with in vivo observations in patients with CF and suggest that our novel cell lines may be useful for further investigation of the proinflammatory responses in CF airways.

Bronchi↗
PubMed2001

The role, responsibilities and educational needs of the non-nurse carer.

Non-nurse carers have been a feature of the British health-care system for many years. Changes in the health service, including the loss of nurses from the workforce, have led to the increased use of non-nurse carers being advocated. However, if they are to be employed effectively, issues relating to their role, responsibilities and educational needs must be carefully addressed. This article examines literature on the contribution of non-nurse carers to the nursing profession in acute and primary care settings and the attitudes of qualified nursing staff, and highlights attempts to define the role and its requirements.

Humans↗