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Biomedical subjects

D Journois

Publications and source records attributed to D Journois.

47 records · Page 3Linked to original sources
PubMed1990

[Comparison of the antithrombotic effects of heparin, enoxaparin and prostacycline in continuous hemofiltration].

Continuous anticoagulation is required during haemofiltration to prevent the deposition of fibrin and the formation of thrombus which would lead to early clotting of the haemofilter. This study aimed to compare the efficiencies of 3 different anticoagulation protocol: 150 IU.kg-1.day-1 heparin (group HEP), 1.2 mg.kg-1.day-1 enoxaparin (group ENX), and a combination of 0.8 mg.kg-1.day-1 enoxaparin with 5 ng.kg-1.min-1 prostaglandin I2 (group ENX and PGI2). A flat ANS69S (Hospal) haemofilter was used for continuous venovenous haemofiltration. Antithrombotic efficiency was assessed with a haemofilter permeability index (HPI) including the transmembraneous pressure gradient and the rate of production of ultrafiltrate. The time required for HPI to decrease to 1/3 of its initial value (HPI1/3) was used to compare the 3 protocols. Treatment tolerance was judged by monitoring the usual haemodynamic and haemostatic parameters. No adverse effects (bleeding, thrombosis, hypotension) were observed. HPI1/3 was 15.1 +/- 2.4 h, 18.3 +/- 3.1 h and 28.2 +/- 4.2 h in groups HEP, ENX and ENX and PGI2 respectively. High dose enoxaparin reached antithrombotic efficiency without increasing the risk of haemorrhage. The use of low doses of prostaglandin I2 greatly increased HPI1/3, without any deleterious haemodynamic effects. However, the high cost of prostaglandin I2 needs to be put in the balance with the increase in duration of haemofilter life. Therefore, further investigations are required to evaluate the possible synergy between heparin and prostaglandin I2, as well as the biological parameters which need to be monitored.

Acute Kidney Injury↗
PubMed1990

Continuous intercostal blockade with lidocaine after thoracic surgery. Clinical and pharmacokinetic study.

The efficacy and the side effects of a continuous infusion of lidocaine in the fifth intercostal space for the management of postoperative pain after lateral thoracotomy were evaluated in 20 adults. An indwelling catheter was inserted in the appropriate intercostal space before thoracotomy closure. After recovery from general anesthesia, a loading dose of 3 mg/kg of 1.5% lidocaine with epinephrine 1:160,000 was injected through the catheter, followed by a continuous infusion of 1% lidocaine without epinephrine at a rate of 1 mg.kg-1.h-1 for 54 h. In seven patients pharmacokinetic data were obtained. Pain, assessed by visual continuous analog scale, decreased from a median score of 8 (range, 7-10) to a score of 5 (range, 2-7) 20 min after the loading dose of lidocaine and continued to decrease until the end of the study (P = 0.0001). Complete cutaneous analgesia, assessed by pinprick test, was seen in a median of three thoracic spinal segments (range, 0-6) with partial cutaneous analgesia in seven segments (range, 6-9) 40 min after the loading dose, and levels that remained unchanged for 54 h (P = 0.0001). Peak lidocaine serum concentrations, 1.9 +/- 0.7 micrograms/mL, were present 9 +/- 3 min after injection of the loading dose. Serum concentrations of lidocaine under steady state conditions averaged 4.8 +/- 0.9 micrograms/mL (range, 3.5-5.8 micrograms/mL). This level under steady state conditions, though below the toxic level, suggests that additional bolus injection of lidocaine during the course of infusion might result in potentially toxic serum levels of lidocaine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Enoximone and pediatric heart surgery].

The double mode of action of enoximone, inotropic and vasodilator, makes it a valuable drug in adult cardiac surgery. There have been no reports of its use in paediatric cardiac surgery. We studied its effects in 15 children with a right heart malformation, 5 with cardiac transplants and 5 with various malformations of different complexity. Enoximone was administered as an IV bolus of 1 mg/kg over 10 minutes, relayed by a continuous infusion of 7.5 gamma/kg/mn. This drug was used alone in 15 patients and in association with dobutamine or dopamine in the others. Enoximone was associated with an improved haemodynamic status after repair of right heart malformations related to better left ventricular contractility, a moderate but statistically significant elevation of mean blood pressure without tachycardia, and stable right heart filling pressures. Improved systemic perfusion was also observed in children awaiting cardiac transplantation. This treatment provided a bridge to cardiac transplantation which was attained in good condition, given the difficulties of using mechanical circulatory assistance in children and the scarcity of donors. When associated with other pulmonary vasodilators, enoximone was effective in the treatment of right heart failure with pulmonary hypertension. When used alone or in association with catecholamines, enoximone is a treatment of choice in per and postoperative paediatric intensive care, especially as the synergist effect obtained enables a reduction in the quantity of classical inotropic agents used, thereby contributing to an attenuation of the phenomenon of exhaustion observed with catecholergic drugs.

Adolescent↗
PubMed1989

[Continuous monitoring of mixed venous oxygen saturation in anesthesia in pulmonary surgery].

The multiplicity of potential causes of variations in mixed venous oxygen saturation (SvO2) during one lung ventilation (OLV), including a constant ventilation/perfusion mismatch, explains that it has been suggested as a routine monitoring procedure. To assess its usefulness, 12 adults undergoing OLV were monitored during surgery with an Oximetrix pulmonary catheter, placed on the side opposite to the surgical field under fluoroscopic control. Seventy two complete sets of haemodynamic measurements were obtained at 6 different times during surgery. We studied the ability of changes in SvO2 to predict changes in arterial oxygen saturation (SaO2), cardiac output (CO), and venous admixture (VA) by calculating sensitivities (Se), specificities (Sp) and predictive values with regard to these variables. There were no complications due to the protocol. However left-sided catheter placement failed in four cases. Correlation between optical and measured SvO2 was very strong (r = 0.94; p less than 0.001). SvO2, oxygen consumption (VO2) and the rate of oxygen extraction remained constant throughout the procedure, even when CO, mean arterial pressure, VA, SaO2 and PaO2 varied. Clamping the pulmonary artery returned VA, SaO2 and PaO2 values to those found before OLV, but produced a significant decrease in CO. SvO2 had low Se and Sp for changes in other variables (CO: 76 +/- 7, 48 +/- 9; PaO2: 79 +/- 6, 59 +/- 9; VA: 54 +/- 7, 48 +/- 7 respectively). In this type of surgery, alterations in variables related to oxygen are probably balanced by haemodynamic changes. In fact, according to Fick's formula, SvO2 is almost completely determined by SaO2 and CO, when VO2 and haemoglobin remain stable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Effects of anesthesia induction with propofol on plasma renin activity and atrial natriuretic factor secretion. A preliminary study].

The authors have noted a substantial increase in plasma renin activity, when the patients were induced with propofol (2.5 mg.kg-1). Although a direct or an indirect effect of propofol may be suggested, the design of this study is not helpful in pointing out the responsibility of the drug in the observed effects. Further studies including peripheral vascular resistance measurements should be undertaken.

Adult↗
PubMedDate not supplied

Effects of calcium concentration, lactobionate content, and sodium/ potassium ratio of preservation solutions on resting left ventricular pressure and postreperfusion function of rabbit heterotopic heart transplants.

BACKGROUND: We tested the hypothesis that the University of Wisconsin solution has a ionic composition (i.e., intracellular, calcium-free, lactobionate-enriched) that may be beneficial for cold heart graft preservation independently from any additives. METHODS: St. Thomas' Hospital and University of Wisconsin solutions were compared with the following: (1) C solution, a simplified University of Wisconsin-like solution (i.e., intracellular, calcium-free, lactobionate-enriched); (2) A solution, an St. Thomas' Hospital-like solution (extracellular, calcium [Ca2+] = 1.2 mmol/L) in which chloride was replaced by lactobionate; (3) B solution, an intracellular, lactobionate-enriched, calcium-containing solution ([Ca2+] = 1.2 mmol/L). Rabbit hearts were transplanted heterotopically in the abdomen of recipient animals either immediately or after 6 hours of storage. Hemodynamic parameters were recorded 60 minutes after unclamping. RESULTS: After a 6-hour storage, University of Wisconsin and C solutions provided better preservation than B and St. Thomas' Hospital solutions: diastolic pressures were lower; developed pressure and rate of pressure rise were higher. C solution was superior to University of Wisconsin solution only for rate of pressure rise. A solution was intermediary. A significant alteration of resting pressure and hemodynamic parameters was generally observed during the 6-hour storage. Nonsignificant changes of developed pressure and rate of pressure rise were only observed in C and B solutions: This is explained by systolic alteration after immediate reimplantation for the B group and good preservation for the C group. Resting pressure was unchanged over a 6-hour storage only for the C group, but this measure was not determined for University of Wisconsin. A correlation exists for various left ventricular volumes between resting pressure and postreperfusion hemodynamic data. Replacement of chloride by lactobionate (A versus St. Thomas' Hospital) may have improved resting and diastolic pressures by other mechanisms than limitation of net water gain during storage.

Adenosine↗