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Biomedical subjects

D Safran

Publications and source records attributed to D Safran.

At least 55 records · Page 3Linked to original sources
PubMed1988

[Respiratory problems related to general anesthesia and artificial respiration in the pregnant woman and during childbirth].

General anaesthesia in pregnancy is still responsible for a significant morbidity and mortality. The most common and most serious complications are respiratory secondary to changes induced by pregnancy. These are dominated by hypoxia during difficult intubation and inhalation of gastric contents. Their incidence could be largely reduced by the extensive use of regional local anaesthesia.

Acid-Base Imbalance↗
PubMed1985

[Enflurane for the voluntary interruption of pregnancy].

A hundred women undergoing elective suction therapeutic abortion received general anesthesia with enflurane. Induction and recovery were quick and comfortable. Heart rate and blood pressure were not significantly modified neither uterine contractility. Enflurane is suggested for DC in out-patients.

Abortion, Induced↗
PubMed1984

An analysis of the diagnostic methods for acute pulmonary embolism.

In spite of numerous sophisticated investigative procedures, acute pulmonary embolism (PE) is very frequently misdiagnosed. In order to improve the diagnostic approach to PE, the sensitivity and specificity of the commonly used methods were reviewed in a group of 421 patients with angiographically proved PE without associated cardio-pulmonary disease. The specificity of diagnostic procedures was, by decreasing order: positive pulmonary angiography (to affirm) = negative perfusion lung scan (to eliminate) greater than chest X-ray much greater than clinical symptoms, positive perfusion lung scan, ECG, blood gas, serum enzymes.

Acute Disease↗
PubMed1984

Penetration of cefsulodin into bronchial secretions.

The objective of this study was to evaluate the penetration of cefsulodin, a new cephalosporin active against Pseudomonas aeruginosa, into the bronchial secretions. The study was carried out in 28 patients with respiratory infections; 11 patients received a single dose of 1 g i.v. (bolus); 17 patients received multiple doses of 1 g every 8 h for 48 h. Simultaneous samples of blood and bronchial secretions were collected 30 min and 1, 2, 4 and 6 h after injection. Bronchial secretions were obtained from 23 patients by means of fiberoptic bronchoscopy and in 5 tracheostomized patients (with severe respiratory insufficiency) through a tracheostomy cannula. The assays of cefsulodin were performed by means of the microbiological agar diffusion technique. The results of the study showed a noticeable penetration of the drug into the bronchial secretions, with a mean peak reaching 3.1-5.3 micrograms/ml at the 3rd or 4th hour, a slow elimination and residual levels at 6 h ranging between 2.0 and 6.0 micrograms/ml. The rate of penetration was not influenced by the administration of multiple doses of the drug. The ratios between bronchial concentrations and simultaneous serum concentrations ranged between 10 and 30%, corresponding to the usual values found for other cephalosporins. In conclusion, this study provides satisfactory results and confirms the presence of bronchial levels capable of inhibiting P. aeruginosa.

Bronchi↗
PubMed1984

[Bronchial diffusion of new anti-pseudomonal beta-lactams. Clinical significance].

In treating severe respiratory infections due to Pseudomonas aeruginosa and in patients with cystic fibrosis, new anti-pseudomonal beta-lactams constitute a good alternative to the traditional aminoglycoside antibiotic therapy. Among several criteria for the choice of an antibiotic, estimation of intrabronchial levels is to be taken into account. The authors report the results of the study of a new semi-synthetic penicillin, apalcillin, and two cephalosporins (cefsulodin, ceftazidime), active in vitro against Pseudomonas; their penetration into respiratory secretions was evaluated in 48 patients, intubated, tracheostomized, or undergoing fiberoptic bronchoscopy. Antibiotic concentrations were measured by the microbiological procedure. Bronchial penetration of apalcillin was early and noticeable, reaching a bronchial peak representing 20% of the simultaneous seric concentration. The local levels of cefsulodin and of ceftazidime did not differ from those achieved with cephalosporins studied previously; the bronchial peak reached 5,6 micrograms/ml for both drugs 2 hours after administration; this bronchial level corresponded to 15 to 20% of the serum concentration. The clinical response could not be evaluated due to the severe underlying pathology which compromised the outcome of the disease in the patients of this study. However, at least for apalcillin, a significant correlation was noted between bronchial levels, susceptibility of bacteria isolated in patients, and eradication of susceptible organisms.

Anti-Bacterial Agents↗
PubMed1983

[Penetration of netilmicin into respiratory secretions].

Aminoglycosides are often used in the treatment of severe Gram-negative infections, particularly those involving the respiratory tract. The purpose of this study was to evaluate the penetration of netilmicin into bronchial secretions. In 8 tracheostomized patients samples of bronchial secretions were taken at intervals through the tracheostomy cannula after intramuscular injection of netilmicin 2 mg/kg bodyweight. Concentrations of the drug were measured in bronchial secretions and in blood samples taken simultaneously, using the agar diffusion method (Grove and Randall procedure). The results showed significant penetration of netilmicin, with a mean bronchial peak reaching 3.4 micrograms/ml 1 h after the injection. Elimination was slow, with a mean residual level of 2 micrograms/ml at 6 hours. The bronchial to serum levels ratio was high (greater than 30% at 1 hour). Individual variations in both serum and bronchial levels were noted; they were unrelated to the underlying pathology. However, changes in bronchial concentrations correlated with changes in serum concentrations, which suggests passive diffusion across the blood-bronchoalveolar barrier. The fluctuations in bronchial levels and the usually low bronchial concentrations of aminoglycosides previously reported are discussed in relation to the methods used.

Adult↗
PubMed1979

[Acute respiratory failure: comparison of spontaneous ventilation with continuous positive airway pressure (CPAP) and mechanical ventilation with positive and expiratory pressure (CPPV) in 6 cases (author's transl)].

The hemodynamic and respiratory effects of spontaneous ventilation with continuous positive airway pressure (CPAP) and mechanical ventilation with positive and expiratory pressure (CPPV) were compared in six patients with acute respiratory failure. Arterial and mixed venous gases, cardiac output, oxygen delivery and consumption, airway and oesophageal pressures were measured, with each patient on intermittent positive pressure ventilation (IPPV), CPAP and CPPV with the same level of positive and expiratory pressure (PEEP = 20 cmH2O). CPAP was as efficient as CPPV for improving arterial oxygenation. Cardiac output was higher on CPAP than on CPPV due to a lower intra-thoracic pressure with spontaneous ventilation, thus oxygene transport was higher with this methode. However total oxygene consumption and PaCO2 were slightly increased with CPAP due to a higher breathing's work. So, CPAP is as efficient as CPPV at the same level of PEEP in improving intra-pulmonary shunt and PaO2, without adversely affecting cardiac output.

Heart Rate↗
PubMed1979

Comparative haemodynamic effects of dopamine and dobutamine in septic shock.

Septic shock associated with depressed myocardial function generally requires the use of catecholamine. Currently dopamine is often selected. Dobutamine is a newly developed catecholamine which has been shown to be of value in severe cardiomyopathic disease. The aim of this work was to determine the most appropriate drug by comparing haemodynamic responses to dopamine and dobutamine in 19 studies carried out in 11 patients with septic shock and heart failure. Cardiac index increased siliarly with dopamine and dobutamine (33%), as did stroke volume (respectively 26.4 and 25%). Arterial pressure increased by 17% with dopamine whereas it did not significantly change with dobutamine due to reduction in vascular resistance of 19%. Dobutamine decreased filling pressure, either right (14%) of left (28%) whilst they slightly but unsignificantly increased with dopamine. Pulmonary shunting increased more with dopamine (47%) than with dobutamine (16%), but PaO2 remained constant with both. Since septic shock is characterized by lowered arterial pressure and vasodilatation it is concluded that effects of dopamine on capacitance and resistance vessels make this drug more suitable. In addition it selectively increases renal blood flow. Nevertheless dobutamine could be appropriate, in case of very high filling pressures, severe peripheral vasoconstriction, marked pulmonary shunting and in some cases where dopamine becomes ineffective.

Catecholamines↗
PubMed1978

[Hemodynamic effects of etomidate].

A study of the haemodynamic effects of an injection of 0.3 mg/kg of Etomidate was carried out in 11 multiple trauma patients under constant controlled ventilation. At the 3 rd minute after injection there was a slight, but significant, increase in cardiac output and in the systolic index of the left ventricle, persisting at the 20th minute. It may be concluded that the injection of a dose of 0.3 mg/kg has no harmful haemodynamic effects in this type of patient.

Adult↗
PubMed1978

[Comparative study of the effects of dobutamine and dopamine in septic shock].

This work aims at the evaluation of the effects of dobutamine in the effects of dobutamine in the treatment of septic shock and to compare them to the effects of dopamine used in the same conditions. Eleven patients presenting with both a state of septic shock and confirmed cardiac insufficiency were submitted to the protocol. The dosage was determined by the clinical results : 6.22 microgram/kg/min for dopamine and 4.2 to 25 microgram/kg/min for dobutamine. The results show that although the effect on cardiac output is comparable with the two drugs, some differences in their effects delineates their respective distinct indications. Indeed, although dobutamine seems less arythmic, lovers more the ventricular filling pressure and increases less the intra-pulmonary shunt, dopamine causes less reduction in the systemic resistance which in the case of septic shock seems more logical. Nevertheless dobutamine is perhaps easier to handle.

Blood Pressure↗