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Biomedical subjects

F Artru

Publications and source records attributed to F Artru.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Use of intravenous lidocaine in neuro-anesthesia and neuro-resuscitation].

Bolus injections of lidocaine are commonly used during neuroanesthesia to prevent or treat ICP elevations caused by tracheal or painful stimuli. Lidocaine can also be employed in case of hard intracranial hypertension, when the usual therapy fails. With continuous perfusion, at high doses, of this agent, a state of lidocaine anesthesia can be induced which is more readily reversible than barbiturate anesthesia. A simultaneous anticonvulsant therapy is mandatory because of the well-known epileptogenicity of lidocaine. Closed cardiovascular monitoring is also needed to detect early signs of cardiotoxicity. Experimental works point to the effectiveness of i.v. lidocaine to prevent ischemic lesions secondary to a cerebral artery occlusion. This protective effect may result from some properties exhibited by lidocaine and not by thiopental: stabilisation of transmembrane ionic fluxes, inhibition of leucocytes intravascular sticking and tissular migration. So, i.v. lidocaine seems help to preserve or improve cerebral perfusion pressure and in cases when the latter decrease below the critical threshold, to protect against cerebral ischemia.

Anesthesia, Intravenous↗
PubMed1991

[Clinical and pharmacokinetic comparative study of sufentanil and fentanyl in supratentorial neurosurgery].

The pharmacokinetic and the effects of sufentanil (S) and fentanyl (F) on cardiovascular stability, brain swelling, respiratory depression and post operative status were studied in 30 neurosurgical patients (group S, n = 15; group F, n = 15). Anesthesia was induced with sufentanil and fentanyl given intravenously (bolus injection 2.5 micrograms.kg-1 vs 25 micrograms.kg-1) followed by a constant rate infusion (0.25 vs 2.5 micrograms.kg-1 x h-1) and a sleep dose of thiopental (3 mg.kg-1) and pancuronium (0.1 mg.kg-1). If necessary, patients could receive more narcotic and, for sudden arousal, a dose of thiopental. Plasma concentrations of sufentanil and fentanyl were measured during and up to 12 hours after infusion. After induction bolus, mean arterial pressure decreased significantly (-30%) with sufentanil. In the group 5, the baseline heart rate and arterial pressure were lower and more stable than in the group F. Brain relaxation always seemed satisfactory. For all but 12 patients with sever neurological status, recovery and extubation times were less than 2 hours and allowed early neurological evaluation. Respiratory depression required naloxone for 2 patients with fentanyl. The plasma clearance of sufentanil and fentanyl (902 vs 914 ml.min-1) are similar. The volumes of distribution are respectively 4.9 and 11.3 l.kg-1, and the half-life 250 and 562 min. The wider volume of distribution and the great half-life compared with previous studies are attributed to corticoïd, osmotic and diuretic preoperative treatment.

Adult↗
PubMed1990

[Treatment of ischemic cerebral edema with intracranial hypertension after neurosurgery of intracranial aneurysms].

Ischemic cerebral edema frequently develops after aneurysm surgery and may lead to severe intracranial hypertension. Of prime importance are reducing the level of ICP and preserving oligemic areas from becoming infarcted. Besides correction of factors known to worsen intracranial hypertension, several therapeutics may be of value: external CSF drainage, perfusion of mannitol, induced arterial hypertension and use of anesthetic agents with cerebral vasoconstricting capability. Hyperventilation is not recommended. Arterial hypotension and hypovolemia certainly contribute to aggravate cerebral ischemia and must be corrected. Cerebral ischemia may be reduced by two specific approaches: by improving cerebral oxygen transport in ischemic areas using arterial hypertension and calcium blockers rather than hemodilution or hypervolemia; by reducing cerebral metabolic rates with heavy anesthesia under the cover of a complete cardiovascular monitoring. In view of the large heterogenicity in cerebral lesions and physiopathological stages, a therapeutical trial appears suitable in each individual case. Criteria allowing to know if any therapeutic, used alone or in association, is beneficial include increase in blood flow in ischemic areas, reduction of ICP level and normalizing of indices like CSF or venous jugular blood lactate.

Blood Pressure↗
PubMed1990

[Hyperthermia in meningeal hemorrhage. Contribution of daily determination of inflammation proteins].

This paper studies the causes of hyperthermias occurring after a subarachnoid hemorrhage by ruptured aneurysm in 54 patients, totalizing 66 febrils episodes. Only 29 episodes bacteriologically proved infections. The profile of thermic curve, the hemodynamical profile, and clinical examination are not convincing. The most convincing elements for the diagnosis of infection are the increasing number of the leucocytes counts, the increasing curve of CRP, and simultaneous decreasing curve of C4. The evolution of these parameters permit to follow the efficiency of antibiotics.

Adult↗
PubMed1990

[Neurogenic pulmonary edema, complication of meningeal hemorrhage: report of 4 cases].

Neurogenic pulmonary edema (NPE) observed in 4 patients admitted in Neurosurgical Intensive Care au SAH by ruptured a vascular malformation. This complication is unusual (1.9%) and has been observed in comatose patients. For 3 patients, NEP resorption was rapid, from 12 to 72 hours with a treatment by CCPV with a P.E.E.P. and with restoring the hemodynamical parameter. The drug must be discussed according to eventual deleterous side effects on cardiac output and systemic resistances. The early hemodynamical study argues for an essentially hemodynamical mechanism due to the brutal symphatic discharge created by cerebral lesions and increasing. ICP, more than a toxic lesionnal edema, as the Weidner's study shows it in ultrastructural analysis of sheep lungs.

Adolescent↗
PubMed1990

[Blood coagulation disorders in intracerebral hematoma caused by rupture of intracranial angioma. Incidences on hemorrhagic recurrence].

In 34 patients admitted in Neurological Intensive Care Unit, for a cerebral hematoma by ruptured arterio-venous malformation, are present in 26 patients, on the first day. In many cases, the APTT is increased and this can be respected. These disorders do not seem to modify the incidence of delayed hemorrhage, except for the severe perturbances, related to a DIC or an hepatic deficiency. In these cases, the delayed hemorrhage must be prevented by transfusions of platelets and/or freeze fresh plasma.

Adolescent↗
PubMed1990

[A rare and severe complication of meningeal hemorrhage: spinal arachnoiditis with paraplegia].

This observation relates a case of spinal arachnoiditis with paraplegia, for a 56 year old patient hospitalized for a S.A.H. by a ruptured aneurysm of the P.I.C.A. This patient present some complications, requiring a prolonged ventilatory support with a tracheostomy, a ventricular shunt for hydrocephalus. The treatment is only surgical, and the corticosteroids delay the evolution, but without successful outcome.

Arachnoiditis↗
PubMed1990

[Intracerebral hematoma caused by rupture of intracranial angioma. Analysis, prognosis and clinical course of 35 comatose patients admitted to intensive care units].

The outcome of 35 patients in deep coma (GSS less than 7) due to an intracerebral hematoma following ruptured arteriovenous malformation (AVM) and admitted to a neurosurgical intensive care unit is reviewed. Eighty percent of these patients had a cerebral AVM and 20% had an AVM in the posterior fossa. All had a medical treatment of increase intracranial pressure (ICP). Twenty-four patients or 68.6% had an early surgical treatment or some days further and 13 had a good outcome, six had a persistent coma or a residual neurological deficit and five died. Four patients or 11.4% had an endovascular embolisation therapy and three had no satisfactory results and one died; all had a new intracranial hemorrhage with hematoma. Seven patients were not treated: four died before 48 hours of hospitalisation, one is in persistent coma and two are waiting an endovascular embolisation, alive but with a neurological deficit. The results suggest that neurosurgical treatment are a safe and effective means for treatment of these AVM with compressive intracranial hematoma.

Adolescent↗
PubMed1989

A controlled study of Dextran 40: effect on cerebral blood flow and metabolic rates in acute head trauma.

A controlled double-blind evaluation of the effects of Dextran 40 at different concentrations on cerebral blood flow (CBF), cerebral oxygen consumption (CMRO2) and cerebral lactate production (CMRLact) was carried out. We studied 40 patients in coma due to recent head injury. Concentrations of Dextran solution were not significantly related to variations in CBF and metabolic rate over the period of infusion. The lack of effect of the Dextran infusion may be explained by the absence of global brain ischemia in these patients at the time of the study. The very low initial CBF values were a consequence of brain metabolic depression and not a sign of global ischaemia. The rheological benefits of treatment with Dextran 40 in head injured patients should preferably be investigated using techniques which permit detection of local changes in CBF and metabolism.

Adolescent↗
PubMed1988

Transient drug-induced abolition of BAEPs in coma.

Combined infusion of high doses of lidocaine and thiopental in a comatose patient induced major latency and amplitude BAEP changes, which progressed to complete BAEP abolition. Responses returned to normal after drugs were discontinued. EEGs during the episodes showed long-lasting periods of activity suppression, but were never isoelectric. BAEPs are resistant to hypothermia and barbiturates, but must be interpreted cautiously in patients treated with a combination of anesthetic drugs that includes lidocaine.

Adult↗