Search PubMed⌕ Search

Biomedical subjects

F Clergue

Publications and source records attributed to F Clergue.

At least 73 records · Page 4Linked to original sources
PubMed1992

Variation in arterial to end-tidal CO2 tension differences during anesthesia in the "kidney rest" lateral decubitus position.

The course of arterial to end-tidal carbon dioxide tension difference [P(a-ET)CO2] was evaluated during general anesthesia in 25 patients scheduled for renal surgery performed in the "kidney position." The difference between arterial PCO2 (PaCO2) corrected to body temperature, and end-tidal PCO2 (PETCO2) measured by mass spectrometry was assessed after induction of anesthesia, after placement in the lateral decubitus position with back arched over a kidney bridge ("kidney position"), and every 20 min until the patients were replaced in the supine position at the end of the surgical procedure. Heart rate, arterial blood pressure, and esophageal temperature were simultaneously recorded. After induction of anesthesia, when the patients were lying supine (T1), P(a-ET)CO2 was 4.8 +/- 3.9 mm Hg (mean +/- SD). Placing the patients in the kidney position (T2) induced a significant increase in P(a-ET)CO2 (to 7.9 +/- 3.5 mm Hg; P less than 0.01). These alterations occurred without any significant change in mean arterial blood pressure or heart rate. A progressive increase in mean P(a-ET)CO2 occurred with maintenance of anesthesia; P(a-ET)CO2 reached 8.8 +/- 4.1 mm Hg (P less than 0.05 vs T2) and 8.9 +/- 4.4 mm Hg (P less than 0.05 vs T2) at 65 and 85 min, respectively, after lateral decubitus positioning. Large variations between and within patients were observed. Although stable mean arterial pressure was maintained, these changes were associated with a significant decrease in body temperature. These results demonstrate that P(a-ET)CO2 increases when patients are placed in the kidney position and may vary with the prolongation of anesthesia in this situation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[A survey on recovery rooms of French university hospitals and Ile de France hospitals].

This study reports the results of a survey of post-anaesthesia recovery rooms (PARR) in French public University Hospitals (UH), and in those of the "Ile de France" (IdFH) area. The study, carried out between the 2nd and 8th of April 1990, aimed to identify the place where patients recovered from anaesthesia, and the personnel and monitoring equipment available in these places. 90% of 55 departments of anaesthesia and intensive care in University Hospitals and 94% of 34 departments in "Ile de France" Hospitals responded. A total number of 20,567 patients was collected, with 10,027 from University Hospitals. Of the latter, 31.4% recovered in the operating room or in the anaesthetic room itself; 7.5% were directly transferred to an intensive care unit (ICU), and 61.1% (10,397) were admitted to a PARR. However, 2,460 of those admitted to such a PARR were in fact admitted to a PARR without any permanent nursing staff. Overall, 45.8% of the patients were not admitted to a PARR where adequate care by nurses was available. Of the 3,540 patients anaesthetized in "Ile de France" Hospitals, 3.1% were transferred to an ICU, 25% were not admitted to a PARR, and the remaining 71.7% were. However, 35% of those admitted to a PARR were admitted to a PARR without any permanent nursing staff. Therefore 50.1% of patients anaesthetized in the "Ile de France" Hospitals did not benefit from adequate post-anaesthetic supervision. In 82% of the patients anaesthetized in University Hospitals, the lowest rates of admission to a PARR were found in patients undergoing gastrointestinal endoscopy (GIE), and ENT, ophthalmological or stomatological surgical procedures. After anaesthesia for GIE, 69% of patients recovered at the anaesthetic post and 12% were admitted to a PARR without any permanent nursing staff. In ENT-Ophthalmology-Stomatology, Gynaecology and Obstetrics, and Radiology departments, 56%, 69% and 69% of patients, respectively, recovered in the anaesthetic room or in a PARR without any permanent staff, or, for the Radiology and Obstetrics departments, sent straight back to their room. Similar results were obtained with the patients in the "Ile de France" Hospitals. Nurses were not always present in 37% and 24% of PARR in University and "Ile de France" Hospitals respectively. In the PARR, there were three ECG monitors for 4 beds, and one pulse oximeter for seven beds. It seems therefore that, despite several ministerial recommendations, not all anaesthetized patients are admitted to a recovery room after their anaesthetic.

Academic Medical Centers↗
PubMed1991

[Severe multiple injuries. Strategy and results. Experience at the Hôpital de la Pitié in 1988 and 1989].

In our series of 97 patients with multiple in juries observed in 2 consecutive years (1988-1989), we have selected only the most severe injuries, of which the patients died within 48 hours, and those that required a long stay in the intensive care department. On admission, we recorded 49 cases of stage II or more severe coma, and 67% of patients under respiratory assistance with an instable hemodynamic state. Out of the 44 deaths recorded, 30 subjects were comatose from the beginning. The justifies the confrontation of 3 specialist teams in 2/3 of cases. The specific recruitment of the hospital and the selection of the most severe cases of these "people under a death sentence" for the study shows a heavy toll of mortality (45,4%), including 60% on the first day. The main cause of death is head injuries (81%). The multivisceral and infectious consequences of long-lasting, heavy intensive care and pulmonary or myocardial contusions account fort secondary deaths in 25% of the patients who had survived. Emergent neurosurgical operations are exceptional, but a neurosurgeon's opinion is always essential. Orthopedic surgical issues are not specific, but the frequency of spinal lesions must be emphasized (27,2%). In this series, 85% of the patients with multiple trauma presented with a lesion of the locomotive apparatus and underwent emergent surgery in every second case in satisfactory conditions. Severe thoracic and maxillofacial lesions requiring surgery are rare. Abdominal lesions are more frequent (17%) and must be dealt with in priority, but they rarely cause death. On the contrary, lesions to the major blood vessels and retroperitoneal compound lesions have a very poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergencies↗
PubMed1991

[The control of respiration in pulmonary fibrosis. The effect of O2 and CO2].

We have studied the mode of ventilation and chemosentivity in 10 patients suffering from pulmonary fibrosis. The total lung capacity was on average 63.5 +/- 8% of the predicted. Their static compliance was 0.078 +/- 0.05 l.cm of water. The patients were studied in the prone position breathing ambient air then on hyperoxia. The response to CO2 was assessed according to the rebreathing method of Read. The results of these patients were compared with those of 11 normal subjects. The ventilation at rest was normal, with a shortened respiratory time and a Ti/Ttot ratio which was lowered. The occlusion pressure (P0.1) was very much higher than that in normal subjects. This rise was correlated with an increase in pulmonary elastance and a reduction in vital capacity. The correction of hypoxia was without effect on the respiratory parameters. In relation to normal subjects the ventilatory response to carbon dioxide in fibrotics was decreased whilst the response of the P0.1 was increased expressing central hyperactivity. In conclusion, fibrotic patients have normal ventilation in spite of an increase in inspiratory work. This normal ventilation results from hyperactivity of the respiratory centre, as in the hyperventilation induced by carbon dioxide when at rest.

Adult↗
PubMed1990

Ventilatory effects of laparoscopy under epidural anesthesia.

This study evaluates the respiratory effects of laparoscopy under epidural anesthesia in seven female patients (ASA physical status I) scheduled for a gamete intrafallopian transfer procedure. Epidural anesthesia was performed with 15-18 mL of 1.5% plain lidocaine using a catheter inserted at the L3-4 level. The upper level of analgesia to pinprick was measured 20 min after lidocaine injection. Ventilatory measurements and arterial blood gas analyses were performed (a) preoperatively, in the horizontal supine position with a T7-9 level of analgesia; (b) in the 20 degrees Trendelenburg position with a T2-5 level of analgesia; (c) during intraabdominal insufflation of CO2 through the laparoscope; and (d) after CO2 exsufflation by manual compression of the abdomen before removal of the laparoscope while in the horizontal position. On-line measurements of VO2, VCO2, VE, VT, F, and PETCO2 were made using a Beckman metabolic cart, while the patients breathed room air through an anesthetic face mask. No significant changes in the ventilatory variables were observed in the Trendelenburg position. In contrast, CO2 insufflation significantly increased VE (from 9.1 +/- 1.0 L/min to 11.8 +/- 2.6 L/min, mean +/- SD), and F (from 16.9 +/- 1.9 breaths/min to 23.1 +/- 3.3 breaths/min, mean +/- SD), whereas VCO2 remained unchanged. PaCO2 remained constant throughout the study. These results suggest that epidural anesthesia may be a safe alternative to general anesthesia for outpatient laparoscopy, as it is not associated with ventilatory depression.

Adult↗
PubMed1989

Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia.

Recovery from inhalation anesthesia is often marked by the occurrence of postoperative tremor that resembles shivering, which is known to be associated with an increase in oxygen uptake (VO2), CO2 output (VCO2), and minute ventilation (VE). This study determined the time course of the ventilatory changes observed during the first hour of recovery from isoflurane anesthesia. Ten patients (ASA PS 1) scheduled for minor orthopedic surgery (knee arthroscopy) were included in this study. Anesthesia was induced with thiopental (5 mg/kg) and maintained with 70% N2O and isoflurane (1-2%) in oxygen, allowing spontaneous ventilation. In the recovery room, after N2O had been discontinued, patients were connected to a Beckman Metabolic measurement cart, which allowed a continuous monitoring of VE, VO2, VCO2, and PETCO2. Postoperative tremor was observed in all patients within 7.1 +/- 1.2 min (mean +/- SEM) after isoflurane discontinuation and was associated with a marked increase in the following: VO2, from 173 +/- 26 ml/min at the end of anesthesia to 457 +/- 88 ml/min; VCO2, from 149 +/- 18 ml/min at the end of anesthesia to 573 +/- 98 ml/min; and VE, from 6.8 +/- 0.7 l/min at the end of anesthesia to 16.6 +/- 2.8 l/min (values obtained 20 min after isoflurane discontinuation). In three patients during intense shivering, VO2, VCO2, and VE reached peak values higher than 800 ml/min, 1,300 ml/min and 30 l/min, respectively. This study shows that postoperative tremor following isoflurane anesthesia may be associated with prolonged and large increases in oxygen uptake, CO2 output, and minute ventilation.

Adolescent↗
PubMed1989

Anesthesia for creation of a forearm fistula in patients with endstage renal failure.

The effects of local infiltration anesthesia, brachial plexus blockade, isoflurane, or halothane anesthesia on blood flow through the brachial artery and through a newly created forearm arteriovenous fistula (AVF) were compared in 36 patients with endstage renal failure. Brachial artery blood flow was measured at two different times, before anesthesia and during anesthesia but before surgery, using a pulsed Doppler flowmeter. AVF flows were calculated from brachial, radial, and ulnar blood flows at the end of surgery, 2 h after surgery, and 3 and 10 days after the procedure. Mean arterial pressure was lower in patients receiving isoflurane or halothane than in those receiving local anesthesia or brachial plexus blockade (BPB). There was a significant increase in brachial artery blood flow following BPB (43.7 +/- 18.7 to 186.9 +/- 98.2 ml.min-1) during isoflurane anesthesia (46.2 +/- 15.9 to 153.1 +/- 80.5 ml.min-1) and during halothane anesthesia (49.9 +/- 24.1 to 97.6 +/- 62.1 ml.min-1). During anesthesia, the difference in brachial artery blood flow between patients in the BPB and halothane groups was significant. Local anesthesia failed to increase brachial artery blood flow (44.0 +/- 12.7 to 45.6 +/- 11.3 ml.min-1). In the immediate postoperative period, the AVF blood flow was lower in patients in the halothane group than in the other groups, but this difference was only significant when compared with BPB group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Ventilatory effects of continuous epidural infusion of fentanyl.

The effects of a continuous epidural administration of fentanyl on pain and on ventilation were studied in eight patients scheduled for orthopedic surgery of the knee. In each subject, epidural fentanyl was given by a bolus dose of 1 microgram.kg-1, followed by a continuous infusion of 1 microgram.kg-1.h-1 over 18 hours. Ventilatory measurements were performed during quiet breathing and during CO2 stimulation tests before surgery. After surgery measurements were made before epidural administration of fentanyl; 1, 2, 5, 18 hours after the start of epidural fentanyl infusion; and 6 hours after its discontinuation. Adequate pain relief was achieved in all patients during fentanyl administration. No significant change in ventilation was noted during quiet breathing. The slope of the ventilatory response to CO2 (VE/PaCO2) decreased significantly from 1.46 +/- 0.2 to 0.75 +/- 0.1 L.min-1.mm Hg-1 (mean +/- SEM; P less than 0.05) one hour after the onset of fentanyl administration, and remained stable throughout the infusion. Eighteen hours after the onset of epidural fentanyl infusion, VE/PaCO2 was still 0.76 +/- 0.14 L.min-1.mm Hg-1. At the end of fentanyl administration, plasma fentanyl levels measured in six patients had progressively increased from 0.42 +/- 0.02 ng.ml one hour after the onset of the infusion to 1.54 +/- 0.19 ng.ml at the end of the infusion. These results suggest that a continuous epidural administration of fentanyl is a technique of analgesia that can provide adequate pain relief but which is associated with ventilatory depression. However, with the doses used in this study, the ventilatory depression remained moderate and of no demonstrable clinical consequence.

Adult↗
PubMed1986

Effect of halothane on diaphragmatic muscle function in pentobarbital-anesthetized dogs.

The mechanism underlying the decrease in minute ventilation (VE) observed under halothane anesthesia was investigated in nine spontaneously breathing dogs. Anesthesia was induced with pentobarbital sodium and was maintained with halothane. Inspired fraction of halothane (FIhal) was increased every 30 min, from 0.005 to 0.02. VE decreased from 8.1 +/- 0.9 to 4.8 +/- 0.4 l . min-1 (P less than 0.001), as FIhal increased from 0 to 0.02. This resulted from a decrease in both mean inspiratory flow (VT/TI) and the duty ratio (TI/TTOT). Transdiaphragmatic pressure (Pdi) and the integrated electrical activity of both hemidiaphragms (Edi) were measured during normal breathing, and during breathing against closed airways (P0di, E0di), in order to obtain an index of the inspiratory neuromuscular output of the diaphragm. With increasing FIhal, there was a significant decrease in Pdi, P0di, Edi, and E0di. The authors measured Pdi and Edi generated during supramaximal stimulation of the two phrenic nerves (PSdi, Esdi) at frequencies of 10, 20, 50, and 100 Hz, in order to eliminate in this decrease the role played by a decrease in the neural drive to breathing. PSdi and ESdi decreased significantly with increasing FIhal, and had not returned to the control values 30 min after discontinuation of halothane administration. The authors conclude that, in pentobarbital-anesthetized dogs, halothane is responsible for a diaphragmatic dysfunction, which may be located either at the neuromuscular junction, on the contractile processes of the muscle, or on both, and for a decrease in the activation time of the inspiratory muscles. Both of these effects contribute to the decrease in VE observed under halothane anesthesia.

Anesthesia↗