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Biomedical subjects

F Clergue

Publications and source records attributed to F Clergue.

88 records · Page 5Linked to original sources
PubMed1986

Ventilatory pattern and chest wall mechanics during ketamine anesthesia in humans.

The effects of anesthetic doses of ketamine (iv bolus of 3 mg X kg-1 followed by a continuous infusion of 20 micrograms X kg-1 X min-1) on functional residual capacity (FRC) measured by the helium dilution method and on the breathing pattern recorded by a noninvasive method (NIM) based on chest wall circumference changes were studied in 14 ASA P.S. I patients. Ketamine anesthesia was associated with: 1) the maintenance of FRC, minute ventilation, and tidal volume; 2) an increase in rib cage contribution to tidal breathing; and 3) an alteration of volume-motion relationships of the chest wall compartments. It is concluded that: 1) in contrast to volatile anesthetic agents, ketamine anesthesia has a sparing effect on intercostal muscle activity, which may explain the maintenance of FRC; and 2) changes in chest wall geometry and compliance induced by anesthetic agents must be taken into account for NIM to be valid.

Adult↗
PubMed1986

[Heart transplantation 1985. Experience of the Pitié].

Heart transplant surgery has come of age over the last four years, after 17 years of clinical application: indications have been specified, techniques systematized and treatment and post-operative follow-ups have been clarified. The results are remarkable: survival at four years is more than 80 per cent, with normal socio-familial and often professional reintegration for almost all heart transplant patients. Increased application of heart transplant surgery in the months to come will transform prognosis in patients presenting irreversible cardiac lesions, but will raise the problem of the supply of donor organs.

Adult↗
PubMed1985

Ventilatory response to CO2 following intravenous and epidural lidocaine.

The authors determined the effects of intravenous infusion and epidural administration of lidocaine on the control of ventilation in two groups of eight healthy unpremedicated subjects. In the intravenous group, an injection of 1.5 mg/kg lidocaine was followed by an infusion at a rate of 60 micrograms X kg-1 X min-1 for 30 min. The slope of the ventilatory response to CO2 was significantly increased (P less than 0.05) from its control value (2.65 +/- 1.22 1 X min-1 X mmHg-1 [mean +/- SD]) at the end of the infusion (58%), while plasma lidocaine level was at 3.14 +/- 0.82 microgram/ml. The correlation between individual plasma lidocaine levels and the changes in the slope of the ventilatory response to CO2 was significant (r = 0.58, n = 24, P less than 0.01). In the epidural group, after the administration of 5 mg/kg of lidocaine, the slope of the ventilatory response to CO2 increased significantly (P less than 0.05) from its control value (1.52 +/- 0.75 1 X min-1 X mmHg-1) at 15 (+22%) and 25 min (+42%), while plasma lidocaine levels were at 1.79 +/- 0.42 and 2.22 +/- 0.47 microgram/ml, respectively. In both groups, resting minute ventilation and end-tidal CO2 values remained unchanged. These results suggest that epidural lidocaine has a stimulating effect on the ventilatory control mechanisms that results from the systemic effect of the drug.

Adult↗
PubMed1984

Oxygen drive to breathing during halothane anesthesia: effects of almitrine bismesilate.

The changes in ventilation and breathing pattern induced by the substitution of pure oxygen for room air were tested in patients during stable halothane anesthesia before and after the administration of almitrine bismesilate, a specific stimulant of the peripheral chemoreceptors. Ventilation was monitored in 25 patients for 15 min while breathing an air-halothane (1.5%) mixture and while breathing then for 10 min an O2-halothane (1.5%) mixture. The maneuver was repeated in 11 of these patients after the infusion of 0.5 mg/kg of almitrine bismesilate. Before almitrine administration, O2 inhalation caused a progressive decrease of minute-ventilation (VE) reaching 94.5 +/- 1.4% (mean +/- SEM) of the initial value at the tenth minute (P less than 0.01). This decrease was secondary to a progressive increase of inspiratory and expiratory times. Almitrine bismesilate caused a significant increase in VE (+11.6%), tidal volume (+14.0%), and mean inspiratory flow (+10.0%) when breathing the air-halothane mixture. Ten minutes after O2 administration, these variables were not different from those observed before almitrine infusion. This study shows that during halothane anesthesia, hypoxic ventilatory drive is not abolished but is depressed severely. Almitrine bismesilate can restore the hypoxic ventilatory drive.

Adult↗
PubMed1984

Respiratory effects of intrathecal morphine after upper abdominal surgery.

The effects of intrathecal (IT) administration of two doses of morphine (Group 1: 2 mg, n = 9; Group 2: 5 mg, n = 10) were studied in 19 patients after upper abdominal surgery. The ventilatory variables and occlusion pressure (P0.1) were recorded during room air breathing and during CO2 rebreathing tests prior to surgery, 24 h after surgery before IT morphine (n = 12), and 3, 5, 7, 11, and 24 h after injection. During room air breathing, minute ventilation (VE) did not change significantly in Group 1 and decreased significantly 3, 5, 7, and 11 h after injection in Group 2. During the rebreathing tests, there was a significant shift to the right of the ventilatory response to CO2 in both groups. The peak of the ventilatory depression was delayed, occurring 7 h and 11 h postinjection in Groups 1 and 2, respectively. Two patients in Group 2 developed clinically significant ventilatory depression. The shallow breathing observed after surgery was not changed after analgesia. In group 2, 5, mg IT morphine was responsible for a significant decrease in f60 (respiratory frequency for a PETCO2 of 60 mmHg). P0.1 increased markedly after surgery during both room air breathing and the rebreathing tests. After IT morphine, compared with the postoperative preanalgesic values, P0.1(60) (P0.1 at a PETCO2 of 60 mmHg) did not change in Group 1 and decreased significantly in Group 2. It is concluded that IT morphine is responsible for a ventilatory depression that is delayed and seems to be dose related and that analgesia does not abolish the shallow breathing observed after upper abdominal surgery.

Abdomen↗
PubMed1983

[Elements predicting respiratory complications after total excision of neurinomas of the 8th nerve. Consequences on the postoperative treatment (study of 12 cases)].

Pulmonary complications are observed after radical surgery of acoustic neurinomas. This study, performed on 12 patients was undertaken to appreciate central respiratory activity by measuring the respiratory response to CO2 before and after the operation and to find out whether they could be used to predict post-operative respiratory complications. The patients who developped pulmonary or bronchial infections had increased PaCO2 (45.1 +/- 3.0 mmHg--mean +/- S.D.) and decreased ventilatory response to CO2 (VE/PACO2: 0.65 +/- 0.37 1/min/mmHg) before the operation. After the operation, all these patients developped swallowing difficulties and a decreased vigilance; therefore we assumed that swallowing troubles and decrease of vigilance could be responsible for bronchopulmonary infection. Patients with a low respiratory response to CO2 have higher risk of developping pulmonary complications and can be detected before surgery by this non-invasive test and by the measure of PaCO2.

Arousal↗
PubMed1982

Preoperative evaluation of hemodynamic factors in cerebral arteriovenous malformations for selection of a radical surgery tactic with special reference to vascular autoregulation disorders.

After reviewing the literature with respect to hemodynamic factors in AVM the authors describe their experience monitoring the blood volume under induced arterial hypotension. They have been able to select cases which presented disorders of the vascular autoregulation of the brain and represent, for this reason, a challenge to a radical excision; in such cases they advise to remove the AVM in several programmed stages. In addition it was possible to predict the efficiency of the hypotension on AVM vessels pressure during operation enabling the surgeon in case of positive effect of the hypotension to realize more securely the haemostasis. Moreover, the authors present the first data regarding the mean circulatory time the knowledge of which seems very promising. The last 33 cases of a series of 179 radical removals have been monitored before and in some cases after operation; the knowledge of these hemodynamic factors allowed the surgical team of La Pitié to extend the surgical indications for radical removal to AVM recently considered as inoperable.

Adult↗
PubMed1981

Depression of respiratory drive by diazepam as premedication.

The respiratory effects of premedication with i.v. injection of diazepam have been assessed in 10 healthy patients awaiting minor operative procedures. Measurements were recorded before and 60 min after administration of diazepam 0.14 mg kg-1. Mouth occlusion pressure (P 0.1) was used as an index of neuromuscular inspiratory drive. Minute-ventilation (VE), respiratory frequency (f) and mean inspiratory flow rate (VT/TI) were significantly reduced after diazepam. During carbon dioxide rebreathing the slopes of VE, f, VT/TI and P 0.1 with PACO2, were significantly reduced. These results confirm that i.v. diazepam produces significant respiratory depression in healthy subjects. We conclude that diazepam used under clinical conditions depresses the respiratory centre.

Adult↗
PubMedDate not supplied

Safety of preoperative enoxaparin in head and neck cancer surgery.

BACKGROUND: Thromboembolism is a risk in major head and neck cancer surgery patients predisposed to thrombosis. This study was designed to determine whether enoxaparin (a low molecular weight heparin) administered prior to surgery induces perioperative bleeding. METHODS: Forty patients scheduled for major cervicofacial cancer surgery were randomized in a double-blind study to receive either 20 mg enoxaparin or placebo, 12 hours before surgery. Blood losses were measured at the end of surgery and 6 hours later. RESULTS: Bleeding was equal in the placebo group and in the enoxaparin group, with losses of 648 +/- 106 mL and 602 +/- 106 mL (p = 0.76), respectively. Six hours after surgery, blood collected was 159.3 +/- 25.7 mL in the placebo group vs 151.4 +/- 21 mL in the enoxaparin group (p = 0.81). CONCLUSION: Preoperative administration of enoxaparin is safe in head and neck cancer surgery, but further studies are required to evaluate its efficacy in preventing thromboembolism.

Adult↗
PubMedDate not supplied

[Acute myocarditis disclosing leptospirosis].

A 44 year old patient presents with acute myocarditis and cardiogenic shock. The evolution is progressively favorable at the price of a residual involvement of the left ventricular function, evolving to a dilated cardiopathy, within three years. The responsibility of an advanced ictero-hemorrhagic leptospirosis is established. The severity of this myocarditis and the revealing characteristics of the leptospirosis are peculiar to this observation which is discussed in terms of data from the literature.

Acute Disease↗