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Biomedical subjects

F Nicolas

Publications and source records attributed to F Nicolas.

At least 91 records · Page 5Linked to original sources
PubMed1980

[Prolonged neuromuscular blockade during a D. penicillamine-induced myasthenia (author's transl)].

The authors report a D. Penicillamine-induced myasthenia gravis in a patient with rheumatoid arthritis. The disorder was revealed by a postoperative respiratory depression which could be attributed to the aggravation of the neuromuscular blockade by the muscle relaxants. D. Penicillamine-induced myasthenia gravis is now well known. The onset of such an accident after anaesthesia of patient treated with D. Penicillamine is a potential risk. Management of these patients in anaesthesia must be similar to the management of patients with classic myasthenia gravis.

Adult↗
PubMed1980

[Induction of anaesthesia. Haemodynamic incidence in patients with ischaemic myocardiopathy (author's transl)].

Haemodynamic incidence of induction of anaesthesia was evaluated in four groups of 10 patients in general surgery: patients without heart disease (gr. I), patients with ischaemic myocardiopathy (gr. II, gr. IV), patients with ischaemic heart disease who were digitalized before anaesthesis (gr. III). An anaesthetic technique comprising a combination of phenoperidine, thiopentone, suxamethonium, pancuronium, N2O/O2 was used in groups I, II, III and patients of group IV were anaesthetized with a protocol of narconeuroleptanalgesia (phenoperidine, droperidol, thiopentone, pancuronium, N2O/O2). Induction of anaesthesia in patient with ischaemic myocardiopathy leads to haemodynamic changes with a predominant decrease of mean arterial pressure. But the haemodynamic changes are less important with neuroleptanalgesia than with balanced anaesthesia. With neuroleptanalgesia decrease of mean arterial pressure is rather less important than with balanced anaesthesia and it is not coupled with a significant decrease of cardiac index but only with a decrease of total peripheral resistances. On contrary with balanced anaesthesia decrease of mean arterial pressure is connected with a significant decrease of cardiac index related to a decrease of systolic index. Pre-operative digitalization do not attenuate cardiac and haemodynamic changes occurring after induction and balanced anaesthesia. Though neuroleptanalgesia appears to be a safe technique in patients with ischaemic heart disease.

Abdomen↗
PubMed1980

[Perioperative cardiac arrhythmias in digitalized patients with ischemic heart disease (author's transl)].

The purpose of this study was to establish the incidence of pre-operative digitalization by intravenous digoxin on cardiac arrhythmias in 24 patients with ischemic heart disease who underwent abdominal surgery. Ambulatory electrocardiographic monitoring was performed for 12 hours before digitalization, for 12 hours during digitalization (before surgery), for the whole period of anesthesia. General anesthesia used thiopentone, phenoperidine, pancuronium and suxamethonium for endotracheal intubation. No more premature ventricular (PVC) and auricular contractions were detected after digitalization and during anesthesia and surgery. But PVC with begeminism or severe bradycardia were recorded in two patients and episodes of "torsades de pointes" occurred in two other patients during endotracheal intubation. "Torsades de pointes" have never been reported after suxamethonium and endotracheal intubation in digitalized patients. Digitalization, ischemic heart disease, cardiac effects of suxamethonium might be factors of the onset of these first reported "torsades de pointes". In conclusion, after a pre-operative digitalization in the coronary patients the frequency of arrhythmias is not exaggerated during the pre- or per-operative period except during induction and intubation. As the role of suxamethonium seems to be important as a trigger for severe arrhythmias endotracheal intubation in digitalized coronary patients should be performed without suxamethonium.

Acid-Base Equilibrium↗
PubMed1980

[Ethical and legal problems of medical responsibility in drug trials (author's transl)].

Trials of new drugs are not without risk. Standards have been laid down ensuring the objectivity and quality of the scientific studies of investigators involved in the clinical trial. Article 19 of the French Medical Code of Ethics and the recommendations on medical ethics formulated by the World Medical Association (Helsinki, 1964; and Tokyo, 1975) are designed to ensure that clinical trials on human subjects are of benefit to the subjects themselves, that the interests of the individual are placed before those of society, and, finally, that the trials are conducted with the informed consent of the subjects. In the case of injury sustained by a subject as a result of a clinical trial, the question arises as to the legal liability of the investigator. Possible grounds for malpractice include absence of licitness of the trial, lack of informed consent and negligence or irresponsibility in the conduct of the trial. In certain cases it is difficult to determine the licitness of a clinical trial; exceptions to the rule of informed consent may appear necessary; and it is sometimes difficult to ensure adequate control and evaluation of potential risks of a trial. Hence the need to submit such cases to an ethical committee, provided its members are so chosen as to guarantee the technical and legal competence of its pronouncements.

Clinical Trials as Topic↗
PubMed1979

[Total replacement of an arm amputated near the shoulder. Difficulties during anesthesia and ressuscitation (author's transl)].

The authors report a recent observation of the total replacement of an arm amputated near the shoulder. The limb was perfused and cooled down from the site of the accident to the general hospital (distance about 50 miles) and was replanted within 13 hours. The procedure itself lasted about 8 hours. The bone replantation was the most critical difficulty for the surgeons. Venous repair was associated with hemorrhage and massive transfusion had to be performed to compensate heavy blood loss. In the post-operative period acute renal insufficiency and septicemia developed. After ten days an arterial rupture occurred and emergency amputation was performed. Recovery was uneventful and the patient was discharged nine weeks after his admission, his renal function being quite restored. The authors compare the hazards of this kind of operation and the chance of recovery of the functions of a replanted limb. They conclude by emphasizing the necessity of carefully choosing the cases for total arm replacement.

Adult↗
PubMed1979

[Ketamine anesthesia for definitive implantation of a cardiac pace maker (author's transl)].

An hemodynamic study has been performed in eight patients (age 68 +/- 7) suffering from complete atrioventricular block. They had to undergo the definitive implantation of a cardiac pace maker under general anesthesia. The fixed cardiac frequency may help to understand the effect of the anesthetic agent used on the cardiac muscle function. Ketamine is the only agent used directly at an initial intravenous dose of 3 mg.kg-1 followed by a perfusion in a constant rate of 0.20 mg.kg-1. min-1. Hemodynamic data (arterial pressure, pulmonary pressures, thermodilution cardiac output) are performed before induction, then every 5 minutes after induction for a 20 minute period. The absence of respiratory depression (PaCO2: 38 +/- 3 mm Hg) shows that hemodynamic changes are entirely due to ketamine. The peak of these changes takes place after 5 minutes (significant rise (p < 0.05) in systemic and pulmonary resistances, in systemic arterial pressure and in pulmonary arterial pressure). Stroke index decreases moderately. After 20 minutes all the parameters have returned to control values. Use of ketamine is not desirable for two reasons: 1 degree The rise of the afterload may alter the hemodynamic state which can be previously deteriorated in patients suffering from atrio-ventricular block. 2 degree Post-anesthetic agitation can displace the right ventricular electrode.

Aged↗
PubMed1978

Dobutamine in the treatment of depressed cardiac function: a study in patients with ischaemic heart disease during the early post-operative period.

Dobutamine was administered by intravenous infusion to 10 patients with ischaemic heart disease who had a low cardiac output syndrome following abdominal surgery. The dosage of dobutamine started from 2.5 mcg kg-1 min-1 and was increased stepwise to 5, 7.5, 10, 12.5 and 15 mcg kg-1 min-1. Cardiac index increased significantly from 2.05 +/- 0.32 to 3.03 +/- 0.61. min-1 min-2 with 15 mcg kg-1 min-1. Heart rate was unchanged with 7.5 mcg kg-1 min-1 but increased significantly from 97.7 +/- 18.5 to 126.1 +/- 21.5 beats. min-1 with 15 mcg kg-1. min-1. Stroke index increased significantly from 21 +/- 4.4 to 25.4 +/- 5.1 ml m-2. beat-1 with 7.5 mcg kg-1 min-1. Pulmonary wedge pressure fell significantly from 14 +/- 2.9 to 9.1 +/- 2.4 mmHg with 2.5 mcg kg-1 min-1. Mean arterial pressure showed no significant change. No side effects were observed in these patients. We conclude that in patients with depressed cardiac function dobutamine at low doses of 2.5 mcg kg-1 min-1 decreases afterload and filling pressures. At the average doses of 5 - 7.5 mcg kg-1 min-1 stroke index and cardiac index are increased. At higher doses of 10 - 15 mcg kg-1 min-1 heart rate and cardiac index increase while stroke index fails to increase further.

Aged↗
PubMed1978

[Adaptation of blood sugar regulation during individually adjusted muscular exercises. Effects of training].

A twenty minutes exercise at 50 to 70% of VO2 max is followed by an increase of glycemia and F.F.A. Moderate physical activities could improve a better use of F.F.A., perhaps preferably to the glucose. Cortisol and A.C.T.H. levels raise, principally by the untrained subjects; however, that exercise is followed by a raise of STH, no dependent to the training's degree.

Adaptation, Physiological↗
PubMed1978

[The effects of dobutamine in postoperative disorders of left ventricular function in coronary patients undergoing abdominal surgery. Apropos of 18 cases].

Increasing doses of dobutamine were administered to the first group of 10 coronarians having undergone and abdominal surgical procedure, and presenting, one hour after awakening from the anesthesia, hemodynamic modifications with a diminution of cardiac index (CI), systolic index (SI), systolic work index of the left ventricle (SWILV) increase in the pulmonary capillary pressure (PCP), and in the total peripheral resistance (TPR), as well as an acceleration of the cardiac rate (CR). Doses of dobutamine of 5 or 7.5 microgram.kg-1.min-1 corrected the IC, PCP and TPR. Dobutamine ameliorated the SI and SWILV in an increasing fashion up to a dose of 10 microgram.kg-1.min-1 only and without restoring them to the control values of the pre-operative period. CR progressively increased with the increasing of the doses reaching 126 +/- 21.5 beats min-1 for 15 microgram.kg-1.min-1. Extrasystoles appeared at dose levels of 12.5 and 15 microgram.kg-1.min-1 in two patients. Tests of vascular filling (pre-charge tests) carried out in the second group of patients under 10 microgram,kg-1.min-1 of dobutamine and in a third group under 15 microgram.kg-1.min-1 showed a good cardiac adaptation to filling, equal or superior to that of the pre-operative period. It also appeared that the amelioration of CF obtained with a moderate vascular filling (300 ml of low molecular weight dextran) under 10 microgram.kg-1.min-1 of dobutamine is greatly superior to the amelioration obtained by 10 to 15 microgram.kg-1.min-1 of dobutamine.

Abdomen↗
PubMed1976

The use of tombramycin in the management of severe infections. Clinical and pharmacological data.

Tobramycin was used in the treatment of 35 severe infections. Its clinical effectiveness was confirmed in broncho-pulmonary infections without septicemia and in septicemia without lung involvement. Poor results were obtained in septicemia where the initial site 9 infection was in the lungs. This antibiotic appeared as a very good antistaphylococcal agent. In vitro superiority over gentamicin against Pseudomonas was not be confirmed clinically. Tobramycin deserves to be administered initially in serious infections because of the possibility that the causative organism might be a gentamicin-resistant, tobramycin susceptible strain. Three such cases were observed in our 35 patients. This susceptibility dissociation in favor of tobramycin was demonstrated in two strains of Klebsiella and one strain of Enterobacter. A dosage regimen in patients with impaired renal function is proposed. It requires confirmation.

Acute Kidney Injury↗