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Biomedical subjects

G Rolly

Publications and source records attributed to G Rolly.

At least 55 records · Page 3Linked to original sources
PubMed1996

A psychoanalytic investigation to improve the success rate of spinal cord stimulation as a treatment for chronic failed back surgery syndrome.

OBJECTIVE: The analysis of patient data concerning psychological structure and functioning produced an instrument to determine whether a neurostimulator ought to be implanted or not. DESIGN: A questionnaire containing 24 items was developed by a psychologist and tested in 40 chronic failed back surgery patients for whom a spinal cord stimulation seemed to be the only therapeutic approach. This questionnaire was based upon some crucial psychological themes, on which the patient took a position. A predictive indication factor (I.F.; %) for implantation of the neurostimulator was obtained from the 24 items. Six months after the implantation of the neurostimulator, we correlated the evaluation factor (E.F.; %) with a six-point evaluation scale considering the pain reduction. The aim was to compare the I.F. and E.F. to verify the correlation between them. This comparison was intended to answer the question if psychological variables included in our scale improve the success rate of the therapy. SETTING: Data were collected by a psychologist at the Pain Clinic of the University Hospital of Gent, Belgium. RESULTS AND CONCLUSIONS: The correlation between the I.F. and the E.F. was calculated for the 40 patients by the Spearman correlation test. A coefficient value of 0.8083 (p = 0.000) was found, indicating the existence of a very close correlation between the predictive I.F. and the E.F. The indication scale appears to be a useful instrument for clinical psychologists to predict the success rate of a spinal cord stimulator in this group of patients.

Back Pain↗
PubMed1996

Systemic piroxicam as an adjunct to patient-controlled analgesia with alfentanil for postoperative pain relief.

In a double-blind, placebo-controlled study, the non-steroidal anti-inflammatory drug, piroxicam, in combination with alfentanil given in a patient-controlled analgesia system, was compared with alfentanil alone given by the same route for analgesic effect, side effects and acute phase reaction over a 4-day period following anterior cruciate ligament reconstruction of the knee. The patients receiving piroxicam had lower pain scores and consumed less alfentanil. There were no differences with regard to side effects between the two treatment groups, apart from significantly more sedation at 08.00 h on the first postoperative day in the non-piroxicam group. Piroxicam did not influence either the levels of interleukin-6 or the acute phase response to surgery.

Adult↗
PubMed1996

Rapidly progressive pulmonary artery hypertension and end-stage liver disease.

Pulmonary hypertension is a recognized but unusual complication of liver disease. It can complicate the perioperative course of liver transplantation. Mild to moderate pulmonary hypertension is generally well tolerated during the procedure and does not appear to contribute to mortality. Since the pulmonary vascular disease may progress rapidly, it may have advanced to the point of irreversibility at the time of surgery. So, patients with known moderate pulmonary hypertension should have pulmonary arterial catheterisation immediately prior to transplantation. If pulmonary artery hypertension has become severe, then a preoperative trial of vasodilators is warranted. If this fails, the procedure should be cancelled. We present a patient with alcoholic liver cirrhosis in whom a rapidly progressive pulmonary hypertension made liver transplantation impossible.

Adult↗
PubMed1996

Epidural spinal cord stimulation does not improve microvascular blood flow in neuropathic pain.

For many years, spinal cord stimulation (SCS) has been used successfully in various pain syndromes. SCS is also used to treat vascularly-impaired patients since it apparently improves the microcirculation. The exact physiological mechanisms involved are still unclear. There are even some anecdotal reports of a cooling of the legs during SCS. This study investigated the vascular effects of SCS in 15 patients with failed back surgery syndrome, using infrared thermography of the affected foot and capillaroscopy in the nailfold of the big toe. There were no statistically significant differences (Student's t test) in temperature (P = 0.923) or red blood cell velocity (P = 0.819 first day and P = 0.218 second day) in the affected foot with or without stimulation. A physiological difference in relation to neuropathic pain might explain the lack of improvement in skin microcirculation with SCS.

Adult↗
PubMed1996

[Postoperative analgesia following surgical correction of hypospadias].

The authors describe the different forms of postoperative pain therapy which can be applied after a surgical repair of hypospadias. Hereby we chose for the caudal analgesia. It is effective, easy to perform and is seldom associated with complications. An overview is given of the technique, the points for attention and the different products which can be injected. Systemic analgesia and penile nerve blockade are often less effective and should only be applied in case caudal analgesia can not be administered.

Anesthesia, Caudal↗
PubMed1995

Postoperative analgesia and plasma levels after transdermal fentanyl for orthopedic surgery: double-blind comparison with placebo.

STUDY OBJECTIVE: To determine whether transdermal fentanyl can provide a significant component of postoperative analgesia. DESIGN: Randomized, double-blind study. SETTING: Inpatient surgery in a university hospital. PATIENTS: 40 adult patients scheduled for orthopedic surgery with general anesthesia. INTERVENTIONS: 20 patients in each group had general anesthesia with propofol, isoflurane in nitrous oxide and oxygen (O2), and small boli of alfentanil or sufentanil. Preoperatively, the first group (F) received a transdermal therapeutic system fentanyl patch (75 micrograms/hr) for 72 hours, and the second group (P) received a placebo patch. Morphine was given postoperatively according to clinical necessity. MEASUREMENTS AND MAIN RESULTS: Morphine consumption, pain visual analog scale, and eventual sedation were assessed, as well as respiratory rate and blood pressure. Plasma fentanyl concentrations were determined. Only 11 Group F patients needed morphine compared with 19 Group P patients, and mean morphine dose was significantly lower in Group F. One Group F patient had decreased O2 saturation and intense sedation, necessitating administration of naloxone. The mean maximum plasma fentanyl concentration in Group F was 1.63 ng/ml. CONCLUSION: Efficacy of transdermal fentanyl for postoperative pain relief is shown, but intense respiratory depression is sometimes seen.

Administration, Cutaneous↗
PubMed1995

Doxacurium block is not influenced by age.

STUDY OBJECTIVE: To determine the influence of aging on the efficacy and safety of doxacurium. DESIGN: Open, randomized, phase III study. SETTING: Inpatient ophthalmic surgery clinic at a university medical center. PATIENTS: 30 elderly patients (65 years or older) compared with a control group of 30 younger patients (18 to 64 years). INTERVENTIONS: An elective ophthalmological surgical intervention of more than 2 hours' expected duration with general anesthesia with isoflurane. MEASUREMENTS AND MAIN RESULTS: Neuromuscular function after a bolus dose of doxacurium was monitored electromyographically. No significant difference was observed in maximum block achieved or onset time. Clinical duration of neuromuscular block was similar in both groups. Hemodynamic changes were clinically unimportant. CONCLUSION: The use of doxacurium in elderly patients is possible with no need for dose adjustment. Doxacurium might be a good choice for patients with cardiac disease who are scheduled for long surgical procedures.

Adolescent↗
PubMed1995

Relevance of epidurography and epidural adhesiolysis in chronic failed back surgery patients.

OBJECTIVE: Pain treatment in the chronic failed back surgery patient remains problematic. Defining the pathogenesis of the pain could be helpful in treatment. The assumption that epidural fibrosis and adhesions might play an important role in the origin of the pain is verified. DESIGN: We investigated 34 patients in whom peridural fibrosis was suspected. An epidural catheter was inserted via the sacral hiatus. Injections of contrast dye, local anesthetic, corticosteroid, and hypertonic NaCl 10% were carried out daily for 3 days. Spread of the contrast dye in the epidural space was evaluated after 10 and 20 ml injection volume. SETTING: Subjects were patients in a pain clinic of a university hospital in Belgium. PATIENTS: Chronic pain patients with failed back surgery syndrome were examined. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with magnetic resonance imaging (MRI) examination. OUTCOME MEASURES: Improvement in the contrast filling defects of the epidural space were noticed during treatment and correlated with pain improvement. RESULTS: Filling defects were noted in 30 of the 34 patients investigated. After the third day an objective improvement of contrast spread was documented in 14 patients. In seven patients improvement in pain occurred for only a very limited period (1 month). Statistical analysis (chi square analysis) could not demonstrate that improvement of contrast spread was correlated with better pain behavior. In 16 patients no improvement in contrast spread could be visualized. Pain improvement occurred in only four patients and for a limited period of 1 month. Long-term results are even worse. CONCLUSION: Epidurography might confirm epidural filling defects for contrast dye in the patients with epidural fibrosis. A better contrast dye spread, assuming scar lysis, does not guarantee a sustained pain relief. A more direct visualization of the resulting functional changes after adhesiolysis as with epiduroscopy might be useful.

Adult↗
PubMed1995

The influence of isoflurane on a continuous infusion of mivacurium.

Sixty surgical patients were studied to evaluate the neuromuscular effects of mivacurium 0.15 mg.kg-1 (2 x ED95) for tracheal intubation. After intubation the patients were randomly allocated to receive alfentanil with either propofol (starting with 9 mg.kg-1 h-1, reducing to 6 mg.kg-1 h-1 after 20 min) or isoflurane (0.5% end-tidal). In addition, all the patients were given a continuous infusion of mivacurium 10 micrograms.kg-1 min-1 after tracheal intubation which was adjusted to maintain 90% depression of T1. Following mivacurium 0.15 mg.kg-1 T1 decreased below 25% in all but four patients. Mean (SD) percentage maximum block attained was 92.9% (12.5) after 309 (89)s. Tracheal intubation was completed 232 (155) s after administration of the relaxant and intubating conditions were graded as 'excellent' or 'good' in 56 patients. Although the mean (SD) mivacurium infusion rate for maintaining T1 at 10% was higher in the propofol group, 4.8 (2.1) compared with 4.4 (2.0) micrograms.kg-1 min-1 in the isoflurane group, this was not significantly different (p > 0.05). The mean (SD) recovery index was prolonged in the isoflurane patients, 757 (508)s, compared to those receiving propofol, 466 (219)s (p < 0.05).

Adolescent↗
PubMed1995

Comparative study of limited intentional normovolaemic haemodilution in patients with left main coronary artery stenosis.

Intentional normovolaemic haemodilution is a blood saving technique which can be performed when major blood loss is expected. Severe coronary artery disease and particularly left main stenosis are considered a contraindication for intentional normovolaemic haemodilution. The effects and complications of limited intentional normovolaemic haemodilution in patients with left main coronary artery stenosis scheduled for coronary artery bypass grafting were evaluated. Patients were randomly allocated to two groups: group A (n = 15) underwent limited intentional normovolaemic haemodilution to a haematocrit of 34%; group B (n = 15), no intentional normovolaemic haemodilution was performed. In both groups succinyl-linked gelatin was used to maintain normovolaemia. Haemodynamic parameters were kept as constant as possible. In group A, a mean (SD) volume of 785 (250) ml of blood was withdrawn [range 500-1200 ml]. ST segment changes occurred on the ECG in three patients in each group. There were no statistically significant differences for frequency, maximum deflection and duration of ST-segment changes. Limited intentional normovolaemic haemodilution can be performed safely in patients with left main coronary artery stenosis. In this study it was not associated with increased frequency, severity or duration of ST-segment changes, or with arrhythmias or haemodynamic instability.

Aged↗
PubMed1995

Awareness during anaesthesia for implantable cardioverter defibrillator implantation. Recall of defibrillation shocks.

Implantable cardioverter defibrillator implantation is performed under general anaesthesia. This report describes awareness or recall in two of 33 patients scheduled for implantation. After induction, anaesthesia was maintained using continuous infusions of propofol and atracurium and intermittent boluses of alfentanil. Propofol was given in the same arm as the implantation side. In these two patients propofol flowed out of the bleeding central venous access. To minimise the possibility of awareness, we advise that continuous infusions should be administered intravenously on the contralateral side to the implantation and that neuromuscular blocking agent be given by intermittent bolus injections.

Anesthesia, General↗
PubMed1995

Evaluation of morphine for patient controlled analgesia with the Infusor system after opiate-free locoregional anesthesia for osteotomy of the foot.

Efficacy and safety of a PCA protocol, without loading dose or background infusion, was investigated in 40 consenting patients after osteotomy of the foot. All patients had intrathecal lidocaine 5% 1.8 ml preoperatively. Postoperative pain relief was provided with morphine from a Baxter Travenol infusor with PC module. The morphine concentration was 2 mg/ml or 3 mg/ml. In order to reach the analgesic blood concentration as quickly as possible, the patients were instructed to start PCA from the very first moment pain occurred. The patients breathed room air. The nursing staff evaluated respiratory and cardiovascular parameters, pain and side effects. Although mean VAS scores were higher than 3 in the early postoperative phase, no supplementary analgesics were required. One patient had urine retention. One patient had a drop in blood pressure at the start of morphine, which was quickly restored with the administration of colloids. Oxygen saturations were lower (SpO2 < 95%) the first hours postoperatively, especially at the first assessment where no morphine was administered. Pain or relative hypovolaemia could be an explanation. Dry mouth and sleepiness were the most frequently reported side-effects, followed by dizziness, vomiting and nausea. Sweating and itching were less frequently reported. The occurrence of the side effects was the highest during the first postoperative day. We conclude that even when morphine is used in PCA without loading dose or background infusion after opiate-free locoregional analgesia, close monitoring is necessary for at least 5 hours.

Adolescent↗
PubMed1994

Spinal analgesia in terminal care: risk versus benefit.

Cancer pain treatment is well established. The World Health Organization provides clinicians an "analgesic ladder" scheme to optimize cancer pain treatment. At the beginning of the pain treatment, oral analgesic administration is preferred. The analgesic dose must be individualized. Many published papers describe the spinal administration of opioids in combination with various other drugs such as bupivacaine in selected patients with cancer pain. Although complications have been reported to be few, some recent reports debate this idea. We first describe a population of 92 cancer patients, 13 of whom received intrathecal morphine. We then present our experience with a separate group of 33 cancer patients who were also managed using intrathecal morphine. Based on this experience, the generally accepted indications for the technique appeared to be justified. Concern about spinal infection is well considered, however. Three out of those patients developed meningitis, a complication rate that is far too high.

Analgesia↗
PubMed1994

Haemodynamic effects of R 80122 immediately after cardiopulmonary bypass; preliminary results.

R 80122 is a new short-acting phosphodiesterase type III inhibitor. In a preliminary investigation, three patients, scheduled for coronary artery bypass surgery, were given R 80122 after weaning from cardiopulmonary bypass. Two patients received 10 micrograms.kg-1.min-1 for 10 min as a loading infusion followed by a 5 micrograms.kg-1.min-1 maintenance dose. One patient received a 20 micrograms.kg-1.min-1 for 10 min loading infusion followed by a 10 micrograms.kg-1.min-1 maintenance infusion. After weaning from cardiopulmonary bypass and during the administration period, no arrhythmias or cardiac ischaemia were detected. The administration of R 80122 improved the haemodynamic profile with an increase in cardiac output, a decrease in systemic vascular resistance and a stable heart rate and mean arterial blood pressure. These preliminary results indicate that R 80122 possesses positive inotropic activity in combination with vasodilating properties.

Aged↗
PubMed1994

Evaluation of the onset and intubation conditions of rocuronium bromide.

Rocuronium 0.6, 0.75, or 0.9 mg kg-1, was given after supramaximal train-of-four stimulation of the ulnar nerve, measuring the compound action potential of the hypothenar muscles, Intubation conditions, onset time, recovery to 25% and recovery index of the three doses of rocuronium bromide were determined in 60 ASA I or II consenting patients, who were receiving propofol, alfentanil and N2O/O2 for ophthalmic surgery. Intubation conditions were randomly assessed either 45 s or 60 s after injection. In general, intubation conditions were excellent or good; in only three patients were poor conditions obtained, always at 45 s. For total intubation score a borderline difference was found in favour of the 60 s subgroups. No difference could be shown between the three dose groups. The onset time was longer (P < 0.01) in the 0.6 mg kg-1 group, compared to that in the 0.9 mg kg-1 group. The recovery to 25% and spontaneous recovery index were shorter in the 0.6 mg kg-1 group (P < 0.01).

Action Potentials↗
PubMed1994

Methane accumulation during closed-circuit anesthesia.

When using the closed-circuit PhysioFlex apparatus for ventilating patients with an O2/air mixture during total intravenous anesthesia (TIVA) for gynecologic laparoscopy, we noticed that the built-in infrared analyzer indicated unexpected values for halothane. In 10 ASA grade I or II patients, the breathing gases were analyzed at the end of the ventilation for the presence of methane, which could be traced in all patients. Mean concentration was 861 ppm after a mean closed-circuit anesthesia time lasting 78 min. The unexpected halothane concentration at the time of gas sampling indicated an average of 1.0%. The anesthetic vapor analysis by infrared absorption is clearly disturbed by the presence of methane.

Adult↗