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Biomedical subjects

G Rolly

Publications and source records attributed to G Rolly.

At least 73 records · Page 4Linked to original sources
PubMed1993

Neuropathic pain in a cancer patient responding to subcutaneously administered lignocaine.

OBJECTIVE: To demonstrate difficulties encountered in alleviating neuropathic pain in a terminally ill cancer patient, with the very tentative diagnosis of postherpetic neuralgia. SETTING: A multidisciplinary pain department in a university hospital. PATIENTS: A patient with Hodgkin's lymphoma and leiomyosarcoma in the liver developed an unusual manifestation of neuropathic pain. INTERVENTION: Oral drug treatment with morphine associated with amitriptyline, valproic acid, mexilitine, flufenazine, and methylprednisolone failed to suppress pain attacks. Only the subcutaneous instillation of lidocaine (2 mg/kg/h) could partially suppress pain. A dorsal root entry zone lesion intervention could only temporary stop the pain attacks. Infiltration and nervous stimulation techniques were not helpful. OUTCOME MEASURES: In determining pain control, the visual analog scale rating scale and the number of attacks per hour were considered. RESULTS: Only the subcutaneous administration of lignocaine could partially suppress pain. Because of the patient's poor hepatic circulation, variable lidocaine plasma concentrations were responsible for intolerable side effects. CONCLUSIONS: Subcutaneous lignocaine administration remains a useful method in treating neuropathic cancer pain. The poor metabolic condition of the patient can lead to deleterious high plasma levels. A dorsal root entry zone lesion could only temporarily stop the pain.

Adult↗
PubMed1992

Influence of converting enzyme inhibition on isoflurane-induced hypotension for cerebral aneurysm surgery.

Twenty-five patients (aged 18 to 72 years), who recovered after the first bleed from a cerebral aneurysm, were operated on under neuroleptanaesthesia. Isoflurane was added to induce hypotension. It was found that the required hypotension (51 (SEM 1) mmHg) could be obtained and maintained at much lower isoflurane concentrations (less than 1%) after blockade of the angiotensin converting enzyme activity by enalaprilat (2.5 mg i.v.) than without such inhibition. During the hypotension which lasted 78 (SEM 10) min, only minor adjustments of the isoflurane concentration (0.70 (0.04%) were needed. The desired level of hypotension was obtained with preservation of the cardiac output and without tachycardia. No resistance to the blood pressure lowering effect of isoflurane was observed. On recovery from anaesthesia, a small increase of blood pressure above control values was seen in 16 patients and was easily reversed by small doses of clonidine (mean total dose: 220 (61) micrograms). The operative conditions were excellent and the postoperative recovery was uneventful and complete in 23 patients.

Adolescent↗
PubMed1992

Effect of intravenous hypnotics on the actions of pipecuronium.

Seventy-five ASA Grades I-III patients (18-85 years, 45-90 kg) were randomized into five groups. All patients received N2O/O2 (2/1) and alfentanil: loading dose (LD) 0.015 mg kg-1 and maintenance dose (MD) 0.045 mg kg-1 h-1 (groups 1-4). Group 1 received propofol (LD 2 mg kg-1 and MD 6 mg kg-1 h-1); Group 2 etomidate (LD 0.3 mg kg-1 and MD 0.6 mg kg-1 h-1); Group 3 midazolam (LD 0.2 mg kg-1 and MD 0.120 mg kg-1 h-1); Group 4 methohexitone (LD 1.5 mg kg-1 and MD 4 mg kg-1 h-1); Group 5 dehydrobenzperidol 0.05-0.23 mg kg-1 and alfentanil (LD 0.100 mg kg-1 and MD 0.060 mg kg-1 h-1). The neuromuscular block induced by pipecuronium (50 micrograms kg-1) was evaluated. No statistically significant differences were found between the five groups as concerned degree of block (expressed as % twitch amplitude in response to the first of the TOF stimuli (Ta1) at intubation, T1 minimum and recovery to Ta1 = 20%, 25% and 75%. Slightly faster intubation was possible when midazolam was used in comparison with propofol, methohexitone or NLA and when etomidate was used in comparison with propofol. A wide range of individual values of maximal neuromuscular blocking activity was found.

Adult↗
PubMed1991

Possible inadvertent subdural block following attempted stellate ganglion blockade.

A case is reported of suspected inadvertent subdural block following attempted stellate ganglion blockade for relief of cervicobrachial pain in a patient suffering from reflex sympathetic dystrophy. Possible complications due to neuraxial spread of local anaesthetics while performing a cervicothoracic ganglion blockade are considered.

Adult↗
PubMed1991

Spinal cord stimulation in chronic pain: evaluation of results, complications, and technical considerations in sixty-nine patients.

Sixty-nine patients undergoing spinal cord stimulation (SCS) were studied for a period of up to 8 years. Indications, implantation techniques, and stimulation systems are presented in this article. Pain-suppressor effects of SCS are reviewed, assessing the clinical efficacy over time as well as complications with the stimulation device. Immediately following implantation, inadequate pain relief was noted in 20% of the patients. Decrease of the efficacy of pain alleviation occurs during the first 3 years after implantation. Most failures are noted in patients presenting with failed back surgery. This study also demonstrates that SCS systems should offer the capability of both monopolar and bipolar stimulation modes by the use of multipolar electrodes.

Chronic Disease↗
PubMed1990

Anaesthetic management of systemic mastocytosis.

Systemic mastocytosis is an uncommon disorder of mast cell proliferation in connective tissues. Mast cell degranulation may occur on exposure to various stimuli and drugs. The release of histamine, heparin and vasoactive substances such as prostaglandin D2 may cause severe hypotension and other anaphylactoid manifestations. Anaesthetic management should include perioperative stabilization of mast cells and avoidance of the use of histamine-releasing drugs. Intradermal skin testing is useful in predicting the sensitivity to drugs that may be used during anaesthesia. We present a patient with systemic mastocytosis who underwent uneventful cholecystectomy.

Aged↗
PubMed1990

Spinal cord stimulation in chronic pain therapy.

Spinal cord stimulation was undertaken in 45 patients referred to the University Hospital in Ghent. Failed back surgery was the major indication for implantation. Raynaud's phenomenon, causalgia, polyneuropathy, phantom limb pain, and diverse causes were the other indications. Before neurosurgical implantation of the system, a percutaneous epidural trial procedure was performed. The efficacy of the implanted stimulation system was estimated by considering the use of medication and the patients' personal appreciation of the obtained pain relief. Thirty-five patients experienced very good pain relief. Only two patients needed further narcotic analgesics. Eight patients stopped using the stimulation system. To ensure good results, strict selection criteria and many surgical reinterventions seemed to be necessary. Although spinal cord stimulation is a nonablative technique, many complications may occur.

Chronic Disease↗
PubMed1990

[Hemodynamic changes with sufentanil-oxygen anesthesia for open heart surgery--a comparison of patients with beta-blocking medication or without it].

We investigated hemodynamic changes in patients undergoing coronary artery bypass grafting (CABG) and valve replacement. The former had been medicated with beta-blocking agent until the morning of operative day. On the other hand, the latter received no medication. We measured systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate, and rate pressure product (RPP) at the following five points; before induction of anesthesia, immediately before intubation, immediately after intubation, one minute after skin incision and one minute after sternotomy. In both groups, SAP and DAP decreased significantly after induction; heart rate did not change during our study; and RPP decreased significantly after skin incision. There were no significant differences between the group with beta-blocking agent and the group without it. These results suggest that beta-blocking agents exert no influence in our study, and sufentanil-oxygen anesthesia produce hemodynamic stability for open heart surgery.

Adrenergic beta-Antagonists↗
PubMed1990

[Comparison of sufentanil and fentanyl anesthesia for coronary artery bypass grafting--changes in stress hormones].

We compared the changes in hemodynamics and stress hormones in 30 patients who received for CABG operation either sufentanil-oxygen or fentanyl-oxygen anesthesia. The mean doses of fentanyl and sufentanil for intubation were 1.66 +/- 0.69 mg and 0.35 +/- 0.14 mg respectively and mean total doses were 6.91 +/- 1.14 mg and 1.68 +/- 0.38 mg, or 21.4 micrograms.kg-1.hr-1 and 4.5 micrograms.kg-1.hr-1 respectively. SAP decreased significantly immediately before intubation in both groups. Immediately after intubation, a significant intergroup difference (P less than 0.05) was noted. The changes in DAP and MAP were almost similar to those of SAP. This study demonstrates that sufentanil-oxygen anesthesia gave more stable hemodynamic parameters before and after intubation. Especially no significant changes in heart rate occurred immediately after intubation and with CABG operation, thus preventing the increase in rate pressure product during procedure. Sufentanil anesthesia did attenuate more effectively the stress hormones release than high dose fentanyl anesthesia, but neither sufentanil nor fentanyl anesthesia could prevent the increases in these hormones postoperatively.

Aged↗
PubMed1990

Clinical evaluation of pulse oximetry monitors on critically ill patients.

Four pulse oximeters and two pulse oximeter-capnographs were evaluated on accuracy of measuring oxygen saturation and heartrate for the former and oxygen saturation, heartrate, respiratory rate and capnography for the latter. In the first part of the study four pulse oximeters (Criticare Systems Model 501 +, Ohmeda Biox 3700 Pulse Oximeter, Nellcor Model N 100 and Datex Satlite) were simultaneously studied on 10 ventilated ICU patients. Fifty simultaneous measurements were done for heartrate and oxygen saturation and compared to arterial saturations and ECG heartrates. Mean differences from pulse oximeter values versus control arterial and ECG values were within two percent for the four instruments. In the second part two oxicaps (Ohmeda 4700 and Nellcor N 1000) were evaluated with the same control parameters. Thirty measurements on 3 patients were done. As in the first part of the study all results were accurate within two percent of control values. From those data we can conclude that all examined monitors were fairly accurate compared to simultaneous arterial blood gas analysis and ECG monitoring. The oxicap monitors have the advantage of giving continuous information on two very important parameters of patient monitoring: CO2 and saturation.

Adult↗
PubMed1989

EEG and SEMG monitoring during induction and maintenance of anesthesia with propofol.

Propofol has been used as IV induction (2 mg/kg) and maintenance agent (150 micrograms/kg/min and 100 micrograms/kg/min after 30 min), combined with N2O/O2 in 16 premedicated (atropine 0.5 mg, Thalamonal 2 ml IM) and mechanically ventilated patients, having ear surgery or arthroscopy. Cranial biopotentials were analysed by 2 different techniques: 1. The Anesthesia and Brain Activity Monitor (ABM Datex) providing the zero crossing frequency (ZXF) as a value for the mean frequency of the EEG signal during a considered time interval, the mean integrated voltage (MIV) as a mean value of the amplitude of the same EEG signal and the spontaneous electromyography of the frontal muscle (SEMG). 2. The EEG trend monitor (rough signal, spectral analysis (S.A.), procentual display). The EEG changes, recorded during propofol anesthesia, are comparable with both techniques. Induction is characterised by a decrease in ZXF, caused by a procentual increase in the low frequency bands (the delta band represents more than 80% of the total power). During the perfusion period an increase in the power of the alpha band (10% to 40%) and a decrease in the delta band is noticed. The ZXF regains its original value. At the end of the procedure the ZXF increases (beta band to more than 30%). A correlation was looked for between the EEG changes and the propofol blood concentrations. The higher the propofol blood concentrations, the more pronounced the low frequency bands. The appearance of beta waves or a ZXF greater than 10 Hz indicates pending arrousal.

Adolescent↗
PubMed1989

[Pulse oximetry].

Explore the source record for details and available documents.

Anesthesiology↗
PubMed1989

Coagulation and fibrinolytic parameters in patients undergoing total hip replacement: influence of the anaesthesia technique.

Eighty patients undergoing total hip replacement (THR) were randomly allocated to three groups. Group I (n = 29) received general anaesthesia, Group II (n = 29) epidural anaesthesia and Group III (n = 22) the same epidural as Group II and the same general anaesthesia as Group I but with a lower isoflurane concentration. Prothrombin time (PT), activated thromboplastin time (APTT), fibrinogen (FG), plasminogen (PG), antithrombin III (AT III), protein C (Proc C), alpha-2-antiplasmin (alpha 2AP), Factor VIII coagulating activity (F VIII:C), von Willebrand factor antigen (vWF:Ag), von Willebrand ristocetin cofactor (vWF:Rcof), tissue plasminogen activator (tPA) as antigen and activity were measured before induction (A), at the end of surgery (B), on the first postoperative morning (C) and 7 days postoperatively (D). The most relevant finding was that AT III was equally depressed immediately after surgery in all groups, but returned to normal significantly faster in the epidural group (mean values at C: 96.2% in Group I, 104.1% in Group II, 92.7% in Group III). The faster return to normal of AT III after epidural anaesthesia could be one of the mechanisms responsible for the beneficial effect of this technique on the prevention of thromboembolic complications.

Adult↗