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Biomedical subjects

I Murat

Publications and source records attributed to I Murat.

At least 37 records · Page 2Linked to original sources
PubMed2000

Fixed 50% nitrous oxide oxygen mixture for painful procedures: A French survey.

OBJECTIVE: Although the equimolecular mixture of oxygen and nitrous oxide (EMONO) seems a good choice to relieve procedure-related pain in children, it has not been accepted everywhere. In France, the rapid spread of its use has elicited suspicion and doubts regarding its safety. To assess the use and the safety of this gas mixture in the pediatric settings in France, we conducted a national survey. METHODOLOGY: Centers that had accepted a nation- wide invitation to participate in the survey filled out a questionnaire after each EMONO administration during a 2-month study. Procedure and inhalation characteristics, as well as pain evaluations and side effects, were reported. RESULTS: One thousand nineteen EMONO inhalations from 31 centers that agreed to participate in this 2-month survey were analyzed. Median (range) age was 6.4 (0-18) years. Four percent (46) of children were 12 months old or younger, 29% (295) were 5 years old or younger, 45% (459) were 6 to 10 years old, and 26% (265) were older than 10 years of age. The procedures performed with EMONO inhalation were: lumbar punctures (286), bone marrow aspirations (BMA; 231), laceration repairs (215), minor procedures (75), minor surgery (53), punctures (49), fractures (45), dental care (43), and pulmonary endoscopy (22). Nine percent of procedures were undertaken without the presence of a physician; the child being observed only by the attending nurse. A drug association was noted in 182 (17.9%) of procedures: midazolam (63%), acetaminophen (18%), nalbuphine (8.5%), hydroxyzine (5%), flunitrazepam (2%), chlorazepate (2%), morphine (1%), and lorazepam (.5%). EMLA cream (Astra) was applied in 98.6% of lumbar punctures, 93.7% of BMA, and 54.2% of punctures including lymph nodes, hematoma, or renal biopsies. Lidocaine infiltration was performed in 51% of minor surgery procedures, 40% of laceration repairs, and 28% of BMA. The inhalation system included a whistle, a scented mask, and a nonrebreathing respiratory valve in 48.9%, 71.2%, and 78.3% of the patients, respectively. Initial physical restraint was needed in 18. 2% of all the patients. Inhalation refusal was noted in 129 (12.7%) children; of these, 53 had an alternative method of analgesia (EMLA or lidocaine infiltration), 15 had no other analgesia, and in the remaining 61, EMONO inhalation was maintained against the child's will. Median (interquartile) inhalation length was 4 (3-5) minutes before starting the procedure and 6 (6-15) minutes for the total inhalation. Median (interquartile) procedural pain evaluations were 9 (0-30) for children on a 0 to 100 visual analog scale, 1 (0-3) for both nurses and parents on a 0 to 10 numerical scale. Median (interquartile) procedural pain as evaluated by nurses for the 3 most frequent procedures were 0 (0-2) for lumbar punctures, 2 (0-4) for bone marrow aspiration, and 2 (0-4) for laceration repair. Comparison of pain assessed by nurses in children 3 years old or younger and those older than 3 years of age showed a median (range) score of 2 (0-10) versus 1 (0-10), respectively. Pain self-assessment was completed in 647 children 6 years of age or older. Median (interquartile) children pain assessments were as follows: lumbar puncture (5; 0-20), bone marrow aspiration (12.5; 0-40), laceration repair (12; 0-40), minor procedures (18; 0-32), minor surgery (10; 0-35), punctures (0; 0-18), fracture (15; 0-30), dental care (20; 0-40), and pulmonary endoscopy (15; 0-30). Ninety-three percent of the 647 children who were able to answer the question said they would accept EMONO analgesia if a new procedure were to be performed. Behavioral reactions during procedures varied with age of the child; cry was observed in 44.1%, 24.4%, 12.9%, and 11.2% of children 3 years or younger, 4 to 6 years, 7 to 10 years, and 11 years or older, respectively. Physical restraint was necessary in 34.2%, 22%, 13.5%, and 8.4% of children aged 3 years or younger, 4 to 6 years, 7 to 10 years, and 11 years or old

Administration, Inhalation↗
PubMed1999

[Anesthesia practice by nurse anesthetists in French speaking Sub-Saharan Africa].

OBJECTIVE: To evaluate the practice of anaesthesia in French-speaking subsaharian countries. TYPE OF STUDY: Prospective survey. PERSONS: Two hundred seventeen nurse anaesthetists, from 11 different countries. METHODS: Anonymous questionnaire. RESULTS: One third of nurses were practising anaesthesia since less than five years and 1/3 since more than 10. Only 39 (18%) were working in the country side. Thirty seven (17%) had been trained outside subsaharian Africa (in Cuba 6%, France 5%, Morocco 5% and Germany 1% respectively). Two hundred thirteen (98%) were performing general anaesthesia and 169 (78%) regional anaesthesia. Hundred sixty eight (97%) used spinal anaesthesia, 57 (33%) epidural, 31 (18%) intravenous regional anaesthesia, 24 (14%) axillary block, 17 (10%) caudal block and 10 (6%) peripheral block respectively. For regional techniques, disposable devices were available in 50% of cases. For general anaesthesia, thiopental was administered by 193 (89%) and ketamine by 156 (72%) nurse anaesthetists respectively. In 50% of cases, these drugs were used alone. An ECG was available in 40%, a pulse oximeter in 14% and a capnographe in less than 2% of cases. A ventilator was present in 66% of the places, but used only in 30% of them because of the lack of maintenance and training. CONCLUSIONS: In this study, 50% of nurse anaesthetists were working alone. However, this rate is probably under-estimated, as the questionnaire did not consider anaesthesia practice in the country side.

Africa South of the Sahara↗
PubMed1999

Assessment of short-term blood pressure variability in anesthetized children: a comparative study between intraarterial and finger blood pressure.

OBJECTIVE: Continuous blood pressure (BP) measurement provides instantaneous information on hemodynamic status, and allows for assessment of sympathetic modulation of vasomotor tone using spectral analysis. As an alternative to intraarterial blood pressure (IABP) measurement, the Finapres, a photoplethysmographic device, allows for non-invasive continuous measurement of finger blood pressure (FBP). This study was designed to evaluate the accuracy of spectral measurements of FBP variability in children during anesthesia and recovery. For this purpose, reliability of BP measurement and short-term BP variability assessed by FBP were calculated and compared with IABP. METHODS: Finger blood pressure was compared with IABP from the ipsilateral radial artery, in 14 children undergoing major surgery. Sixty-seven simultaneous recordings of both signals were performed during anesthesia and 32 during recovery period. The accuracy of the FBP was determined by measuring its bias and precision according to the Bland and Altman method. To assess the ability of the FBP to follow short term BP variability, bias of total spectral power and bias of the 3 main spectral components (LF, MF, HF) were calculated. Transfer functions between invasive and non-invasive signals were calculated. RESULTS: The average bias of SBP measurement was 3.8 +/- 7.4 mmHg during anesthesia and 2.2 +/- 6.7 mmHg during recovery. During anesthesia overall variability and spectral components of FBP and IABP were similar with both techniques; while during recovery, a selective amplification of the low frequencies (< 0.15 Hz) of FBP was observed. Frequency response analysis of the pressure waveform, showed a high coherence between both signal with a gain of 0.96 +/- 0.52 mmHg FBP/ mmHg IABP under anesthesia, and of 0.74 mmHg FBP/ mmHg IABP during recovery. CONCLUSIONS: The differences evidenced between FBP and IABP spectral profiles might result from specific physiological properties of digital arteries, which are sympathetic effectors. This study supports the use of FBP in children to assess non-invasively the vascular sympathetic component of the autonomic nervous system during anesthesia and recovery.

Anesthesia↗
PubMed1999

Relative effectiveness of lignocaine-prilocaine emulsion and nitrous oxide inhalation for routine preoperative laboratory testing.

We studied the impact of age-related factors and the benefits of 50% nitrous oxide or EMLA cream in 108 children undergoing preoperative laboratory testing. Procedural pain was assessed by behavioural scores (CHEOPS) and pain intensity ratings. Age, preexisting behavioural distress and difficulty of venous access were significant predictors of outcome in univariate analysis. Nitrous oxide and EMLA cream were both effective in lowering pain related behaviour and pain ratings generated by the different adult observers and the children where applicable. EMLA cream was more effective than 50% nitrous oxide in children 1-4 years old. Although EMLA cream was responsible for a 28+/-5 min prolongation of waiting time at the clinic, the present results suggest that it should remain the first line intervention to alleviate pain from venepuncture in paediatric outpatients.

Adult↗
PubMed1999

Oxidative stress in systemic lupus erythematosus and allied conditions with vascular involvement.

OBJECTIVE: To evaluate the occurrence and clinical significance of lipid peroxidation (oxidative stress) in rheumatic diseases characterized by vascular involvement. PATIENTS AND METHODS: Plasma 8-epi-PGF2alpha (oxidative stress marker) was measured by gas chromatography-mass spectrometry in 36 patients with systemic lupus erythematosus (SLE), 13 with systemic sclerosis (SSc), 13 with systemic vasculitis [Wegener's granulomatosis (WG), n = 4; Churg Strauss syndrome (CSS), n = 3; Behcet syndrome, n = 6], 12 with rheumatoid arthritis (RA) and in 23 healthy controls (n = 23). RESULTS: 8-epi-PGF2alpha levels were higher in patients with SLE (P = 0.007), SSc (P < 0.001) and vasculitis (P = 0.001) than in controls. In SLE, a positive Coombs' test and arterial hypertension independently predicted 8-epi-PGF2alpha concentrations (P = 0.004 and P = 0.001, respectively). SLE patients not taking prednisolone showed higher 8-epi-PGF2alpha concentrations than SLE patients on prednisolone (P = 0.02). In the latter group, a dose response relationship was noted between 8-epi-PGF2alpha and steroid dosage (r = 0.6, P = 0.0003). In WG and CSS, 8-epi-PGF2alpha concentrations correlated with disease activity (r = 0.8, P = 0.01) and were higher than in patients with Behcet disease (P = 0.003). CONCLUSIONS: Oxidative stress may be pathogenetically relevant in some autoimmune rheumatic diseases with vascular involvement. Amelioration of some clinical manifestations of these diseases may be envisaged by targeting lipid peroxidation with dietary or pharmacological antioxidants.

Adult↗
PubMed1999

Changes in electroencephalogram and autonomic cardiovascular activity during induction of anesthesia with sevoflurane compared with halothane in children.

BACKGROUND: This study was design to assess clinical agitation, electroencephalogram (EEG) and autonomic cardiovascular activity changes in children during induction of anesthesia with sevoflurane compared with halothane using noninvasive recording of EEG, heart rate, and finger blood pressure. METHODS: Children aged 2-12 yr premedicated with midazolam were randomly assigned to one of three induction techniques: 7% sevoflurane in 100% O2 (group SevoRAPID); 2%, 4%, 6%, and 7% sevoflurane in 100% O2 (group SevoINCR); or 1%, 2%, 3%, and 3.5% halothane in 50% N2O-50% O2 (group HaloN2O). An additional group of children who received 7% sevoflurane in 50% N2O-50% O2 (group SevoN2O) was enrolled after completion of the study. Induction was videotaped. EEG, heart rate, and finger blood pressure were continuously recorded during induction until 5 min after tracheal intubation and analyzed in frequency domain using spectral analysis. RESULTS: Agitation was more frequent when anesthesia was induced with 100% O2 compared to the mixture of oxygen and nitrous oxide. No seizures were recorded in any group. In the four groups, induction of anesthesia was associated with an increase in EEG total spectral power and a shift toward the low-frequency bands. Sharp slow waves were present on EEG tracings of the three sevoflurane groups, whereas slow waves and fast rhythms (spindles) were observed in the halothane group. Sevoflurane induced a greater withdrawal of parasympathetic activity than halothane and a transient relative increase in sympathetic vascular tone at loss of eyelash reflex. CONCLUSIONS: Agitation observed during sevoflurane induction was not associated with seizures. Sevoflurane induction induced a marked inhibition of parasympathetic control of heart rate.

Anesthesia, Inhalation↗
PubMed1999

Pulse rate variability is not a surrogate for heart rate variability.

To investigate the differences between heart rate (HR) variability and pulse rate (PR) variability, short-term variability of finger pulse wave and ECG signals were studied in 10 children with a fixed ventricular pacemaker rhythm (80 beats/min). Ten healthy children in sinus rhythm served as a reference population. Distal PR and HR were measured continuously using a Finapres device and an ECG respectively. Power spectra for HR and PR were calculated in both the supine and orthostatic positions. In paced subjects, PR spectra exhibited the characteristic respiratory peak, although the HR spectra were flat. Similarly, in healthy children the respiratory fluctuations were more pronounced when calculated from the finger pulse wave signal compared with the ECG signal. The overestimation of HR respiratory fluctuation resulting from distal PR measurement was more pronounced in the standing position; however, this postural effect was demonstrated only in healthy subjects. We observed mechanical respiratory modulation of distal PR independent of classical HR modulations. Our results suggest a mechanical respiratory influence via cardiac output and aortic transmural pressure changes on pulse wave velocity. We conclude that respiratory PR variability does not precisely reflect respiratory HR variability in standing healthy subjects and in patients with low HR variability. Consequently, HR modulation should be studied using the ECG signal rather than the distal pulse wave signal. However, when ECG recording is not available, the distal pulse wave is an acceptable alternative.

Adolescent↗
PubMed1999

Comparison of three techniques for induction of anaesthesia with sevoflurane in children.

This study was designed to evaluate the clinical characteristics of three induction techniques using sevoflurane in children scheduled for tonsillectomy: incremental induction with sevoflurane(2,4,6,7%) in 100% O2 (group IC-O2; n=23); induction with high concentration of sevoflurane in 100% O2 (group HC-O2; n=22); and induction with high concentration of sevoflurane in a mixture of O2:N2O(50:50) (group HC-N2O; n=20). Induction was well accepted and well tolerated in most children. The addition of nitrous oxide resulted in faster loss of consciousness (P< 0.001) compared to the other induction techniques and in a tendency for reduced excitement compared with the same rapid technique without nitrous oxide (P=0.053). Time to tracheal intubation was identical in the three groups and intubation conditions were scored as good in most children. During the early induction phase, an increase in SAP and HR was observed in the three groups. Changes were maximal at two min after the beginning of induction in the three groups. SAP and HR values were back to baseline values at the time of tracheal intubation. In conclusion, the addition of nitrous oxide to a high sevoflurane concentration decreases the time to loss of eyelash reflex, tends to reduce the incidence of excitement and is not associated with an increased incidence of respiratory complications even in patients with obstructive airway.

Analysis of Variance↗
PubMed1998

[Pros or cons of accessory anesthetic circuits. I. Arguments for their use].

In addition to the circle breathing system, which represents the main circuit of the anaesthetic machine, the use of an accessory breathing system (ABS), either a partial rebreathing system according to Mapleson's classification, or a system including a non-rebreathing valve, is appropriate for the anaesthetic management of many patients, depending on their physical status, age, indication and duration of surgery. The same safety rules, namely full checking procedure before use of the system and monitoring of inhaled gases and end-tidal CO2 must be applied as for the main circle system. Potential complications resulting from non compliance with these rules cannot be considered valuable reasons for denying the use of breathing systems that have safely been used for decades in millions of patients.

Adult↗
PubMed1998

Severe hyponatraemia after plastic surgery in a girl with cleft palate, medial facial hypoplasia and growth retardation.

A ten-year-old girl with middle face hypoplasia, cleft lip and palate developed severe hyponatraemia on the first day following surgery. Final diagnosis was inappropriate secretion of antidiuretic hormone (ADH) and complete hormonal investigation revealed partial deficit in growth hormone secretion. The incidence of hormonal deficiency associated to midline facial malformations is discussed.

Child↗
PubMed1998

Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children.

Caudal anaesthesia is indicated for surgical procedures lasting less than 90 min. Fentanyl and clonidine are known to prolong postoperative caudal analgesia, but there are no data on their effect on duration of surgical analgesia. We evaluated if the addition of clonidine or fentanyl to local anaesthetics prolonged the duration of surgical analgesia after single shot caudal block in children in a randomized, double-blind study. We studied 64 children, aged 6-108 months, undergoing bilateral correction of vesicoureteral reflux which was expected to last more than 90 min. Patients were allocated to one of four groups: group O received 1 ml kg-1 of a mixture of 0.25% bupivacaine with epinephrine and 1% lidocaine in equal parts; group F received the same mixture of local anaesthetics in addition to fentanyl 1 microgram kg-1; group C received the same mixture of local anaesthetics in addition to clonidine 1.5 micrograms kg-1; and group C + F received the same mixture of local anaesthetics in addition to fentanyl 0.5 microgram kg-1 and clonidine 0.75 microgram kg-1. Single shot caudal block was sufficient in only 57% of children in group O compared with 93% in groups C and F and 86% in group C + F (P = 0.035). Global assessment of anaesthesia, defined as the time from caudal injection to the first administration of analgesic (either during or after surgery), was significantly longer in the three groups of children who received additives compared with local anaesthetics alone (P = 0.035), but there were no differences between the three additive groups. Vomiting was observed only in children who received fentanyl. Addition of clonidine or fentanyl to local anaesthetics prolonged the duration of surgical analgesia of caudal block, allowing single shot caudal anaesthesia to be recommended for surgery lasting 90-150 minutes. Clonidine had some advantages over fentanyl as it did not produce clinically significant side effects.

Adrenergic alpha-Agonists↗
PubMed1998

Evaluation of routine tracheal extubation in children: inflating or suctioning technique?

We studied prospectively the effects of the technique of tracheal extubation on arterial haemoglobin oxygen saturation (SpO2) in 120 ASA I-III children, mean age 5.3 (range 0.25-16.9) yr. At completion of surgery, tracheal extubation was performed when spontaneous ventilation had resumed, children were fully awake and SpO2 was 99-100%. Children were allocated randomly to receive a single lung inflation manoeuvre with 100% oxygen before tracheal extubation (group I; n = 59) or to have the tracheal tube removed while applying suction through the tube (group S; n = 61). SpO2 was monitored during the first 5 min after tracheal extubation in the operating room. Supplementary oxygen was given if SpO2 decreased to less than 92%. The time between tracheal extubation and decrease in SpO2 to 92% (T92) was recorded. Children in group S required oxygen administration more frequently after tracheal extubation than those in group I (65.6% vs 45.8%; P = 0.04), and had a three-fold shortening of T92 (mean 25 (SD 19) s vs 85 (63) s; P = 0.0001). These effects were more pronounced in children less than 4 yr of age compared with older children. We conclude that tracheal extubation greatly impaired oxygenation and therefore administration of oxygen was appropriate. This impairment was more marked when suction was used, and in young children. Lung inflation with 100% oxygen before removal of the tracheal tube is advised before routine tracheal extubation in children.

Adolescent↗
PubMed1998

Diagnosis and anaesthesia management of haemophilia during the neonatal period.

We report here the case of a newborn infant admitted to our hospital for moderate gastro-intestinal bleeding. Despite abnormal value for aPTT, diagnosis of moderate haemophilia A was only made preoperatively when surgery was deemed necessary to treat pyloric stenosis. Clinical circumstances of the diagnosis and anaesthesia management of haemophilia during the neonatal period are discussed.

Anesthesia, General↗