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Biomedical subjects

J Fusciardi

Publications and source records attributed to J Fusciardi.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Cocaine contact anesthesia for endonasal surgery. Kinetics and clinical tolerance of a concentrated solution].

OBJECTIVE: To assess the pharmacokinetics and clinical tolerance of a 33% cocaine solution administered topically for intranasal surgery. STUDY DESIGN: Clinical prospective open trial. PATIENTS AND METHODS: Twelve ASA I patients scheduled for intranasal surgery were sedated with midazolam 2 mg and fentanyl 50 micrograms. Topical anaesthesia was obtained with aqueous 33% cocaine HCl 360 mg, lidocaine HCl 140 mg, adrenaline 0.04 mg and naphazoline 0.4 mg. Venous blood samples were taken before cocaine application and 15, 30, 45, 60, 90, 120, 150, 180, 240 min later. The plasma was immediately separated and the samples were frozen. The concentration of cocaine was measured by HPLC. Potential cardiotoxic and neurotoxic effects were clinically monitored. RESULTS: The mean dose of cocaine applied was 5.85 +/- 1.3 mg.kg-1 and the dose actually delivered was 4 +/- 1.5 mg.kg-1. The Cmax was 859 +/- 503 ng.mL-1 after a Tmax to 47 +/- 17 min. The mean elimination half-life was 87 +/- 19 min (mean +/- SD). The total clearance and the volume of distribution were respectively 4,521 +/- 1,858 mL.min-1 and 568 +/- 273 L. No clinical evidence of toxicity was found. CONCLUSIONS: This study shows that it is possible to perform major intranasal surgery under topical anaesthesia with a concentrated solution (33%) of cocaine at a high dose (6 mg.kg-1). These results differ completely with data obtained in addicts.

Administration, Intranasal↗
PubMed1994

[Proposal for a new multifactor screening score of difficult intubation in ORL and stomatognathic surgery: preliminary study].

This study assessed prospectively in 295 ENT adult patients the predictive value of clinical indicators for difficult intubation and of a new multifactorial score, established by the allocation of points (0, 3, 5 or 7) depending on the degree of presence of seven factors: pathology known to be associated with a difficult intubation, clinical signs of airways' pathology, inter-incisors gap and mandible's luxation, submental mandibular-thyroid distance, normal or short and broad neck, head and neck movements, and Mallampati's test. The incidence of difficult laryngoscopy was 14% and the use of particular techniques for tube insertion was required in 8% of patients. The presence of malformation or pathology often associated with a difficult intubation and the presence of functional signs of airways' pathology predict the difficulties of laryngoscopy and tracheal intubation with a good sensitivity and specificity. The analysis of the "Receiver Operating Characteristic curves" showed that a score higher or equal to 11 allows the prediction of difficult intubations with a sensitivity of 96% and a specificity of 90%.

Humans↗
PubMed1994

[Transfusion-associated HIV contamination between January 1980 and September 1985].

This study reports the results of a retrospective survey of transfusion-related HIV-contamination in patients who were admitted in our neurosurgery department, between the 1st January 1980 and the 30th September 1985. In our area of France, the risk of HIV-contamination is low. During this 5-year-period the blood donors were not tested for HIV. Six hundred twenty-one patients were identified from the operating room registers. The administered blood components were always noted in these registers for each patient. Among these 621 patients, 233 died rapidly. Three hundred eighty files were taken out from the central archives' department. Eight files could not be found. These 380 files were examined for the patient's address, or the family's one, or the regular doctor's name and address. A letter was sent to the latter in order to inform him about the patient's transfusion. The doctor had to ask the patient to order a HIV-test. A recall letter was sent 8 months later as required. The patients who did not have a regular doctor were contacted directly by phone or letter, or indirectly through their family. Thirteen months after the beginning of this survey it was established that 334 patients died (53.5%) and only 151 patients were found and tested. One of them was HIV-positive. As this patient suffered from a hemophilia B, he had been medically followed and his positive serology was known since 1988. It was impossible to get any answer from 136 other patients who represent 22% of all patients and 47% of still alive patients or supposed to be so.(ABSTRACT TRUNCATED AT 250 WORDS)

France↗
PubMed1993

Airway complications in thyroid surgery.

Perioperative and postoperative morbidity and mortality were studied in a series of 3,008 thyroidectomies. Compressive symptoms, frequent in substernal and cancerous goiters, were present in 11.0% of the patients, although a low rate of dyspnea (2.7%) was observed. In large goiters, some orotracheal intubations were difficult. In such cases, the transtracheal approach can also be difficult, so failure should be anticipated. Postoperative causes of respiratory obstruction included local hemorrhages, bilateral recurrent nerve palsies, and laryngeal edema. A tracheal collapse was not observed. These respiratory obstructions led to repeat surgery in 11 patients, tracheostomy in 3, and temporary reintubation with steroid therapy in 1. The recurrent laryngeal nerve, which may have been affected preoperatively, was found to be damaged postoperatively in 0.5% of the patients with benign goiters, compared to 10.6% of the patients with thyroid cancer. In this last group a bilateral palsy was observed in 3 cases with prolonged or extensive surgery. After these short-term orotracheal intubations (114 minutes on average), injuries of the airway caused by the endotracheal tube were found in 4.6% of the patients.

Airway Obstruction↗
PubMed1990

[Anesthesia and factor VII deficiency].

A case is reported of a 17 year-old patient undergoing emergency internal fixation of a mandibular fracture after a road traffic accident. Routine preoperative blood analysis revealed an isolated deficiency in factor VII (33%), with a normal activated partial thromboplastin time and a reduced prothrombin level (50%). Because there was no previous history of an haemorrhagic diathesis, the surgical procedure was carried out without any factor VII replacement. The course of surgery was normal, with no abnormal blood loss. The possible causes of this deficiency, and its treatment are discussed.

Adolescent↗
PubMed1987

[Transurethral surgery and persistent urinary infection: effect of a single preoperative dose of cefuroxime].

To evaluate the efficacy of cefuroxime, a second generation cephalosporin, in minimizing the risk of per and postoperative infection complications in patients with urinary tract infection undergoing transurethral surgery, 86 patients (ASA I, II) with persistent urinary tract infection despite antibiotic therapy were studied. A double blind protocol was followed. Patients were randomly assigned to receive 10 minutes before surgery either I.V. cefuroxime (1.5 g) (group C, n = 39) or placebo (group P, n = 47) the incidence of positive peroperative systematic blood cultures was lower in group C (9.7%) than in group P (25.2%) (p less than 0.001). The incidence of postoperative blood cultures taken when clinical septic signs were present, was significantly lower in group C (0%) than in group P (21.7%) (p less than 0.05). However neither the incidences of both postoperative urinary tract infection at the 48th postoperative hour and the clinical signs of bacteraemia including fever nor the average length of hospitalization were significantly different in the 2 groups. This lack of significant clinical benefit was not explained by the pharmacokinetic properties of this antibiotic. Thus, preoperative administration of a single dose of cefuroxime, reduces the incidence of per and postoperative bacteraemias in ASA I-II patients with persistent urinary tract infection.

Adolescent↗
PubMed1986

[Hemodynamic effect of the clamping of the carotid in the surgically treated coronary patient].

To determine both the incidence of myocardial ischaemia and haemodynamic response to carotid cross-clamping in coronary artery disease, 30 patients undergoing carotid endarterectomy were studied with a clear history of effort related disabling angina pectoris. Myocardial ischaemia was detected by a recording of lead CM5 of the electrocardiogram. A radial arterial and a thermodilution pulmonary catheter were inserted to obtain haemodynamic measurements before and after carotid cross-clamping and unclamping. Anaesthesia was induced with increments of thiopental, fentanyl 6 micrograms X kg-1 and pancuronium. Additional fentanyl (2 micrograms X kg-1) was injected before skin incision and before carotid cross-clamping. Carotid cross-clamping results in a significant increase in both mean arterial blood pressure and capillary wedge pressure. Two patients experienced myocardial ischaemia with ST segment depression during carotid cross-clamping. Nitroglycerin infusion led to the improvement of ST segment depression. When halothane was additionally administered to patients who developed hypertension in response to carotid cross-clamping, arterial blood pressure returned to normal value. These results indicate that carotid cross-clamping increases determinants of myocardial oxygen demand and may cause myocardial ischaemia in patients suffering from angina pectoris.

Aged↗
PubMed1986

Hemodynamic effects of high-frequency jet ventilation in patients with and without circulatory shock.

Nineteen critically ill patients with acute respiratory failure were studied to compare the hemodynamic effects of continuous positive-pressure ventilation (CPPV) and high-frequency jet ventilation (HFJV) at comparable levels of alveolar ventilation. Patients were divided into three groups: Group 1 included seven patients without circulatory shock in whom mean airway pressure (Paw) was slightly higher during CPPV than during HFJV (17.3 +/- 3.0 vs. 13.0 +/- 2.9 mmHg); Group 2 included six patients without circulatory shock in whom HFJV and CPPV were compared at the same level of Paw (19.2 +/- 5.0 mmHg); Group 3 included seven patients with circulatory shock in whom HFJV and CPPV were compared at the same level of Paw (16.0 +/- 3.9 mmHg). The following respiratory frequencies were used in HFJV: Group 1, 200 +/- 76 beats/min; Group 2, 238 +/- 103 beats/min; Group 3, 286 +/- 149 beats/min. In all patients comparable levels of PaCO2 were obtained with CPPV and HFJV. In Group 1 patients, mean arterial pressure, cardiac index, and stroke index were significantly higher during HFJV. In Group 2 patients, no significant difference was found between HFJV and CPPV. In Group 3 patients, the following hemodynamic variables were significantly higher during HFJV: mean arterial pressure (71 +/- 24 vs. 84 +/- 23 mmHg), cardiac index (3.6 +/- 1 vs. 4.1 +/- 1.41 X min-1 X m-2), and oxygen delivery (403 +/- 93 vs. 471 +/- 124 ml X min-1 X m-2).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1986

Roles of fentanyl and nitroglycerin in prevention of myocardial ischemia associated with laryngoscopy and tracheal intubation in patients undergoing operations of short duration.

The purpose of this study was to evaluate intravenous nitroglycerin given during induction of anesthesia as a means for prevention of myocardial ischemia and hemodynamic changes associated with induction, laryngoscopy, and intubation, in patients with stable angina scheduled for vascular operations of moderate duration. Forty-six patients were randomly assigned to receive either fentanyl, 3 micrograms/kg (group 1, n = 6), fentanyl, 8 micrograms/kg (group 2, n = 20), or fentanyl 3 micrograms/kg plus a continuous intravenous nitroglycerin infusion, 0.9 microgram X kg-1 X min-1 (group 3, n = 20), in addition to thiopental-pancuronium anesthetic induction, prior to laryngoscopy and intubation. The criteria for recognizing myocardial ischemia were the following: horizontal or downsloping ST segment depression equal to or greater than 1 mV, and/or ventricular arrhythmia, on CM5 recording. In group 1, myocardial ischemia occurred during laryngoscopy and intubation in four patients, and mean blood pressure (MBP), heart rate, and mean pulmonary wedge pressure (PCWP) increased significantly (P less than 0.05). Despite greater stability in MBP and heart rate in group 2, myocardial ischemia still occurred in four patients (not significantly different from group 1). Nitroglycerin added to low-dose fentanyl (group 3) produced significant reduction in myocardial ischemia (1/20) when compared with group 1 (P less than 0.01), and significantly greater stability in PCWP during laryngoscopy and intubation in comparison to groups 1 and 2. In patients with stable angina undergoing operations of short duration, the use of nitroglycerin infusion and low-dose fentanyl significantly decreases the incidence of myocardial ischemia associated with induction of anesthesia and tracheal intubation.

Aged↗
PubMed1984

Hemodynamic consequences of increasing mean airway pressure during high-frequency jet ventilation.

Six critically ill patients with acute respiratory failure were ventilated using high-frequency jet ventilation (HFJV)-frequency 100.min-1, driving pressure 35 psi, 1.8 mm inside diameter injector cannula. Hemodynamic measurements using radial artery and Swan-Ganz catheters, esophageal pressure (EP), and mean airway pressure (Paw) were measured at four different I:E ratios: 0.25, 0.43, 0.67 and 1.0. Static respiratory compliance, using the super syringe method, was measured during intermittent positive pressure ventilation (IPPV) and during HFJV. The results suggested that decreased venous return, increased right ventricular afterload, and decreased PaCO2 accounted for the decrease in cardiac index observed during HFJV using elevated I:E ratios. These variations, related to marked increases in intrathoracic pressures, are very similar to those observed during conventional ventilation with PEEP.

Adult↗
PubMed1984

Impact of changes in operating pressure during high-frequency jet ventilation.

Fifteen critically ill patients with acute respiratory failure were ventilated with high-frequency jet ventilation (HFJV; frequency 100 breaths/min; I/E ratio 0.43; 1.8-mm internal diameter injector cannula). The patients were divided into two groups according to their initial PaO2 during intermittent positive pressure ventilation at FIO21: in eight patients (group I) the mean PaO2 was 141 +/- 34 mm Hg, and in seven patients (group II) mean PaO2 was 376 +/- 75 mm Hg. During HFJV three different operating pressures were used at random: 1.3, 1.8, and 2.3 bars. Increase in operating pressures significantly decreased PaCO2 and significantly increased mean lung volume above apneic FRC, mean airway pressure, and mean alveolar pressure in both groups. A close relationship was found between variations in mean airway pressure and mean alveolar pressure (r = 0.99, P less than 0.001). Significant increases in PaO2 with increasing operating pressures were observed only in group I. In group II, PaCO2 was significantly lower than in group I for a given operating pressure. We conclude that operating pressure is a main determinant of arterial oxygenation during HFJV because of the concomitant increases in intrathoracic pressures and lung volume. Operating pressure also influences carbon dioxide clearance, PaCO2 varies inversely with operating pressure.

Adult↗