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J J Eledjam

Publications and source records attributed to J J Eledjam.

At least 19 recordsLinked to original sources
PubMed2003

[Phoning study about postoperative practice and application of non-invasive ventilation].

OBJECTIVES: Incidence and management of positive pressure non-invasive ventilation (NIV) in intensive care unit (ICU) in the postoperative period. STUDY DESIGN: Phoning study performed on September 2001 in 60 ICU of south of France (public: 47, private: 13, medical: 11, surgical: 20, medical-surgical: 29), which were randomized from a national list. RESULTS: NIV was used currently on 55% and casually on 35% of the units. Ten percent of ICU, which never use NIV, were surgical on 83% with a lower number of bed (7 +/- 3 vs. 12 +/- 5). The most often humidification device used was a Heat and Moisture Exchanger (HME) (52%), a Heated Humidifier (HH) (26%), either (4%) and none device (19%). ICU that never used a humidification device used a home ventilator in 30%. Ventilators used were more often heavy ICU ventilators (80%) with a facial mask (89%). NIV was performed exclusively by physicians in 15% of cases and in collaboration after the first application in 71% of cases. Sixty-nine % of intensivists used NIV as a first choice for the treatment of acute postoperative respiratory failure and 54% of intensivists for the treatment of postoperative atelectasis. CONCLUSION: Use of NIV increases in ICU, particularly in surgical units. Practices are different between ICU. An HME is the most frequently humidification device used.

Data Collection↗
PubMed2003

[Orbital haemorrhage after medial canthus episclera (sub-Tenon's) anaesthesia].

Medial canthus episclera (sub-Tenon's) anaesthesia is a technique proposed as a suitable alternative to the more classical peribulbar block because of the greater reliability and more constancy in effectiveness. We report two cases of retrobulbar haematoma after sub-Tenon's anaesthesia, one with central retina artery compression needed anterior room punction. Sub-Tenon's anaesthesia, like peribulbar anaesthesia, can give also retrobulbar haemorrhage if the insertion of the needle is not limited to the anterior orbit.

Aged↗
PubMed2002

[Multitruncular block at the elbow for a major hand trauma for prehospital care].

Upper limb peripheral nerve blocks offer many advantages but they are not widely used in prehospital care. We report the case of a multitroncular block at the elbow made by the emergency department team out of the hospital after a major hand trauma. A successful axillary brachial plexus block was done two hours later, without any problem. This case report allows us to discuss about different analgesia techniques useful in prehospital care.

Amputation, Traumatic↗
PubMed2002

Pharmacodynamics and atracurium and laudanosine concentrations during a fixed continuous infusion of atracurium in mechanically ventilated patients with acute respiratory distress syndrome.

The present study was designed to assess the pharmacodynamics and the plasma levels of atracurium and laudanosine found during a 72-hour fixed rate infusion of atracurium in acute respiratory distress syndrome patients without renal or liver failure. Nine sedated and mechanically ventilated acute respiratory distress syndrome patients without renal or liver failure were paralysed with a bolus of atracurium (1 mg x kg(-1)) followed by a 72-hour continuous infusion (1 mg x kg(-1) x h(-1)). The count of train-of-four (TOF) and TOF ratio were monitored by an accelerograph until full neuromuscular recovery (T4/T1 > or = 0.7). Atracurium and laudanosine concentrations were measured from the onset to four days after cessation of the infusion. An electroencephalogram was recorded daily. Analysis showed that TOF count was always < or = 3 until cessation of the infusion. Following cessation, neuromuscular recovery occurred between 31 and 96 minutes (median value = 45 min). The highest atracurium and laudanosine concentrations ranged from 3.3 to 5.8 microg x ml(-1) and from 3 to 20 microg x ml(-1) respectively. In four patients with renal impairment, the highest laudanosine concentration was > 10 microg x ml(-1). No seizure was recorded. A fixed infusion rate of atracurium in acute respiratory distress syndrome patients provided an effective muscle paralysis with a rapid neuromuscular recovery but can lead to accumulation of laudanosine in patients with renal impairment.

Aged↗
PubMed2001

The Mini Nutritional Assessment-Short Form for preoperative nutritional evaluation of elderly patients.

The Mini Nutritional Assessment (MNA) is a clinical tool designed for assessing nutritional status of elderly patients. Used in preoperative evaluation of ambulatory patients over 60 years of age seen on anesthesia consultation in a previous study, it identified 6.9% patients with overt malnutrition out of a group of 408. However, four-fifths of 291 ASA 1-2 patients were well nourished, and underwent needless, non-contributory and time-consuming test. The MNA-Short Form (MNA-SF) has recently been devised as the first step of a two-step process: if negative, there would be no need to complete "full" MNA. Therefore, the base data of 408 MNA forms completed during the above-mentioned study was used for the purpose of comparing the MNA-SF to the MNA, to test whether the MNA-SF could have been the first step of a two-step nutritional evaluation of anesthesia patients. Median (range) age, and BMI were 72 (60-98) years, and 25.2 (12.8-40.4) kg x m(-2), respectively. There were equal numbers of men and women. In 144 cases, the MNA-SF was found positive (35.3%) with a median MNA of 21.5 (1.5-27) points. The MNA-SF predicted absence of overt malnutrition revealed by the MNA, with 100% sensitivity and negative predictive value (NPV). It was found less efficient for predicting absence of "possible" nutritional problems detected by the MNA (sensitivity 85.6% and NPV 92.8%). However, none of the 19 borderline patients would have had overt malnutrition, being only found "at risk of malnutrition" by the MNA. On the studied sample, the MNA-SF would have correctly sorted out 69.5% of the patients without severe malnutrition. We believe the MNA-SF should be used as the first step of an efficient preoperative nutritional evaluation of ambulatory elderly patients.

Aged↗
PubMed2001

[Pulmonary artery catheterization in the intensive care unit: at what time?].

OBJECTIVES: Recording the time at which the insertion of a pulmonary artery catheter was decided. STUDY DESIGN: Prospective and descriptive study. PATIENTS: Critically ill patients in an university hospital. METHODS: The times at which the insertion of a PAC was decided were recorded. For each pulmonary artery catheterization, immediate complications were recorded (arterial puncture, pneumothorax, ventricular arrhythmia, hard and failed pulmonary artery catheterization). RESULTS: One hundred and forty-nine patients were included (99 males, age = 63 +/- 15 year, body mass index = 25 +/- 6 kg.m-2, median Apache II score = 16). One hundred and sixty-five PAC insertions were decided (16 patients requiring two PACs). Nine arterial punctures, two pneumothoraces, 42 ventricular arrhythmias, 32 hard and eight failed pulmonary artery catheterizations occurred. Thirty-four PAC insertions were decided between 9 and 10 am whereas = 3 PAC insertions per hour were decided between 1 and 9 am. CONCLUSION: The rate of decision of PAC insertion are decreased during the second half of the night (1 to 9 AM).

APACHE↗
PubMed2001

[Dural puncture in obstetric analgesia. Epidemiologic features and therapeutic management].

OBJECTIVE: To assess the time of occurrence, circumstances and presenting symptoms of unintentional dural puncture (UDP), the location and intensity of postdural puncture headaches (PDPH), and the efficacy of their treatment by epidural blood-patch (EBP). STUDY DESIGN: Cohort study. PATIENTS: Cases of UDP recorded over a 4-year period in an obstetric anaesthesia unit. METHODS: The following variables were studied: maternal age, weight and height, hour of occurrence and number of puncture attempts, existence of reflux of cerebrospinal fluid (CSF) through the needle, experience of the practitioners, subsequent modalities of obstetrical analgesia, frequency of occurrence, clinical characteristics and therapeutic management of PDPH. In case of EBP, the amount of blood and the efficacy of the procedure were also recorded. RESULTS: Twenty-one patients presented with UDP (0.66%). No reflux of CSF was identified in nine cases. Most UDP occurred at the first or second attempt, usually when performed by a practitioner poorly trained in epidural analgesia in obstetrics. The risk of UDP was higher during night-time work (risk ratio: 3.0; 95% confidence interval: 1.1-8.0; p = 0.04). Subsequent analgesia was provided via the epidural route in 19 cases, subarachnoidal route in one, and intravenous route in one case. PDPH did not develop in two patients. Three patients were given prophylactic EPB, and 16 received curative EBP. A second EBP was required 24 h later in seven patients. One patient developed meralgia paresthetica following EBP. CONCLUSION: In parturients, UDP usually results in PDPH. A rapid and effective treatment is required, mainly EBP. Another EBP is eventually necessary in some patients.

Analgesia, Epidural↗
PubMed2001

The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects.

UNLABELLED: We investigated the incidence of bacterial and vascular or neurological complications resulting from femoral nerve catheters used for postoperative analgesia. Patients requiring continuous femoral blockade were consecutively included. Using surgical aseptic procedure, 211 femoral nerve catheters were placed (short-beveled insulated needle, peripheral nerve stimulator). After 48 h, each catheter was removed and semiquantitative bacteriological cultures were performed on each distal catheter tip. Postoperative analgesia and antibiotics were standardized. All complications during the insertion of the catheters and postoperatively (after 48 h and 6 wk) were noted. Few initial complications with no immediate or delayed complications were noted (20 difficult insertions, 3 impossible injections, 3 ineffective catheters, and 12 vascular punctures). After 48 h, 208 catheters were analyzed; 57% had positive bacterial colonization (with a single organism in 53%). The most frequent organisms were Staphylococcus epidermidis (71%), Enterococcus (10%), and Klebsiella (4%). Neither cellulitis nor abscess occurred. Three transitory bacteremias likely related to the catheter occurred. After 6 wk, no septic complications were noted. One femoral paresthesia, partially recovered 1 yr later, was noted. We conclude that the risk of bacterial complications is small with femoral nerve catheters, although the rate of colonization is frequent. IMPLICATIONS: In this prospective study, continuous femoral nerve catheters were effective for postoperative analgesia but had a frequent rate of bacterial catheter colonization. We found no serious infections after short-term (2-day) infusion. Side effects were few, but one nerve injury occurred.

Adolescent↗
PubMed2001

The comparative electrophysiologic and hemodynamic effects of a large dose of ropivacaine and bupivacaine in anesthetized and ventilated piglets.

UNLABELLED: Ropivacaine is less potent and less toxic than bupivacaine. We administered these two local anesthetics in a cardiac electrophysiologic model of sodium thiopental-anesthetized and ventilated piglets. After assessing the stability of the model, bupivacaine (4 mg/kg) and ropivacaine (6 mg/kg) were given IV in two groups (n = 7) of piglets. No alteration in biological variables was reported throughout the study. Bupivacaine and ropivacaine similarly decreased mean aortic pressure from 99 +/- 22 to 49 +/- 31 mm Hg and from 87 +/- 17 to 58 +/- 28 mm Hg, respectively, and decreased the peak of the first derivative of left ventricular pressure from 1979 +/- 95 to 689 +/- 482 mm Hg/s and from 1963 +/- 92 to 744 +/- 403 mm Hg/s, respectively. Left ventricular end-diastolic pressure was similarly increased from 6 +/- 5 to 9 +/- 5 mm Hg and from 6 +/- 4 to 12 +/- 4 mm Hg, respectively. Bupivacaine and ropivacaine similarly lengthened the cardiac cycle length (R-R; from 479 +/- 139 to 706 +/- 228 ms and from 451 +/- 87 to 666 +/- 194 ms, respectively), atria His (from 71 +/- 15 to 113 +/- 53 ms and from 64 +/- 6 to 86 +/- 10 ms, respectively), and QTc (QTc = QT x R-R(-0.5), Bazett formula; from 380 +/- 71 to 502 +/- 86 ms and from 361 +/- 33 to 440 +/- 56 ms, respectively) intervals. Bupivacaine altered to a greater extent the PQ (the onset of the P wave to the Q wave of the QRS complex) (from 97 +/- 20 to 211 +/- 60 ms versus from 91 +/- 8 to 145 +/- 38 ms, P < 0.05), QRS (from 58 +/- 3 to 149 +/- 34 ms versus from 60 +/- 5 to 101 +/- 17 ms, P < 0.05), and His ventricle interval (from 25 +/- 4 to 105 +/- 30 ms vs from 25 +/- 4 to 60 +/- 30 ms, P < 0.05) than ropivacaine. A 6 mg/kg ropivacaine dose induced similar hemodynamic alterations as 4 mg/kg bupivacaine. However, bupivacaine altered the variables of ventricular conduction (QRS and His ventricle) to a greater extent. IMPLICATIONS: A 6 mg/kg ropivacaine dose induced similar hemodynamic alterations as 4 mg/kg bupivacaine. However, bupivacaine altered the variables of ventricular conduction (QRS and His ventricle) to a greater extent.

Amides↗
PubMed2001

Peribulbar versus retrobulbar anesthesia for ophthalmic surgery: an anatomical comparison of extraconal and intraconal injections.

BACKGROUND: Peribulbar and retrobulbar anesthesia have long been opposed on the basis of the existence of an intermuscular membrane, which is supposed to separate the intraconal from the extraconal spaces in a water-tight fashion. A local anesthetic injected outside the cone should spread through this septum to reach the nerves to be blocked. The existence of this septum is questioned. The aim of this study was to compare the spread of a colored latex dye injected intraconally or extraconally to simulate both retrobulbar and peribulbar anesthesia. METHODS: The authors used 10 heads from human cadavers. For each head, one eye was injected intraconally, and the other eye was injected extraconally. The heads were then frozen and sectioned into thin slices following various planes. They were then photographed and observed. RESULTS: There was no evidence of the existence of an intermuscular septum separating the intraconal and extraconal spaces. Those two spaces appeared to be part of a common spreading space, the corpus adiposum of the orbit. CONCLUSIONS: These results are in accord with the fact that clinical studies were not able to clearly demonstrate that retrobulbar anesthesia is more efficient than peribulbar anesthesia. On the basis of a similar clinical efficacy of the two techniques as a result of similar spreading of the local anesthetic injected, and a potentially higher risk of introducing the needle into the muscular cone, the authors recommend replacing retrobulbar anesthesia with peribulbar anesthesia.

Anesthesia, Local↗
PubMed2001

Clinical application of ropivacaine for the lower extremity.

Ropivacaine is a new amide local anaesthetic, which is the first commercially available in its category as a pure S-(-) enantiomer. In most recent studies, ropivacaine exhibited a very close pharmacodynamic profile to equipotent doses of bupivacaine. Concentrations of 0.5%, 0.75% and 1% (5, 7.5 and 10 mg/mL, respectively) ropivacaine are used for intraoperative anaesthesia, while the concentration of 0.2% (2 mg/mL) is preferred for postoperative analgesia, either alone or in combination with opioids and/or clonidine. Ropivacaine is responsible for excellent postoperative analgesia following epidural and peripheral perineural injections, using single-shot injections and continuous infusions. Differential sensory/motor block is only apparent at low concentrations (0.2% and less). A significant amount of recent literature focuses on its use for peripheral blocks of the lower limbs, i.e. sciatic and femoral nerve blocks. The primary benefit of ropivacaine is its lower toxicity, mainly lower cardiotoxicity, following accidental intravascular injection. This higher therapeutic index leads to an improved safety profile as compared with potent local anaesthetics such as racemic bupivacaine. For that reason, ropivacaine is a good choice for both intraoperative and postoperative regional anaesthesia and analgesia.

Amides↗
PubMed2000

CO assessment by suprasternal Doppler in critically ill patients: comparison with thermodilution.

OBJECTIVE: Comparison of suprasternal Doppler (SST) and thermodilution (TD) for the measurement of cardiac output (CO) in critically ill patients. DESIGN: Prospective study. SETTING: Intensive care unit of a university hospital. PATIENTS AND PARTICIPANTS: 65 consecutive critically ill patients requiring a pulmonary artery catheter. INTERVENTIONS: Paired CO measurements were made simultaneously using SST and TD by two independent operators. The time to obtain a CO value by SST was measured. Correlation coefficients and the linear regression equation were determined. A Bland and Altman diagram was plotted. A Bland and Altman diagram was also plotted for the level of cardiac index (CI) values (low: CI < 2.5 l min(-1) m(-2); normal: 2.5 < or = CI < or = 4.5 l min(-1) m(-2); high: CI > 4.5 l min(-1) m(-2)). MEASUREMENTS AND RESULTS: In seven patients SST failed to measure CO. In the remaining 58 patients 314 paired CO measurements were performed. The mean time to measure CO by SST was 73 +/- 45 s. The equation of linear regression was: SST(CO) = 0.84 TD(CO) + 1.39. The correlation coefficient was 0.84. The bias between SST and TD was -0.2 +/- 1.4 l min(-1). Biases were -0.23 +/- 0.50, -0.20 +/- 0.68, and 0.25 +/- 0.92 l min(-1) m(-2) for low, normal, and high levels of CI, respectively. CONCLUSION: SST does not accurately measure CO but allows a rapid assessment of CI level in critically ill patients.

Adult↗
PubMed2000

Caruncle single injection episcleral (Sub-tenon) anesthesia for cataract surgery: mepivacaine versus a lidocaine-bupivacaine mixture.

UNLABELLED: We compared the quality of anesthesia provided by mepivacaine 2% or a mixture of lidocaine 2%-bupivacaine 0.5%, both with hyaluronidase, in caruncle single-injection episcleral (sub-Tenon) anesthesia. Sixty patients undergoing cataract surgery were included in this randomized, double-blinded study. The time to the onset of blockade, maximal akinesia, need for supplemental injection, and time to recovery were recorded. With mepivacaine, the time to onset was slightly shorter, and the akinesia score higher, than with the mixture. Although statistically significant, these differences are small. With mepivacaine, the time to recovery was shorter. We conclude that the reproducible short duration of the block may be an advantage in outpatient surgery. IMPLICATIONS: We compared the classic mixture of lidocaine 2% plus bupivacaine 0.5% to mepivacaine 2% for caruncle episcleral (sub-Tenon) anesthesia for cataract surgery. Mepivacaine provided a more efficient block with a quicker onset and a quicker recovery. However, these differences were very small and were of little clinical interest.

Aged↗
PubMed2000

Mechanisms of ventricular arrhythmias induced by myocardial contusion: a high-resolution mapping study in left ventricular rabbit heart.

BACKGROUND: The aims of the Langendorff-perfused rabbit heart study were to evaluate the arrhythmogenic consequences of myocardial contusion and to determine the mechanism of arrhythmia. METHODS: Six hearts were in the control group, and 24 hearts (intact heart protocol) were submitted to one of four different contusion kinetic energies (75, 100, 150, or 200 millijoules [mJ]; n = 6). Occurrence of arrhythmia, of an electrically silent area (i.e., area with no electrical activity), and of line of fixed conduction block were reported before and for 1 h after contusion. In 16 hearts (frozen hearts) submitted to cryoprocedure and contusion impact of 100 or 200 mJ, ventricular conduction velocities, anisotropic ratio, wavelengths, ventricular effective refractory period, and its dispersion were measured before and for 1 h after contusion. Using high-resolution mapping, arrhythmias were recorded and analyzed. RESULTS: The intact heart study showed that the number and seriousness of contusion-induced arrhythmias increased with increasing contusion kinetic energy, as did the number of electrically silent areas (five of six ventricular fibrillations and five of six electrically silent areas at 200 mJ). In the frozen heart study, immediately after contusion ventricular effective refractory periods were shortened and dispersed, and wavelengths were also shortened. The arrhythmia analysis showed that all ventricular tachycardias but one were based on reentry developed around an electrically silent area or a line of fixed conduction block. CONCLUSIONS: Myocardial contusion has direct arrhythmogenic effects, and the seriousness of arrhythmia increases with the level of contusion kinetic energy. The mechanism of arrhythmia was mainly based on reentrant circuit around a fixed obstacle.

Animals↗
PubMed2000

Ophthalmic regional anesthesia: medial canthus episcleral (sub-tenon) anesthesia is more efficient than peribulbar anesthesia: A double-blind randomized study.

BACKGROUND: Regional anesthesia and especially peribulbar anesthesia commonly is used for cataract surgery. Failure rates and need for reinjection remains high, however, with peribulbar anesthesia. Single-injection high-volume medial canthus episcleral (sub-Tenon's) anesthesia has proven to be an efficient and safe alternative to peribulbar anesthesia. METHODS: The authors, in a blind study, compared the effectiveness of both techniques in 66 patients randomly assigned to episcleral anesthesia or single-injection peribulbar anesthesia. Motor blockade (akinesia) was used as the main index of anesthesia effectiveness. It was assessed using an 18-point scale (0-3 for each of the four directions of the gaze, lid opening, and lid closing, the total being from 0 = normal mobility to 18 = no movement at all). This score was compared between the groups 1, 5, 10, and 15 min after injection and at the end of the surgical procedures. Time to onset of the blockade also was compared between the two groups, as was the incidence of incomplete blockade with a need for supplemental injection and the satisfaction of the surgeon, patient, and anesthesiologist. RESULTS: Episcleral anesthesia provided a quicker onset of anesthesia, a better akinesia score, and a lower rate of incomplete blockade necessitating reinjection (0 vs. 39%; P < 0.0001) than peribulbar anesthesia. Even after supplemental injection, peribulbar anesthesia had a lower akinesia score than did episcleral anesthesia. Peribulbar anesthesia began to wear off during surgery, whereas episcleral anesthesia did not. CONCLUSION: Medial canthus single-injection episcleral anesthesia is a suitable alternative to peribulbar anesthesia. It provides better akinesia, with a quicker onset and more constancy in effectiveness.

Aged↗
PubMed2000

Insertion time of the pulmonary artery catheter in critically ill patients.

OBJECTIVES: Measurement of the time elapsed from the decision to use a pulmonary artery catheter to the onset of the adapted treatment. DESIGN: Prospective study. SETTING: Critical care unit of a university hospital. PATIENTS: A total of 104 critically ill patients. INTERVENTIONS: The time elapsed from the decision to use a pulmonary artery catheter to the onset of the adapted treatment. Five time intervals (availability, preparation, catheterization, data collection, and therapeutic intervals) were individualized according to the times of decision of pulmonary artery catheter insertion, operator's hand washing, venipuncture, postoperative dressing, data collection, and the effective onset of subsequent therapy. MEASUREMENTS AND MAIN RESULTS: Among 120 used pulmonary artery catheters, seven could not be inserted. The time to use the pulmonary artery catheter was never shorter than 45 mins (median value = 120 mins). For availability, preparation, catheterization, data collection, and therapeutic intervals, the median values were 30, 20, 20, 20, and 10 mins, respectively. The availability and data collection intervals were shortened during the night period and the fourth quarter of the study, respectively. CONCLUSIONS: The pulmonary artery catheter use is time consuming. However, the availability and data collection intervals could be shortened.

Adult↗