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Biomedical subjects

L Brasseur

Publications and source records attributed to L Brasseur.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Audit of the management of postoperative pain].

OBJECTIVE: The aim of this study was to assess the incidence and severity of postoperative pain in patients undergoing operations in various surgery clinics in the Assistance Publique des Hôpitaux de Paris (AP-HP) and to evaluate management of pain during the 24 hours following surgery. METHODS: Data from surgical and anesthesia observation sheets and from patient complaints collected in a one-day external audit were obtained for 96 surgery clinics in the AP-HP. RESULTS: At the time of surgery, most patients were receiving opioids, especially fentanyl: low dose ( < 1 microgram/kg/h) was given in 17.1% of the patients and regional anesthesia was used in 13%. In 95% of the cases, postoperative orders were written by anesthesiologists. Initial orders were modified according to patient response in 11.8% of the cases. "On demand" prescriptions were used in 10% of the orders. Patient controlled analgesia and regional analgesia were not routine techniques (2 and 0% respectively). Finally, 37.8% of the patients were given a single prescription of a step-1 drug (e.g. propacetamol i.v.), 25.9% a step-2 drug either alone or in combination with a step-1 drug, and 28.9% of the patients were given strong opioids at least once. CONCLUSIONS: For all types of drugs, dosage level was considered as correct in 86.5% of the cases. For approximately 10% of the opioid prescriptions, an ineffective dose was used. The interval between doses was too long in 54.1% of the prescriptions for at least one drug (e.g. for peripheral analgesia with propacetamol). The incidence of severe pain was 46.4%, especially after abdominal, high urologic and back surgery.

Analgesia↗
PubMed1995

Oncologists and primary care physicians' attitudes toward pain control and morphine prescribing in France.

BACKGROUND: Two representative samples of primary care physicians (N = 600) and medical oncologists (N = 300) in France were surveyed about their attitudes toward and knowledge about cancer pain management. METHODS: The survey was conducted by telephone with a questionnaire based on a model developed by the University of Wisconsin-Madison Pain Research Group. It was designed to assess physicians' estimates of the prevalence of pain among patients with cancer, their practice in prescribing analgesics, their training in cancer pain management, and the quality of care received by cancer patients in their own practice and in France. RESULTS: Barriers to adequate cancer pain management are prevalent and consistently more common among primary care physicians than among medical oncologists. Although 85% of primary care physicians and 93% of medical oncologists express satisfaction with their own ability to manage cancer pain, 76% of primary care physicians and 50% of medical oncologists report being reluctant to prescribe morphine for cancer pain. Both groups cite fear of side effects as their main reason to hesitate to prescribe morphine. Concerns about the risk of tolerance (odds ratio [OR], 1.15-2.52), perceptions that other effective drugs are available (OR, 1.11-2.41), perceptions that morphine has a poor image in public opinion (OR, 0.96-2.07), and the constraints of prescription forms (OR, 1.12-2.26) contribute significantly to physicians' infrequent prescription of morphine, as are being female (OR, 1.01-2.03) and being an older oncologist (OR, 1.09-2.51). CONCLUSIONS: This study (1) confirms the existence among French physicians of attitudinal barriers and knowledge deficits previously reported in other countries that can impede cancer pain management, (2) identifies new barriers to the proper prescription of morphine for cancer pain control, and (3) reveals discrepancies in physicians' attitudes and knowledge about pain control which suggest a need for the systematic evaluation of cancer patients' care.

Adult↗
PubMed1995

Multicentre study of cancer pain and its treatment in France.

OBJECTIVE: To describe the treatment of cancer pain in France and to evaluate the predictive factors for inadequate management. DESIGN: Multicentre, representative cross sectional survey. SETTING: 20 treatment centres, including cancer centres, university hospitals, state hospitals, private clinics, and one homecare setting (in which patients are supported at home). SUBJECTS: 605 patients with cancer. MAIN MEASURES: Patients rated prevalence and severity of pain and functional impairment related to pain. Doctors reported patients' cancer characteristic, performance status, pain severity, and analgesic drugs ordered. RESULTS: 57% (340/601) of patients with cancer reported pain due to their disease, and, of those with pain, 69% (224/325) rated their worst pain at a level that impaired their ability to function. 30% (84/279) were reported as receiving no drugs for their pain. Of the 270 patients in pain for whom information on treatment was available 51% (137/270) were not receiving adequate pain relief, according to an index based on the World Health Organisation's guidelines. French doctors were found to underestimate the severity of their patients' pain. Younger patients, patients without metastatic disease, patients with a better performance status, and patients who rated their pain as more severe than their doctors did were at greater risk for undertreatment of their pain. CONCLUSIONS: In the light of the high prevalence and the severity of pain among patients with cancer, the assessment and treatment of cancer pain in France remain inadequate, emphasising the need for changes in patient care.

Analgesia↗
PubMed1995

[Interactions between opioids and local anesthetics at the level of the dorsal horn of the spinal cord].

For many years, local anaesthetic drugs, given spinally, have been used to control pain after surgery or during parturition. For nearly 20 years, we have known that opioids given by the same way have an analgesic effect. However the later group do not provide satisfactory analgesia in several pain contexts but also give troublesome side effects; local anaesthetics are associated also with side effects. Experimental and clinical studies have shown that the combination of local anaesthetics with opioids provides some degree of synergism, associated with a reduction of side effects. Further studies are needed to confirm the analgesic benefit and the potential decrease of side effects, but also to determine the minimal effective dose regimen in relation with the type of pain.

Analgesics, Opioid↗
PubMed1994

[Introducing patient-controlled analgesia in a private hospital].

Patient controlled analgesia (PCA) is now a well recognized technique for postoperative analgesia. This study reports an experience of 24 months with 768 patients in a French private hospital. The first step was to train the team for this new technique. The second step was to agree on standards of prescription and safety monitoring rules (respiratory rate plus sedation score), as well as on the selection of patients. Analgesia was obtained with self administrated bolus plus a constant infusion (0.5 milligram per hour) of morphine in all patients, and in some with an addition of paracetamol or ketoprofene for a sparing effect on morphine consumption. All patients were returned to their ward, after an initial titration of pain treatment in the recovery room. No major problems occurred during the study period. In 13 patients the respiratory rate decreased to or under 10 c.min-1 without increased sedation and for safety reasons, the PCA was discontinued. PCA is now routinely used postoperatively for a majority of painful procedures in our institution.

Adolescent↗
PubMed1992

[Postoperative analgesia in France. A study of the prescribing doctor's approach].

Every year nearly 4 million surgical procedures are carried out in France: about two thirds of the patients will suffer moderate to severe postoperative pain. Beside the obvious philosophical reasons, purely medical arguments also favour good quality postoperative pain relief. In this country, unlike the situation prevailing in many other countries, anaesthetists are in charge of postoperative pain relief. The survey reported here was carried out by questioning the usual prescribers and it reports their attitudes and practices. The results would show a rather good situation: anaesthetists seem to have an interest in the subject, and the approach looks very satisfactory but these points remain to be proved in practice. There is considerable interest in some drugs, but others are in disgrace for unclear reasons. New methods of administration are not very familiar. We may conclude from this study that a greater awareness of the problem is desirable, that general and specific scientific information should be made available, that clearly defined treatment plans should be established and evaluated regularly, and that financial resources must be envisaged.

Acetaminophen↗
PubMed1992

[Patient-controlled analgesia by the peridural route and classical methods of analgesia].

Patient controlled analgesia was developed to compare drug effects. Later its psychological implications were studied. Drug administration by intravenous or epidural injection has been used. The latter provides relief with much smaller doses. Simultaneous use of opioids and anti-inflammatory drugs enhances the analgesic effects. For pain relief in childbirth, opioids need to be combined with local anaesthetics for best results. Little has been achieved by patient controlled analgesia in the treatment of chronic pain.

Acute Disease↗
PubMed1991

Comparison of continuous epidural bupivacaine infusion plus either continuous epidural infusion or patient-controlled epidural injection of fentanyl for postoperative analgesia.

We compared the postoperative epidural analgesia provided by the continuous epidural infusion of bupivacaine supplemented with patient-controlled injection (PCA) of epidural fentanyl with that provided by a continuous infusion of bupivacaine supplemented with a continuous epidural infusion of fentanyl. Our patient population comprised 16 ASA physical status I or II patients undergoing laparotomy with a midline incision under general anesthesia combined with bupivacaine epidural analgesia. Post-operatively, a continuous epidural infusion of bupivacaine (0.1 mg.kg-1.h-1) was combined with epidural fentanyl given by either (a) PCA (15-micrograms bolus with a lockout interval of 12 min, n = 8) or (b) continuous infusion (1 microgram.kg-1.h-1, n = 8). In the case of inadequate pain relief in the latter group, the fentanyl infusion rate was increased by 10 micrograms/h. Analgesia evaluated by a visual analogue pain score and by a verbal pain score was similarly effective in both groups. The sedation score was also similar in both groups. The total dose of epidural fentanyl administered during the first 24 h was significantly lower in the PCA group than in the continuous infusion group (405 +/- 110 micrograms vs 1600 +/- 245 micrograms, P less than 0.001). The dose of fentanyl given during each 4-h interval ranged between 40 and 160 micrograms in the PCA group and 251 and 292 micrograms in the continuous infusion group. Clinically detectable respiratory depression was not observed in either group. In conclusion, epidural administration of 0.1 mg.kg-1.h-1 bupivacaine combined with fentanyl provides effective postoperative analgesia with a total dose of fentanyl required that is lower when fentanyl is administered by epidural PCA rather than by continuous epidural infusion.

Adult↗
PubMed1987

Impairment of ventilatory function and pulmonary gas exchange in non-smoking coalminers.

Indices of ventilatory function and pulmonary gas exchange in 32 non-smoking coalminers (mean age 38.1) were compared with those of 34 non-smoking steelworkers of similar age. The coalminers had significantly lower forced expiratory volume in 1 s (FEV1) and maximum expiratory flow rates and significantly higher residual volume, but similar vital capacity and indices derived from the single-breath test. Pulmonary diffusing capacity for CO and indices of CO2 exchange were similar in both groups. Arterial partial pressure of O2 (PaO2) was significantly lower and alveolar-arterial O2 difference was significantly higher in coalminers than in controls, both at rest and during exercise. There was no relation between lung function and radiological signs of simple pneumoconiosis (10 coalminers had pneumoconiosis). The differences in FEV1 (0.42 l) and in PaO2 (10 mm Hg) between the two groups are the same or larger than those usually found between smokers and non-smokers. Exposure to coaldust may result in biologically significant alterations of lung function even in the absence of pneumoconiosis.

Adult↗
PubMed1986

[Determination of the standard oxyhemoglobin dissociation curve in horses. Effects of temperature, pH and diphosphoglycerate].

The equine blood oxyhemoglobin dissociation curve has been traced in its entirety in standard conditions and the effects of temperature, pH and 2,3-diphosphoglycerate on this curve have been measured. When compared to that of human blood, the curve showed a higher oxygen affinity of hemoglobin (23.8 +/- 0.8 versus 26.6 mm Hg). The effect of the pH, expressed by d log P50/dpH, was found to be identical in man and horse (-0.47). The effect of temperature, however, expressed by d log P50/dT, proved to be lower in the horse (0.016 versus 0.024). The P50 showed an increase of 1 mm Hg each time 2,3-diphosphoglycerate was experiencing an elevation of 4 mumol/gHb in the horse. The results obtained from this experiment are intended for the replacement of the values related to the human blood which have been found to be somewhat inadequate for the horse blood, when the data of blood gases are given in algorithms.

2,3-Diphosphoglycerate↗
PubMed1985

Lung function measurements over 21 days shiftwork in steelworkers from a strandcasting department.

On the assumption that short term changes in lung function may reflect the potential for a long term decline the evolution of lung function indices in 25 steelworkers from a strandcasting department and in 11 comparable steelworkers not exposed to dust was investigated over an almost uninterrupted 21 day working period and over three different workshifts. The mean total dust level in the strandcasting department, assessed by personal sampling, was 11.8 mg/m3. All subjects were examined at the beginning, in the middle, and at the end of their first (day 1) morning shift (0600 to 1400), their last (day 14) afternoon shift (1400 to 2200), and their last (day 21) night shift (2200 to 0600). Indices measured were vital capacity (VC), forced expiratory volume in one second (FEV1) and in three seconds (FEV3), forced expiratory flow over the middle half of the forced vital capacity (FEF25-75), peak expiratory flow rate (PEFR), the slope of the N2 plateau (delta N2) and the closing volume (CV) of the single breath oxygen test. Differences in indices between initial values (0600 on day 1) and final values (0500 on day 21) were not significant in the control group (except delta N2 which became lower); in the casting group there were significant (p less than 0.05) decreases in FEF25-75 and FEV3, but these decreases were not significantly greater than in the control group. Lung function changes were not significant in either group over the morning shift. During the afternoon there were significant decreases in spirometric indices in the casting group, with no significant decreases in the control group, but the interactions between exposure and time were generally not significant. During the night shift, however, the decreases in FEV1 and FEF25-75 observed in the strandcasting group were significantly more pronounced than in the control group. The single breath test, which many subjects failed to perform correctly on each occasion, showed no significant changes in closing volumes, and an "improvement" of delta N2 over the morning and the night shift in the control but not the exposed subjects needs to be interpreted with caution. The more pronounced decrease in spirometric indices, suggestive of slight airways obstruction, found over the night shift in the strandcasting workers is attributed to their working environment.

Belgium↗
PubMed1985

Assessment of a bubble tonometer as a quality control system for blood gas analyzers (PO2 and PCO2).

A blood gas tonometer device, comprising an accurate gas mixer (Corning 192) associated with a dual channel bubble tonometer (Corning 184) was tested for reliability, accuracy and ease of use as a quality control system for pO2 and PCO2 blood gas analyzers. From our results it is apparent that this system can be used instead of older and more bulky tonometry devices, gas mixing systems or cylinders of fixed composition.

Blood Gas Analysis↗