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Biomedical subjects

M Pinaud

Publications and source records attributed to M Pinaud.

At least 163 records · Page 9Linked to original sources
PubMed1979

[Ketamine anesthesia for definitive implantation of a cardiac pace maker (author's transl)].

An hemodynamic study has been performed in eight patients (age 68 +/- 7) suffering from complete atrioventricular block. They had to undergo the definitive implantation of a cardiac pace maker under general anesthesia. The fixed cardiac frequency may help to understand the effect of the anesthetic agent used on the cardiac muscle function. Ketamine is the only agent used directly at an initial intravenous dose of 3 mg.kg-1 followed by a perfusion in a constant rate of 0.20 mg.kg-1. min-1. Hemodynamic data (arterial pressure, pulmonary pressures, thermodilution cardiac output) are performed before induction, then every 5 minutes after induction for a 20 minute period. The absence of respiratory depression (PaCO2: 38 +/- 3 mm Hg) shows that hemodynamic changes are entirely due to ketamine. The peak of these changes takes place after 5 minutes (significant rise (p < 0.05) in systemic and pulmonary resistances, in systemic arterial pressure and in pulmonary arterial pressure). Stroke index decreases moderately. After 20 minutes all the parameters have returned to control values. Use of ketamine is not desirable for two reasons: 1 degree The rise of the afterload may alter the hemodynamic state which can be previously deteriorated in patients suffering from atrio-ventricular block. 2 degree Post-anesthetic agitation can displace the right ventricular electrode.

Aged↗
PubMed1978

Dobutamine in the treatment of depressed cardiac function: a study in patients with ischaemic heart disease during the early post-operative period.

Dobutamine was administered by intravenous infusion to 10 patients with ischaemic heart disease who had a low cardiac output syndrome following abdominal surgery. The dosage of dobutamine started from 2.5 mcg kg-1 min-1 and was increased stepwise to 5, 7.5, 10, 12.5 and 15 mcg kg-1 min-1. Cardiac index increased significantly from 2.05 +/- 0.32 to 3.03 +/- 0.61. min-1 min-2 with 15 mcg kg-1 min-1. Heart rate was unchanged with 7.5 mcg kg-1 min-1 but increased significantly from 97.7 +/- 18.5 to 126.1 +/- 21.5 beats. min-1 with 15 mcg kg-1. min-1. Stroke index increased significantly from 21 +/- 4.4 to 25.4 +/- 5.1 ml m-2. beat-1 with 7.5 mcg kg-1 min-1. Pulmonary wedge pressure fell significantly from 14 +/- 2.9 to 9.1 +/- 2.4 mmHg with 2.5 mcg kg-1 min-1. Mean arterial pressure showed no significant change. No side effects were observed in these patients. We conclude that in patients with depressed cardiac function dobutamine at low doses of 2.5 mcg kg-1 min-1 decreases afterload and filling pressures. At the average doses of 5 - 7.5 mcg kg-1 min-1 stroke index and cardiac index are increased. At higher doses of 10 - 15 mcg kg-1 min-1 heart rate and cardiac index increase while stroke index fails to increase further.

Aged↗
PubMed1978

Left ventricular function in tetanus: influence of therapy.

Nine patients hospitalized for tetanus were studied under the same protocol which included two haemodynamic studies with a preload trial (PLT). The first being made during therapy (diazepam barbiturate association), on the sixth day of hospitalisation, and the second one after recovery. The comparison of the results shows that before PLT the mean arterial pressuure (MAP) is significantly increased (p less than 0.05) in patients after recovery in comparison to the same patients undergoing therapy. After PLT there is no significant difference between the two groups. Lastly, the variation of the left ventricular function points under PLT shows no significant difference between patients during therapy and after recovery. These results suggest that the diazepamphenobarbital combination does not alter the left ventricular function of the patients undergoing this therapy during tetanus.

Diazepam↗
PubMed1978

[The effects of dobutamine in postoperative disorders of left ventricular function in coronary patients undergoing abdominal surgery. Apropos of 18 cases].

Increasing doses of dobutamine were administered to the first group of 10 coronarians having undergone and abdominal surgical procedure, and presenting, one hour after awakening from the anesthesia, hemodynamic modifications with a diminution of cardiac index (CI), systolic index (SI), systolic work index of the left ventricle (SWILV) increase in the pulmonary capillary pressure (PCP), and in the total peripheral resistance (TPR), as well as an acceleration of the cardiac rate (CR). Doses of dobutamine of 5 or 7.5 microgram.kg-1.min-1 corrected the IC, PCP and TPR. Dobutamine ameliorated the SI and SWILV in an increasing fashion up to a dose of 10 microgram.kg-1.min-1 only and without restoring them to the control values of the pre-operative period. CR progressively increased with the increasing of the doses reaching 126 +/- 21.5 beats min-1 for 15 microgram.kg-1.min-1. Extrasystoles appeared at dose levels of 12.5 and 15 microgram.kg-1.min-1 in two patients. Tests of vascular filling (pre-charge tests) carried out in the second group of patients under 10 microgram,kg-1.min-1 of dobutamine and in a third group under 15 microgram.kg-1.min-1 showed a good cardiac adaptation to filling, equal or superior to that of the pre-operative period. It also appeared that the amelioration of CF obtained with a moderate vascular filling (300 ml of low molecular weight dextran) under 10 microgram.kg-1.min-1 of dobutamine is greatly superior to the amelioration obtained by 10 to 15 microgram.kg-1.min-1 of dobutamine.

Abdomen↗
PubMed1977

[Giant cell tumors of the sphenoid bone. Report of 3 cases and review of the literature].

Three cases of giant cell tumor of the sphenoid bone are reported together with a revision of the previously reported cases in the neurosurgical literature. The importance of this tumor in the neurosurgical pathology is stressed, mainly to the impossibility of a correct diagnosis on a clinical and radiological basis. A good prognosis is possible with a least agressive surgery, transphenoidal biopsy and decompression, folowed by radiotherapy.

Adult↗
PubMed1977

[Neurosurgical aspects of fronto-ethmoidal osteomas; report of 6 cases and review of the literature].

The cases of six patients with fronto-ethmoidal osteomas which have produced intracranial complications are reported. The patients have been divided in two groups depending on their clinical aspects, from cranio-facial deformities to exophtalmus, rinorrhea, pneumocephalus, meningitis and mucocele. A review of the literature is made and the importance of such lesions is stressed together with a critical analysis of the methods proposed for their surgical treatment. The results obtained with a frontal approach and a plastic closure of the dura were uniformelly good with restoration of functions in all patients.

Adolescent↗
PubMedDate not supplied

Spinal or systemic analgesia after extensive spinal surgery: comparison between intrathecal morphine and intravenous fentanyl plus clonidine.

STUDY OBJECTIVE: To compare two different methods of postoperative analgesia after extensive spinal fusion. DESIGN: Double-blind, randomized study. SETTING: University-affiliated hospital. PATIENTS: Twenty four adult patients undergoing scoliosis correction. INTERVENTIONS: Before the end of surgery, patients received either intravenous clonidine 0.3 micrograms/kg/hr and fentanyl 25 micrograms/kg (after an hourly dose of clonidine 2.5 micrograms/kg) or intrathecal morphine 0.3 mg. A saline infusion was administered to patients receiving morphine intrathecally. MEASUREMENTS AND MAIN RESULTS: Pain and sedation scores, hemodynamic data, and blood gases were collected in the recovery room at tracheal extubation and then every 2 hours for the next 14 hours. Tracheal extubation was performed at the same time in both groups (i.e., an average of 4 hours after the analgesic regimens were started). Intrathecal morphine provided a mean score of 20 mm on a visual analog scale ranging from 0 mm (no pain) to 100 mm (severe pain), but it resulted in increased PaCO2 at extubation (44 +/- 7 mmHg) and 2 hours later (42 +/- 7 mmHg). PaCO2 was greater than 50 mmHg in four patients receiving intrathecal morphine. Fentanyl-clonidine resulted in equipotent analgesia but was accompanied by sedation (sleeping but arousal by light tactile stimulation) and moderate hypotension (up to 69 +/- 9 mmHg for mean arterial pressure). CONCLUSIONS: This study shows that there is a major risk of respiratory depression with a single intrathecal dose of morphine 0.3 mg to control postoperative pain after scoliosis surgery. Systemic clonidine-fentanyl may be a possible approach to the postoperative pain treatment of this surgery.

Adult↗
PubMedDate not supplied

[Hemodynamic effects of equipotent doses of phenoperidine and fentanyl in man].

The haemodynamic effects of phenoperidine and fentanyl were studied in ten patients with craniocerebral trauma who presented no surgical indications. They were all mechanically ventilated with a constant tidal volume and rate and their cardiovascular state was stable. The patients were given 5 gamma/kg of fentanyl intravenously; the haemodynamic measurements were performed at two mn interval for 20 mn. Three hours later, the patients were given 30 gamma/kg of phenoperidine intravenously and the haemodynamic measurements were performed similarly. Phenoperidine and fentanyl had the same effects: a significant fall in heart rate, mean arterial pressure and cardiac index without any change in pulmonary wedge pressure. These changes do not dangerously alter the haemodynamic condition of the patients and thus are not a contra-indication to the general use of phenoperidine and fentanyl in anaesthetic practice and in intensive care.

Adult↗
PubMedDate not supplied

[Hemodynamic effects of a new antidepolarizing agent: fazadinium bromide].

Studies concerning the hemodynamic effects of this new antidepolarizing agent are scarce and difficult to interpret because of drug interactions, and of an accentuation of vagal tonus related to the use of morphinomimetic analgesics. For a better approach of the effects proper to fazadinium, we have tried to perform a study freed, to a maximum, from any drug interference. We studied the hemodynamic effects to a single dose of 1 mg.kg-1 of fazadinium bromide during 35 minutes in coronary patients normal hemodynamically or rhythmically, non-premedicated, ventilated with 50 p. 100 nitrous oxide in oxygen, and bebore any surgical procedure. All hemodynamic modifications are moderate and maximal 10 minutes after injection. The stroke index decreases 16 p. 100, heart rate increases 6 p. 100 and cardiac index falls 10 p. 100. Total peripheral resistance remains unchanged and mean arterial pressure drops 10 p. 100. Finally pulmonary wedge pressure decreases slightly. None of these modifications are statistically significant. One may, therefore, conclude that fazadinium tolerance, when the drug is freed from any drug interference, in coronary patients normal hemodynamically and free from rhythm disorders is excellent from a hemodynamic and rhythmic point of view. However, other isolated observations of hypovolemic subjects, or patients with atrial fibrillation receiving fazadinium and studied hemodynamically suggest a poorer tolerance in these cases.

Aged↗
PubMedDate not supplied

[Holter registration in ophthalmic surgery in adults. Peroperative arrhythmia under halothane or enflurane].

In 100 adult patients undergoing ophthalmic surgery under halothane or enflurane anaesthesia, the electrocardiogram was recorded on magnetic tape and analyzed subsequently for arrhythmias using a high-speed analyzer. Enflurane induced a much less premature atrial contractions (kappa 2 = 4.75; p less than 0.05) and a nodal rhythms (kappa 2 = 4.39; p less than 0.05) than halothane. There were no significant differences between the two drugs in the frequency of premature ventricular contractions and wandering pace maker. Our results confirm those of previous studies during oral surgery that enflurane produced significantly fewer arrhythmias than halothane. The lower incidence of cardiac dysrhythmias and the preservation of cardiovascular stability suggest that enflurane may be the agent of choice for this kind of surgery.

Adult↗