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Biomedical subjects

P Feiss

Publications and source records attributed to P Feiss.

At least 19 recordsLinked to original sources
PubMed2001

[General anesthesia].

General anaesthesia is a reversible loss of consciousness induced and maintained with a hypnotic drug given either by venous injection and infusion, or by inhalation. A potent opioid is usually associated to inhibit the transmission of pain and thus to lessen sympathetic and endocrine reactions to nociceptive stimuli. Myorelaxation is used to facilitate tracheal intubation and surgery. Whatever the anaesthetic protocol use, the patient and anaesthesia machine require close monitoring. In addition to vital signs, the depth of anaesthesia may be monitored using automated electroencephalographic analysis and myorelaxation should always be monitored using a nerve stimulator, but pain or analgesia evaluation is only based on clinical signs of sympathetic stimulation. Because anaesthesia-related death and morbidity have decreased considerably, future improvements in outcome should concern perioperative comfort, i.e. prevention of cognitive disturbances, nausea, vomiting and pain.

Anesthesia, General↗
PubMed2001

Induction with propofol target-concentration infusion vs. 8% sevoflurane inhalation and alfentanil in hypertensive patients.

Haemodynamic parameters during an inhalation induction with 8% sevoflurane were compared with those obtained with a target-controlled infusion of propofol in 50 hypertensive patients in a prospective randomised study. Heart rate and arterial pressure were recorded continuously. End-tidal sevoflurane and nitrous oxide concentration, SpO2 and bispectral index (BIS) were also collected from the beginning of anaesthesia until 8 min after tracheal intubation. Patients either received 4 mg.l-1 target-concentration propofol or performed a vital capacity inhalation of 8% sevoflurane in a high flow of oxygen (8 l.min-1) supplemented with 50% nitrous oxide at loss of consciousness. As soon as BIS was < 60, 20 microg.kg-1 alfentanil and 0.6 mg.kg-1 rocuronium were injected and orotracheal intubation was then performed 1 min later. Thereafter, the end-tidal concentration of sevoflurane was reduced to 1.3 minimum alveolar concentration (MAC). Hypotension was defined as a 30% decrease in arterial pressure and was treated with repeated 3-mg boluses of ephedrine. When 12 mg ephedrine was unable to correct hypotension, the concentration of propofol was reduced by 1 mg.l-1 and that of sevoflurane by 0.5%. Hypotension occurred in 22 patients in the sevoflurane group and 21 in the propofol group, and hypertension occurred in two and three patients in each group, respectively. The maximal reduction in mean (SD) arterial pressure was similar in the sevoflurane (45 (4) mmHg) and propofol (41.3 (2.6) mmHg) groups, as were the ephedrine requirements (9.6 (1.1) vs. 9.1 (1.1) mg, sevoflurane vs. propofol, p > 0.05), the duration of hypotension (276 (37) vs. 292 (38) s, sevoflurane vs. propofol, p > 0.05), and the number of hypotensive episodes or anaesthetic changes and depth of anaesthesia. Nevertheless, heart rate was lower during the 8 min following tracheal intubation in the sevoflurane group. In both groups, the duration of hypotension was easily controlled either by ephedrine or by adjusting the anaesthetic concentrations. Overall, haemodynamic tolerance appears to be similar in the two techniques. Because hypotension occurred after alfentanil in most patients, this study questioned which is the best opioid dose, if any, to associate with propofol or sevoflurane for the induction in hypertensive patients.

Aged↗
PubMed2000

Plasma interleukin-4, interleukin-10, and interleukin-13 concentrations and complications after coronary artery bypass graft surgery.

OBJECTIVES: To determine whether plasma interleukin (IL)-4, IL-10, and IL-13 concentrations are associated with complications after coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). STUDY DESIGN: Prospective descriptive study. SETTING: University teaching hospital. PARTICIPANTS: Thirty-two patients during and 24 hours after CABG surgery. MEASUREMENTS AND MAIN RESULTS: Hemodynamic measurements and blood samples were obtained from 32 patients during and after surgery. Coagulation, pulmonary, and cardiovascular functions were specifically assessed during the first 24 hours postoperatively. Plasma IL-4 and IL-13 levels remained unchanged during CABG surgery. In contrast, plasma IL-10 concentrations increased by 117-fold in the immediate postoperative period and returned to pre-CPB values by 24 hours postoperatively. Plasma IL-10 levels were not different in patients with or without cardiovascular impairment, coagulation disorders, and lung injury. Plasma IL-10 levels did not correlate with the leukocyte count, the amount of catecholamines infused, or the duration of CPB. CONCLUSION: The present results suggest that the development of post-CABG surgery complications might be linked to an insufficient production of anti-inflammatory cytokines, such as IL-4, IL-10, or IL-13, which are unable to counteract the overproduction of inflammatory cytokines.

Aged↗
PubMed2000

New halogenated agents: should I change my practice?

Sevoflurane and Desflurane are relatively new halogenated agents which make induction and control of depth of anaesthesia easier, recovery rapid and of good quality and they have less side-effects and toxicity. In children sevoflurane could replace halothane because it provides smooth and rapid induction with less cardiovascular depression and arrhythmias. Desflurane is not used because of its pungent odour. In adults sevoflurane could be preferred to desflurane because it allows rapid induction and laryngeal mask insertion or tracheal intubation without myorelaxants, a similar time of recovery, no clinical evidence for renal and hepatic toxicity, no more costs for anaesthesia for a lower MAC.

Anesthesia, Inhalation↗
PubMed1999

Are lipid mediators implicated in the production of pro- and anti-inflammatory cytokines during cardiopulmonary bypass graft with extracorporeal circulation?

In this study the authors assessed the sequential release of lipid mediators (TXB2, PGE2, 6-keto-PGF1alpha, LTB4, LTC4, PAF), pro-inflammatory cytokines (IL-6, IL-8, TNF-alpha) and anti-inflammatory cytokines (IL-4, IL-10) in 17 patients undergoing coronary artery bypass graft (CABG) with extracorporeal circulation (ECC). Time course of appearance of inflammatory mediators revealed the early and transient increase in lipid mediator plasma concentrations (6-keto-PGF1alpha, LTB4, LTC4, PAF) whereas cytokines (IL-6, IL-8, IL-10) were involved only in late pre- and post-operative periods. No variation of TXB2, PGE2, IL-4 and TNF-alpha levels were found. No correlation was documented between the levels of lipid mediators and pro- or anti-inflammatory cytokines suggesting that lipidic compounds are not implicated in the genesis of cytokines which appear much later involved. Despite the common use of high doses of aprotinin (a non-specific enzyme inhibitor) in hope to abrogate the inflammatory response to cardiopulmonary bypass procedure, this study reports the persistent release of several inflammatory compounds that might be involved in the post-CABG multiple organ failure syndromes.

6-Ketoprostaglandin F1 alpha↗
PubMed1999

[Anesthesia equipment: fresh gas delivery systems. I. Mecanical systems with rotameters and calibrated vaporizers].

OBJECTIVES: To analyse the design, performance, failures, the checking before use of mechanical fresh gas delivery units (FGDUs) equipped with bobbin or ball-flowmeters delivering a continuous gas flow and calibrated vaporizers, marketed in France in 1999. DATA SOURCES: Articles were obtained from a Medline review (1960-1999; search terms: anaesthetic machine, flowmeter, vaporizer), textbooks and personal files; specific data were provided by manufacturers. STUDY SELECTION AND DATA EXTRACTION: The articles were considered for performance data, benefits and drawbacks, and characteristics, as well as the risks carried by mechanical FGDUs. DATA SYNTHESIS: Seven anaesthetic machines out of 11 are equipped with mechanical FGDUs, including rotameters delivering a gas mixture up to 30 L.min-1, calibrated vaporizers and an O2-flush valve delivering at least 500 mL O2 per second (30 L.min-1). These units allow closed circuit anaesthesia. They carry a risk for barotrauma as three out of them can deliver at the gas outlet of the FGDUs a gas mixture at a pressure reaching 3.5 bars and four others at a pressure of 150-200 mmHg. They also carry a risk for hypoxia, either from a preferential leak of oxygen at the corresponding rotameter or the O2-flush valve, or from a leak of fresh gas mixture either in a vaporizer or the selectatec manifold. The vaporizers carry a risk for vapor delivery at a concentration differing notably from the value set on the concentration dial. Therefore their accuracy must be checked periodically and the FGDUs checked for a leak after the addition to or the removal of a vaporizer from the selectatec manifold. The optimal technique for leak detection is the negative pressure test.

Anesthesia, Inhalation↗
PubMed1999

[Anesthetic equipment: fresh gas delivery systems. II. Electronic systems].

OBJECTIVES: To analyse the design, functioning, benefits and drawbacks of electronic fresh gas delivery units (FGDUs) included in anaesthetic machines marketed in France in 1999. DATA SOURCES: Articles were obtained from a Medline review (1980-1999; search terms: anaesthetic machine, flowmeter, vaporizer), textbooks and personal files; specific data were also provided by manufacturers. STUDY SELECTION AND DATA EXTRACTION: The articles were analysed in considering the differences between mechanical and electronic FGDUs. DATA SYNTHESIS: Four anaesthetic machines out of 11 are equipped with electronic FGDUs. In comparison to mechanical units, they include the following benefits: wide range of accurate gas flow, especially in the low flow range, with analog and digital display; intermittent delivery of each gas, which is essential for automated gas delivery and quantitative anaesthesia or target controlled (FET vapor) inhalational anaesthesia; facilitated oxygen ratio control; possibility to print the gas and vapor flows on the automated anaesthetic record; interruption of gas flow when the main switch of the machine is set to off; and absence of risk for retropollution. Three FGDUs out of four are adapted for gas delivery to an accessory (ancillary) anaesthetic circuit. However, only one of them delivers a gas flow up to 30 L.min-1. The specificity of the ADU AS/3 (Datex-Ohmeda) is the bypass vaporizer included in the FGDU with an exchangeable vaporizing chamber (cassette). The specificity of the Julian (Dräger) is the delivery of fresh gas limited to the expiratory phase during mechanical ventilation. The specificity of the the FGDU from Kion (Siemens) is the possibility to act as an open circuit ventilator, similar to a Servoventilator. The specificity of the PhysioFlex is an FGDU included in the circle circuit, each gas and liquid anaesthetic being directly injected into the circuit. Data from the French medical device surveillance commission indicate that the main failures occur in the power supply device and the microprocessor.

Anesthesia, Inhalation↗
PubMed1999

Thrombelastogram reveals hypercoagulability after administration of gelatin solution.

We have compared the effects of gelatin, low molecular weight hydroxyethyl starch (HES) or albumin on tests of haemostasis and on the thrombelastogram in 42 ASA I patients undergoing total hip or knee replacement. Patients were allocated randomly to receive one of the three blood substitutes to obtain moderate intraoperative haemodilution. Blood loss and packed red cell infusion was the same in each group. A greater amount of gelatin was given (1.5 times the measured blood loss) because of its shorter half-life. There was a statistically significant but clinically negligible decrease in platelets count, prothrombin time and fibrinogen, and an increase in bleeding time in all groups. Platelets were slightly but significantly lower after HES. Haemodilution was comparable between groups. TEG showed a state of hypercoagulability in the gelatin group with a significant decrease in r, r + k and an increase in alpha angle.

Adult↗
PubMed1999

A multicentre comparison of the costs of anaesthesia with sevoflurane or propofol.

Day-case anaesthesia requires rapidly eliminated anaesthetics which are relatively expensive. This multinational, multicentre European study assessed the relative costs of propofol or sevoflurane anaesthesia in 211 patients. Anaesthesia was induced and maintained with propofol in group 1, with propofol and sevoflurane in group 2, and with sevoflurane in group 3. Drug and delivery costs were calculated in US$. Induction of anaesthesia was fastest in groups 1 and 2, although spontaneous ventilation resumed earliest in group 3. Emergence times and times at which patients were fit for discharge were similar in all groups. Group 2 had the lowest costs based on actual drug use (mean $14.2 (SEM 0.8) vs $18.7 (0.8) and $17.3 (0.8) in groups 1 and 3, respectively). Anaesthetic drug wastage and disposable costs were highest in group 1 and lowest in group 3. Consequently, total costs were highest in group 1 ($31.9 (0.9)) compared with groups 2 ($19.7 (0.9)) and 3 ($18.8 (0.9)). Although we observed increased nausea and vomiting in groups 2 and 3 and reduced patient satisfaction in group 3, these differences should be balanced against the greater cost of propofol anaesthesia.

Adolescent↗
PubMed1999

[Accessory anesthetic breathing systems: verification before use].

Accessory or ancillary anaesthesia breathing systems can be defined as all those connected to the fresh gas outlet of the anaesthetic apparatus and used instead of the circle system associated with the ventilator, which is the main circuit. They include: the Mapleson systems, the systems with a nonrebreathing valve and the disposable systems with a carbon dioxide absorber. They can be a cause of major accidents when not checked before and monitored during use. This technical note describes techniques of preanaesthetic checking and monitoring during anaesthesia.

Anesthesia, Closed-Circuit↗
PubMed1998

Comparison of sevoflurane and propofol for ambulatory anaesthesia in gynaecological surgery.

PURPOSE: To analyse the cost-efficiency ratio of sevoflurane compared with propofol for gynaecological ambulatory anaesthesia. METHODS: In a prospective randomised study 52 ASA I patients scheduled for ambulatory pregnancy termination were premedicated with lorazepam and received alfentanil prior to anaesthesia induction with propofol (group P, n = 26) or with sevoflurane 8% (group S, n = 26) using the single breath vital capacity technique. Anaesthesia was maintained with N2O in both groups supplemented with sevoflurane (group S) or propofol boluses (group P). RESULTS: The quality of induction and maintenance of anaesthesia was similar between groups except for the incidence of movement during anaesthesia (14/26 patients in group P and 4/26 in group S, P < 0.05). The incidence of post-operative emesis was increased in the sevoflurane group (P < 0.05) but the patients felt able to perform normal activity after a similar delay (18.4 +/- 2.9 hr vs 20.6 +/- 2.8 hr, P > 0.05). The direct cost of anaesthesia was lower in the sevoflurane group (679 FF, n = 24 vs 1153 FF, n = 2-5 in propofol group) but the weight of uterine aspiration products was higher (293 +/- 66 g, median = 230 g, Range 110-800 g, n = 13 vs 108 +/- 8 g, median = 110 g, Range 60-160 g, n = 12, group S vs group P respectively, P = 0.004). Four patients needed reoperation and ambulatory anaesthesia failed in six patients because of uterine haemorrhage. CONCLUSION: Ambulatory anaesthesia with sevoflurane offers a good alternative to propofol but further investigation concerning blood loss with sevoflurane needs to be performed in gynaecological practice.

Abortion, Induced↗
PubMed1998

[Pros and cons of adding an accessory breathing system to the main circle circuit. II. Arguments against their use].

When compared to the circle system alternative breathing systems (ABS) are of no benefit. When the only indication of an ABS is emergency oxygen administration it should be connected to the O2 pipeline upstream from the flowmeter bank and the vaporiser. The use of an ABS for anaesthesia maintenance is no longer justified because of the difficulties in monitoring pressure, flow and concentrations of the gas mixture, the cost of gas and vapour administered at a high flow and the resulting pollution. The use of an ABS for very short anaesthetics is only acceptable if the administered gas mixture is monitored.

Anesthesia, Closed-Circuit↗
PubMed1998

International, multicentre, placebo-controlled study to evaluate the effectiveness of ondansetron vs. metoclopramide in the prevention of post-operative nausea and vomiting.

Ondansetron 4 mg was compared with metoclopramide 10 mg for prevention of post-operative nausea and emesis in in-patients undergoing major gynaecological surgery in this double-blind, randomized, placebo-controlled, multicentre study. A total of 1044 patients received a single intravenous (i.v.) injection of study medication immediately before induction of anaesthesia. Nausea and emesis were assessed over the 24 h post-operative period. Significantly more patients who received ondansetron experienced no emetic episodes (44%) compared with those who received metoclopramide (37%, P = 0.049) or placebo (25%, P < 0.001). No nausea was experienced by significantly more patients who received ondansetron (32%) than with patients who received metoclopramide (24%, P = 0.009) or placebo (16%, P < 0.001). In addition, fewer emetic episodes, less severe nausea and a reduced need for rescue antiemetics were also observed with ondansetron (P < 0.05 vs. metoclopramide and placebo). Metoclopramide and placebo-treated patients were also 1.5 times (95% Cl 1.5-4.2) and 2.5 times (95% Cl 1.1-2.0) more likely, respectively, to experience nausea post-operatively. Overall, ondansetron was the most effective antiemetic in this patient population.

Adolescent↗