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P Pere

Publications and source records attributed to P Pere.

At least 19 recordsLinked to original sources
PubMed2006

Comparison of airway management with the intubating laryngeal mask, laryngeal tube and CobraPLA by paramedical students in anaesthetized patients.

BACKGROUND: Because of the importance of airway management in emergency care, alternative methods with shorter learning curves for inexperienced personnel have been looked for as a substitute for endotracheal intubation (ETI). METHODS: We compared the success of insertion, oxygenation and ventilation of the intubating laryngeal mask (ILMA), laryngeal tube (LT) and CobraPLA (COB) in anaesthetized patients when used by paramedical students. After informed consent, 96 patients were monitored and anaesthetized for general surgery without the use of a muscle relaxant. After the induction of anaesthesia, 32 paramedical students inserted the ILMA, LT or COB in a random order and ventilated the patient for a 60-s period. The number of insertion attempts, the time needed for insertion, and oxygenation and ventilation parameters were recorded. The students gave a subjective evaluation of the airway devices after the test. RESULTS: Twenty-four of the 32 students (75%) successfully inserted ILMA at the first attempt, compared with 14 of 32 (44%) for LT and seven of 32 (22%) for COB (P<0.001, ILMA vs. COB). One student failed to insert ILMA after all three attempts, compared with seven of 32 (21%) using LT and seven of 32 (21%) using COB (P=not significant). Oxygenation and ventilation parameters did not differ between the groups after successful insertion. CONCLUSION: Clinically inexperienced paramedical students can successfully use ILMA in anaesthetized patients. Further investigations are warranted to study whether ILMA or LT can replace ETI in emergency airway management when used by inexperienced medical or paramedical staff.

Anesthesia, General↗
PubMed2004

Comparison of 27-gauge (0.41-mm) Whitacre and Quincke spinal needles with respect to post-dural puncture headache and non-dural puncture headache.

BACKGROUND: The incidence of headache after spinal anaesthesia has varied greatly between studies. We compared the incidence of postoperative headache in general and postdural puncture headache (PDPH) when using 27-gauge (G) (outer diameter 0.41 mm) Quincke and Whitacre spinal needles in ambulatory surgery performed under spinal anaesthesia. METHODS: In a prospective, randomized study, 676 ASA physical status I-II day-case outpatients were given a spinal anaesthetic through either a 27-G (0.41 mm) Quincke or a 27-G (0.41 mm) Whitacre spinal needle. The incidence of any type of postoperative headache was assessed and the type of headache defined using a standardized questionnaire including PDPH criteria. The severity of the headache was defined using a 100-mm visual analogue scale. RESULTS: For the final analysis, 529 patients were available (259 patients in the Quincke group and 270 patients in the Whitacre group). The overall incidence of postoperative headache was 20.0%, but the incidence of true PDPH was very low (1.51%). The incidence of PDPH in the Quincke group was 2.70%, while in the Whitacre group it was only 0.37% (P < 0.05). The overall incidence of non-dural puncture headache was 18.5% and did not differ between the study groups. CONCLUSIONS: True PDPH seldom occurs when a 27-G (0.41 mm) spinal needle is used, although postoperatively a non-specific headache is common. Using the 27-G (0.41 mm) Whitacre spinal needle further reduced the incidence of PDPH. Thus, we recommend routine use of the 27-G (0.41 mm) Whitacre spinal needle when performing spinal anaesthesia.

Adult↗
PubMed2004

Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey.

Breakthrough pain (BKP) is a transitory flare of pain that occurs on a background of relatively well controlled baseline pain. Previous surveys have found that BKP is highly prevalent among patients with cancer pain and predicts more severe pain, pain-related distress and functional impairment, and relatively poor quality of life. An international group of investigators assembled by a task force of the International Association for the Study of Pain (IASP) evaluated the prevalence and characteristics of BKP as part of a prospective, cross-sectional survey of cancer pain. Fifty-eight clinicians in 24 countries evaluated a total of 1095 patients with cancer pain using patient-rated items from the Brief Pain Inventory (BPI) and observer-rated measures. The observer-rated information included demographic and tumor-related data, the occurrence of BKP, and responses on checklists of pain syndromes and pathophysiologies. The clinicians reported BKP in 64.8% of patients. Physicians from English-speaking countries were significantly more likely to report BKP than other physicians. BKP was associated with higher pain scores and functional interference on the BPI. Multivariate analysis showed an independent association of BKP with the presence of more than one pain, a vertebral pain syndrome, pain due to plexopathy, and English-speaking country. These data confirm the high prevalence of BKP, its association with more severe pain and functional impairment, and its relationship to specific cancer pain syndromes. Further studies are needed to characterize subtypes of BKP. The uneven distribution of BKP reporting across pain specialists from different countries suggests that more standardized methods for diagnosing BKP are needed.

Analysis of Variance↗
PubMed2002

Peroral tramadol premedication increases postoperative nausea and delays home-readiness in day-case knee arthroscopy patients.

BACKGROUND AND AIMS: To evaluate the effect of preoperative oral tramadol on postoperative pain and its effect on the patient's home-readiness after diagnostic day-case knee arthroscopy performed under spinal anaesthesia. MATERIAL AND METHODS: We studied 156 outpatients in a prospective, randomized, double-blind fashion to examine the postoperative analgesic effect of preoperative oral slow-release tramadol. Postoperative pain was measured using a 100-mm visual analogue scale (VAS). Postoperative nausea and vomiting (PONV) and the patients home-readiness were assessed. RESULTS: There were no statistically significant differences in the postoperative VAS scores between the tramadol and placebo groups, nor was there any significant difference in the need for postoperative pain medication. Patients in the tramadol group had higher incidence of PONV and they were discharged from hospital later than those given placebo although the tramadol patients required less intravenous midazolam for sedation. CONCLUSIONS: Preoperatively given slow-release tramadol is ineffective for reduction of postoperative pain after day-case arthroscopy of the knee. Additionally, preoperative tramadol is associated with higher incidence of PONV and it seems to cause delay in the patient's home-readiness.

Adult↗
PubMed2001

Ketorolac is not nephrotoxic in connection with sevoflurane anesthesia in patients undergoing breast surgery.

UNLABELLED: Ketorolac, which may cause renal vasoconstriction by cyclooxygenase inhibition, is often administered to patients anesthetized with sevoflurane that is metabolized to inorganic fluoride (F(-)), another potential nephrotoxin. We assessed this possible interaction using urine N-acetyl-beta-D-glucosaminidase indexed to urinary creatinine (U-NAG/crea) as a marker of proximal tubular, beta2-microglobulin as a tubular, urine oxygen tension (P(u)O(2)) as a medullary, and erythropoietin as a marker of tubulointerstitial damage. Thirty women (ASA physical status I-II) undergoing breast surgery were included in our double-blinded study. They were allocated into two groups receiving either ketorolac 30 mg IM (Group K) or saline (Group C) at the time of premedication, at the end of, and 6 h after anesthesia maintained with sevoflurane. Urine output, U-NAG/crea, P(u)O(2,) serum creatinine, urea, and F(-) were assessed. Blood loss was larger in Group K (465 +/- 286 mL vs 240 +/- 149 mL, mean +/- SD, P < 0.05). The MAC-doses of sevoflurane were similar. U-NAG/crea increased during the first 2 h of anesthesia and serum F(-) peaked 2 h after the anesthesia without differences between the groups. There were no statistically significant changes in P(u)O(2), erythropoietin, beta2-microglobulin, serum creatinine, urea, or urine output during anesthesia or the recovery period in either group. Our results indicate that the kidneys are not affected by ketorolac administered in connection with sevoflurane anesthesia. IMPLICATIONS: The different kinetics of N-acetyl-beta-D-glucosaminidase indexed to urinary creatinine and serum inorganic fluoride during and after sevoflurane anesthesia suggest that the observed mild renal tubular function deterioration is not caused by inorganic fluoride. Administration of ketorolac IM is therefore considered safe in adequately hydrated healthy adult patients given sevoflurane anesthesia.

Acetylglucosaminidase↗
PubMed2001

Alveolar echinococcosis of the spine.

Alveolar echinococcosis (AE) is a rare parasitic disease caused by the larval stage of Echinococcus multilocularis. It differs from cystic echinococcosis caused by Echinococcus granulosus. The main endemic areas of AE are Alaska, Canada, Japan, and parts of Europe. Hepatic involvement invariably occurs, but it is unusual for bone to be affected. We report the case of a woman presenting with a long history of pain, cachexia, morning stiffness, and biological signs of inflammation. Radiographs and principally magnetic resonance images were nonspecific, showing inhomogeneous osteolysis of vertebral bodies without loss of intervertebral disc height but with a paravertebral mass. The diagnosis ultimately relied on pathological examination, which showed an anhistic laminated membrane colored in red with Periodic-Acid-Schiff surrounding a central cavity, and by the serologic testing, principally ELISA Em2(+) method, which allowed a 97% specificity and 99% specificity in the diagnosis of AE. AE involving bone is an uncommon condition. Although magnetic resonance imaging can be used to search for local complications, the features it detects are, like those revealed by radiographs, nonspecific and can lead to AE being misdiagnosed as neoplasm or tuberculous osteitis. When a patient presents with suspected AE in an endemic area, the diagnosis can be achieved by serological testing alone (Western blot and Em2(+) ELISA), thereby avoiding the need for biopsy.

Journal Article↗
PubMed2000

Effect of intra-aortic magnesium on renal function during and after abdominal aortic surgery: a pilot study.

BACKGROUND: Infrarenal aortic cross-clamping causes renal vasoconstriction. Magnesium may protect against renal deterioration through its vasodilatory properties. METHODS: Thirty patients with normal preoperative renal function undergoing infrarenal aortic cross-clamping for elective aortic surgery received magnesium (4 mmol) or saline into the aorta immediately after aortic cross-clamping and again just before unclamping in a double-blind fashion. Pulmonary artery occlusion pressure was maintained 215 mmHg. Five patients with magnesium were excluded due to need for intravenous nitroglycerine because of myocardial ischaemia during the study. RESULTS: Postoperative creatinine clearance remained unchanged in both groups. Urinary N-acetyl-beta-D-glucosaminidase excretion increased before and decreased after aortic cross-clamping in both groups. The concentrations of glutathione peroxidase in serum were identical between the two groups. CONCLUSIONS: These data indicate that intra-aortic magnesium had no effect on renal function during or after aortic cross-clamping.

Acetylglucosaminidase↗
PubMed2000

Are diabetic patients in danger at renal transplantation? An invasive perioperative study.

It is assumed that diabetic patients with uraemia have more complications at renal transplantation than those who are not diabetic. We compared the preoperative ECGs, and invasive perioperative haemodynamic and oxygenation parameters in 15 diabetic and 15 non-diabetic uraemic patients undergoing renal transplantation. The number of patients with increased QT dispersion in the ECG was higher in diabetic than in non-diabetic patients (P<0.05). Before anaesthesia, heart rate and mean arterial pressure were higher (P<0.05) in the diabetic than in the non-diabetic group. After preanaesthetic volume loading all patients showed a hyperdynamic circulation, which subsided during anaesthesia. However, stroke volume index remained unchanged. Four patients in the diabetic group and six in the non-diabetic group needed additional oxygen therapy after surgery. No cardiac dysrhythmias were noted. However, the increased QT dispersion in diabetic patients calls for an adequate perioperative ECG monitoring for dysrhythmias. The diabetic and non-diabetic uraemic patients performed equally well at renal transplantation. In conclusion, renal transplantation for diabetics is justified.

Adult↗
PubMed2000

Cerebral blood flow and oxygenation in liver transplantation for acute or chronic hepatic disease without venovenous bypass.

The autoregulation of cerebral blood flow (CBF) is impaired in patients with end-stage liver disease and encephalopathy. These patients are vulnerable to sudden deterioration of cerebral perfusion and oxygenation during liver transplantation. We compared CBF and metabolism during liver transplantation without venovenous bypass and 24 hours postoperatively in 9 patients with acute liver failure (ALF) and 16 patients with chronic liver disease. A fiberoptic catheter was inserted cranially through the left internal jugular vein for determination of jugular venous oxygen saturation, cerebral oxygen extraction ratio (COER), lactate level, and neuron-specific enolase (NSE) level. Arterial concentrations of lactate were also measured. Flow velocity in the middle cerebral arteries was monitored bilaterally using transcranial Doppler sonography. Mean flow velocity and pulsatility index (PI) were regarded as indicators of intracranial pressure. Core body temperatures were recorded. Mild hyperventilation, perioperative hemofiltration, and N-acetylcysteine infusion were used according to our clinical practice. NSE level was greater in acute patients at the end of surgery (P <.05), but not 24 hours later. Lactate concentrations were greater in patients with ALF (P <.001) preoperatively and intraoperatively but were similar in both groups 24 hours postoperatively. There was no difference between arterial and jugular venous concentrations of lactate. Changes in blood flow velocity, PI, and COER were parallel and without statistical significance between the groups. The patients' core temperature did not correlate with CBF, NSE level, or clinical outcome. Caval clamping was well tolerated in both patient groups.

Adolescent↗
PubMed1999

Factors associated with post-operative myocardial ischaemia in elderly patients undergoing major non-cardiac surgery.

Forty patients (> 65 years) undergoing hip arthroplasty or peripheral vascular surgery both associated with high risk for post-operative myocardial ischaemia were randomized to receive either spinal or general anaesthesia. Ambulatory ECG recording (Holter) until the third post-operative morning, a daily 12-lead ECG and serum creatine kinase and troponine concentraItions were obtained. The number of ischaemic episodes, total duration of ischaemia and ischaemic minutes per hour were noted for each patient peri-operatively. Sixteen of the patients (40%) had post-operative myocardial ischaemia. An intra-operative increase in the plasma concentration of norepinephrine but not epinephrine was detected in the patients who later developed post-operative myocardial ischaemia. The increase in plasma norepinIephrine concentrations correlated with the decrease in core temperature. The type of anaesthesia had no effect on the incidence of myocardial ischaemia during or after surgery. Our results suggests that intra-operatively decreased core temperature and the increase in plasma concentration of norepinephrine probably caused peripheral vasoconstriction leading to latent cardiac dysfunction. These events should be avoided in the patients at risk of post-operative cardiac ischaemia.

Aged↗
PubMed1998

Detrimental effect of dietary sodium and beneficial effect of dietary magnesium on glomerular changes in cyclosporin-A-treated spontaneously hypertensive rats.

BACKGROUND: Cyclosporin A (CsA) causes renal magnesium wasting, hypertension, and occasionally irreversible renal damage. We examined the effect of dietary sodium and magnesium on renal histology in spontaneously hypertensive rats (SHR) receiving CsA. METHODS: Forty-six 8-week-old SHR were divided into six groups and given different dietary levels of sodium (low 0.3%, high 2.6%) and magnesium (low 0.2%, high 0.6%). Low-dose CsA (5 mg/kg/d) was given subcutaneously for 6 weeks in four groups. Systolic blood pressure, serum creatinine, degree of proteinuria, and renal tissue CsA and calcium concentrations were determined. Kidney wet weight to total body-weight ratio was calculated as an index of renal hypertrophy. Renal histological alterations were scored according to glomerular changes: 100 glomeruli were assigned for severity of change a score from 0 to 3. The number of affected glomeruli was multiplied by the damage score to obtain a damage index. RESULTS: In the CsA-treated high-sodium diet group systolic blood pressure and glomerular damage index were increased, and renal hypertrophy was the most common. These changes were prevented by oral magnesium supplementation. The glomerular damage index correlated positively with increases in systolic blood pressure, serum creatinine, proteinuria, and renal calcium concentration. CONCLUSIONS: Dietary sodium enhanced CsA-induced functional and morphological renal changes in SHR and aggravated hypertensive renal arteriolar and glomerular lesions. Dietary magnesium supplementation protected against the deleterious effects of sodium and CsA.

Animals↗
PubMed1998

Delayed facial palsy following uneventful middle ear surgery: a herpes simplex virus type 1 reactivation?

In rare cases, a facial palsy appears a few days after uneventful middle ear surgery. The reason for this delayed palsy is unclear. One hypothesis is that it results from a reactivation of herpes simplex virus type 1 (HSV-1) in the geniculate ganglion of the facial nerve. From 1987 to 1996, in the course of over 1,800 middle ear operations, we observed 7 ipsilateral delayed facial palsies and investigated 5 of them using immunologic and virologic methods, including the polymerase chain reaction (PCR). We could detect HSV-1 genome with the nested primer PCR in the tongue swabs of 4 of the 5 examined patients with delayed facial palsy. The immunologic changes in these palsies are also compatible with a reactivation of HSV-1. We conclude that minimal stimulation of the facial nerve during middle ear surgery could result in a reactivation of HSV-1 in the geniculate ganglion, which may in turn lead to a facial palsy.

Adult↗