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Biomedical subjects

R Fuzier

Publications and source records attributed to R Fuzier.

10 recordsLinked to original sources
PubMed2006

[Characteristics of mepivacaine axillary brachial plexus block performed at 2800 m of altitude].

OBJECTIVE: We evaluated the feasibility and pharmacodynamic profile of axillary brachial plexus nerve blocks performed in high altitude. STUDY DESIGN: A prospective study was performed in healthy volunteers. PATIENTS AND METHODS: Ten male volunteers received 20 ml of 1.5% mepivacaine on radial and median nerves (total 40 ml), first at altitude of 150 then at 2877 m. Onset and offset times for sensory, motor and sympathetic blocks were recorded. Blood was sampled up to 60 min after injection to measure plasma concentrations of mepivacaine. RESULTS: At 150 and 2877 m of altitude, onset times for blocks were similar. Duration of sensory and motor blocks was not different at low and high altitude (193+/-35 min and 180+/-47 min; and 237+/-32 min and 217+/-44 min, respectively). Plasma mepivacaine concentrations were significantly lower at 20 minutes in high altitude (p<0.05). At higher altitude, one patient showed clinical signs of neurological toxicity, with plasma concentrations of mepivacaine ranging from 0.94 to 1.21 mug/ml. CONCLUSION: At altitude of 2877 m, axillary brachial plexus block with 1.5% mepivacaine is feasible, with onset and offset times for sensory and motor effects similar to those performed at 150 m.

Adult↗
PubMed2006

[Decompressive craniectomy and intracranial hypertension].

Decompressive craniectomy was purposed for the treatment of refractory intracranial hypertension after head injury. This review discusses results obtained by this surgery in severe head trauma. Several studies have confirmed a reduction in intracranial pressure secondary to decompressive craniectomy. Mortality decreased and the proportion of good outcome of the survivors increased. These results have not been confirmed prospectively, and indications have to be clarified. The positive effects of decompressive craniectomy compared to barbiturate or hypocapnia in the "second tier therapy" in refractory intracranial hypertension could be interesting to evaluate.

Craniocerebral Trauma↗
PubMed2006

Double- vs. single-injection infraclavicular plexus block in the emergency setting: higher success rate with lower volume of local anaesthetic.

BACKGROUND AND OBJECTIVES: Infraclavicular plexus block has many advantages of particular interest in the emergency setting. However, the number of nerve stimulations needed to optimize the technique remains unclear. We evaluated both the local anaesthetic requirement and the success rate of Sim's derived infraclavicular plexus block performed with a nerve stimulator when either one or two responses were sought. METHODS: In this prospective study, 50 patients who presented for distal upper limb surgery were randomized into two groups: in Group 1, ropivacaine 0.75% 40 mL was injected when nerve stimulation elicited a distal motor response (median, ulnar or radial). In Group 2, only 30 mL of the same local anaesthetic was injected, 7 mL to the musculocutaneous nerve and 23 mL to the median, ulnar or radial nerves. Sensory and motor blocks were tested at 5-min intervals over 30 min. RESULTS: The time to perform the block was similar in both groups. The success rate of the block increased from 80% in the single-stimulation group to 92% in the double-stimulation group (not significant). The onset time of sensory and motor block was shorter and block extension was greater in ulnar, antebrachial cutaneous and brachial cutaneous nerve distributions in the multistimulation group (P < 0.05). CONCLUSIONS: We conclude that only 30 mL of local anaesthetic seems to be sufficient to ensure a high level of success when performing an infraclavicular block with stimulation of both the musculocutaneous nerve and median, ulnar or radial nerve.

Adult↗
PubMed2006

[Continuous spinal anesthesia for femoral fracture in two patients with severe aortic stenosis].

Neuraxial blockade is usually not recommended in patients with aortic stenosis. However, neuroaxial blockade techniques such as continuous spinal or epidural anaesthesia can be tailored to minimize potentially dramatic consequences of decrease in systemic vascular resistance, often encountered after standard single shot spinal anaesthesia. We report the cases of two severe aortic stenosis patients (aortic valve area<0.5 cm2) that underwent hip surgery under continuous spinal anaesthesia. Small doses of isobaric 0.25% bupivacaine titrated to limit total dose below 5 mg, injected through the intrathecal catheter allowed the control of haemodynamic parameters. No clinical complication occurred in these two patients.

Aged, 80 and over↗
PubMed2002

[Evaluation of regional anesthesia procedure in an emergency department].

OBJECTIVES: Evaluation of regional anaesthesia procedures for limb traumatic surgery performed in an emergency department. METHOD: Anaesthetic procedures concerning traumatic emergencies have been studied from 1995 to 2000. RESULTS: A 32% increase in anaesthesia practice was observed from 1995 (221) to 2000 (292) with a 52% increase in regional anaesthesia. Since 1996, regional anaesthesia represents more than 80% of the anaesthetic procedures and 90% for the upper limb surgery (66% of the surgical procedures). Axillary block (50%), interscalene brachial plexus block (15%) and combined sciatic and femoral nerve block (17%) were the main regional anaesthesia procedures. Spinal anaesthesia (9 cases) and intravenous locoregional anaesthesia (12 cases) were rarely used. CONCLUSION: In our study, regional anaesthesia is the most used technique when compared to general anaesthesia for emergency procedure. The anaesthetic staff has to be motivated and trained.

Anesthesia↗
PubMed2000

[Management of acute respiratory distress syndrome in Midi-Pyrnees].

OBJECTIVE: To assess management of acute respiratory distress syndrome (ARDS) in Midi-Pyrénées, France. METHODS: A prospective study using a questionnaire divided into 10 parts, definition, etiology, radiography, computed tomography, management, was conducted in 26 intensive care units in the Midi-Pyrénées. Management of ARDS in Midi-Pyrénées was comparted with management elsewhere as described in the literature. RESULTS: Overall participation rate was 73%. Disparities were found concerning the definition. Four etiologies accounted for 75% of all ARDS cases. Chest x-rays were used for positive diagnosis and thoracic scans for complications. Ventilatory and hemodynamic optimizations were the first line therapy used. Twenty-nine percent and 41% of the intensive care unites used nitric oxide and prone position respectively. CONCLUSIONS: There are differences between ARDS management in Midi-Pyrénées and that described in the current literature. Epidemiologic studies such as this one are necessary before publishing guidelines for the management of ARDS.

Diagnosis, Differential↗