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Biomedical subjects

T Pottecher

Publications and source records attributed to T Pottecher.

At least 55 records · Page 3Linked to original sources
PubMed1990

Long-chain versus medium and long-chain triglyceride-based fat emulsion in parental nutrition of severe head trauma patients.

In order to assess the metabolic value of medium-chain triglycerides (MCT) in severely stressed intensive care unit patients, two fat emulsions containing either long-chain triglycerides (LCT), or a mixture of 50% MCT and 50% LCT were compared in 24 head trauma patients over a 10 day period. Variations of serum triglyceride, non-esterified fatty acid, glycerol and phospholipid concentrations remained comparable after both lipid infusions. Bilirubin, alkaline phosphatase and transaminase plasma levels were altered in both groups without any significant differences or clinical consequences. Cumulative nitrogen balance remained negative (-10 g N. day-1 i.e. -100 g N. 10 days-1) and comparable in both groups. However, thyroxin-binding prealbumin concentrations increased significantly in patients receiving the MCT/LCT mixture. It is concluded that MCT might have a beneficial effect on visceral protein metabolism after trauma.

Blood Proteins↗
PubMed1990

[Prevention of exogenous respiratory infection].

The exogenous respiratory infections have two transmission channels, the airborne and the handborne ways, and two entrance doors, tracheotomy and intubation. Indeed, most often, contamination of the oropharynx occurs prior to the bacterial pneumonia. These microorganisms are isolated on healthy carries, on linen, furniture, air-conditioning system and so on... Special precautions are recommended as disinfection or sterilization of ventilators equipment changing circuits every 48 hours, using sterile water in humidifiers, and rigorous aseptic technic for tracheal suctions. An experimental study shows that microorganisms present in the humidifier disseminate through the circuit with the airstream. Therefore septic isolation of patients with pneumonia and disinfection of the room after his departure are considered as essential measure of prevention.

Clinical Protocols↗
PubMed1990

[Consequences on the nursing team of the information of spinal cord injured patients].

For spine-wounded people, an early information about lesions forecast is as necessary as difficult. At the beginning, patients have'nt still realized their state seriousness, and diagnosis stays uncertain. This retrospective work tries to explore how early information is remembered and the consequences about hospital experience, in intensive care unit and in rehabilitation. It shows that early information does'nt modify this experience, but that relations between nurses and patients become better.

Adaptation, Psychological↗
PubMed1990

[Ethic problems caused by the information of families of organ donors].

Before organ harvesting, previous information of the donor's family is mandatory in France. However information's content and consequences are not specified and may vary widely between hospitals. In some institutions, relatives are only informed of harvesting intent; in others, some teams require family's authorization before harvesting. To make easier and more efficient this information some improvements are suggested.

Brain Death↗
PubMed1989

[An unusual failure of the 900 C Siemens Servo ventilator].

Lung overinflation was observed in a patient ventilated by a Siemens Servo Ventilator 900 C. The expiratory valves failure to open was related to a transducer disconnection in the expiratory limb. This transducer controls opening of the expiratory valve and when disconnected expiratory valve remains closed.

Equipment Failure↗
PubMed1989

[Retrograde orotracheal intubation].

Four different techniques of retrograde tracheal intubation were studied in 77 cadavers (patients who had died less than 4 h before). None had any laryngeal disease or a previous intubation. Following techniques were evaluated: cricothyroid membrane puncture; infracricoid puncture; catheter guide inserted through the endotracheal tube; catheter guide only inserted through the distal lateral eye (Murphy eye) of the endotracheal tube. An epidural catheter was used as a guide. Success rate was low (5 out of 17 attempts) when cricothyroid puncture was used, and the guide passed through the whole length of the tube. All 20 attempts were successful when infracricoid puncture was used and the guide passed through the distal lateral eye of the endotracheal tube. The different techniques and equipment needed are discussed in the light of the available literature. Retrograde tracheal intubation seems to be an easy and useful technique, which all anaesthetists should know, in case of difficult intubation.

Cadaver↗
PubMed1989

[Early informing of patients with spinal cord injuries].

Early information to patients on the prognosis of acute spinal injuries is an important and uneasy task. This retrospective study was undertaken to assess the consequences of this information. It appears that early information involves easier and more confident relationships between patient, nurses and medical staff in the ICU. This early information, despite its difficulty, seems beneficial.

Adolescent↗
PubMed1988

Prolonged sedation with propofol in ICU patients: recovery and blood concentration changes during periodic interruptions in infusion.

Propofol (mean dose 2.85 mg kg-1 h-1) was administered for 4 days by continuous i.v. infusion for sedation in 14 agitated and restless ICU patients. This provided rapid control of the level of sedation. When the infusion was discontinued, adequate recovery with response to commands was obtained in most patients by 10 min. Recovery times and the decrease in blood propofol concentration were similar after 24, 48, 72 and 96 h of infusion. Cumulative effects, tachyphylaxis, or other untoward effects were not observed.

Adult↗
PubMed1987

[Current status of perioperative preventive use of antibiotics in colorectal surgery].

The rate of postoperative wound infections following colorectal surgery can be considerably reduced by rational perioperative short-time antibiotic prophylaxis. The anaerobic and aerobic microflora of the colon as well as the half-life of the medicaments used have to be taken into due consideration for good choice of antibiotics. Persistent orthograde intestinal flushing, using physiological electrolyte solution without any addition of antibiotics, on the eve of surgery as well as perioperative antibiotic prophylaxis "en flash", using slow-drop intravenous infusion of 1 g Ornidazole and 2 g Mezlocilline along with introduction of anaesthesia, made for a good approach to reducing wound infections following colorectal surgery to two per cent. Twice as much antibiotics were administered for 24 to 28 hours in emergency cases in which preoperative intestinal flushing was not possible. This helped to reduce the rate of postoperative infections from 32 to six per cent.

Anti-Bacterial Agents↗
PubMed1986

[Cardiac arrest during anesthesia and the recovery period. Data from the INSERM survey 1978-1982].

This report analyses rate, predisposing factors, causes and outcome of 458 cardiac arrests occurring during anaesthesia and the following 24 hours and collected in France by a national prospective survey between 1978 and 1982. The overall rate of cardiac arrests was 1 per 433 anaesthetics, resulting in death before the 24th postoperative hour in 79% of cases, i.e. 1 per 547 anaesthetics. Cardiac arrests not related to anaesthesia were three times more frequent than those related to anaesthesia. Among these, one half is partially related to anaesthesia and the other totally. The prognosis of cardiac arrests totally related to anaesthesia is six times better than that of not related arrests (64% of recoveries without sequelae vs 10%). The cardiac arrests not related to anaesthesia occur mainly at the end of surgery and the following 24 hours. The main causes are hypovolaemia, sepsis and severity of surgical illness. Among cardiac arrests related to anaesthesia, a quarter occurred during induction, another during maintenance and a half during recovery from anaesthesia. The first were mainly related to histamine release and had the lowest mortality rate. The last were mainly related to unrecognized postoperative respiratory depression and resulted in the highest mortality. The authors underline the necessity of better preoperative detection of high risk patients, smooth induction of anaesthesia, continuous clinical monitoring of the patient during surgery and the recovery period.

Age Factors↗
PubMed1985

[Electro-drug anesthesia. Clinical and hormonal effects of transcranial electrostimulation].

The French technique of anaesthesia by electrostimulation described in 1972 by Cara and coworkers, consists of transcranial electrostimulation by means of a high frequency current combined with administration of a neuroleptic drug, a benzodiazepine, a curare and nitrous oxide with oxygen. Fentanyl is also given by some authors. In order to assess the benefit of such electrostimulation, this study compared two randomized groups of ten patients, scheduled for abdominal and pelvic surgery. Both groups received the same drugs (i.e. droperidol, flunitrazepam, pancuronium and nitrous oxide with oxygen), whereas patients in group I were also submitted to electrostimulation. This study describes and discusses the clinical behaviour of patients and the hormonal reactions before, during and after surgery. In both groups, operative conditions were satisfactory. Recovery and onset of spontaneous ventilation were rapid and no patient had an unpleasant recall of the operation itself. However, most of them complained of postoperative pain. Electrostimulation did not reduce the quantity of drugs required during and after surgery. In both groups, circulatory activity was significantly increased. In group I, the arterial pressure and the heart rate were significantly higher than in group II during and after surgery. The hormonal reactions showed that in both groups adrenocorticotrophic hormone, growth hormone and antidiuretic hormone increased during surgery. Adrenocorticotrophic hormone concentration was higher in group I during the operation. The serum levels of cortisol decreased before surgery in group I and rose in both groups during and after laparotomy; prolactin increased before surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenocorticotropic Hormone↗
PubMed1984

[Emergency translaryngeal ventilation with a Tuohy needle. Use in case of an inability to intubate and ventilate a curarized patient].

Intermittent translaryngeal insufflations of oxygen at high pressure by a needle could be a life-saving procedure, especially in a patient whose trachea the anesthesiologist was unable to intubate or ventilate. This study was designed to evaluate the quality of translaryngeal ventilation performed with a 16-gauge Tuohy needle and an oxygen pressure of 3 bar (300 kPa) in comparison with an usual plastic cannula of the same calibre. The studies carried out in the laboratory have shown a distinct advantage over the conventional cannula. Whereas an O2 jet delivered by a straight cannula impinged on the posterior wall of the larynx and trachea, the curved tip of the Tuohy needle deflected the axis of the O2 flow emerging from it, which then lay parallel to the longitudinal axis of the trachea. Consequently, gas flow through a simulated trachea was increased (2610 ml X s-1 vs 1240 ml X s-1), the inflation pressure being higher and the tidal volume larger. Moreover, the likelihood of injury to the posterior wall of the airway was reduced; the Tuohy needle held with a clamp close to the skin was more stable in position. Blood gases and clinical data obtained in 10 anesthetized and curarized patients without airway obstruction made it clear that translaryngeal insufflations with a 16-gauge Tuohy needle provided adequate ventilation (PaO2 values between 174 and 851 mmHg, PaCO2 between 38 and 64 mmHg). It was concluded that this technique was an efficient alternative in case of an inability to intubate a patient in apnea.

Blood Gas Analysis↗
PubMed1984

Cardiac arrest related to anaesthesia: a prospective survey in France (1978-1982).

This report analyses the rate, predisposing factors, causes and outcome of 119 cardiac arrests related (totally or partially) to anaesthesia which were collected in France by a national prospective survey performed between 1978 and 1982. The overall rate of cardiac arrests occurring during anaesthesia and recovery was 1 per 1665 anaesthetics, resulting in death, before the 24th postoperative hour, in 56% of cases, i.e. 1 per 2900 anaesthetics. Approximately a quarter of cardiac arrests occurred during induction, another quarter during maintenance and a half during recovery from anaesthesia. The first were mainly related to anaesthesia and had the lowest mortality rate. The last were mainly related to unrecognized postoperative respiratory depression and resulted in the highest mortality. Cardiac arrests were less frequent in private hospitals than in teaching hospitals but the mortality rate was higher.

Adolescent↗