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Y Blanloeil

Publications and source records attributed to Y Blanloeil.

At least 19 recordsLinked to original sources
PubMed1998

[Cholinesterases].

OBJECTIVE: To review current data on butyrylcholinesterase. DATA SOURCES: Search through Medline data bases of articles in French or English. STUDY SELECTION: Original articles and case reports were selected. Letters to editor were excluded. DATA EXTRACTION: The articles were analyzed in order to obtain current data on biochemical structure, action, major pathological variations, especially with regard to the recent informations obtained by molecular biology concerning the identification of genetic variants. DATA SYNTHESIS: Butyrylcholinesterase must be differentiated from acetylcholinesterase, which cannot hydrolyse succinylcholine. The physiological action of butyrylcholinesterase remains unknown, although it can hydrolyse many drugs. Excluding genetical mutations, several physiopathological situations alter butyryl-cholinesterase activity. Butyrylcholinesterase activity assessment does not allow the diagnosis of genetic variants. Whatever the origin, only deficits of more than 50% modify significantly the metabolism of succinylcholine or mivacurium. The diagnosis of a prolonged neuromuscular blockade is obtained with systematic monitoring of the neuromuscular function in case of administration of mivacurium or succinylcholine. Mivacurium should only be re-injected when one response at train of four is obtained. In case of prolonged neuromuscular blockade, the anticholinesterasic agent should not be administered when no response at train of four is obtained. The biochemical methods using inhibitors (dibucaine, fluoride) of the butyrylcholinesterase and a familial study lead to the diagnosis in most cases because the atypical and fluoride variants are the most frequent. When results are doubtful, genetic molecular methods with the use of PCR and restriction enzymes allow a rapid diagnosis.

Acetylcholinesterase↗
PubMed1998

[Post-traumatic hematoma of the esophagus].

A 20-year-old man was admitted after a traffic accident for a closed chest trauma. Initial evaluation showed a sternal fracture with a minor pneumomediastinum. Twenty-four hours later be experienced an acute respiratory failure, due to total left pulmonary atelectasis from indirect compression of the left main stem bronchus. Mediastinal widening at the postero-superior level was visualized by CT scan. The aortogram was normal. Thoracotomy showed a moderate left haemothorax, associated with an intramural haematoma of the low thoracic oesophagus which was respected. The time course was uneventful, except repetitive atelectases treated by fibrescopic aspiration. Oesophageal haematoma secondary to chest trauma is a rare injury, with around 10 cases reported in the literature. Compression of tracheobronchial axis is exceptional. Because of the delayed occurrence of such a complication after chest trauma, with sternal fracture, close clinical surveillance and CT scans are essential.

Accidents, Traffic↗
PubMed1998

Prolonged mivacurium neuromuscular block in children.

The authors report two cases of prolonged neuromuscular block after administration of mivacurium in children with previously undiagnosed plasma cholinesterase deficiency related to homozygous atypical genotype. Their anaesthetic management is described as well as determination of the phenotype of both children and their family.

Anesthesia Recovery Period↗
PubMed1997

Right ventricular function during weaning from mechanical ventilation after coronary artery bypass grafting: effect of volume loading.

OBJECTIVE: The study was designed to investigate the right ventricular (RV) reaction to weaning from mechanical ventilation (MV) in patients with and without volume loading after coronary artery bypass grafting (CABG). DESIGN: Controlled study. SETTING: Surgical intensive care unit in a university hospital. PATIENTS: 18 patients were randomized in two groups, Control group (n = 9) and Volume group (n = 9), when the established criteria for weaning from the respirator were satisfied. INTERVENTION: During MV, patients in the Volume group received in rapid (10-min) 6 ml/kg infusion of a 6% hydroxyethyl starch preparation. MEASUREMENTS AND RESULTS: Hemodynamic parameters were measured using a combined right ventricular (RV) ejection fraction-oximetry pulmonary artery catheter at T0 (during MV: baseline), T1 (during MV: 10 min after volume loading or at the same time in the Control group), T2 [after 20 min of spontaneous ventilation (SV)]. In the Control group, RV volumes did not differ throughout the study, while cardiac index (CI) and RV stroke work index (RVSWI) increased from T1 to T2. In the Volume group, RV volumes increased from T0 to T1, further increasing from T1 to T2, whereas CI increased only from T0 to T1. In this group, RVSWI increased from T0 to T1 in 8/9 patients and from T1 to T2 in 6/9 patients. CONCLUSIONS: An increase in RV volumes with a concomitant increase in RVSWI was observed in high preload patients when going from MV to SV, suggesting a preserved RV function during weaning from MV in this group compared with control patients. The depression in RV contractility observed in some patients suggested that rapid volume expansion before weaning from MV in CABG patients must be done carefully.

Aged↗
PubMed1997

The effects of a nonsteroidal antiinflammatory drug (ketoprofen) on morphine respiratory depression: a double-blind, randomized study in volunteers.

Nonsteroidal antiinflammatory drugs (NSAIDs) decrease the postoperative requirements for opioid analgesic medication. To determine whether NSAIDs potentiate the respiratory effects of opioids, we studied the effects of ketoprofen (K), an NSAID, on respiratory depression induced by morphine (M) in volunteers. After ethics committee approval, 12 healthy male volunteers received infusions of K (1.5 mg/kg), M (0.1 mg/ kg), and KM (1.5 mg/kg + 0.1 mg/kg) in a double-blind, randomized, three-treatment, three-period cross-over trial. During the three sessions, CO2 rebreathing challenges for ventilatory and occlusion pressure responses to CO2 were performed immediately before and 10, 70, 130, 190, and 250 min after drug infusion over 10 min. Venous blood samples for plasma drug concentrations were withdrawn at the same times. Comparisons were made on slopes of ventilatory and occlusion pressure responses to CO2. Venous blood samples confirmed that morphine plasma concentrations were similar when subjects had received morphine alone and when they had received the combination of drugs. Morphine alone induced a respiratory depression with a decrease in both ventilatory and occlusion pressure responses to CO2. Ketoprofen alone did not produce any respiratory effects. The combination of drugs induced a decrease in ventilatory responses to CO2, but intergroup comparisons showed that this was significantly less marked than the decrease induced by morphine alone. In conclusion, for similar morphine plasma concentrations, respiratory depression was less marked with the combination of drugs than with morphine alone. Therefore, ketoprofen may reduce the respiratory depression induced by morphine.

Adult↗
PubMed1996

[Indications and role of albumin for vascular loading during postoperative intensive care].

Prospective clinical trials comparing human albumin to other plasma volume expanders during the three first postoperative days in adult patients were analysed. Fifteen studies were selected. Nine of them concerned the evaluation during the immediate postoperative period, after cardiac surgery with cardiopulmonary bypass (CPB). Only one trial referred to hyperoncotic albumin and therefore did not allow to produce recommendations. However, a priori hyperoncotic albumin should not be used for plasma volume expansion. All other studies compared isooncotic albumin to crystalloid or hydroxyethylstarches (HES). It is concluded that albumin can be recommended neither after vascular (aortic abdominal surgery), nor abdominal surgery and can be replaced by Ringer lactate solution in a volume 1.5 to 2 times higher than with albumin. After cardiac surgery, mainly uncomplicated coronary artery bypass graft or valve replacement, albumin can be substituted by HES. These conclusions are only valid for blood losses below 50% of blood volume. The place of isooncotic albumin for fluid resuscitation in case of blood loss exceeding 50% of blood volume cannot be specified.

Albumins↗
PubMed1996

[Prolonged apnea after suxamethonium administration during staphylococcal toxic shock].

A toxic shock syndrome occurred after a femoral nail removal requiring revision surgery. After administration of suxamethonium (1 mg.kg-1), an apnoea prolonged over 45 minutes was observed. The trachea was extubated 105 minutes after suxamethonium administration. For the nail removal, two days before, the anaesthetic had been given by the same anaesthesiologist, with a similar protocol. Apnoea extended over 20 minutes. The day of the revision surgery, plasma cholinesterase activity was 410 UI.L-1 and reached 910 UI.L-1, 9 months later. Dibucaine number was 20 and fluorure number 17. The apnoea was in relation with a genetic plasma cholinesterase deficiency increased by the toxic shock syndrome. Shock and hepatic insufficiency were suspected to contribute to the decrease in plasma cholinesterase. Suxamethonium should be avoided in case of toxic shock syndrome.

Adult↗
PubMed1996

[Decrease in plasmatic cholinesterase activity in severe bacterial infections: comparison with the decrease observed in severe liver cirrhosis].

As the influence of sepsis on plasma cholinesterase activity is not clearly established, plasma cholinesterase activity was measured in 30 healthy surgical orthopaedic patients, 11 patients with severe postoperative infections and 18 patients with patent cirrhosis (Child-Pugh C). Plasma cholinesterase activities were significantly decreased (P < 0.001) in patients with postoperative infections (1,706 +/- 535 Ul.L-1) and in those with patent cirrhosis (1,318 +/- 538 Ul.L-1) in comparaison to healthy surgical patients (4,716 +/- 1,232 Ul.L-1). The decrease in patients with postoperative infections and in those with patent cirrhosis was similar. It remains to be assessed whether the activity of anaesthetic agents biotransformed by plasma cholinesterase is modified during severe infections.

Anesthetics↗
PubMed1996

Post-operative intravenous continuous analgesia: comparison of buprenorphine, fentanyl and nalbuphine.

Continuous intravenous infusions of fentanyl, buprenorphine or nalbuphine were investigated to provide pain relief for patients after major abdominal surgery. Buprenorphine (n = 23) was given as a loading dose of 5 micrograms kg-1 and infused at 0.8 micrograms kg-1 h-1. Fentanyl (n = 20) was given as a loading dose of 2 micrograms kg-1 and infused at 0.7 micrograms kg-1 h-1. Nalbuphine (n = 21) was given as a loading dose of 200 micrograms kg-1 and infused at 80 micrograms kg-1 h-1. The infusion rate was increased when analgesia was inadequate, and decreased if respiratory depression occurred. Mean doses were respectively 0.74 +/- 0.15 microgram kg-1 h-1 buprenorphine, 0.68 +/- 0.18 microgram kg-1 h-1 fentanyl, 83 +/- 21 micrograms kg-1 h-1 nalbuphine. Titration of continuous intravenous infusion of buprenorphine and fentanyl provided better analgesia than nalbuphine with smaller doses than those reported in similar studies allowing spontaneous breathing.

Adult↗
PubMed1995

[In which patients and for which procedures has the efficacy of postoperative artificial nutrition be proven?].

This study reviewed 19 prospective studies for the incidence of postoperative nutritional support on outcome in elective surgery. It compared enteral and parenteral nutrition initiated no more than three days preoperatively or postoperatively and prolonged maximally for one month, to a simple infusion of glucose or saline. As all studies had methodological weaknesses, concerning mainly the sample size, it is impossible to propose relevant recommendations. Nevertheless, among the 11 studies on total parenteral nutritional support (nitrogen and caloric supply with carbohydrates and/or lipids), three of them produced valuable results. As the available data do not show any beneficial effect, a routine postoperative nutritional support cannot be recommended, even in patients at high risk of postoperative complications. However for the latter a possible benefit cannot be totally excluded in some of them. When an alimentation per mouth cannot be started during the 8 to 10 days after surgery, an artificial nutritional support becomes mandatory.

Elective Surgical Procedures↗
PubMed1995

Comparison between oxygen consumption calculated by Fick's principle using a continuous thermodilution technique and measured by indirect calorimetry.

We calculated oxygen consumption by the reverse Fick principle (cVO2) using cardiac output measured with a new technique of continuous thermal dilution and compared these values with measurements made at the same time using a gas exchange method (mVO2). We studied nine patients in a stable condition after cardiac surgery. In each patient six successive measurements of continuous cardiac output and mVO2 were made over 5 min at 10-min intervals. The mean difference between the estimates (mVO2-cVO2) was 15 ml min-1 m2 (95% confidence limits, -3 to 33 ml min-1 m2). The relative error of each method was 5% and 4% (continuous cardiac output and gas exchange methods, respectively). Calculation of VO2 using the new cardiac output technology had good repeatability compared with direct measurement, probably because of the high precision of measurement of cardiac output.

Aged↗
PubMed1995

Effect of interpleural administration of bupivacaine or lidocaine on pain and morphine requirement after esophagectomy with thoracotomy: a randomized, double-blind and controlled study.

The purpose of the present study was to investigate the efficacy of interpleural (IP) analgesia with bupivacaine or lidocaine after esophageal surgery and to measure the plasma concentrations of bupivacaine and lidocaine after intermittent IP administrations. Two IP catheters were inserted percutaneously in the seventh intercostal space during operation. Patients in the bupivacaine group (Gr B) received 1 mg/kg of 0.5% bupivacaine with epinephrine 1:200000 in 20 mL of saline 0.9%, patients in the lidocaine group (Gr L) received 3 mg/kg of 2% lidocaine with epinephrine in 20 mL of saline 0.9%, and patients in the placebo group (Gr P) received 20 mL of saline 0.9% every 4 h during 2 days. Pain was assessed by visual analog scale (VAS) every 4 h at rest (VASR), after a deep breath or cough (VASC), at the thoracotomy (VAST), and at the laparotomy (VASL). Morphine consumption using a patient-controlled analgesia (PCA) device was recorded. There was no significant difference in the mean VASR, VASC, and VASL scores among the three groups. VAST scores were significantly lower in Gr B at 12, 16, 28, and 32 h when compared with Gr P and Gr L (P < 0.05). There was no statistical difference in mean VAST between Gr L and Gr P. Total consumption of morphine was lower in Gr B than in Gr P and Gr L (41.2 +/- 13 mg vs 66.1 +/- 21 mg in Gr P (P < 0.02) and 75.5 +/- 27 mg in Gr L (P < 0.01)), but were similar in Gr L when compared with Gr P.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesia↗
PubMed1995

Induction of anaesthesia by propofol and hepatic blood flow in the rabbit.

Effects of propofol (12.5 mg kg-1, i.v. bolus injection) or 0.9% sodium chloride on arterial blood pressure, arterial blood gases and hepatic circulation (radio-labelled microsphere technique) were studied in 15 conscious and unpremedicated rabbits. No significant changes were observed after sodium chloride. Propofol resulted in anaesthesia, respiratory depression (-49 +/- 14% decrease in PaO2; mean +/- SD) and hypotension (-49 +/- 13% decrease in mean arterial pressure; mean +/- SD) but no changes in hepatic arterial and portal venous blood flows. We conclude that propofol does not affect the liver circulation despite marked depression of mean arterial pressure and respiration.

Anesthesia↗
PubMed1995

[Invasive aspergillosis in intensive care].

Invasive pulmonary aspergilloses occur in patients with antineoplasic chemotherapy, mainly when associated with a prolonged neutropenia, in transplanted patients with continuous corticotherapy and less frequently in immunocompetent surgical patients. The clinical features are those of an acute infective pneumonia, not responding to antibiotherapy. Radiologic signs are often non specific. Diagnosis is obtained with bronchoalveolar lavage in which Aspergillus is found both at direct examination and in culture. Serological tests are of little interest for the diagnosis of invasive aspergillosis. Extrapulmonary locations such as sinusitis, cutaneous or brain abscesses occur in 20% of cases. The gold standard of treatment is intravenous amphotericin B which elicits an acute reaction often followed by a nephrotoxic effect which can be decreased by fluid loading with saline. Oral itraconazole administration can follow the initial treatment with amphotericin B. The mortality rate remains high and an early diagnosis and an appropriate treatment are essential.

Amphotericin B↗
PubMed1994

[Acute hepatic porphyria and Diprivan].

Propofol may be used without any restriction in all cases of asymptomatic hepatic porphyria, as a bolus injection for induction and maintenance of anaesthesia and as a continuous infusion to produce anaesthesia of short and medium duration. If in doubt as to the absolute safety of propofol in case of symptomatic hepatic porphyria, preference has to be given to neuroleptanalgesia, benzodiazepines and muscle relaxants. If propofol is to be used, treatment with haematin should be readily available. In all cases, it is essential to determine porphyrins and their precursors prior to and after surgery. Urine collection should strictly adhere to the recommended procedure: sterile conditions, protected from light and high temperature. Any abnormal reaction after the administration of a drug, especially propofol, should be notified to and discussed with the National Porphyria Centre (Centre Français des Porphyries). In case of symptomatic hepatic porphyria the use of propofol should always be notified to the National and to the European Porphyria Centres (Orphan Europe).

Anesthesia, Intravenous↗
PubMed1994

[Comparison of cardiac output measured continuously by thermodilution and calculated according to Fick's principle].

Recently, a thermodilution technique for continuous measurement of cardiac output was introduced. The aim of this study was to evaluate the accuracy of continuous cardiac output measurement using the thermodilution technique (CCO) and to assess the correspondence between CCO and cardiac output obtained with the Fick's principle (Fick-CO). Nine patients were studied in the postoperative period after cardiac surgery. A new pulmonary artery catheter modified by attachment of a thermal filament (Intellicath, Model PA3-H-8Fr) was inserted and connected to a continuous cardiac output computer (Vigilance Monitor). Oxygen consumption was continuously measured using the gas exchange method (Deltatrac Metabolic Monitor). Fick-CO was calculated according to the Fick's principle. The study in each patient consisted of 6 serial determinations of both CCO and Fick-CO at 10 min intervals. For 54 pairs of measurements, the mean difference (Fick-CO-CCO) was 0,6 L.min-1. The limits of agreement were--0,6 to 1,8 L.min-1 respectively. The relative error was 6% for CCO and 10% for Fick-CO. It is concluded that CCO and Fick-CO cannot be considered as being interchangeable. However, the accuracy of CCO is acceptable. The technique does not require any user calibration and eliminates the need of bolus injections. Further studies are necessary to determine the benefits of this new technique in the various clinical situations.

Aged↗