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Y Blanloeil

Publications and source records attributed to Y Blanloeil.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1994

[Bronchopleural fistula after transbronchial passage of a feeding tube].

Inadvertent transbronchial insertion of a narrow-bore feeding tube using a metallic wire resulted, twice in less than 24 hours, in a right pneumothorax complicated by a bronchopleural fistula. This accident occurred in a conscious patient but with central neurologic chronic disorders recently aggravated by a postoperative Gayet-Wernicke syndrome. The incidence of transbronchial insertion is relatively important [2 to 4%]. Risk factors include a previous endotracheal intubation and an altered mental status. The insertion may be especially hazardous when the patient is uncooperative or unconscious or has lost the cough reflex. The presence of a cuffed endotracheal tube should not be considered as a safeguard for tracheobronchial penetration. Recommendations for prevention are presented. The usual procedure of testing for proper location of the tube following its insertion consisting in the injection of air through the tube with auscultation for gastric borborygmi, is inadequate and should no longer be used.

Acute Disease↗
PubMed1994

[Comparison of amoxicillin and cefamandole in the prevention of bronchopulmonary infections in pulmonary surgery. A randomized double-blind study].

Antibiotic prophylaxis is currently recommended in clean-contamined surgery (type II of Altemeier classification). Pulmonary surgery belongs to this type. This prospective randomized and controlled study was designed to compare amoxicillin and cefamandole for prevention of pleural and bronchopulmonary infections after pulmonary resections. It included 256 patients, admitted between October 1st 1989 and July 1st 1991, for elective thoracotomy and probable pulmonary resection. The patients were allocated into two groups, group A (amoxicillin) and group C (cefamandole). The first intravenous antibiotic injection took place immediately after induction of anaesthesia (1 g of amoxicillin or 1.5 g of cefamandole). Postoperative injections were performed every 6 hours during 36 hours (i.e. a total of 6 injections). Infection was defined by the association of general signs including hyperthermia (> 38 degrees C), hyperleucocytosis (> 12,000/mm3), and local signs such as bronchitis (B), pneumonia (P), empyema (E), wound sepsis (W) and non thoracic infection (S). Follow-up included the hospital stay and a period of eight months after surgery for possible rehospitalisation for infection. Respiratory infections (bronchitis n = 35, pneumonia n = 5, empyema n = 2) occurred in 18% of the total population. No difference was seen between the two groups concerning the type of infection and the repartition of infection in relation to the type of pulmonary surgery. The causative bacterial organisms were Haemophilus influenzae (n = 4), Streptococcus pneumoniae (n = 2), Escherichia coli (n = 1), anaerobic bacteria (n = 1). Multiple bacteria were found in one case. The empyema and wound sepsis occurred in the amoxicillin group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Effects of oral ranitidine, famotidine and omeprazole on gastric volume and pH at induction and recovery from general anaesthesia.

We have studied, in 150 patients undergoing elective general surgery, the effect on gastric content of omeprazole 40 mg, ranitidine 300 mg and famotidine 40 mg, given orally the night and the morning before surgery. Volume and pH of gastric content were measured at induction and recovery from anaesthesia. Gastric volumes did not differ between groups. The median gastric pH was lower with omeprazole compared with ranitidine and famotidine at intubation (5.11, 7.05 and 6.99, respectively) (P < 0.001) and extubation (6.41, 6.98 and 6.96) (P < 0.001). The proportion of patients with gastric pH < 2.5 at induction was 40% for omeprazole, 12% for famotidine and 10% for ranitidine (P < 0.02); the proportion did not differ significantly at extubation.

Administration, Oral↗
PubMed1993

[Invasive aspergillosis in surgical intensive care patients].

Aspergillosis is a rare event in intensive care patients. Three cases of invasive aspergillosis due to Aspergillus fumigatus were diagnosed in a surgical critical care unit. Risk factors for aspergillosis were found in two liver transplanted patients. One of them had a primitive cutaneous aspergillosis, and the other, treatment difficulties due to the unavailability of an injectable preparation of itraconazole, a new triazole antifungal agent efficient against Aspergillus species. The third case occurred in a patient who had had surgery for gastric carcinoma with liver metastasis. The mycological examination of the air and workbench in the patients' rooms disclosed between 2 and 13 CFU.mm-3 of different Aspergillus species. Plasma itraconazole concentrations were measured in one patient only. They were below the therapeutic range, probably because of intestinal disturbances. The oral administration of itraconazole capsules through gastro-intestinal feeding tubes results in a poor availability of the drug. Such a technique of administration should therefore be undertaken with larger doses than those commonly recommended. Moreover, itraconazole plasma concentrations should be monitored. The association with amphotericin B is recommended until normal intestinal absorption has been obtained.

Adult↗
PubMed1992

Oxygen consumption after cardiac surgery--a comparison between calculation by Fick's principle and measurement by indirect calorimetry.

Oxygen consumption calculated by Fick's principle (cVO2) was compared to oxygen consumption measured (mVO2) by indirect calorimetry (Deltatrac Metabolic Computer) in 10 patients in the post-operative period after cardiac surgery. For 50 pairs of measurements the mean difference (mVO2-cVO2) was 34 +/- 27 ml/min.m2. The limits of agreement were -20 ml/min.m2 to 88 ml/min.m2. These results showed that cVO2 and mVO2 were not interchangeable in this study.

Aged↗
PubMed1992

[Interpleural anesthesia].

In 1986, Reiestad and Strömskag introduced interpleural postoperative analgesia with local anaesthetic solutions. The aim of this review was to describe the physiological mechanisms, indications and limits of this new mechanisms, indications and limits of this new technic. Interpleural analgesia has been successfully used for pain relief after cholecystectomy by subcostal incision. Nevertheless, the potential side-effects of this technic and the reduction of the postoperative pain with the use of coelioscopic approach discard interpleural analgesia. After thoracotomy, if this technic seemed to be simple by visual placement of the catheter tips by the surgeon, most of the studies failed to demonstrate reduction of postoperative pain. Finally, interpleural analgesia has recently been shown to be effective in the management in various chronic pain syndromes of the upper abdomen (pancreatitis...) and thorax (postherpetic neuralgia, upper extremity reflex sympathetic dystrophy). The efficacy of this technic for long-term chronic pain involves the blockade of the sympathetic chain of the injected side.

Analgesics↗
PubMed1991

[Hemodynamic effects of dobutamine in hyperkinetic septic shock treated with norepinephrine].

A prospective study of the haemodynamic effects of dobutamine was carried out in six men and four women suffering from hyperkinetic septic shock, already treated with noradrenaline and dopamine. All ten patients had septic shock, defined as a mean arterial blood pressure of less than 70 mmHg and an urine output under 15 ml.h-1, persisting despite fluid loading, associated with positive blood cultures, increased white blood cell counts, and a septic area. Initial treatment consisted in fluid loading, so as to increase cardiac output whilst keeping pulmonary wedge pressure (Ppw) between 8 and 10 mmHg. Dopamine was then added, up to a dose of 15-20 micrograms.kg-1.min-1, in an attempt to improve coronary and renal blood flows. In patients in whom this failed, the amounts of dopamine were then decreased, down to 3 micrograms.kg-1.min-1, and replaced by noradrenaline. When patients had as steady cardiac index (CI) greater than 3 l.min-1.m-2 and a systemic arterial resistance index (RsaI) of less than 1,800 dyn.s.cm-5.m-2 for more than 60 min, they were included in the protocol. Dopamine was then replaced by increasing doses of dobutamine (0, 5, 7.5, 10, 15 and again 0 micrograms.kg-1.min-1). The usual haemodynamic parameters were measured and calculated once a steady state had been obtained at each dose (within 20 to 30 min). Ppw was kept between 8 and 10 mmHg by fluid loading with a 4% albumin solution. At the beginning of the study, patients had a mean blood pressure of 78 +/- 6 mmHg, a CI of 4.8 +/- 1.5 l.min-1.m-2 and a RsaI of 1,285 +/- 341 dyn.s.cm-5.m-2 RsaI.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Inotropic and vasopressive drugs during anesthesia and critical care. Current data].

Recent therapeutic advances in inotropic drugs and vasipressors uses allow a reappraisal of their indications during the perioperative period. Non-catecholamines vasopressors, ephedrine and phenylephrine, are particularly suitable for treatment of abrupt peroperative arterial hypotensions as observed during induction of general and medullar anesthesias. Cardiac arrest, peroperative anaphylactoid and toxic accidents are treated with epinephrine. In non-cardiac surgery, circulatory insufficiency is usually due to a peripherical origin. Cardiogenic failure occurs in rare cases mainly in vascular surgery. Therefore dopamine remains the first amine to be used in non-cardiac surgery in conjunction with volume expansion. A cardiogenic factor is responsible for most of low-cardiac output syndromes observed after cardiopulmonary bypass for cardiac surgery. However, hypovolemia may be involved and could be undiagnosed. For these reasons, dobutamine is used because of its rapid half-life of elimination and its potent effects. Inodilators (enoximone, amrinone and milrinone) ans nex dopaminergic compound (dopexamine) are powerful vasodilators agents to be introduced with care when association of amines and current vasodilators have failed. Finally, arterial pressure has to be maintained with norepinephrine after dopamine failure. Epinephrine remains last chance.

Anesthesia, General↗