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Y Blanloeil

Publications and source records attributed to Y Blanloeil.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Peroperative pneumothorax in thoracotomy: the value of pulse oximetry].

Two cases of pneumothorax occurring during thoracotomy under one-lung ventilation are reported. One case occurred before pneumonectomy was carried out. The decrease in Spo2 shown by pulse oximetry, together with the increase in airway pressures, rapidly led to the diagnosis of pneumothorax. In the other case, the accident occurred after pneumonectomy, with a suddenly impossible ventilation, and a drastic decrease in Spo2 leading to hypoxic circulatory arrest. Hypoxaemia occurring during one-lung ventilation may be due to different causes. Shunting in the upper part of the lung is the main cause, but other diagnoses must be discussed, such as airway obstruction by blood or sputum, displacement of the selective endotracheal tube, bronchospasm, and pneumothorax. Monitoring of Spo2 by pulse oximetry would therefore seem to be mandatory during thoracic surgery, in order to allow an early diagnosis of hypoxaemia and speed up the treatment of its cause.

Blood Gas Monitoring, Transcutaneous↗
PubMed1989

[Postoperative thyrotoxic crisis during beta blockade: an atypical picture of generalized muscle deficiency].

The case is reported of a 42 year old female patient with Graves disease who presented with an atypical thyroid storm after subtotal thyroidectomy. Surgery was indicated because of poor patient compliance with the medical treatment, and its partial failure. High doses of propranolol (240 mg a day) were given for 5 days preoperatively. Anaesthesia and surgery were uneventful however, towards the end of the first postoperative day, a severe myopathic syndrome started, with neither fever nor tachycardia. Respiratory failure and pneumonia occurred 24 h later. This was deemed to be due to an atypical thyroid storm. The patient was intubated and ventilated, and treated with high doses of propranolol (320 mg a day). Muscle strength began returning to normal on the 4th postoperative day, being completely normal 2 months later. Even though a particularly severe form of thyrotoxic myopathy appeared to be the most likely cause of this temporary muscle disorder, beta-blockers may have been involved. Their potential role is discussed.

Adult↗
PubMed1989

[Anesthesia and hepatic porphyria].

Three of the acute hepatic porphyrias, acute intermittent porphyria, variegata porphyria and hereditary coproporphyria, are characterized by an idiosyncratic reaction to many common drugs; the resulting excessive excretion of porphyrin precursors is responsible for episodes of acute neurological dysfunction. This review aimed to focus the attention of the anaesthesiologist on the porphyrinogenic properties of all the drugs used in anaesthesia and intensive care. An outline of the chemistry of porphyrins and the enzymatic pathways were recalled, so as to place the acute porphyrias in their proper perspective. There follows a reminder of the clinical aspect of acute porphyric crises. The part played by drugs is then assessed from clinical and laboratory data concerning their porphyrinogenicity. Those drugs for which there is conflicting evidence regarding their safe use in porphyric patients are discussed: propofol, ketamine, benzodiazepines, etomidate, local anaesthetics. Recommendations supported by clinical and experimental data are given, especially the results obtained with the chick embryo liver model. Treatment of the acute crisis is provided, with particular emphasis on the use of haematin. The anaesthetic management of hepatic porphyric patients is described. Those drugs which are well-known porphyrinogenic compounds in the chick embryo liver must be excluded from use for anaesthesia in the porphyric patients, even if they have been observed to be innocuous in rare cases of asymptomatic patients. Finally, recommendations for anaesthesia in symptomatic cutanea porphyria are given.

Alcuronium↗
PubMed1988

[Postoperative hypoglycemia after excision of pheochromocytoma. A case].

A case of hypoglycaemia consecutive to excision of a bilateral phaeochromocytoma in a 33-year old patient with Sipple's syndrome is reported. The severity of the hypoglycaemia (1.3 mmol/l) accounted for the brain lesions which ultimately resulted in the patient's death. Eight cases of hypoglycaemia occurring in similar circumstances have been published. The condition is due to the massive release of insulin during the hours that follow removal of the tumour. This results in the persistence of the peri-operative hyperglycaemic stimulation and in the suppression of the previous inhibition of insulin secretion due to alpha-adrenergic stimulation of catecholamines in the beta-cells of Langerhans' islets.

Adrenal Gland Neoplasms↗
PubMed1987

Vecuronium and atracurium in patients with end-stage renal failure. A comparative study.

Twenty patients with end-stage renal failure, undergoing kidney transplantation, were assigned randomly to receive either vecuronium or atracurium under evoked twitch tension control. The cumulative-dose technique was used to obtain 95% twitch depression (vecuronium: initial bolus 15 micrograms kg-1, increments 6 micrograms kg-1; atracurium: initial bolus 100 micrograms kg-1, increments 40 micrograms kg-1). Using ED95 values derived from the log-probit dose-response curves, vecuronium was 4.6 times more potent than atracurium. The durations of action of the initial cumulative-doses (from end of injection of the last increment to 25% recovery) were 11.1 +/- 3.3 min for vecuronium and 16.2 +/- 3.9 min for atracurium (P less than 0.05). In terms of duration of action of the maintenance doses (vecuronium one-quarter of the total incremental dose; atracurium one-third) some cumulation was observed with vecuronium (interaction time X treatment; cumulation ratio 1.46 +/- 0.31 v. 0.98 +/- 0.10 for atracurium, P less than 0.001). After 2 h of surgery, the mean recovery times (25% to 75% twitch height) did not differ (18.5 +/- 2.8 min and 16.7 +/- 4.4 min). It is concluded that vecuronium might be less safe than atracurium in patients with end-stage renal failure undergoing prolonged operations.

Adult↗
PubMed1987

Hemodynamic effects of continuous norepinephrine infusion in dogs with and without hyperkinetic endotoxic shock.

We compared, at constant preload maintained by polygeline (gelatin) infusion, the hemodynamic effects of continuous infusion of norepinephrine (0.5, 1, and 1.5 micrograms/kg X min) in anesthetized dogs with and without hyperdynamic endotoxic shock. In both groups, norepinephrine infusion increased systolic, diastolic and mean aortic BP, cardiac index, stroke index, index of myocardial contractility, and mean pulmonary artery pressure. No significant change in right atrial pressure, left ventricular end-diastolic pressure, heart rate, systemic vascular resistance, or pulmonary vascular resistance was observed. Oxygen consumption index and oxygen extraction ratio remained unchanged. Increases in systolic aortic BP were dose-related, whereas maximal effects on other variables were obtained at 0.5 to 1 microgram/kg X min. The rise in aortic pressure resulted from an increased cardiac index but not from an increased systemic vascular resistance. Stroke index increased as contractility improved. The slight alpha-adrenergic effect of continuous, low-dose norepinephrine infusion did not impede the beneficial effects of the marked beta-adrenergic stimulation on cardiac function. The combination of these two effects improved hemodynamic disturbances of hyperdynamic endotoxic canine shock.

Animals↗
PubMed1987

Rapid gas-chromatographic assay of bupivacaine in plasma.

A method for estimating bupivacaine concentration in human plasma by capillary gas-chromatography using solid injection and nitrogen-specific detection is described. Etidocaine, another anilidetype local anesthetic was used as internal standard and added to the sample before single-step extraction with diethylether. This method demonstrates high sensitivity (6 ng/ml plasma) and combines selectivity, rapidity, and simplicity. Results of this procedure correlate well with those obtained by an HPLC method.

Bupivacaine↗
PubMed1986

Atracurium infusion in liver transplantation.

A continuous infusion of atracurium was used to provide neuromuscular blockade in 25 adult patients undergoing liver transplantation following atracurium, suxamethonium or vecuronium for intubation. Blockade was monitored by recording evoked electromyographic response and maintained with a mean infusion rate of 0.38 +/- 0.14 mg kg-1 h-1 during 306 +/- 80 min of operation. Atracurium requirements appeared to be less during the anhepatic period and greater after removal of the vascular clamps on the new liver. No instances of arterial hypotension or anaphylactoid reactions attributable to atracurium were reported. It can be concluded that a continuous infusion of atracurium is a safe, effective and convenient technique of ensuring neuromuscular blockade during liver transplantation, at a rate of infusion no different from that needed in patients with normal hepatic function.

Adolescent↗
PubMed1985

[Plasma renin activity and prostaglandin E2 in hypotension induced by nicergoline].

The hypotensive actions of nicergoline, a new alpha 1-adrenoreceptor blocking agent, were studied in six dogs during stable anaesthesia under mechanical ventilation. Systemic haemodynamic parameters were measured before the infusion of nicergoline (500 micrograms X kg-1 in 5 min), and regularly after it during 2 h. Plasma renin activity (PRA), right atrial (V PGE2) and arterial (A PGE2) prostaglandin E2 concentrations measured by radio-immunoassay were collected before, and 10 and 20 min after nicergoline infusion. The mean aortic pressure fell to its lowest figure (-30%) at the 5th min, this being maintained for 45 min. Heart rate and cardiac output remained unchanged. Pulmonary wedge pressure (p less than 0.01) and central venous pressure (p less than 0.05) decreased. All parameters reached their control values in 120 min. PRA was unchanged. V PGE2 (p less than 0.01) and pulmonary extraction in PGE2 (V PGE2 - A PGE2/V PGE2) (p less than 0,05) increased whilst A PGE2 was unmodified. The fall in mean aortic pressure was linked (p less than 0.001) to the increase in V PGE2. Nicergoline infusion induced hypotension by reducing vascular tone of resistance and capacitance beds. Hypotension was related to the vasoplegia and to an inhibition of the rapid pressor control mechanisms. The reasons for the lack of renin release were unknown. V PGE2 release was stimulated by the hypotension. The increase in pulmonary extraction in PGE2 was involved in the maintenance of A PGE2 concentration. Nicergoline gave mild hypotension without reflex sympathetic activation. Its alpha-adrenoreceptor blocking properties were similar to those of prazosin.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗