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Biomedical subjects

Y Lepage

Publications and source records attributed to Y Lepage.

16 recordsLinked to original sources
PubMed1990

Rapid induction sequence with vecuronium: should we intubate after 60 or 90 seconds?

The purpose of the study was to determine intubating conditions after administration of either succinylcholine or vecuronium in a rapid induction sequence. Patients received either succinylcholine 1.5 mg.kg-1 (Groups I and II) after d-tubocurarine 0.05 mg.kg-1 four minutes earlier, or vecuronium (Groups III and IV) in an initial dose of 0.01 mg.kg-1 followed four minutes later by 0.1 mg.kg-1. In Groups I and III an apnoeic delay of one minute was allowed before intubation whereas in Groups II and IV the delay was 90 sec. There was no significant difference in intubating conditions between Groups I and IV. Intubating conditions in Group III (vecuronium-delay of one minute) were statistically worse than in any of the three other groups. A delay of 90 sec after succinylcholine improved intubating conditions in male patients. Considering that intubating conditions obtained after 90 sec in patients given a priming sequence with vecuronium (Group IV) were not different from those obtained 60 sec after succinylcholine (Group I), the authors conclude that vecuronium is an acceptable alternative for rapid tracheal intubation. In the doses used in this study, intubating conditions 60 sec after vecuronium were unacceptable for rapid induction of anaesthesia.

Adult↗
PubMed1990

Occurrence of gastroesophageal reflux on induction of anaesthesia does not correlate with the volume of gastric contents.

In an attempt to explain the discrepancy between the high number of patients said to be at risk of aspiration pneumonitis and the low reported incidence of this anaesthetic complication, 100 ASA physical status I-II elective surgical patients were studied. The volume of fluid present in the stomach at the time of induction of anaesthesia was correlated with gastroesophageal reflux (GER) detected by visual inspection of the pharynx and by continuous measurement of upper oesophageal pH. Mean gastric volume was 30 +/- 28 ml (range 0-210 ml). Gastric fluid volume greater than or equal to 0.4 ml.kg-1 at pH less than or equal to 2.5 was present in 46 patients. No GER was detected during induction of anaesthesia in our sample of 100 patients. Furthermore, patient age, duration of preoperative fasting, body mass index, cigarette smoking, alcohol consumption, preoperative anxiety, and a history of preoperative GER were not correlated with significant modifications of gastric volume or pH. We conclude that the low incidence of aspiration pneumonitis in elective surgical patients may be explained in part by the very low risk of GER, despite gastric fluid volumes of more than 0.4 ml.kg-1 in a high proportion of this patient population.

Adult↗
PubMed1990

Recruitment and compliance in school-based FMR programs.

A study on the effectiveness of a fluoride mouthrinse program was conducted over a 20-month period among 610 children attending grade 5 in two unfluoridated communities. The results showed that the preventive agent had no significant cariostatic effect. Participation and compliance problems were investigated as possible explanations. Comparisons were made between children who refused to participate or dropped out of the program and those who completed it, to see whether group-specific characteristics could be responsible for the low reduction of caries resulting from the mouthrinse. The relationship between compliance and DMFS increment was also examined. The analysis revealed that the children who refused to participate in the study or who dropped out showed sociodemographic characteristics associated with a high caries risk. This suggests that children who need the program most might not benefit because of low participation or failure to remain in the program. Moreover, the DMFS increment over the 20-month period was lower among the children exposed to 50 rinse sessions or more.

Child↗
PubMed1989

Decreasing the toxic potential of intravenous regional anaesthesia.

In an attempt to reduce the dose of local anaesthetic agent during intravenous regional anaesthesia (IVRA) of the upper limb, we have used a forearm tourniquet in 12 adult volunteers. The volume of the forearm venous system was predetermined angiographically. We performed IVRA with three solutions of lidocaine (0.25, 0.375, 0.5 per cent) administered in a volume equal to the forearm venous system. Angiographic results indicate that: a forearm tourniquet provides adequate vascular isolation; the volume of the forearm venous system can be correlated with body weight; the progression of the fluid in the venous system follows a pattern that is similar for all patients with the small veins of the distal forearm and proximal hand being filled last. With this technique, lidocaine 0.5 per cent resulted in a dose of 1.5 mg.kg-1 and provided excellent analgesia. Lower concentrations were unsatisfactory. We conclude that the use of a forearm tourniquet allows reduction of the local anaesthetic dose to a non-toxic level and thus increases the safety of IVRA.

Adult↗
PubMed1987

Determining gastric contents during general anaesthesia: evaluation of two methods.

Two methods used to measure the volume of gastric contents were evaluated in 24 supine anaesthetized adults. Methods compared were: (1) aspiration of stomach contents through a large, vented, multi-orificed gastric tube, and (2) indirect determination by a dye dilution method using polyethylene glycol (PEG) as the marker. The volumes determined by these methods (Vasp and Vpeg respectively) were compared to the total volume (Vtot) present in the stomach, determined by direct inspection of the gastric pouch by the surgeon at the beginning of surgery. The results show that the volume of aspirated gastric fluid, using this type of tube, is a very good estimate of the total volume of gastric residue. The PEG dilution method yields similar results. However, correlation between Vpeg and Vtot was not as close-fitting as the correlation between Vasp and Vtot. PEG dilution is more complicated, time-consuming and offers no advantage over aspiration.

Anesthesia, General↗
PubMed1986

Nausea and vomiting after strabismus surgery in preschool children.

The incidence of nausea and vomiting after strabismus surgery was studied in 64 children aged one to six years. Incidence was determined in the post-anaesthesia recovery room (PARR), in the same day surgery (SDS) unit, and at home on days one and two after the operation. After induction of anaesthesia, the children received an intravenous injection of droperidol (50 micrograms . kg-1) or saline in a double-blind randomized fashion, and an intravenous injection of glycopyrrolate (7.5 micrograms . kg-1) or atropine (10 micrograms . kg-1) in an open randomized fashion. The incidence of emetic symptoms was highest in the SDS unit and at home on day one. Droperidol slightly but significantly delayed awakening and was not, at least in this particular age group, associated with any difference in postoperative sickness. Despite theoretical advantages, glycopyrrolate offered no significant benefit over atropine as far as postoperative emesis was concerned.

Anesthesia, General↗
PubMed1985

Predictors of asymptomatic gonorrhea among patients seen by private practitioners.

Nineteen physicians participating in a program for detecting and treating gonorrhea and other sexually transmitted diseases (STD) in high-risk groups filled out encounter forms for the initial visits by the first 3144 patients. This information was used to describe the program users and, by means of logistic regression analysis, to identify predictors of gonorrhea in asymptomatic patients. Overall, 17.3% of the users had culture-proved gonorrhea. Of the symptomatic patients 24.5% had gonorrhea. Of the asymptomatic patients 20.4% of those with a history of contact with a known or suspected case of STD had the disease, and 5.3% of those without a history of contact had the disease. The independent predictors of gonorrhea identified were, in order of importance, a history of contact with a case of STD and being aged less than 30 years. These predictors underline the importance of contact tracing, an underused but productive method of gonorrhea control that can be used effectively in private practice.

Adolescent↗
PubMed1985

Colpohistologic correlations. A computerized study.

Data from 300 colposcopic cases were computerized to study the correlations between the colposcopic observations and the histologic and other data. Colposcopy was shown to be most useful in women under 35 years of age. Use of oral contraceptives (the Pill) seemed to relate to a higher level of successful colposcopic visualization and may even prevent the need for conization, based on a higher incidence of negative endocervical curettages. Although 14.5% of the cases were colposcopically undergraded and 17% overgraded when compared to the histopathology, the histologic predictability of the colposcopic observation of white epithelium and vascular changes (punctation and mosaicism) was excellent. Colposcopy remains an essential technique in the appraisal and management of cervical intraepithelial neoplasia.

Adult↗
PubMedDate not supplied

Principal components analysis of an evaluation of the hemiplegic subject based on the Bobath approach.

An evaluation based on the Bobath approach to treatment has previously been developed and partially validated. The purpose of the present study was to verify the content validity of this evaluation with the use of a statistical approach known as principal components analysis. Thirty-eight hemiplegic subjects participated in the study. Analysis of the scores on each of six parameters (sensorium, active movements, muscle tone, reflex activity, postural reactions, and pain) was evaluated on three occasions across a 2-month period. Each time this produced three factors that contained 70% of the variation in the data set. The first component mainly reflected variations in mobility, the second mainly variations in muscle tone, and the third mainly variations in sensorium and pain. The results of such exploratory analysis highlight the fact that some of the parameters are not only important but also interrelated. These results seem to partially support the conceptual framework substantiating the Bobath approach to treatment.

Cerebrovascular Disorders↗