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Biomedical subjects

Y Louville

Publications and source records attributed to Y Louville.

At least 19 recordsLinked to original sources

[A study of 11 ventilators for anesthesia: laboratory testing].

Eleven anaesthesia ventilators were instrumentally tested under various conditions. They included: Excel and Modulus II Plus (Ohmeda); 710 and Servo anaesthesia circle 985 (Siemens); Jollytronic (Soxil) and Elsa (Engström); SA2 and Cicero (Dräger); ABT 4,300 (Kontron); Monnal A and the prototype Alys (Taema). The test circuit comprised a two compartment model lung, a pneumotachograph, a pressure gauge in the "airway". The volume was calculated as the integral of flow rate. Each machine was calibrated by the firms' technicians. Before each test, the pneumotachograph was calibrated using a 11 air syringe and the pressure gauge with a 5 cm water column. Each machine ventilated the model lung for 30 min before starting the tests. There were five tests: 1) reliability of the machine's spirometer, 2) reliability of the ventilation rate, 3) reliability of pressure measurements, 4) effect of increasing fresh gas flow on spirometry, 5) effect of increasing downstream resistances. In usual simulated ventilatory conditions, all the machines accurately delivered the setted ventilation and spirometric measurements were with minimal error only. Several ventilators (SA2, Excel, 710, Elsa, ABT 4,300) did not succeed in maintaining their performances when compliance was strongly decreased or resistance of the test lung notably increased. Resistance in the circuit during simulated spontaneous ventilation was < 3.6 cmH2O.l-1.s-1. Increasing fresh gas flow raised the minute volume delivered in six ventilators. It is concluded that, during extreme ventilatory conditions, the inspired volume must be adjusted so as to maintain the inspired tidal volume. However, ventilators which increase inspiratory time in response to an increased mechanical load cannot be adjusted by this way.

Anesthesia, Closed-Circuit

[Spinal anesthesia and prevention of thrombosis by heparin].

Non traumatic spinal hematomas are a rare pathology, anticoagulant treatments are one of their most frequent etiology. Therefore, the association of spinal anesthesia and a preventive treatment which has antithrombotic aim by the use of subcutaneous heparin (non fragmented or low molecular weight) is being discussed by many authors. It is lawful to associate spinal anesthesia with a soft dose of non fragmented subcutaneous heparin (Kakkar method) if the protocols are strictly respected. It is certainly possible to use low molecular weight subcutaneous heparin as well. However a slight decline in their use urges anyone to be very cautious.

Anesthesia, Conduction

[Technics of anesthesia and hypothermia for the infant. Choice of replacement fluid for the circuit].

Sixty-five infants were submitted to complete repairment of a congenital cardiopathy under profound hypothermia and ECC. Description of the preparation of the young surgical patient, of the anesthesia, of the technique of ECC. The overall mortality was 35.5 p. 100. The hypothermia induced by ECC, does not introduce any supplementary risks as long as strict technical rules are respected.

Anesthesia

[Anesthesia for resections-anastomoses of the trachea and the tracheal bifurcation].

Resection and anastomosis of the trachea or the tracheal bifurcation, raises numerous problems, which will be discussed in a series of 81 patients: -there is more or less marked ventilatory insufficiency related to the degree of the stenosis, and difficulties of expectoration responsible for retention of sputum; -per-operative ventilation. One must choose between an intubation catheter of small caliber in order to overcome the stenosis, or a large catheter to remain above it. The problem is all the more delicate to solve when the stenosis is tighter and higher; -during the period when the trachea is open, the surgeon must intubate the central part of the trachea with a sterile catheter. If the division is low, it is necessary to intubate the main bronchi or one only, and then create a marked shunt effect which would be ill-supported by the patient; -It is advisable to remove the catheter at the end of the operation. Awakening should be perfect in order to cough to be immediately efficacious in a patient who often has to remain with his head flexed forwards.

Adolescent

[Anantomical aspects and surgical treatment of pulmonary stenoses and atresias with intact interventricular septum in the newborn and the infant under 6 months].

The series presented consists of 25 babies (18 of which were neonates), seen between 1972 and 1974. The anatomical and angiographic study revealed 5 anatomical types, according to whether the pulmonary orifice was patent or atretic, and according to the size of cavity of the right ventricle, which may be normal or reduced (perhaps almost totally). The diagnostic clinical features and findings on angiography are recalled. The operative procedure in all 25 cases was pulmonary valvotomy carried out with a brief normothermic period of cirulatory arrest. The technique is described briefly. The results, which vary widely with the anatomical type, were as follows: out of the 25 operated cases there were 12 deaths during or immediately after surgery. The figures are none-the-less encouraging, given the grave natural history of this condition in the baby. The best results were seen in cases in which there was a right ventricular cavity of normal or at least acceptable size. The maximum postoperative follow-up period was 3 years. Most of these children have a persistant pulmonary stenosis and hypertrophic right ventricle, and require a second operation in early infancy.

Follow-Up Studies

[Atheromatous stenosis of the left coronary trunk. 28 surgical cases].

22 patients with atheromatous narrowing of the left coronary trunk underwent surgery between 1969 and 1974. Most of these patients had severe and incapacitating angina pectoris. The clinical features are readily explained by the size of the diffuse anatomical lesions, which are to be found on the left coronary trunk as well as on the three coronary vessels themselves. This series has not confirmed the serious risk of surgery in such cases, as there were no operative deaths. Secondary mortality was low (9%), and the 20 survivors (average length of follow-up: 26 months) were mostly (18/20) in an excellent condition functionally. These facts have lead us to advise surgery whenever possible.

Adult

[Congenital cardiopathies appearing during the neonatal period. The view points of the cardiologist, the hemodynamics specialist, the surgeon, and the anesthetist].

The best chances of survival for a new-born depend on the following factors: the possibility of clinical and haemodynamic diagnosis of the malformation, adequate reanimation and surgery. All this must be carried out as early as possible. Although catheterization is very risky it should be complete and as fast as possible, under monitoring of ventilation and haemodynamies. Reanimation is very important before, during and after surgery; it should be more preventive than curative. Very often, surgery is only palliative at this age. Taking into account progress in surgical techniques, the authors report their experience in anaesthesia and ressuscitation of 100 patients under 10 days old. They were all operated on in Laennec in Professor MATHEY's department but only some of them were catheterized there.

Anesthesia, General