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At least 127 records · Page 7Linked to original sources
PubMed1991

[Changes in plasma histamine and catecholamines levels after injection of chymopapain in chemonucleolysis].

Because pruritus, erythema and tachycardia are observed in some patients during chemonucleolysis, a prospective study was designed to investigate the plasma levels of histamine and catecholamines occurring after an injection of chymopapain. Thirteen patients (11 men and 2 women), mean age 38 +/- 11 years, were studied. They all had negative prick skin tests, human basophil degranulation tests (HBDT) and radio-absorbent tests (RAST) to chymopapain. The patients were premedicated with 100 mg hydroxyzine and 3 g tranexamic acid. Sedation was carried out using 0.1 mg.kg-1 droperidol and 0.02 mg.kg-1 phenoperidine. The nucleosus pulposus was visualized with 3 ml of contrast medium (lopamiron 300); 2 ml of chymopapain were then injected. Blood samples were obtained at T1 (after the contrast medium, but before the chymopapain), and then 5, 10, 15, 20 and 30 minutes after the chymopapain. The usual haemodynamic parameters were recorded at the same times. Four patients had clinical signs (group I), whereas the other nine (group II) did not. There was an increase in histamine levels in three patients from group 1, as well as in two in group II (up to 33 nmol.l-1). However, mean histamine and catecholamines levels were comparable in both groups at all times, and between times, of sampling. There therefore was no relationship between clinical signs and the release of histamine or catecholamines. The premedication with an antihistamine may have protected the patients, but the signs reported by four patients may also be due to the chymopapain itself.

Adult↗
PubMed1991

[Effectiveness of the Cell Saver and salvage from ultrafiltered extracorporeal circulation in heart surgery].

The efficiency of two intraoperative techniques of blood saving were compared prospectively. During a period of eight months, in 120 adults patients undergoing heart surgery with a cardiopulmonary bypass (CPB). They all had blood removed before the start of CPB for isovolaemic haemodilution. They were randomly assigned to two groups (n = 60 for each): for group A patients, blood was salvaged during surgery before the start of the CPB, during cardioplegia, and from the CPB circuit at the end of surgery, using a Cell Saver 1V (Haemonetics), and returned to the patient in theatre or in intensive care; in group B patients, blood in the CPB circuit at the end of surgery was ultrafiltered and returned to the patient at the same time as 0.8 mg.kg-1 protamine sulfate. The same anaesthetic protocol was used in all the patients (flunitrazepam, phenoperidine and pancuronium bromide). There was no significant difference between the two groups in the volume of blood removed at the start of surgery (9.12 +/- 2.01 ml.kg-1 (A) vs. 8.85.2.22 ml.kg-1 (B)), in the amounts of replacement fluid (Haemaccel, 4% albumin) given to maintain volaemia, and in postoperative blood loss Red cell count, haemoglobin level and haematocrit were higher in the Cell Saver group at the third postoperative hour and on the first postoperative day, whereas fibrinogen levels and platelet count were higher in the ultrafiltration group at the same times. A mean of 1.02 +/- 1.71 homologous blood units were given to group A and 1.45 +/- 1.71 in group B (not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Perforation of the esophagus during attempted endotracheal intubation].

A case is reported of oesophageal perforation which occurred during an attempt to carry out endotracheal intubation. A 54-year-old female patient was scheduled for mastectomy. She had no clinical features likely to predict a difficult endotracheal intubation. After induction with thiopentone, phenoperidine and suxamethonium, three attempts were made to carry out tracheal intubation with a Mallinckrodt Lo-pro tube, internal diameter 7.5 mm. During the third attempt, the oesophagus was accidentally intubated. The diagnosis was made before any insufflation was carried out. Another anaesthetist took over, and intubated the patient. At that time, there was left-sided cervical emphysema which quickly spread. An oesophageal perforation was suspected, and the patient was given 500 mg of metronidazole and 1 g of cefotetan. Postoperatively, the antibiotics were continued, and the patient had nothing by mouth. Oesophagography showed a posterior fistula in the upper third. Conservative treatment was continued until the seventh day, when another oesophagography was carried out. This showed that the perforation had completely healed. This rather rare complication of endotracheal intubation may have a poor prognosis if it results in mediastinitis. The diagnosis and prognosis of this complication and its treatment, whether conservative or surgical, are discussed.

Esophageal Perforation↗
PubMed1992

[Hemodynamic effects of bathing in severe burnt patients].

Repeated water immersion is currently used in France in the treatment of severe burn injury. A prospective study was carried out to assess the haemodynamic effects of immersing such patients in a half sitting position in water, the temperature of which was kept at 35 degrees C. The burn exceeded 50% of body surface area (BSA), with at least 30% being third degree burns. The study was carried out during the first bath, three days after the injury. The patients were immersed up to the clavicles. They were sedated with 2 mg.h-1 of both flunitrazepam and phenoperidine, and were mechanically ventilated. The following haemodynamic parameters were monitored: heart rate, arterial blood pressure (the transducer being level with the arterial catheter), right atrial and pulmonary arterial pressures (the transducer being level with the right atrium, level which had been marked on the chest before immersion and placed two intercostal spaces higher after immersion because of the change in position of the heart). The cardiac output was measured using the thermodilution method. The patient's temperature was monitored with the thermistance of the Swan-Ganz catheter. Values were obtained before immersion, after 15 and 30 minutes of immersion, and 5 minutes after the end of the bath. Nine patients were included, 2 women and 7 men, aged between 24 and 45 years, weighing 73.7 kg on average. Burn size was 78% of BSA (range 64 to 95%). Water immersion was maintained for 34 +/- 3 min. The right atrial, mean pulmonary arterial, and wedge pressures, and the cardiac and systolic indices increased.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Monitoring of intracranial pressure with intraparenchymal fiberoptic transducer. Technical aspects and clinical reliability].

A fiberoptic intracranial pressure transducer (Camino) was assessed prospectively in 100 patients. In all, 122 sensors were inserted intraparenchymally at the bedside, without the help of a neurosurgeon. Before the procedure, patients were given 2 to 4 mg of phenoperidine. The scalp was opened over a few millimeters in the frontal paramedian area. A burr holc was made with a 2 mm bit. The dura mater was opened and a hollow screw inserted in the diploë. When the zero of the transducer had been obtained, a 5 cm length was inserted within the screw. The transducer was then about 5 mm deep within cerebral parenchyma. The procedure took an average of about 15 min. An intracerebral haematoma around the transducer occurred five times. One had to be drained surgically. There were no infectious complications. The daily baseline drift was about 0.3 mmHg. The system seemed to be reliable: there was close agreement between the intracranial pressure (ICP), neurological status and CT scan findings. In trauma cases, there was also good correlation between mean ICP and the basal cistern obliteration score, finally, ICP became equivalent to mean arterial blood pressure in all brain dead patients. It is concluded that this system may be used in all cases where ICP requires to be monitored, even when the lateral ventricles are no longer visible, or when craniotomy has been performed. This will most probably result in a more extended use of ICP monitoring in neurosurgical intensive care.

Adolescent↗
PubMed1994

[Treatment of acute colonic pseudoobstruction (Ogilvie's syndrome) by cisapride].

A case is reported of a 68-year-old woman admitted in the ICU for acute exacerbation of a chronic obstructive respiratory disease. The trachea was intubated and the lungs ventilated mechanically. She received sedation including midazolam and phenoperidine 1 mg.h-1. On the 6th day, she experienced a massive colonic dilation (caecal diameter of 10 cm at X-ray examination). A colonoscopy was performed which showed the absence of obstruction, confirmed the diagnosis of pseudo-obstruction of the colon and allowed a decompression which was inefficient. A new colonoscopic decompression was performed on the 8th day, without prolonged effect. At that time, the patient was given cisapride in her gastric tube (80 mg). This treatment restarted the bowel movements within 48 hours and the caecal diameter decreased immediately to 7 cm. Cisapride was maintained for 10 days and mechanical ventilation for 30 days. No further dilation occurred during this time and the patient was discharged from the ICU. Few cases of Ogilvie's syndrome successfully treated with cisapride have been reported in the literature. The efficacy of this agent for the treatment of Ogilvie's syndrome remains to be assessed in a controlled study.

Aged↗
PubMed1984

[Anesthesia protocol in the swine. Effects of bleeding on circulation and acid-base equilibrium].

Haemodynamic parameters and their variations after the loss of 250 and 500 ml of blood under anaesthesia were studied in nine, 11 to 12 week-old, domestic swine weighing 37.4 +/- 2.6 kg. Premedication consisted of 2 ml azaperone i.m. Anaesthesia was induced with thiopentone, followed by suxamethonium to allow the easy placement of a cuffed endotracheal tube. Anaesthesia was maintained with phenoperidine and pancuronium. The animals were mechanically ventilated with a 50/50 nitrous oxide-oxygen mixture. A catheter was inserted in each of the femoral artery, upper hepatic vein, vena cava and portal vein. Right atrial, pulmonary and wedge pressures were measured; stroke volume, systemic and pulmonary resistances were calculated (fC 90 c X min-1, Pa 82 mmHg, Pra 4.7 mmHg, Ppa 24 mmHg, Ppw 11.6 mmHg, Q 4.45 l X min-1 and Rsa 1460 dyn X s X cm-5). The swine were then bled. After a bleed of 250 ml (t1), the haemodynamic parameters were significantly modified. After another bleed of 250 ml (t2), the heart rate only was significantly higher than at t1; but the blood transfusing could not re-establish a normal haemodynamic state. Blood samples were obtained to measure pH and total CO2 in a systemic artery, and the upper hepatic veins, vena cava and portal vein: the results suggested that the liver took part in the removal of acid metabolites.

Acid-Base Equilibrium↗
PubMed1987

[Anesthesia for the surgery of malignant pheochromocytoma. Hypertensive crisis after the administration of droperidol].

A case of malignant phaeochromocytoma is reported. Computerized tomography and scintigraphy using metaiodobenzylguanidine localized the tumour and metastases. The anesthetic management included invasive monitoring of pulmonary pressures with a Swan-Ganz catheter and arterial pressure with a radial arterial cannula. Plasma catecholamine concentrations were measured before and during adrenalectomy and resection of a metastatic lesion on the fourth right rib. Induction of anaesthesia was carried out with droperidol, phenoperidine, thiopentone and pancuronium. After intravenous administration of droperidol, blood pressure increased together with the heart rate, vascular resistances and pulmonary pressure, whilst cardiac output decreased. Plasma noradrenaline levels were also greatly increased at the same time. The mechanism of this paradoxic pressor effect of droperidol is discussed.

Adrenal Gland Neoplasms↗
PubMed1987

[Effects of isoflurane on bleeding in microsurgery of the middle ear].

40 patients undergoing middle ear microsurgery were anaesthetized with a narconeuroleptanalgesia (droperidol, phenoperidine, thiopentone) associated with a randomly selected halogenated volatile anaesthetic, either halothane or isoflurane at a concentration of 1 MAC. Clinical and haemodynamic tolerance was perfect. Respiratory and haemodynamic parameters were not significantly different in either series at the different moments that were common to all the operations. There was less bleeding in the isoflurane group, and it was stable (p less than 0.01). Isoflurane would seem to have the double advantage of maintaining anaesthesia and producing a bloodless surgical field, so avoiding the use of added hypotensive agents.

Adult↗
PubMed1988

[Comparison of the action kinetics of alcuronium and vecuronium by electromyographic monitoring].

Twenty-eight ASA I or ASA II adults undergoing microsurgery were anaesthetized according to a standard protocol using droperidol, phenoperidine and thiopentone followed by enflurane. The patients were randomly assigned to two homogeneous groups: the first group (n = 14) received 0.2 mg.kg-1 alcuronium, whereas the second group (n = 14) received 0.08 mg.kg-1 vecuronium. There was no reinjection of either drug and curarization tapered off spontaneously. Neuromuscular monitoring was begun once anaesthesia was stable and after intentional isovolaemic haemodilution. The type of stimulus used was the train-of-four, delivered by a Relaxograph monitor to the ulnar nerve. Muscle response was measured at the hypothenar eminence. The kinetic study considered the time interval required between the injection of the muscle relaxant and the appearance of the minimal value of the twitch (first response of the train-of-four = T1min). The times to recovery of the twitch height to 25, 75 and 100% of the reference value (T1/T0) and of the fourth response of the train-of-four to 25 and 75% of the ratio (T4/T1) were also recorded. Finally, the recovery indexes represented by the times required for T1/T0 and T4/T1 to rise from 25% to 75% respectively were studied. The maximal twitch height inhibition was significantly greater (p less than 0.001) in the vecuronium group (T1min = 0.36 +/- 1.33%) than in the alcuronium group (T1min = 4.36 +/- 5.08%); it occurred significantly more quickly (p less than 0.001) with vecuronium (139 +/- 48 s) than with alcuronium (316 +/- 133 s).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

[Changes in intraocular pressure during anesthesia with intratracheal intubation or laryngeal mask].

OBJECTIVE: To compare the effects of the laryngeal mask airway (LMA), and the tracheal tube (TT) insertion on intra-ocular pressure (IOP) in eye surgery. STUDY DESIGN: Prospective non-randomized study. PATIENTS: Eighty patients scheduled for eye surgery under general anaesthesia were allocated into either a LMA group (n = 37) or a TT group (n = 43). METHODS: After induction of anaesthesia with propofol, vecuronium and phenoperidine, either a TT or a LMA were inserted. IOP, heart rate (HP) and mean arterial pressure (MAP) were measured before (TO) and after induction (T1), after TT or LMA insertion (20 s:T2, 6 min:T3), and before extubation (T4). RESULTS: The HR, MAP and IOP increased significantly at T2 (compared to T1 but not to T0) in the TT group, for a short time, whereas no significant changes occurred in the LMA group. CONCLUSION: LMA insertion does not elicit significant haemodynamic or IOP changes. Conversely, the TT increases HR, MAP and IOP. These changes can be deleterious in case of emergency surgery for perforating eye injuries. The LMA can be recommended as an alternative to TT in eye surgery, provided security rules are followed, because of the risk of displacement of LMA during surgery.

Adult↗
PubMed1978

Premedication for upper gastrointestinal endoscopy: a comparative study of flunitrazepam, diazepam and neuroleptanalgesia.

Flunitrazepam or diazepam with atropine and a combination of phenoperidine, droperidol and cyclizine (neuroleptanalgesia) were compared as premedication in three groups of 25 patients undergoing routine upper gastrointestinal endoscopy. Drug doses were titrated carefully against response and all three regimes were found to be similar in terms of safety, patient co-operation, relaxation and speed of recovery. Neuroleptanalgesia however produced a statistically significant rise in endtidal pCO2 and systolic blood pressure. The benzodiazepines, and in particular flunitrazepam, produced a significantly greater amnesia for the procedure, patients given these drugs being more willing to undergo repeat endoscopy.

Anti-Anxiety Agents↗
PubMed1977

Anaesthetic management of patients with phaeochromocytoma. A review of 102 cases.

A total of 102 patients with phaeochromocytoma who underwent surgery by the same team between 1964 and 1976 were allocated to three groups according to the anaesthetic protocol used: (1) balanced anaesthesia and control of hypotension with noradrenaline; (2) anaesthesia with halothane and replacement of blood volume; (3) neuroleptanalgesia (droperidol and phenoperidine) and replacement of blood volume. None of the patients in any of the three groups received adrenergic inhibitors before anaesthesia. Comparison of the results in the three groups revealed that the major factor responsible for reduction of operative mortality to almost zero was control of hypotension by replacement of blood volume rather than by the use of noradrenaline following resection of the tumour, whereas the type of anaesthetic agent used was of secondary importance.

Adolescent↗
PubMed1978

Effect of certain anaesthetic agents on the activity of rat hepatic delta-aminolaevulinate synthase.

The activity of delta-aminolaevulinic acid synthase (E.C.2.3.1.37) (the rate-limiting enzyme for haem and porphyrin biosynthesis) has been measured in the rat liver after the repeated administration of anaesthetic agents in vivo. The activity of the enzyme was increased by Althesin, chlordiazepoxide, enflurane, etomidate, lignocaine, methohexitone, methoxyflurane, pentazocine and thiopentone and decreased by procaine. No significant changes in activity occurred after the administration of amethocaine, atropine, bupivacaine, diazepam, droperidol, halothane, ketamine, morphine, nitrous oxide, pethidine, phenoperidine, prilocaine and propanidid. It is suggested that those anaesthetic agents which induced activity of the enzyme should not be administered to patients with an acute porphyria.

5-Aminolevulinate Synthetase↗
PubMed1982

Controlled comparison of I.M. morphine and buprenorphine for analgesia after abdominal surgery.

In a double-blind randomized non-crossover trial 47 patients received either morphine or buprenorphine by regular i.m. injection for 24 h after abdominal surgery. The two drugs were equally effective as analgesics at the doses used. Five in the buprenorphine group and none in the morphine group were excluded because of respiratory depression. Four of these had received opiates during operation. The remainder of the buprenorphine group developed progressively slower respiration rates after 12 h. The results indicate that buprenorphine has a synergistic respiratory depressant effect with fentanyl and phenoperidine and may have a cumulative effect when given regularly on a 6-hourly regimen.

Adolescent↗
PubMed1985

Circulatory responses to thiopentone and tracheal intubation in patients with coronary artery disease. Effects of pretreatment with labetalol.

The haemodynamic responses to induction and tracheal intubation have been studied in patients with coronary artery disease randomly assigned to a labetalol pretreatment group (n = 14) or to a placebo group (n = 16). Twelve hour before operation, treated patients received a bolus dose of labetalol 0.5 mg kg-1 followed by a constant infusion of 0.1 mg kg-1 h-1 i.v. Anaesthesia was induced with thiopentone and phenoperidine, and intubation performed following the administration of suxamethonium. At intubation, the changes in heart rate (P less than 0.01), mean arterial pressure (P less than 0.05) and rate-pressure product (P less than 0.01) were significantly smaller in the labetalol group compared with the placebo group. Labetalol pretreatment appears satisfactory and may be useful in patients with coronary artery disease who have a normal left ventricular ejection fraction.

Anesthesia, General↗
PubMed1993

Effect of bolus doses of midazolam on intracranial pressure and cerebral perfusion pressure in patients with severe head injury.

We have studied the effects of bolus doses of midazolam 0.15 mg kg-1 i.v. on intracranial pressure (ICP), mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) in 12 patients with severe head injury (Glasgow Coma Scale score < or = 6). The study was performed in patients aged 17-44 yr who were sedated (phenoperidine 20 micrograms kg-1 h-1) and paralysed (vecuronium 2 mg h-1). Midazolam reduced MAP from 89.0 mmHg to 75.0 mmHg (P < 0.0001), while CPP decreased from 71.0 mmHg to 55.8 mmHg (P < 0.0001). During the study, CPP decreased to less than 50 mmHg in four patients. Midazolam induced small, non-significant changes in ICP. However, when control ICP was less than 18 mmHg (n = 7 patients), an increase in ICP was observed. The remaining five patients (control ICP > or = 18 mmHg) exhibited a slight decrease in ICP. These findings suggest that bolus administration of midazolam should be performed with great caution in patients with severe head injury, especially when ICP is less than 18 mmHg.

Adolescent↗
PubMed1990

Effects of propofol on cerebral hemodynamics and metabolism in patients with brain trauma.

The authors determined the effect of propofol on cerebral blood flow, intracranial pressure, and cerebral arteriovenous oxygen content difference in severely brain-injured patients during orthopedic treatment of fractures of the extremities. The Glasgow Coma Scale score was 6 or 7 at the time of the study. Data were collected in the operating room before and during (5 and 15 min) administration of propofol (2 mg/kg iv bolus immediately followed by a 150 micrograms.kg-1.min-1 infusion) before surgical stimulation. Propofol was infused during 41.4 +/- 7.3 min. After operation, the last set of measurements was made 15 min after propofol was stopped. The study was performed on 10 adults (age range, 15-40 yr) whose lungs were mechanically ventilated (air/O2) and who were sedated (phenoperidine, 1 mg/h), and was conducted using a radial artery cannula; a 7.5-Fr, thermodilution, flow-directed, pulmonary artery catheter; an intraventricular catheter; and a catheter in the jugular venous bulb. The 133xenon intra-internal carotid artery injection technique was used to determine regional cerebral blood flow (rCBF). Anesthetic blood concentration of propofol (3-5 micrograms/ml) was associated with decreases in cerebral perfusion pressure (CPP; from 82 +/- 14 to 59 +/- 7 mmHg; P less than 0.001), rCBF (from 35 +/- 6 to 26 +/- 5 ml.100 g-1.min-1; P less than 0.001), and intracranial pressure (ICP; from 11.3 +/- 2.6 to 9.2 +/- 2.5 mmHg; P less than 0.001). Cerebrovascular resistance and cerebral arteriovenous oxygen content difference were unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗