References of "BONHOMME, Vincent"
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See detailAnesthésie pour la chirurgie hypophysaire
Bonhomme, Vincent ULg; Franssen, Colette ULg; Hans, Pol ULg

in Ravussin, Patrick; Vincent, Jean-Louis; Martin, C. (Eds.) Le point sur le patient neuro-chirurgical (2004)

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See detailThe rationale for perioperative brain protection
Hans, Pol ULg; Bonhomme, Vincent ULg

in European Journal of Anaesthesiology (2004), 21(1), 1-5

Perioperative brain protection refers to prophylactic measures instituted during the perioperative period to prevent or reduce ischaemic damage and to improve neurological outcome. In that context ... [more ▼]

Perioperative brain protection refers to prophylactic measures instituted during the perioperative period to prevent or reduce ischaemic damage and to improve neurological outcome. In that context, strategies for protecting the brain rely on the control of physiological variables, anaesthesia, administration of non-anaesthetic pharmacological agents and preconditioning. Avoiding hyperthermia, hyperglycaemia and arterial hypotension are passive neuroprotective measures acknowledged in human beings. The protective effect of anaesthesia, compared to the awake state, is demonstrated in animals but remains to be validated in clinical practice. Laboratory studies investigating pharmacological neuroprotection have shown interesting results but most clinical trials have been disappointing except for a few drugs in specific settings. Preconditioning which results in the induction of some resistance to ischaemia appears as a promising strategy. Up to now, the translation of beneficial experimental results into clinical success is considered an entirely permissible hope but remains an unachieved objective. [less ▲]

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See detailPotential neuroprotective properties of atracurium and cisatracurium in neurosurgical anaesthesia
Hans, Pol ULg; Bonhomme, Vincent ULg

in European Journal of Anaesthesiology (2004), 21(4), 334-335

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See detailPrise en charge anesthesique des craniotomies en etat vigile.
Bonhomme, Vincent ULg; Born, J.-D.; Hans, Pol ULg

in Annales Françaises d'Anesthésie et de Réanimation (2004), 23(4), 389-94

This review article presents a detailed analysis of patients' management for awake craniotomy, at the light of the available data in the literature and the authors' experience. Indications of this type of ... [more ▼]

This review article presents a detailed analysis of patients' management for awake craniotomy, at the light of the available data in the literature and the authors' experience. Indications of this type of surgery are discussed as well as anaesthetic management itself, from preoperative assessment of the patient to peroperative concerns. Anaesthetic strategy, choice of anaesthetic agents, anaesthetic technique, and management of the airway and possible complications are discussed. The authors emphasize the tricky aspect of the procedure, the necessity of rigorous patient selection and good preparation. They emphasize the need for controlled studies to validate the proposed techniques. [less ▲]

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See detailMonitoring depth of anaesthesia: is it worth the effort?
Bonhomme, Vincent ULg; Hans, Pol ULg

in European Journal of Anaesthesiology (2004), 21(6), 423-8

In this review paper, the authors critically analyse the use of a number of depth of anaesthesia monitors in light of the most recent literature and their own clinical experience. There appears to be ... [more ▼]

In this review paper, the authors critically analyse the use of a number of depth of anaesthesia monitors in light of the most recent literature and their own clinical experience. There appears to be increasing evidence that anaesthesia depth monitors reduce the incidence of unexpected intraoperative awareness and also that they improve the quality of anaesthesia. Proper use of these monitors necessitates background knowledge about the physiology of the loss of consciousness, the type of variable recorded and processed by the monitoring devices, the factors that might interfere with recording and the limits of use. The information provided by anaesthesia depth monitors is detailed and relationships with clinical practice are established to provide the reader with key features for optimal use of those monitors and correct interpretation of data. Practitioners and patient's knowledge and expectations regarding this matter, as well as the cost-benefit relationship are also discussed. [less ▲]

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See detailLes agents anesthésiques hypnotiques, les opiacés et les myorelaxants en neuroanesthésie
Albanèse, J.; Bonhomme, Vincent ULg; Hans, Pol ULg

in Ravussin, Patrick; Vincent, Jean-Louis; Martin, C. (Eds.) Le point sur le patient neuro-chirurgical (2004)

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See detailEffect of intra-operative magnesium sulphate on pain relief and patient comfort after major lumbar orthopaedic surgery
Levaux, Christine ULg; Bonhomme, Vincent ULg; Dewandre, Pierre-Yves et al

in Anaesthesia (2003), 58(2), 131-135

The effects of intra-operative magnesium sulphate on pain relief after major lumbar surgery were investigated in 24 patients. Patients were randomly allocated to receive either an infusion of 50 mg x kg ... [more ▼]

The effects of intra-operative magnesium sulphate on pain relief after major lumbar surgery were investigated in 24 patients. Patients were randomly allocated to receive either an infusion of 50 mg x kg(-1) magnesium sulphate or an equivalent volume of saline at induction of anaesthesia. Anaesthesia was induced with propofol and remifentanil. Tracheal intubation was facilitated using rocuronium. Maintenance was achieved with remifentanil and sevoflurane in nitrous oxide/ oxygen. Intra-operative monitoring included standard equipment and neuromuscular transmission. During surgery, neuromuscular block recovery was longer in the magnesium group. Postoperative opioid consumption and pain scores were lower in the magnesium group. The first night's sleep and the global satisfaction scores were better in the magnesium group. The results of the study support magnesium sulphate as a useful adjuvant for postoperative analgesia after major lumbar surgery. [less ▲]

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See detailEpidural hematoma after cervical spine surgery.
Hans, Pol ULg; Delleuze, Pierre Philippe; Born, Jacques Daniel et al

in Journal of Neurosurgical Anesthesiology (2003), 15(3), 282-5

The authors report an acute epidural hematoma after the surgical removal of a cervical C6-C7 disc herniation through an anterolateral approach of the cervical spine. Clinical history consisted of ... [more ▼]

The authors report an acute epidural hematoma after the surgical removal of a cervical C6-C7 disc herniation through an anterolateral approach of the cervical spine. Clinical history consisted of respiratory distress and flaccid tetraplegia that appeared 2.5 hours after surgery. Without any complementary radiologic investigation, the patient was immediately transferred to the operating room for a second look, which was unsuccessful. Magnetic resonance imaging performed after this second surgical procedure showed an anterior cervical hematoma extending from C3 to T3 without significant spinal cord compression. A cervical laminectomy was performed to evacuate the hematoma. The patient was extubated the next morning and discharged from the hospital after 5 days with no residual neurologic deficit. An extensive postoperative investigation revealed no coagulation disorder. [less ▲]

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See detailMuscle relaxants in neurosurgical anaesthesia: a critical appraisal.
Hans, Pol ULg; Bonhomme, Vincent ULg

in European Journal of Anaesthesiology (2003), 20(8), 600-5

The use of muscle relaxants, considered until recently as common practice in current neurosurgical anaesthesia protocols, becomes increasingly more questionable today. The reasons rely on the evolution of ... [more ▼]

The use of muscle relaxants, considered until recently as common practice in current neurosurgical anaesthesia protocols, becomes increasingly more questionable today. The reasons rely on the evolution of neurosurgery including the advent of new surgical techniques, the evolution of anaesthesia having the benefit of new drugs and devices, and the rationale for using muscle relaxants balanced against their potential side-effects and possible pharmacodynamic alterations in neurosurgical patients. [less ▲]

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See detailPrise en charge perioperatoire des pertes sanguines au cours du traitement chirurgical des craniostenoses
BONHOMME, Vincent ULg; Damas, François ULg; Born, J. D. et al

in Annales Françaises d'Anesthésie et de Réanimation (2002), 21(2), 119-25

Blood saving is the major challenge during the surgical repair of craniofacial deformities. Treated patients have a low reserve volume and the techniques available to lower homologous blood transfusions ... [more ▼]

Blood saving is the major challenge during the surgical repair of craniofacial deformities. Treated patients have a low reserve volume and the techniques available to lower homologous blood transfusions are limited or insufficiently evaluated in this particular case. The most important factor determining blood loss is the quality of the surgical haemostasis. Blood saving begins with early preoperative evaluation of the patient's bleeding risk, which is a function of the type of surgery, of the surgical technique, of the number of sutures involved, of the length of surgery, and of the patients age, weight and physical status. Elaborated blood saving techniques such as preoperative autologous blood donation, erythropoietin administration, normovolaemic haemodilution, and peroperative autologous blood saving and reinfusion have revealed disappointing where used alone. These techniques require a heavy setup and still need to be evaluated extensively. They should be used in selected cases such as in patients with a very high risk of bleeding or face to Jehovah Witnesses. Monitoring during surgery should include precise evaluation of blood losses and haematocrit measurements at regular intervals. The haematocrit threshold allowing homologous blood transfusion should be set at 21%, provided that any other source of autologous blood is exhausted. Postoperative monitoring should also include precise evaluation of blood losses and haematocrit measurements. The 21% threshold should remain the reference during that period. [less ▲]

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See detailEpidural administration of low-dose morphine combined with clonidine for postoperative analgesia after lumbar disc surgery
Bonhomme, Vincent ULg; Doll, Anne; Dewandre, Pierre-Yves et al

in Journal of Neurosurgical Anesthesiology (2002), 14(1), 1-6

This study evaluates the efficacy and side effects of a low dose of epidural morphine combined with clonidine for postoperative pain relief after lumbar disc surgery. In 36 of 51 patients who accepted the ... [more ▼]

This study evaluates the efficacy and side effects of a low dose of epidural morphine combined with clonidine for postoperative pain relief after lumbar disc surgery. In 36 of 51 patients who accepted the procedure, an epidural catheter was inserted (L1-L2 level). General anesthesia was induced with propofol and sufentanil, and maintained with sevoflurane in O2/N2O. After emergence from anesthesia, epidural analgesia was initiated according to two randomly assigned protocols: 1 mg of morphine with 75 microg of clonidine (Group M) or 12.5 mg of bupivacaine with 75 microg of clonidine (Group B), in 10 mL saline. Piritramide was administered during the first postoperative 24 hours using a patient-controlled analgesia device (PCA). The following parameters were recorded: piritramide consumption during the first 24 hours; pain at rest during the first postoperative hours (D0), during the first night (D1), and during the first mobilization; [visual analogue scale (VAS)]; and the occurrence of drowsiness, motor blockade, respiratory depression, nausea, vomiting, itching, micturition problems, and bladder catheterization during D0 and D1. Epidural administration of morphine-clonidine significantly improved postoperative pain relief and reduced piritramide consumption as compared to epidural bupivacaine-clonidine. Side effects did not differ between groups except for a higher incidence of micturition problems in Group M during D1. The occurrence of bladder catheterization was not significantly higher in that group. We conclude that a low dose of epidural morphine combined with clonidine offers a better postoperative analgesia than does bupivacaine-clonidine. The excellent analgesic conditions were obtained at the expense of a higher incidence of difficulties in initiating micturition. [less ▲]

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See detailRéanimation cardiopulmonaire chez la femme enceinte
Brichant, Jean-François ULg; Dewandre, Pierre-Yves ULg; Bonhomme, Vincent ULg et al

in Praticien en Anesthésie Réanimation (Le) (2002), 6

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See detailNeuroprotection with Anaesthetic Agents
Hans, Pol ULg; BONHOMME, Vincent ULg

in Current Opinion in Anaesthesiology (2001), 14(5), 491-6

The term 'neuroprotection' is used to refer to any prophylactic measure that is initiated during the peri-ischaemic period in order to improve neuronal survival. Cell death after ischaemia has an ... [more ▼]

The term 'neuroprotection' is used to refer to any prophylactic measure that is initiated during the peri-ischaemic period in order to improve neuronal survival. Cell death after ischaemia has an immediate, necrotic and a delayed, apoptotic origin. The major biochemical mechanisms that are involved in this process include transmembrane ionic fluxes and intracellular calcium increase, excitotoxicity, free radical formation, peroxynitrite production, release of inflammatory mediators, mitochondrial dysfunction, cytochrome c release, and activation of caspases and transcription factors. Strategies of neuroprotection essentially impact on those biochemical pathways. The label 'neuroprotectant' requires that the therapy has basic properties that are consistent with potential mechanisms of neuroprotection, and that conclusive results are available from animal studies that can be converted into clinical benefit. The present review focuses on neuroprotective effects of anaesthetics and is based on the most recently published reports. [less ▲]

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See detailEffect of Nitrous Oxide on the Bispectral Index and the 95% Spectral Edge Frequency of the Electroencephalogram During Surgery
Hans, Pol ULg; Bonhomme, Vincent ULg; Benmansour, H. et al

in Anaesthesia (2001), 56(10), 999-1002

We studied the effect of nitrous oxide on the bispectral index and 95% spectral edge frequency of the electroencephalogram in 20 patients undergoing lumbar surgery under general anaesthesia combined with ... [more ▼]

We studied the effect of nitrous oxide on the bispectral index and 95% spectral edge frequency of the electroencephalogram in 20 patients undergoing lumbar surgery under general anaesthesia combined with epidural administration of 5 mg morphine. [less ▲]

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See detailLes hypernatremies en pathologie neurochirurgicale
Hans, Pol ULg; BONHOMME, Vincent ULg; Damas, François ULg

in Annales Françaises d'Anesthésie et de Réanimation (2001), 20(2), 213-8

Hypernatraemia is defined as an increase in extracellular sodium concentration, associated with plasma hyperosmolality and cellular dehydration. It can result from excessive water loss, from an increase ... [more ▼]

Hypernatraemia is defined as an increase in extracellular sodium concentration, associated with plasma hyperosmolality and cellular dehydration. It can result from excessive water loss, from an increase in the total sodium content or from both mechanisms. As far as neurosurgical pathology is concerned, hypernatraemia due to excessive water loss may be observed in patients who do not sense thirst or are unable to ingest water. Urinary water loss is seen in diabetes insipidus and osmotic diuresis. Extrarenal water losses from pulmonary origin may be observed in intubated or tracheotomized patients. Hypernatraemia with sodium and water retention may be encountered in patients suffering from Cushing diseases or syndromes, or more frequently in those who are given excessive amounts of sodium (hypertonic saline, sodium salts). Clinical manifestations of hypernatraemia consist of neurologic symptoms related to cellular dehydration; their severity is correlated with the rapidity of the onset of the electrolytic disorder. Depending on the pathophysiological mechanism, treatment of hypernatraemia involves stopping sodium intake, restoring normovolaemia and administering hypotonic fluids. Treatment of diabetes insipidus relies on the administration of the antidiuretic hormone and of drugs that increase its secretion rate or its responsiveness in the kidneys. [less ▲]

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See detailTarget-Controlled Infusion of Propofol and Remifentanil Combined with Bispectral Index Monitoring for Awake Craniotomy
Hans, Pol ULg; Bonhomme, Vincent ULg; Born, J. D. et al

in Anaesthesia (2000), 55(3), 255-9

We describe the target-controlled administration of propofol and remifentanil, combined with monitoring of the bispectral index, during an awake craniotomy for removal of a left temporo-parietal tumour ... [more ▼]

We describe the target-controlled administration of propofol and remifentanil, combined with monitoring of the bispectral index, during an awake craniotomy for removal of a left temporo-parietal tumour near the motor speech centre. Target concentrations of the two drugs were adjusted according to the patient's responses to painful stimuli and surgical events, and the need for speech testing. Allowing the effect-site concentrations of propofol and remifentanil to decrease during surgery allowed the performance of cortical speech mapping and the testing of the patient's ability to speak. Although the bispectral index was not used as a guide for the administration of the drugs, its value correlated better with the patient's responsiveness than did the predicted effect-site concentrations of propofol. Side-effects, comprising hypotension, respiratory depression and airway obstruction, were related to rapid increases in drug infusion rates and were easily managed. [less ▲]

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See detailEvaluation of Acute Normovolemic Hemodilution for Surgical Repair of Craniosynostosis
Hans, Pol ULg; Collin, Vincent; Bonhomme, Vincent ULg et al

in Journal of Neurosurgical Anesthesiology (2000), 12(1), 33-6

This clinical report investigated the potential benefit of acute normovolemic hemodilution (ANH) as a blood-saving technique in the surgical repair of craniosynostosis. Over a 4-year period, 34 healthy ... [more ▼]

This clinical report investigated the potential benefit of acute normovolemic hemodilution (ANH) as a blood-saving technique in the surgical repair of craniosynostosis. Over a 4-year period, 34 healthy children undergoing surgical repair of scaphocephaly or pachycephaly were randomly assigned to two groups of 17 patients each. Patients of the first group (ANH group) were submitted to ANH (target Ht: 25%) immediately before surgery and patients of the second group (Control group) were not. During surgery, estimated blood loss was compensated with a 5% albumin solution and no autologous or homologous blood was transfused. At the end of surgery, intraoperative blood loss (mean +/- SD) calculated on the basis of the Ht value and the children weight was 21.3+/-8% of the estimated blood volume (EBV) in the ANH group and 24+/-6.6% in the Control group. Children of the ANH group received their autologous blood (18.9+/-3.3% of EBV) systematically at the end of surgery. In the postoperative period, homologous blood was transfused when the Ht value was equal or less than 21%. Both groups were comparable regarding age, weight, type of craniosynostosis, duration of surgery, EBV, and preoperative Ht value. No difference was observed between ANH and Control groups in the number of patients who received homologous blood (15/17 and 14/17, respectively), in the amount of homologous blood transfused (17+/-4.7% and 19.6+/-6.3% of the EBV, respectively), and in the Ht value before hospital discharge (29.4+/-5.0% and 30.7+/-4.9%, respectively). In conclusion, this report suggests that ANH reduces neither the incidence of homologous transfusion nor the amount of homologous blood transfused in this series of children undergoing surgical repair of craniosynostosis. [less ▲]

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See detailAuditory steady-state response and bispectral index for assessing level of consciousness during propofol sedation and hypnosis.
Bonhomme, Vincent ULg; Plourde, Gilles; Meuret, Pascal et al

in Anesthesia and analgesia (2000), 91(6), 1398-403

We assessed the effect of propofol on the auditory steady-state response (ASSR), bispectral (BIS) index, and level of consciousness in two experiments. In Experiment 1, propofol was infused in 11 subjects ... [more ▼]

We assessed the effect of propofol on the auditory steady-state response (ASSR), bispectral (BIS) index, and level of consciousness in two experiments. In Experiment 1, propofol was infused in 11 subjects to obtain effect-site concentrations of 1, 2, 3, and 4 microg/mL. The ASSR and BIS index were recorded during baseline and at each concentration. The ASSR was evoked by monaural stimuli. Propofol caused a concentration-dependent decrease of the ASSR and BIS index values (r(2) = 0.76 and 0.93, respectively; P<0.0001). The prediction probability for loss of consciousness was 0.89, 0.96, and 0.94 for ASSR, BIS, and arterial blood concentration of propofol, respectively. In Experiment 2, we compared the effects of binaural versus monaural stimulus delivery on the ASSR in six subjects during awake baseline and propofol-induced unconsciousness. During baseline, the ASSR amplitude with binaural stimulation (0.47+/-0.13 microV, mean +/- SD) was significantly (P<0.002) larger than with monaural stimulation (0.35+/-0.11 microV). During unconsciousness, the amplitude was 0.09+/-0.09 microV with monaural and 0.06+/-0.04 microV with binaural stimulation (NS). The prediction probability for loss of consciousness was 0.97 (0.04 SE) for monaural and 1.00 (0.00 SE) for binaural delivery. We conclude that the ASSR and BIS index are attenuated in a concentration-dependent manner by propofol and provide a useful measure of its sedative and hypnotic effect. BIS was easier to use and slightly more sensitive. The ASSR should be recorded with binaural stimulation. The ASSR and BIS index are both useful for assessing the level of consciousness during sedation and hypnosis with propofol. However, the BIS index was simpler to use and provided a more sensitive measure of sedation. IMPLICATIONS: We have compared two methods for predicting whether the amount of propofol given to a human subject is sufficient to cause unconsciousness, defined as failure to respond to a simple verbal command. The two methods studied are the auditory steady-state response, which measures the electrical response of the brain to sound, and the bispectral index, which is a number derived from the electroencephalogram. The results showed that both methods are very good predictors of the level of consciousness; however, bispectral was easier to use. [less ▲]

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See detailPhysostigmine reverses propofol-induced unconsciousness and attenuation of the auditory steady state response and bispectral index in human volunteers.
Meuret, Pascal; Backman, Steven; Bonhomme, Vincent ULg et al

in Anesthesiology (2000), 93(3), 708-17

BACKGROUND: It is postulated that alteration of central cholinergic transmission plays an important role in the mechanism by which anesthetics produce unconsciousness. The authors investigated the effect ... [more ▼]

BACKGROUND: It is postulated that alteration of central cholinergic transmission plays an important role in the mechanism by which anesthetics produce unconsciousness. The authors investigated the effect of altering central cholinergic transmission, by physostigmine and scopolamine, on unconsciousness produced by propofol. METHODS: Propofol was administered to American Society of Anesthesiologists physical status 1 (n = 17) volunteers with use of a computer-controlled infusion pump at increasing concentrations until unconsciousness resulted (inability to respond to verbal commands, abolition of spontaneous movement). Central nervous system function was assessed by use of the Auditory Steady State Response (ASSR) and Bispectral Index (BIS) analysis of electrooculogram. During continuous administration of propofol, reversal of unconsciousness produced by physostigmine (28 microgram/kg) and block of this reversal by scopolamine (8.6 microgram/kg) were evaluated. RESULTS: Propofol produced unconsciousness at a plasma concentration of 3.2 +/- 0.8 (+/- SD) microgram/ml (n = 17). Unconsciousness was associated with reductions in ASSR (0.10 +/- 0.08 microV [awake baseline 0.32 +/- 0.18 microV], P < 0.001) and BIS (55.7 +/- 8.8 [awake baseline 92.4 +/- 3.9], P < 0.001). Physostigmine restored consciousness in 9 of 11 subjects, with concomitant increases in ASSR (0.38 +/- 0.17 microV, P < 0.01) and BIS (75.3 +/- 8.3, P < 0.001). In all subjects (n = 6) scopolamine blocked the physostigmine-induced reversal of unconsciousness and the increase of the ASSR and BIS (ASSR and BIS during propofol-induced unconsciousness: 0.09 +/- 0.09 microV and 58.2 +/- 7.5, respectively; ASSR and BIS after physostigmine administration: 0.08 +/- 0.06 microV and 56.8 +/- 6.7, respectively, NS). CONCLUSIONS: These findings suggest that the unconsciousness produced by propofol is mediated at least in part via interruption of central cholinergic muscarinic transmission. [less ▲]

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