Surveillance des états hypertensifs sévères

in Gunaïkeia (1997), 2

Le bronchospasme périopératoire

in Les situations critiques au bloc opératoire (1996)

Effect of Plasma Anticonvulsant Level on Pipecuronium-Induced Neuromuscular Blockade: Preliminary Results

in Journal of Neurosurgical Anesthesiology (1995), 7(4), 254-8

Patients receiving anticonvulsants are resistant to nondepolarizing muscle relaxants (NDMR). This study examines the effect of plasma anticonvulsant levels on pipecuronium-induced neuromuscular blockade ... [more ▼]

Patients receiving anticonvulsants are resistant to nondepolarizing muscle relaxants (NDMR). This study examines the effect of plasma anticonvulsant levels on pipecuronium-induced neuromuscular blockade. Twenty adult patients scheduled for neurosurgery were assigned to one of two groups. Group 0 (G0) consisted of 10 patients not on anticonvulsant therapy; group 1 (G1) included 10 patients treated either with phenytoin or carbamazepine. G1 patients were further divided into G1u (n = 4) and G1w (n = 6) subgroups, according to the plasma anticonvulsant level measured the day before surgery--under (G1u) or within (G1w) the therapeutic range. Neuromuscular transmission was monitored with a Biometer International A/S Accelograph. Anesthesia was induced and maintained using propofol and sufentanil. After calibration of the accelograph, a bolus of pipecuronium 0.08 mg/kg was given IV. The time from pipecuronium injection to the peak reduction of T1 was taken as the onset time. The time in min from pipecuronium injection to recovery of T1% (first accelograph response/baseline response) x 100 and TR% (fourth accelograph response/first accelograph response) x 100 were recorded at 25, 50, and 75% of baseline. The recovery index (RI) was taken as the time from 25 to 75% of baseline. The recovery index (RI) was taken as the time from 25 to 75% recovery of the baseline response. The onset time was not different in G0 (203 +/- 60.4 s), G1 (230.5 +/- 79.3 s), and G1u (181.8 +/- 60.4 s) but prolonged in G1w (279.2 +/- 67.7 s).(ABSTRACT TRUNCATED AT 250 WORDS) [less ▲]

Anaesthesia for minimally invasive abdominal surgery

in Recent advances in anaesthesia and analgesia (1995)

Pre-operative respiratory evaluation and preparation: what is important?

in Refresher Course Lectures (1994)

Do canine scalene and sternomastoid muscles play a role in breathing?

in Journal of Applied Physiology (Bethesda, Md. : 1985) (1994), 76(1), 242-52

To assess the respiratory function of the scalene and sternomastoid muscles in the dog, we studied the effect of graded increases in inspiratory airflow resistance and single-breath airway occlusion on ... [more ▼]

To assess the respiratory function of the scalene and sternomastoid muscles in the dog, we studied the effect of graded increases in inspiratory airflow resistance and single-breath airway occlusion on the electrical activity of these muscles in 18 supine anesthetized spontaneously breathing animals. The sternomastoids never showed any activity, and the scalenes showed some inspiratory activity during occlusion in only two animals. The adoption of the prone position and bilateral cervical vagotomy did not affect this pattern. Hypercapnia also did not elicit any sternomastoid activity and induced scalene inspiratory activity during occlusion in only four of nine animals. On microscopic examination, however, both muscles were found to contain large numbers of spindles, suggesting that they have the capacity to respond to stretch. In addition, with increases in inspiratory resistance, both the sternum and ribs were displaced in the caudal direction. As a result, the scalenes demonstrated a gradual inspiratory lengthening and the normal inspiratory lengthening of the sternomastoids was accentuated. Additional studies in three unanesthetized animals showed consistent activity in the scalene and sternomastoid muscles during movements of the trunk and neck but no activity during breathing, including occluded breathing. These observations thus indicate that the alpha-motoneurons of the scalene and sternomastoid muscles in the dog have very small central respiratory drive potentials with respect to their critical firing threshold. In this animal, these muscles do not have a significant respiratory function. [less ▲]

Comparison between Alprazolam and Hydroxyzine for Oral Premedication

in Canadian Journal of Anaesthesia = Journal Canadien d'Anesthésie (1993), 40(1), 13-7

The safety and efficacy of alprazolam and hydroxyzine administered orally as surgical premedicants were compared in a double-blind controlled study. Sixty-five patients were given either alprazolam 1 mg ... [more ▼]

The safety and efficacy of alprazolam and hydroxyzine administered orally as surgical premedicants were compared in a double-blind controlled study. Sixty-five patients were given either alprazolam 1 mg or hydroxyzine 75 mg, one to two hours before surgery. Anxiety was assessed by both the patient and the anaesthetist, the patient using a visual analogue scale, the anaesthetist employing both analogue and ordinal ratings. Sedation was assessed by the anaesthetist only, using the same two methods. Amnesia was appraised with a simple memory test. Safety was assessed by recording adverse effects and measuring haemodynamic variables. Premedication with alprazolam produced a modest reduction in anxiety (28%) (P < 0.01) while hydroxyzine had no detectable effect. The comparison of the sedation level and of the memory test revealed no difference between the two premedicants. Minor side effects were only observed in the hydroxyzine group. Changes in blood pressure were more pronounced in the hydroxyzine group. This study shows that alprazolam and hydroxyzine are safe and efficient oral premedicants. However, alprazolam is preferable to hydroxyzine in terms of anxiolytic and adverse effects. [less ▲]

Epidural anesthesia and intrathoracic blood volume.

in Anesthesia and Analgesia (1993), 77(1), 135-40

To investigate how epidural anesthesia changes intrathoracic gas volume, high epidural anesthesia was administered to five pentobarbital-anesthetized dogs lying supine, and the total intrathoracic volume ... [more ▼]

To investigate how epidural anesthesia changes intrathoracic gas volume, high epidural anesthesia was administered to five pentobarbital-anesthetized dogs lying supine, and the total intrathoracic volume at end-expiration was measured with a high-speed three-dimensional x-ray scanner. The amount of gas in the lungs at end-expiration [the functional residual capacity (FRC)] was measured with a nitrogen washout technique, and the intrathoracic tissue volume, including the intrathoracic blood volume, was calculated as the difference between intrathoracic volume at end-expiration and FRC. High epidural anesthesia with the local anesthetic etidocaine to a T-1 myotomal level significantly (P < 0.05) increased intrathoracic volume at end-expiration [76 +/- 35 mL (M +/- SD)] by significantly increasing both intrathoracic tissue volume (33 +/- 15 mL) and FRC (43 +/- 26 mL). Increases in intrathoracic tissue volume were probably caused by increases in intrathoracic blood volume. We conclude that increases in FRC caused by epidural anesthesia in anesthetized dogs lying supine may be minimized by a concurrent increase in intrathoracic blood volume. These results suggest that measurements of thoracic gas volume alone may be insufficient to describe chest wall responses to epidural anesthesia. [less ▲]

Reversal of Neurological Deficit with Naloxone: An Additional Report

in Intensive Care Medicine (1992), 18(6), 362-3

We report the repeated improvement in neurological function following naloxone administration in a patient who developed acute hemiplegia after an intracranial neurological procedure. The mechanisms ... [more ▼]

We report the repeated improvement in neurological function following naloxone administration in a patient who developed acute hemiplegia after an intracranial neurological procedure. The mechanisms responsible for the neurological deficit and for its reversal by naloxone are discussed. A review of the literature suggests that the beneficial effect of naloxone can result from an improvement in haemodynamic status or from metabolic effects that could be favorable during cerebral ischaemia. [less ▲]

Effets de l'anesthésie péridurale sur le système respiratoire

Doctoral thesis (1991)