Anesthésie du patient asthmatique

Conference (2005, April 27)

Comparative effects of ketamine on Bispectral Index and spectral entropy of the electroencephalogram under sevoflurane anaesthesia

in British Journal of Anaesthesia (2005), 94(3), 336-340

BACKGROUND: The Bispectral Index (BIS) and spectral entropy of the electroencephalogram can be used to assess the depth of hypnosis. Ketamine is known to increase BIS in anaesthetized patients and may ... [more ▼]

BACKGROUND: The Bispectral Index (BIS) and spectral entropy of the electroencephalogram can be used to assess the depth of hypnosis. Ketamine is known to increase BIS in anaesthetized patients and may confound that index as a guide to steer administration of hypnotics. We compared the effects of ketamine on BIS, response entropy (RE) and state entropy (SE) during surgery under sevoflurane anaesthesia. METHODS: Twenty-two women undergoing gynaecological surgery were enrolled in this double-blind, randomized study. Anaesthesia was induced i.v. and maintained with sevoflurane. Under stable surgical and anaesthetic conditions, patients were assigned to receive either a bolus of ketamine 0.5 mg kg(-1) or the same volume of saline. Blood pressure, heart rate, BIS, RE and SE were measured every 2.5 min from 10 min before (baseline) until 15 min after ketamine or saline administration. The maximum relative increase in BIS, RE and SE compared with baseline was calculated for each patient. Values are mean (sd). RESULTS: Baseline values were BIS 33 (4), RE 31 (5), SE 30 (5) for the ketamine patients and BIS 35 (3), RE 33 (5) and SE 32 (6) for the patients receiving saline. BIS, RE and SE increased significantly from 5 min (BIS) and 2.5 min (RE and SE) after ketamine administration, peaking at 46 (8) (BIS), 52 (12) (RE) and 50 (12) (SE) respectively. The maximum relative increase in RE [42.2 (10.4%)] and SE [41.6 (10.9)%] was higher than that of BIS [29.4 (10.4%)]. Blood pressure, heart rate and RE-SE gradient did not change in either group. CONCLUSIONS: Ketamine administered under sevoflurane anaesthesia causes a significant increase in BIS, RE and SE without modification of the RE-SE gradient. This increase is paradoxical in that it is associated with a deepening level of hypnosis. [less ▲]

Shunting the intervillous space: New concepts in human uteroplacentat vascularization

in American Journal of Obstetrics and Gynecology (2005), 192(1), 323-332

Objective: It is supposed that the intervillous space. is not perfused by maternal blood during the first trimester, suggesting vascular shunts in the myometrium. We therefore attempted to provide ... [more ▼]

Objective: It is supposed that the intervillous space. is not perfused by maternal blood during the first trimester, suggesting vascular shunts in the myometrium. We therefore attempted to provide arguments for a functional vascular anastomotic network located in the placental bed during human pregnancy. Study design: Three-dimensional (3D) sonogyraphy, laboratory analyses. and anatomic studies (hysterectomy specimens, uteroplacental vascular cast) were performed. Results: Color Doppler showed a vascular network with anastomotic aspect located in the placental bed. A vascular cast of a uterus. obtained after postpartum hemorrhage. demonstrated a vascular anastomotic network in the myometrium. Higher Po-2 levels in the uterine vein compared with the intervillous space confirmed the functional nature of this Shunt. Low resistances in the uterine arteries during the first week after delivery suggested that this vascular network remains functional after placental expulsion. Conclusion: Our studies have yielded functional and anatomic evidence of an arteriovenous Shunt located in the subplacental myometrium. (C) 2005 Elsevier Inc. All rights reserved. [less ▲]

Maladie thromboembolique périopératoire et obstétricale. Pathologie gynécologique et obstétricale

in Annales Françaises d'Anesthésie et de Réanimation (2005), 24

La position de la SBAR à l'égard de la prémédication

in Acta Anaesthesiologica Belgica (2005), 56

Belgian guidelines concerning central neural blockade in patients with drug-induced alteration of coagulation: an update

in Acta Anaesthesiologica Belgica (2005), 56(2), 139-146

Prepartum management of severe preeclampsia

Conference (2004, December 11)

Pregnancy induced hypertension. Principles of management

Conference (2004, June)

Preoperative evaluation in the developed countries

Conference (2004, April)

Recovery from Neuromuscular Block after an Intubation Dose of Cisatracurium and Rocuronium in Lumbar Disc Surgery

in Acta Anaesthesiologica Belgica (2004), 55(2), 129-33

BACKGROUND AND OBJECTIVE: Residual muscle paralysis remains a concern for anaesthesiologists. This study investigated the recovery from neuromuscular block (NMB) after an intubation dose of cisatracurium ... [more ▼]

BACKGROUND AND OBJECTIVE: Residual muscle paralysis remains a concern for anaesthesiologists. This study investigated the recovery from neuromuscular block (NMB) after an intubation dose of cisatracurium (C) or rocuronium (R) in 32 patients undergoing lumbar disc surgery. METHODS: Anaesthesia was induced with propofol and sufentanil, and maintained with sevoflurane in nitrous oxide/oxygen. Patients were randomised to receive twice the ED95 of either cisatracurium (GC) or rocuronium (GR) before tracheal intubation. After placement in prone position, neuromuscular transmission was monitored at the wrist by accelerometry. NMB was antagonised when the TOF ratio (TOFR) was < 0.75 at muscle closure. The time from muscle relaxant to muscle closure, and to TOFR of 0.25 and of 0.50 were recorded. Data were analysed using Student's t-tests, chi-squared tests and two-way mixed-designed ANOVA's. The prediction probability (Pk) of the times from muscle relaxant to muscle closure, and to TOFR of 0.25 for the necessity to antagonize NMB was calculated in both groups. P < 0.05 was considered statistically significant. RESULTS: NMB was antagonized in 8 (GC) and 6 (GR) patients, respectively. The time from muscle relaxant to muscle closure was shorter in patients whose NMB was antagonized. The Pk of this time was significant in GC (0.85) but not in GR (0.69). In GR contrarily to GC, the times to a TOFR of 0.25 and 0.50 were longer in patients whose NMB was antagonized. The Pk of the time to TOFR of 0.25 was significant in GR (0.95) but not in GC (0.64). CONCLUSIONS: A single dose of cisatracurium or rocuronium may be associated to some degree of NMB at the end of lumbar surgery, depending on the duration of surgery and on the duration of action of the muscle relaxant which is more variable for rocuronium than for cisatracurium. [less ▲]