Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine.
Joris, Jean ; ; et al
in Anesthesia and Analgesia (1995), 81(2), 379-84
Although pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort. Furthermore, the characteristics of ... [more ▼]
Although pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort. Furthermore, the characteristics of postlaparoscopy pain differ considerably from those seen after laparotomy. Therefore, we investigated the time course of different pain components after laparoscopic cholecystectomy and the effects of intraperitoneal bupivacaine on these different components. Forty ASA physical status grade I-II patients were randomly assigned to receive either 80 mL of bupivacaine 0.125% with epinephrine 1/200,000 (n = 20) or the same volume of saline (n = 20) instilled under the right hemidiaphragm at the end of surgery. Intensity of total pain, visceral pain, parietal pain, and shoulder pain was assessed 1, 2, 4, 6, 8, 24, and 48 h after surgery. Analgesic consumption was also recorded. Patient data were similar in the two groups. In the saline group, visceral pain was significantly more intense than parietal pain at each time point; visceral and parietal pain were greater than shoulder pain during the first 8 h postoperatively. Intraperitoneal bupivacaine did not significantly affect any of the different components of postoperative pain. Analgesic consumption was similar in the two groups. This study demonstrates that visceral pain accounts for most of the pain experienced after laparoscopic cholecystectomy. Intraperitoneal bupivacaine is not effective for treating any type of pain after laparoscopic cholecystectomy. [less ▲]Detailed reference viewed: 78 (0 ULg)
Pneumothorax during laparoscopic fundoplication: diagnosis and treatment with positive end-expiratory pressure.
Joris, Jean ; ; Lamy, Maurice
in Anesthesia and Analgesia (1995), 81(5), 993-1000
Pneumothorax can develop during laparoscopy, particularly during laparoscopic fundoplication, since the left parietal pleura is exposed and can be torn during dissection in the diaphragmatic hiatus. Such ... [more ▼]
Pneumothorax can develop during laparoscopy, particularly during laparoscopic fundoplication, since the left parietal pleura is exposed and can be torn during dissection in the diaphragmatic hiatus. Such an event will result in specific pathophysiologic changes, since CO2, under pressure in the abdominal cavity, will pass into the pleural space. The aim of this study was to document the pathophysiologic changes induced by pneumothorax, and to evaluate the benefit of positive end-expiratory pressure (PEEP) to treat pneumothorax. Forty-six ASA physical status I and II patients scheduled for laparoscopic fundoplication were monitored extensively; heart rate, mean arterial pressure, end-tidal CO2 (PETCO2), oxygen saturation of hemoglobin (Spo2), minute ventilation, tidal volume, dynamic total lung thorax compliance, and airway pressures were recorded. In 25 patients, oxygen uptake, CO2 elimination and arterial blood gases were also measured. Pneumothorax was diagnosed in seven patients. It resulted in the following pathophysiologic changes: decrease in total lung thorax compliance, increase in airway pressures, and increase in CO2 absorption. Consequently, PACO2 and PETCO2 also increased. Spo2, however, remained normal. The use of PEEP largely corrected these respiratory changes. None of these pneumothoraces required drainage. These data suggest that pneumothorax is common during laparoscopic fundoplication. Early diagnosis is possible by simultaneous monitoring of PETCO2, total lung thorax compliance, and airway pressures. Finally, treatment with PEEP provides an alternative to chest tube placement when pneumothorax is secondary to passage of peritoneal CO2 into the interpleural space. [less ▲]Detailed reference viewed: 39 (1 ULg)
Anesthetic management of laparoscopy: new developments
in Miller, Ronald D (Ed.) Anesthesia (1995)Detailed reference viewed: 20 (1 ULg)
L'exérèse coelioscopique des phéochromocytomes. Etude détaillée des modifications hémodynamiques peropératoires
Hamoir, Etienne ; Meurisse, Michel ; Joris, Jean
in Lyon Chirurgical (1995), 91Detailed reference viewed: 53 (0 ULg)
L'hyperthyroïdie sévère associée à la prise d'amodarone: une urgence chirurgicale
Meurisse, Michel ; Hamoir, Etienne ; Joris, Jean et al
in Revue Française d'Endocrinologie Clinique, Nutrition, et Métabolisme (La) (1995), 36(1), 35-45
L'évolution de certaines thyréotoxicoses associées à la prise d'amiodarone peut être particulièrement grave et rapide, menaçant le pronostic vital. De déclenchement brutal, sans relation avec la durée du ... [more ▼]
L'évolution de certaines thyréotoxicoses associées à la prise d'amiodarone peut être particulièrement grave et rapide, menaçant le pronostic vital. De déclenchement brutal, sans relation avec la durée du traitement par amiodarone, elles peuvent survenir aussi bien chez des sujets porteurs de thyroïdopathies méconnues ou négligées au moment de l'induction du traitement, que chez des patients apparemment indemnes de toute pathologie thyroïdienne pré-existante. Le traitement médical conservateur est le plus souvent inefficace. Dans ces cas, il convient de poser sans hésitation, l'indication d'une thyroïdectomie la plus radicale possible. Ce rapport traite de l'évolution post-opératoire spectaculaire et favorable de 13 cas consécutifs de thyréotoxicose sévère associée à la prise d'amiodarone. La validité de l'approche chirurgicale repose sur la correction rapide et définitive de l'état toxique après exérèse glandulaire. La morbidité quasi nulle liée au geste chirurgical est la seule alternative thérapeutique antithyroïdienne existante qui permette de poursuivre un traitement par amiodarone lorsque celui-ci est indiqué pour contrôler une arytmie menaçante [less ▲]Detailed reference viewed: 99 (9 ULg)
High-dose aprotinin reduces blood loss in patients undergoing total hip replacement surgery
Janssens, Marc ; Joris, Jean ; et al
in Anesthesiology (1994), 80Detailed reference viewed: 11 (1 ULg)
Epidural anesthesia impairs both central and peripheral thermoregulatory control during general anesthesia.
Joris, Jean ; ; et al
in Anesthesiology (1994), 80(2), 268-77
BACKGROUND: The authors tested the hypotheses that: (1) the vasoconstriction threshold during combined epidural/general anesthesia is less than that during general anesthesia alone; and (2) after ... [more ▼]
BACKGROUND: The authors tested the hypotheses that: (1) the vasoconstriction threshold during combined epidural/general anesthesia is less than that during general anesthesia alone; and (2) after vasoconstriction, core cooling rates during combined epidural/general anesthesia are greater than those during general anesthesia alone. Vasoconstriction thresholds and heat balance were evaluated under controlled circumstances in volunteers, whereas the clinical importance of intraoperative thermoregulatory vasoconstriction was evaluated in patients. METHODS: Five volunteers were each evaluated twice. On one of the randomly ordered days, epidural anesthesia (approximately T9 dermatomal level) was induced and maintained with 2-chloroprocaine. On both study days, general anesthesia was induced and maintained with isoflurane (0.7% end-tidal concentration), and core hypothermia was induced by surface cooling and continued for at least 1 h after fingertip vasoconstriction was observed. Patients undergoing colorectal surgery were randomly assigned to combined epidural/enflurane anesthesia (n = 13) or enflurane alone (n = 13). In appropriate patients, epidural anesthesia was maintained by an infusion of bupivacaine. The core temperature that triggered fingertip vasoconstriction identified the threshold. RESULTS: In the volunteers, the vasoconstriction threshold was 36.0 +/- 0.2 degrees C during isoflurane anesthesia alone, but significantly less, 35.1 +/- 0.7 degrees C, during combined epidural/isoflurane anesthesia. Cutaneous heat loss and the rates of core cooling were similar 30 min before vasoconstriction with and without epidural anesthesia. In the 30 min after vasoconstriction, heat loss decreased 33 +/- 13 W when the volunteers were given isoflurane alone, but only 8 +/- 16 W during combined epidural/isoflurane anesthesia. Similarly, the core cooling rates in the 30 min after vasoconstriction were significantly greater during combined epidural/isoflurane anesthesia (0.8 +/- 0.2 degrees C/h) than during isoflurane alone (0.2 +/- 0.1 degrees C/h). In the patients, end-tidal enflurane concentrations were slightly, but significantly, less in the patients given combined epidural/enflurane anesthesia (0.6 +/- 0.2% vs. 0.8 +/- 0.2%). Nonetheless, the vasoconstriction threshold was 34.5 +/- 0.6 degrees C in the epidural/enflurane group, which was significantly less than that in the other patients, 35.6 +/- 0.8 degrees C. When the study ended after 3 h of anesthesia, patients given combined epidural/enflurane anesthesia were 1.2 degrees C more hypothermic than those given general anesthesia alone. The rate of core cooling during the last hour of the study was 0.4 +/- 0.2 degrees C/h during combined epidural/enflurane anesthesia, but only 0.1 +/- 0.3 degrees C/h during enflurane alone. CONCLUSIONS: These data indicate that epidural anesthesia reduces the vasoconstriction threshold during general anesthesia. Furthermore, the markedly reduced rate of core cooling during general anesthesia alone illustrates the importance of leg vasoconstriction in maintaining core temperature. [less ▲]Detailed reference viewed: 53 (0 ULg)
Is aprotinin worth the risk in total hip replacement?
Janssens, Marc ; Joris, Jean
in Anesthesiology (1994), 81(2), 518-519Detailed reference viewed: 8 (0 ULg)
The treatment of amiodarone-induced hyperthyroidism. Is there a place for surgery?
Meurisse, Michel ; Detroz, Bernard ; et al
in Acta Chirurgica Belgica (1994), 94(1), 36-41
In many instances amiodarone-induced hyperthyroidism has been reported as mild, thyroid functions returning to normal after discontinuation of the drug. Nevertheless, life-threatening amiodarone-induced ... [more ▼]
In many instances amiodarone-induced hyperthyroidism has been reported as mild, thyroid functions returning to normal after discontinuation of the drug. Nevertheless, life-threatening amiodarone-induced thyrotoxicosis has also been described. Conventional treatments such as with antithyroid drugs (Thionamide) and corticosteroids are essentially ineffective or fail to stop the dramatic course of the thyroid crisis. This limited efficacy of medical therapy, particularly in patients with previously--neglected or unknown--thyroid disease, prompted us to intervene surgically. We report a series of six patients who underwent total or nearly total thyroidectomy as first line therapy for four of them. Surgery resulted in rapid resolution of thyrotoxicosis with an uneventful postoperative course. This approach has the advantage of immediate and safe efficacy, low risk of relapse and finally, appears to be the only antithyroid treatment that permits continued therapy with amiodarone. [less ▲]Detailed reference viewed: 36 (0 ULg)
Laparoscopic adrenalectomy in pheochromocytoma and Cushing's syndrome. Reflections about two case reports.
Meurisse, Michel ; Joris, Jean ; Hamoir, Etienne et al
in Acta Chirurgica Belgica (1994), 94(6), 301-6
Laparoscopic adrenalectomy is possible as well on the left as on the right side using a percutaneous transabdominal approach. The exposure of the glands seems better than it could be achieved with an open ... [more ▼]
Laparoscopic adrenalectomy is possible as well on the left as on the right side using a percutaneous transabdominal approach. The exposure of the glands seems better than it could be achieved with an open method. In combination with intraoperative infusion of nicardipine, a calcium-channel blocker, the laparoscopic removal of a pheochromocytoma was performed safely and under stable conditions. In case of Cushing's syndrome, the laparoscopic approach reduces the problems related to poor healing. In all cases of laparoscopic adrenalectomy, this approach could offer the clear advantages of smaller incisions, reduced postoperative pain and incisional discomfort as well as complications related to large and invasive procedure and finally allows quicker recovery. Moreover, conversion to open surgery remains always possible, if needed. [less ▲]Detailed reference viewed: 35 (1 ULg)
Hemodynamic changes during laparoscopic cholecystectomy.
Joris, Jean ; ; Legrand, Marc et al
in Anesthesia and Analgesia (1993), 76(5), 1067-71
Hemodynamics during laparoscopic cholecystectomy under general anesthesia (isoflurane in N2O/O2 (50%)) were investigated in 15 nonobese ASA Class I patients by using invasive hemodynamic monitoring ... [more ▼]
Hemodynamics during laparoscopic cholecystectomy under general anesthesia (isoflurane in N2O/O2 (50%)) were investigated in 15 nonobese ASA Class I patients by using invasive hemodynamic monitoring including a flow-directed pulmonary artery catheter. During surgery, intraabdominal pressure was maintained automatically at 14 mm Hg by a CO2 insufflator, and minute ventilation was controlled and adjusted to avoid hypercapnia. Hemodynamics were measured before anesthesia, after the induction of anesthesia, after tilting into 10 degrees head-up position, 5 min, 15 min, and 30 min after peritoneal insufflation, and 30 min after exsufflation. Induction of anesthesia decreased significantly mean arterial pressure and cardiac index (CI). Tilting the patient to the head-up position reduced cardiac preload and caused further reduction of CI. Peritoneal insufflation resulted in a significant increase (+/- 35%) of mean arterial pressure, a significant reduction (+/- 20%) of CI, and a significant increase of systemic (+/- 65%) and pulmonary (+/- 90%) vascular resistances. The combined effect of anesthesia, head-up tilt, and peritoneal insufflation produced a 50% decrease in CI. Administration of increasing concentrations of isoflurane, via its vasodilatory activity, may have partially blunted these hemodynamic changes. These results demonstrate that laparoscopy for cholecystectomy in head-up position results in significant hemodynamic changes in healthy patients, particularly at the induction of pneumoperitoneum. [less ▲]Detailed reference viewed: 80 (7 ULg)
Total intravenous anesthesia in South-African genetic porphyria (variegate porphyria)
; Joris, Jean ; et al
in Acta Anaesthesiologica Belgica (1993), 44(1), 25-29Detailed reference viewed: 33 (0 ULg)
Analgésie médullaire. Association anesthésiques locaux - opiacés: modalités d'utilisation
in Analgésie péri-opératoire (1993)Detailed reference viewed: 19 (0 ULg)
Une salle d'analgésie postopératoire: une alternative à l'Acute Pain Service
Joris, Jean ; Lamy, Maurice
in Douleur et analgésie (1993), 2Detailed reference viewed: 31 (3 ULg)
Clonidine and ketanserin both are effective treatment for postanesthetic shivering.
Joris, Jean ; ; et al
in Anesthesiology (1993), 79(3), 532-9
BACKGROUND: Although meperidine is an effective treatment of postanesthetic shivering, its mechanism of action remains unknown. Investigation of other drugs might help clarify the mechanisms by which ... [more ▼]
BACKGROUND: Although meperidine is an effective treatment of postanesthetic shivering, its mechanism of action remains unknown. Investigation of other drugs might help clarify the mechanisms by which shivering can be controlled. Accordingly, we investigated the efficacy of clonidine, an alpha 2-adrenergic agonist, and ketanserin, a 5-hydroxytryptamine antagonist, in treating postanesthetic shivering. METHODS: First, 54 patients shivering after general anesthesia were allocated randomly to receive an intravenous bolus of saline, 150 micrograms clonidine, or 10 mg ketanserin. A second study explored the dose-dependence of clonidine. Forty shivering patients were given saline or clonidine, 37.5, 75, or 150 micrograms. RESULTS: The duration of shivering was significantly shorter in those given clonidine (2.1 +/- 0.9 min) than in the other two groups and shorter in the ketanserin group (4.3 +/- 0.9 min) than in the saline group (12.0 +/- 1.6 min). Clonidine and ketanserin significantly decreased systolic arterial blood pressure when compared to saline. Core rewarming was significantly slower in the clonidine group. In the second study, 37.5 micrograms clonidine was no more effective than saline. Two minutes after treatment, 150 micrograms obliterated shivering in all patients. Five minutes after treatment, all patients given 75 micrograms had stopped shivering. Systolic arterial pressure and heart rate decreased significantly in patients given 75 and 150 micrograms clonidine. CONCLUSIONS: Clonidine (150 micrograms) and ketanserin (10 mg) both are effective treatment for postanesthetic shivering. The effect of clonidine on shivering is dose-dependent: whereas 37.5 micrograms had no effect, 75 micrograms clonidine stopped shivering within 5 min. [less ▲]Detailed reference viewed: 34 (1 ULg)
Analgésie postopératoire par analgésie péridurale autocontrôlée
in Douleur et analgésie (1993), 4Detailed reference viewed: 17 (2 ULg)