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Plass F, Nicolle C, Zamparini M, Al Issa G, Fiant AL, Le Roux Y, Gérard JL, Fischer MO, Alvès A, Hanouz JL. Effect of intra-operative intravenous lidocaine on opioid consumption after bariatric surgery: a prospective, randomised, blinded, placebo-controlled study. Anaesthesia 2020; 76:189-198. [PMID: 32564365 DOI: 10.1111/anae.15150] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2020] [Indexed: 12/28/2022]
Abstract
Peri-operative lidocaine infusion warrants investigation in bariatric surgery because obese patients present different physiological and pharmacological risks. This single-centre, prospective, randomised double-blind placebo-controlled study enrolled obese patients scheduled for laparoscopic bariatric surgery using an enhanced recovery protocol. Patients received either lidocaine (bolus of 1.5 mg.kg-1 , then a continuous infusion of 2 mg.kg-1 .h-1 until the end of the surgery, then 1 mg.kg-1 .h-1 for 1 h in the recovery area) or identical volumes and rates of 0.9% saline. The primary outcome was the consumption of the equivalent of oxycodone consumption over the first 3 postoperative days. Secondary outcomes were: postoperative pain; incidence of nausea and vomiting; bowel function recovery; and lengths of stay in the recovery area and in hospital. Plasma concentrations of lidocaine were measured. On the 178 patients recruited, data were analysed from 176. The median (IQR [range]) equivalent intravenous oxycodone consumption was 3.3 mg (0.0-6.0 [0.0-14.5]) and 5.0 mg (3.3-7.0 [3.3-20.0]) in the lidocaine and saline groups, respectively (difference between medians (95%CI): 1.7 (0.6-3.4) mg; p = 0.004). Length of stay in the recovery area, postoperative pain, nausea and vomiting, day of recovery of bowel function, and length of stay in hospital were not different between groups. Mean (SD) lidocaine plasma concentrations were 2.44 (0.70) µg.ml-1 and 1.77 (0.51) µg.ml-1 at the end of surgery and 1 hour after the end of infusion, respectively. Lidocaine infusion during bariatric surgery resulted in a clinically non-relevant difference in postoperative oxycodone consumption.
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Affiliation(s)
- F Plass
- Department of Anaesthesiology, Intensive Care and Peri-operative Care, CHU de Caen Normandie, Caen, France
| | - C Nicolle
- Department of Anaesthesiology, Intensive Care and Peri-operative Care, CHU de Caen Normandie, Caen, France
| | - M Zamparini
- Department of Anaesthesiology, Intensive Care and Peri-operative Care, CHU de Caen Normandie, Caen, France
| | - G Al Issa
- Department of Anaesthesiology, Intensive Care and Peri-operative Care, CHU de Caen Normandie, Caen, France
| | - A L Fiant
- Department of Anaesthesiology, Intensive Care and Peri-operative Care, CHU de Caen Normandie, Caen, France
| | - Y Le Roux
- Department of Digestive and Bariatric Surgery, CHU de Caen Normandie, Caen, France
| | - J L Gérard
- Department of Anaesthesiology, Intensive Care and Peri-operative Care, CHU de Caen Normandie, Caen, France
| | - M O Fischer
- Department of Anaesthesiology, Intensive Care and Peri-operative Care, CHU de Caen Normandie, Caen, France
| | - A Alvès
- Department of Digestive and Bariatric Surgery, CHU de Caen Normandie, Caen, France
| | - J-L Hanouz
- Department of Anaesthesiology, Intensive Care and Peri-operative Care, CHU de Caen Normandie, Caen, France
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Gouëzel C, Lorne E, Bonnet V, Fradin S, Saplacan V, Gérard JL, Hanouz JL, Fellahi JL, Fischer MO. Assessment of changes in lactate concentration with intravascular microdialysis during high-risk cardiac surgery using the trend interchangeability method. Br J Anaesth 2019; 119:1110-1117. [PMID: 29028910 DOI: 10.1093/bja/aex338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 01/10/2023] Open
Abstract
Background Blood lactate is a strong predictor of mortality, and repeated blood lactate assays are recommended during surgery in high-risk patients. We hypothesized that the use of intravascular microdialysis incorporated in a central venous catheter would be interchangeable with the reference blood gas technique to monitor changes in blood lactate. Methods Microdialysis and central venous blood lactate measurements were recorded simultaneously in high-risk cardiac surgical patients. The correlation between absolute values was determined by linear regression, and the Bland-Altman test for repeated measurements was used to compare bias, precision, and limits of agreement. Changes in lactate measurements were evaluated with a four-quadrant plot and trend interchangeability method (TIM). Results In the 23 patients analysed, the central venous catheter was used as part of standard care, with no complications. The correlation coefficient for absolute values ( n =104) was 0.96 ( P <0.0001). The bias, precision, and limits of agreement were -0.19, 0.51, and -1.20 to 0.82 mmol litre -1 , respectively. The concordance rate for changes in blood lactate measurements ( n =80) was 94% with the four-quadrant plot. In contrast, the TIM showed that 23 (29) changes in lactate measurements were not interpretable, and among the remaining 57 (71) interpretable changes, 18 (32) were interchangeable, 8 (14) were in the grey zone, and 31 (54) were not interchangeable. Conclusions Microdialysis with a central venous catheter appears to provide reliable absolute blood lactate values. Although changes in blood lactate measurements showed an excellent concordance rate, changes between the two methods were poorly interchangeable with the TIM. Clinical trial registration NCT02296593.
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Affiliation(s)
- C Gouëzel
- Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France
| | - E Lorne
- Anaesthesiology and Critical Care Department, Amiens University Medical Centre, avenue René Laennec, F-80054 Amiens, France.,INSERM U1088, Jules Verne University of Picardy, Centre Universitaire de Recherche en Santé (CURS), Chemin du Thil, F-80025 Amiens cedex, France
| | - V Bonnet
- Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France
| | - S Fradin
- Department of Biology, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France
| | - V Saplacan
- Cardiac Surgery, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France
| | - J-L Gérard
- Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France
| | - J-L Hanouz
- Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France.,EA 4650, Caen Normandy University, Esplanade de la Paix, CS 14 032, F-14000 Caen, France
| | - J-L Fellahi
- Department of Anaesthesia and Intensive Care Medicine, Hôpital cardiologique Louis Pradel, Avenue du Doyen Lepine, F-69 677 Lyon, France.,Faculty of Medicine, University of Lyon 1 Claude Bernard, F-69 008 Lyon, France
| | - M-O Fischer
- Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France.,EA 4650, Caen Normandy University, Esplanade de la Paix, CS 14 032, F-14000 Caen, France
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Bonnet V, Dupont H, Glorion S, Aupée M, Kipnis E, Gérard JL, Hanouz JL, Fischer MO. Influence of bacterial resistance on mortality in intensive care units: a registry study from 2000 to 2013 (IICU Study). J Hosp Infect 2019; 102:317-324. [PMID: 30659869 DOI: 10.1016/j.jhin.2019.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/09/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bacterial resistance to antibiotics is a daily concern in intensive care units. However, few data are available concerning the clinical consequences of in-vitro-defined resistance. AIM To compare the mortality of patients with nosocomial infections according to bacterial resistance profiles. METHODS The prospective surveillance registry in 29 French intensive care units (ICUs) participating during the years 2000-2013 was retrospectively analysed. All patients presenting with a nosocomial infection in ICU were included. FINDINGS The registry contained 88,000 eligible patients, including 10,001 patients with a nosocomial infection. Among them, 3092 (36.7%) were related to resistant micro-organisms. Gram-negative bacilli exhibited the highest rate of resistance compared to Gram-positive cocci (52.8% vs 48.1%; P < 0.001). In-hospital mortality was higher in cases of patients with antibiotic-resistant infectious agents (51.9% vs 45.5%; P < 0.001), and critical care length of stay was longer (33 ± 26 vs 29 ± 22 days; P < 0.001). These results remained significant after SAPS II matching (P < 0.001) and in the Gram-negative bacilli and Gram-positive cocci subgroups. No difference in mortality was found with respect to origin prior to admission. CONCLUSION Patients with bacterial resistance had higher ICU mortality and increased length of stay, regardless of the bacterial species or origin of the patient.
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Affiliation(s)
- V Bonnet
- Department of Anaesthesiology and Critical Care, University Hospital of Caen, Caen, France
| | - H Dupont
- Anaesthesiology and Critical Care Department, Amiens University Medical Center, Amiens, France; INSERM U 1088, University of Picardie Jules Verne, Centre Universitaire de Recherche en Santé, Amiens, France
| | - S Glorion
- Regional Coordinating Centre for Healthcare-Associated Infections Control (CClin Ouest), Rennes, France
| | - M Aupée
- Regional Coordinating Centre for Healthcare-Associated Infections Control (CClin Ouest), Rennes, France
| | - E Kipnis
- Department of Anaesthesiology and Critical Care - CHU Lille, Lille, France; Host-Pathogen Translational Research, EA 7366, University of Lille, Lille, France
| | - J L Gérard
- Department of Anaesthesiology and Critical Care, University Hospital of Caen, Caen, France; Normandie Université, Esplanade de la Paix, CS 14 032, Caen, France
| | - J L Hanouz
- Department of Anaesthesiology and Critical Care, University Hospital of Caen, Caen, France; Normandie Université, Esplanade de la Paix, CS 14 032, Caen, France
| | - M O Fischer
- Department of Anaesthesiology and Critical Care, University Hospital of Caen, Caen, France; Normandie Université, Esplanade de la Paix, CS 14 032, Caen, France.
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Zamparini G, Buléon C, Bonnieux D, De Facq Regent H, Oriot G, Rebet O, Al Afandi B, Arrot X, Genain Soulier AS, Halbout L, Harel D, Leraitre T, Moneron M, Gérard JL, Hanouz JL. [Epidemiology of out-of-hospital sudden cardiac arrest in « Basse-Normandie » according to RéAC registry]. ACTA ACUST UNITED AC 2014; 33:648-54. [PMID: 25464908 DOI: 10.1016/j.annfar.2014.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Identify from the RéAC registry, out-of-hospital sudden cardiac arrest in Caen and it's suburbs, to study epidemiology and assess our medical practices. STUDY DESIGN Observational, prospective and monocentric study. PATIENTS AND METHODS From March 2012 to March 2013, we identified 151 patients. Demographic parameters, delays until treatment, drugs given and patient outcomes were analyzed from the RéAC data registry. Depending on the variable studied, the statistical analysis used Mann-Whitney or the Chi(2) tests. RESULTS Twenty-two patients were excluded (no resuscitation attempt and patients who were transported to hospital with chest compressions only, in the absence of spontaneous circulation). One hundred and twenty-nine sudden cardiac arrests were analyzed: 107 (83%) with medical origin and 22 (17%) with traumatic origin. Direct witnesses were present for 94 (73%) of them. Basic life support actions were begun for 59 (46%) patients and a telephone advice was issued by the medical response team for 47 (36%) of them. After an advanced life support, 74 (57%) patients died on the spot. Of the 55 patients reaching the hospital alive, 39 (71%) died in the intensive care unit and 16 (29%) were discharged alive from hospital, of whom 14 (88%) with a favorable neurological outcome. CONCLUSION RéAC national registry has allowed us to analyze epidemiological data on out-of-hospital sudden cardiac arrests in our center. This register has also allowed us to highlight areas for improvement. They should be taken into account to improve our medical practices.
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Affiliation(s)
- G Zamparini
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; EA.4650-Signalisation, électrophysiologie et imagerie des lésions d'ischémie reperfusion myocardique, UFR de médecine, université Caen Basse-Normandie, avenue de la Côte-de-Nacre, 14032 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France.
| | - C Buléon
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - D Bonnieux
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - H De Facq Regent
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - G Oriot
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - O Rebet
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - B Al Afandi
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - X Arrot
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - A-S Genain Soulier
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - L Halbout
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - D Harel
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - T Leraitre
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - M Moneron
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - J-L Gérard
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; EA.4650-Signalisation, électrophysiologie et imagerie des lésions d'ischémie reperfusion myocardique, UFR de médecine, université Caen Basse-Normandie, avenue de la Côte-de-Nacre, 14032 Caen cedex, France
| | - J-L Hanouz
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; EA.4650-Signalisation, électrophysiologie et imagerie des lésions d'ischémie reperfusion myocardique, UFR de médecine, université Caen Basse-Normandie, avenue de la Côte-de-Nacre, 14032 Caen cedex, France
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Fellahi JL, Butin G, Zamparini G, Fischer MO, Gérard JL, Hanouz JL. Lower limb peripheral NIRS parameters during a vascular occlusion test: an experimental study in healthy volunteers. ACTA ACUST UNITED AC 2013; 33:e9-14. [PMID: 24373673 DOI: 10.1016/j.annfar.2013.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/18/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of the study was to compare NIRS parameters in combination with a vascular occlusion test (VOT) at a proximal (leg) and a distal (foot) site in male and female. STUDY DESIGN A prospective experimental study in healthy subjects. PATIENTS AND METHODS Twenty volunteers (10 male, 10 female, 28 ± 4 years) were investigated during 4 experimental steps: baseline, ischemia, reperfusion, and baseline. For each volunteer, 3 NIRS optodes were placed on right and left calves and the left arch of the foot. Blood pressure, heart rate and peripheral pulse oxymetry were monitored. RESULTS Significant differences were observed at baseline between regional oxygen saturation (rSO₂) values according to the site of measurement (proximal rSO₂ 81 ± 9% vs distal rSO₂ 60 ± 5%, P<0.001) but not according to gender. Both decreases in proximal and distal rSO₂ during ischemia and increases over baseline values during reperfusion depended on group membership (male or female). NIRS parameters during the VOT were significantly higher in male when compared with female at the proximal site: desaturation rate 5.6% (IQR: 5.5) vs 2.5% (IQR: 0.8), P=0.001; resaturation rate 40.7% (IQR: 6.6) vs 21.7% (IQR: 5.4), P=0.003; and ΔrSO₂ 10.0% (IQR: 7.0) vs 5.5% (IQR: 6.0), P=0.041. CONCLUSIONS Values of rSO₂ at the lower limb varied according to the anatomical site of measurement. A VOT induced major changes in rSO₂ that differed between male and female. These results should be taken into account in further clinical studies.
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Affiliation(s)
- J-L Fellahi
- Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Faculty of Medicine EA4650, Université de Caen, 14000 Caen, France.
| | - G Butin
- Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Faculty of Medicine EA4650, Université de Caen, 14000 Caen, France
| | - G Zamparini
- Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Faculty of Medicine EA4650, Université de Caen, 14000 Caen, France
| | - M-O Fischer
- Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Faculty of Medicine EA4650, Université de Caen, 14000 Caen, France
| | - J-L Gérard
- Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Faculty of Medicine EA4650, Université de Caen, 14000 Caen, France
| | - J-L Hanouz
- Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Faculty of Medicine EA4650, Université de Caen, 14000 Caen, France
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Fischer MO, Garreau N, Jarno P, Villers D, Dufour Trivini M, Gérard JL, Fellahi JL, Hanouz JL, Parienti JJ. [Multicenter survey on ventilator-associated pneumonia prevention in intensive care]. ACTA ACUST UNITED AC 2013; 32:833-7. [PMID: 24184168 DOI: 10.1016/j.annfar.2013.07.822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 07/28/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in intensive care unit (ICU). The aim of the study was to evaluate the follow-up of the guidelines for VAP prevention. STUDY DESIGN Retrospective, observational and multicenter study. PATIENTS AND METHODS During one year, all patients with mechanical ventilation over 48 hours were included in the CCLIN-Ouest Network. The demographic characteristics of the patients, the use of specific protocol for VAP prevention and the density of incidence of VAP were recorded. The use of a protocol for preventing VAP (absence, incomplete, complete and care bundle (i.e. complete prevention of VAP with weaning mechanical protocol and sedation protocol)) was collected. RESULTS 26 ICU with 5742 patients were included. Ten ICU (38%; 2595 patients) had no protocol for VAP prevention, eight ICU (31%; 1821 patients) had an incomplete protocol, five ICU (19%; 561 patients) had a complete protocol and three ICU (12%; 765 patients) had a care bundle. The density of incidence of VAP was 14.8‰ (Interquartile range [IQR]: 10.2-0.1) for no protocol group, 15.6‰ [IQR: 12.6-6.2] for incomplete protocol group, 11.0‰ [IQR: 9.1-14.0] for complete protocol group and 12.9‰ [5-7,7-9,9-12] for care bundle group (P=0.742). CONCLUSIONS The compliance to prevention of VAP was poor. Proposals for improving practice are discussed.
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Affiliation(s)
- M-O Fischer
- Pôle réanimations anesthésie Samu/Smur, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14000 Caen, France; EA 4650, université de Caen-Basse-Normandie, Esplanade-de-la-Paix, CS 14032, 14000 Caen, France.
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Fischer MO, Parienti JJ, Daurel C, Debruyne D, Verdon R, Gérard JL, Hanouz JL, Fellahi JL. An information campaign on aminoglycosides use during septic shock failed to improve the quality of care. ACTA ACUST UNITED AC 2011; 31:e1-5. [PMID: 22154443 DOI: 10.1016/j.annfar.2011.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 08/16/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Septic shock remains a major cause of death in intensive care units (ICU) and an inappropriate antibiotic regimen worsens the prognosis. The aim of the study was to assess the impact of an information campaign on modalities of prescription of aminoglycosides in septic shock. STUDY DESIGN A prospective observational study. METHODS Consecutive septic shock patients admitted to the surgical ICU over a 2-year period were included. An information campaign allowed to differentiate between a pre- (P1) and a post- (P2) interventional period. The campaign clarified the rules and requirements for pharmacological monitoring of aminoglycosides. The main objective was to increase the rate of prescription of peak serum aminoglycoside following the first intravenous injection. RESULTS One hundred and forty-eight patients (P1=76 and P2=72) were finally included into the study. Similar clinical characteristics were observed during both periods. The rate of prescription of peak serum aminoglycoside following the first injection was performed in 49% (P1) versus 65% (P2), P=0.09. The length of stay in ICU was 16 days [extremes: 1-74] (P1) versus 17 days [extremes: 1-133] (P2) (P=0.84). Inhospital mortality was 28% (P1) versus 26% (P2), P=0.86. CONCLUSIONS An information campaign describing the modalities of prescription of aminoglycosides in septic shock failed to improve medical practices and patient outcomes. A mobile team of antibiotics could be useful in daily practice.
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Affiliation(s)
- M-O Fischer
- Pôle anesthésie-réanimation-Samu-Smur-coordination hospitalière-hémovigilance, CHU de Caen, France.
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Lemoine S, Zhu L, Buléon C, Massetti M, Gérard JL, Galera P, Hanouz JL. Mechanisms involved in the desflurane-induced post-conditioning of isolated human right atria from patients with type 2 diabetes. Br J Anaesth 2011; 107:510-8. [PMID: 21862498 DOI: 10.1093/bja/aer201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Desflurane triggers post-conditioning in the diabetic human myocardium. We determined whether protein kinase C (PKC), mitochondrial adenosine triphosphate-sensitive potassium (mitoK(ATP)) channels, Akt, and glycogen synthase kinase-3β (GSK-3β) were involved in the in vitro desflurane-induced post-conditioning of human myocardium from patients with type 2 diabetes. METHODS The isometric force of contraction (FoC) of human right atrial trabeculae obtained from patients with type 2 diabetes was recorded during 30 min of hypoxia followed by 60 min of reoxygenation. Desflurane (6%) was administered during the first 5 min of reoxygenation either alone or in the presence of calphostin C (PKC inhibitor) or 5-hydroxydecanoate (5-HD) (mitoK(ATP) channel antagonist). Phorbol 12-myristate 13-acetate (PKC activator) and diazoxide (a mitoK(ATP) channel opener) were superfused during early reoxygenation. The FoC at the end of the 60 min reoxygenation period was compared among treatment groups (FoC(60); mean and sd). The phosphorylation of Akt and GSK-3β was studied using western blotting. RESULTS Desflurane enhanced the recovery of force [FoC(60): 79 (3)% of baseline] after 60 min of reoxygenation when compared with the control group (P>0.0001). Calphostin C and 5-HD abolished the beneficial effect of desflurane-induced post-conditioning (both P<0.0001). Phorbol 12-myristate 13-acetate and diazoxide enhanced the FoC(60) when compared with the control group (both P<0.0001). Desflurane increased the level of phosphorylation of Akt and GSK-3β (P<0.0001). CONCLUSIONS Desflurane-induced post-conditioning in human myocardium from patients with type 2 diabetes was mediated by the activation of PKC, the opening of the mitoK(ATP) channels, and the phosphorylation of Akt and GSK-3β.
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Affiliation(s)
- S Lemoine
- Laboratory of Experimental Anaesthesiology and Cellular Physiology EA3212, Institut Fédératif de Recherche ICORE146, Université de Caen Basse Normandie, Caen, France.
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Lemoine S, Zhu L, Massetti M, Gérard JL, Hanouz JL. Continuous administration of remifentanil and sufentanil induces cardioprotection in human myocardium, in vitro. Acta Anaesthesiol Scand 2011; 55:758-64. [PMID: 21615344 DOI: 10.1111/j.1399-6576.2011.02456.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Remifentanil and sufentanil are widely used opioids during general anaesthesia for cardiac and non-cardiac surgery. This study was conducted to evaluate the hypothesis that the continuous administration of remifentanil and sufentanil, at clinically relevant concentrations, could provide protection of human myocardium, in vitro, against hypoxia-reoxygenation injury. METHOD Isometrically contracting isolated human right atrial trabeculae were exposed to 30 min of hypoxia and 60 min of reoxygenation. In separate groups, remifentanil at 10(-11), 10(-10), 10(-9), or sufentanil at 10(-11), 10(-10), 10(-9) M were administered 10 min before hypoxia until the end of the experiment. The force of contraction (FoC) of trabeculae was recorded continuously. Developed force was compared (mean ± standard deviation) between the groups using a variance analysis and post hoc tests. RESULTS At the end of the 60-min reoxygenation, remifentanil 10(-11) M (FoC: 82 ± 7% of baseline), 10(-10) M (FoC: 78 ± 5% of baseline), 10(-9) M (FoC: 80 ± 4% of baseline) and sufentanil 10(-11) M (FoC: 78 ± 8% of baseline), 10(-10) M (FoC: 83 ± 6% of baseline), 10(-9) M (FoC: 83 ± 8% of baseline) enhanced the recovery of FoC as compared with the control group (53 ± 9% of baseline, P<0.0001). CONCLUSIONS Remifentanil and sufentanil, at clinically relevant concentrations, confer cardioprotection of human myocardium against hypoxia reoxygenation, in vitro.
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Affiliation(s)
- S Lemoine
- Laboratory of Experimental Anaesthesiology and Cellular Physiology, Institut Fédératif de Recherche ICORE146 Université de Caen Basse Normandie, France.
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11
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Lemoine S, Durand C, Zhu L, Ivasceau C, Lepage O, Babatasi G, Massetti M, Gérard JL, Hanouz JL. Desflurane-induced postconditioning of diabetic human right atrial myocardium in vitro. Diabetes Metab 2009; 36:21-8. [PMID: 19945895 DOI: 10.1016/j.diabet.2009.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 06/01/2009] [Accepted: 06/03/2009] [Indexed: 11/25/2022]
Abstract
AIM We tested the hypothesis that brief exposure to desflurane at the time of reoxygenation might be able to protect against hypoxia-reoxygenation injury in human myocardium from diabetic (insulin-dependent, ID; and non-insulin-dependent, NID) patients and non-diabetic (ND) subjects. METHODS The force of contraction (34 degrees C, stimulation frequency 1Hz) in the right atrial trabeculae was recorded during 30min of hypoxia followed by 60min of reoxygenation. Desflurane (at 3, 6 and 9%) was administered during the first 5min of reoxygenation. The force of contraction at the end of the 60-min reoxygenation period (FoC(60)) was compared in the study groups (means+/-SD). RESULTS In the ND group, desflurane at 3, 6 and 9% (FoC(60): respectively 78+/-10%, 84+/-4% and 85+/-12% of baseline) enhanced the recovery of FoC(60) compared with the ND-controls (53+/-7% of baseline; P<0.05). In the ID group, desflurane at 3% (61+/-4%) did not modify the recovery of FoC(60) compared with the ID-controls (54+/-6%), whereas desflurane at 6 and 9% (75+/-11% and 81+/-8%, respectively) enhanced the recovery of FoC(60)vs the controls (P<0.05). In the NID group, desflurane at 3% (57+/-5%) also failed to modify the recovery of FoC(60) compared with the NID-controls (52+/-10%), while desflurane at 6 and 9% (80+/-10% and 79+/-7%, respectively) enhanced the recovery of FoC(60)vs the controls (P<0.05). CONCLUSION Desflurane in vitro was able to postcondition diabetic (both ID and NID) human myocardium at 6 and 9%, but not at 3%.
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Affiliation(s)
- S Lemoine
- Laboratoire d'anesthésiologie expérimentale et de physiologie cellulaire EA 3212, service d'anesthésie réanimation, institut fédératif de recherche ICORE 146, université de Caen, Basse Normandie, avenue Côte-de-Nacre, Caen cedex, France.
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12
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Zhu L, Lemoine S, Babatasi G, Lepage O, Massetti M, Gérard JL, Hanouz JL. Sevoflurane- and desflurane-induced human myocardial post-conditioning through Phosphatidylinositol-3-kinase/Akt signalling. Acta Anaesthesiol Scand 2009; 53:949-56. [PMID: 19496766 DOI: 10.1111/j.1399-6576.2009.02009.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The role of phosphatidylinositol-3-kinase (PI3K) in sevoflurane- and desflurane-induced myocardial post-conditioning remains unknown. METHODS We recorded isometric contraction of isolated human right atrial trabeculae (oxygenated Tyrode's at 34 degrees C, stimulation frequency 1 Hz). In all groups, a 30-min hypoxic period was followed by a 60-min reoxygenation period. At the onset of reoxygenation, muscles were exposed to 5 min of sevoflurane 1%, 2%, and 3%, and desflurane 3%, 6%, and 9%. In separate groups, sevoflurane 2% and desflurane 6% were administered in the presence of 100 nM wortmannin, a PI3K inhibitor. Recovery of force after the 60-min reoxygenation period was compared between groups (mean +/- SD). RESULT As compared with the Control group (49 +/- 7% of baseline) PostC by sevoflurane 1%, 2%, and 3% (78 +/- 4%, 79 +/- 5%, and 85 +/- 4% of baseline, respectively) and desflurane 3%, 6%, and 9% (74 +/- 5%, 84 +/- 4%, and 86 +/- 11% of baseline, respectively) enhanced the recovery of force. This effect was abolished in the presence of wortmannin (56 +/- 5% of baseline for sevoflurane 2%+wortmannin; 56 +/- 3% of baseline for desflurane 6%+wortmannin). Wortmannin alone had no effect on the recovery of force (57 +/- 7% of baseline). CONCLUSION In vitro, sevoflurane and desflurane post-conditioned human myocardium against hypoxia through activation of phosphatidylinositol-3-kinase.
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Affiliation(s)
- L Zhu
- Laboratoire d'Anesthesiologie et de Physiologie Cellulaire, Centre Hospitalier Régional, Caen, France
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13
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Abstract
Objectives To assess the feasibility of saphenous veins ablation by laser in a clinic room. To study immediate and short term (1 to 6 months) complications and to pinpoint those that could be directly linked to this environment. Efficacy of the technique should also be documented. Methods Retrospective study (22 centres) carried out in France and Switzerland. Patients with insufficiency of great saphenous vein (GSV) or small saphenous vein (SSV). Clinical stages of clinical, aetiological, anatomical and pathophysiological classification (CEAP) were C2 to C6. Endovenous laser procedures were performed outside an operating theatre, under local anaesthesia and without high ligation. Efficacy criteria: occlusion of the vein and disappearance of the pathological reflux (duplex scan assessment). The side effects and complications were studied. Results A total of 1703 procedures (1422 patients) were performed; 74% of the patients were women. The mean age of the patients was 57. A total of 1394 GSV and 309 SSV were treated (mean diameters 7.2 mm and 6.4 mm, respectively). Overall success level was 97% and mean length of veins treated was 40 cm for GSV and 21 cm for SSV. Energy applied in joules per centimeter was homogenous (mean and median 64 for GSV and 65 for SSV). Complications were rare and ‘simple’ apart from one pulmonary embolism which occurred 10 days after a GSV procedure, although no deep vein thrombus was found. A total of two infections were observed: one was an infection localized at the site of access and the other was erysipelas. Conclusion Except 2 limited infections (0.1%), this large retrospective study of laser procedures performed outside the operating theatre did not reveal any significant specific complications as regards the environment required. The efficacy results were equivalent to those found in the literature. Regarding cost and constraints induced by operating theatre environment, the clinic room should be able to offer an easier and economic alternative option for saphenous veins ablation with laser.
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Affiliation(s)
- C Hamel-Desnos
- Saint Martin Private Hospital – Vascular Medicine, Caen, France
| | - J-L Gérard
- University Hospital – Vascular Surgery, Creteil Paris XII, France
| | - P Desnos
- Private Surgery – Vascular Medicine, Caen, France
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Grandin W, Dessieux T, Hounfodji P, Viquesnel G, Ouchikhe A, Gérard JL. Mucormycose pulmonaire chez un patient polytraumatisé. ACTA ACUST UNITED AC 2006; 25:521-4. [PMID: 16531002 DOI: 10.1016/j.annfar.2005.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 12/20/2005] [Indexed: 11/25/2022]
Abstract
Mucormycosis are opportunist infections occurring usually among predisposed patients. We report a case of an 18-year-old male with a severe thoracic trauma who developed an Absidia infection on his contused pulmonary parenchyma, without presenting the usual risk factors (diabetes mellitus, immunodeficiency). The early diagnosis using bronchoscopy has probably improved the outcome by allowing a faster treatment. After 18-months, the infectious process resolved thanks to a combination of a medical treatment composed of high-dose amphotericin B lipid formulation, itraconazole and a complementary surgical treatment.
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Affiliation(s)
- W Grandin
- Département d'Anesthésie-Réanimation Chirurgicale-Samu, Centre Hospitalier Régional et Universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
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Fischer MO, Dequiré PM, Kalem A, Gérard JL, Plaud B. Hypothermie après rachianesthésie : rôle de la morphine ? ACTA ACUST UNITED AC 2006; 25:296-8. [PMID: 16377124 DOI: 10.1016/j.annfar.2005.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 09/28/2005] [Indexed: 11/20/2022]
Abstract
Spinal anaesthesia is the gold standard for elective caesarean section. This technique presents several adverse effects. We report a severe case of hypothermia (33.3 degrees C) after spinal administration of bupivacaine (10 mg) and morphine (100 microg) for elective caesarean section. After excluding other causes of hypothermia, this one could be explained by both the own effects of local anaesthesia (i.e. peripheral vasodilatation) and by the central effect of intrathecal morphine. Because hypothermia is not predictable after spinal injection of morphine both monitoring of central temperature and active warming of the patients could be proposed. Naloxone has been proposed in a case of hypothermia related to spinal injection of morphine.
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Affiliation(s)
- M O Fischer
- Département d'anesthésie-réanimation chirurgicale, Samu, CHU de Côte-de-Nacre, Caen, France.
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16
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Ouchikhe A, Lehoux P, Gringore A, Renouf P, Deredec R, Tasle M, Massetti M, Khayat A, Saloux E, Grollier G, Samama G, Gérard JL. Le phéochromocytome comme cause inhabituelle de choc cardiogénique. ACTA ACUST UNITED AC 2006; 25:46-9. [PMID: 16386403 DOI: 10.1016/j.annfar.2005.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Accepted: 08/29/2005] [Indexed: 11/19/2022]
Abstract
The authors reported a case involving a young patient with a cardiogenic shock associated to an acute pulmonary oedema. According to the seriousness of the shock, an external ventricular assist device (VAD) was initially inserted and replaced thereafter because of the cardiovascular instability, by an external pneumatic biventricular assist device. A cardiogenic shock induced by an acute adrenergic myocarditis due to a phaeochromocytoma was diagnosed. The patient was weaned from the VAD on day 84 and was scheduled for elective surgery of the phaeochromocytoma on day 93. The authors discussed the time of the surgery according to the anticoagulation therapy necessary to the VAD and the necessary caution taken if a cardiogenic shock appeared around surgery.
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Affiliation(s)
- A Ouchikhe
- Département d'anesthésie-réanimation et de médecine d'urgence, CHU Côte-de-Nacre, 14033 Caen, France.
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17
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Haelewyn B, Zhu L, Hanouz JL, Persehaye E, Roussel S, Ducouret P, Gérard JL. Cardioprotective effects of desflurane: effect of timing and duration of administration in rat myocardium. Br J Anaesth 2004; 92:552-7. [PMID: 14977796 DOI: 10.1093/bja/aeh100] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We compared the cardioprotective effects of 1 minimum alveolar concentration (MAC) desflurane administered before, during or after ischaemia, or throughout the experiment (before, during and after ischaemia) on myocardial infarct size following 30 min occlusion of the left anterior descending coronary artery and 3 h reperfusion in adult rats. METHODS Fifty male Sprague-Dawley rats were anaesthetized with pentobarbital, intubated and mechanically ventilated. Blood gases, pH and body temperature (37.5-38 degrees C) were controlled. Heart rate and arterial pressure were measured continuously. Animals were randomly assigned to the following groups (n=10 in each group): pentobarbital only ("Pento"); 15 min desflurane administration followed by 10 min of washout before 30 min ischaemia and 3 h reperfusion ("Precond"); 30 min desflurane administration during ischaemia period ('Isch'); desflurane administration during the 15 first min of reperfusion ("Reperf") and desflurane administration throughout the experiment (before, during and after ischaemia; "Long"). Volumes at risk and infarct sizes were assessed by Indian ink and with 2,3,5-triphenyltetrazolium chloride staining, respectively. RESULTS Physiological parameters and volumes at risk were not significantly different between groups. In the Pento group, mean myocardial infarct size was 65 (sd 15)% of the volume at risk; myocardial infarct size was reduced to a significant and comparable extent in the desflurane-treated groups (Precond 42 (14)%; Isch 34 (11)%; Reperf 41 (15)%; Long 33 (10)%; P<0.0002 vs Pento group). CONCLUSIONS In rats, desflurane 1 MAC significantly decreased myocardial infarct size whatever the period and duration of administration.
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Affiliation(s)
- B Haelewyn
- University of Caen: UPRES EA 3212, IFR47; Département d'Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU), Côte de Nacre, Caen, France.
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18
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Dhainaut JF, Payen DM, Bernardin G, Gérard JL, Martin C, Perrotin D, Regnier B. [Clinical approach to the identification of patients suffering from severe sepsis with several organ failures for the administration of drotrecogin alfa (activated): from the PROWESS study to clinical practice]. Ann Fr Anesth Reanim 2003; 22 Spec No 1:53-64. [PMID: 15359946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- J F Dhainaut
- Département de réanimation, hôpital Cochin, Paris, France
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19
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Haelewyn B, Yvon A, Hanouz JL, MacKenzie ET, Ducouret P, Gérard JL, Roussel S. Desflurane affords greater protection than halothane against focal cerebral ischaemia in the rat. Br J Anaesth 2003; 91:390-6. [PMID: 12925480 DOI: 10.1093/bja/aeg186] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We studied the potential neuroprotective effects of halothane and desflurane, compared with the awake state, on infarct size following 2 h of intraluminal middle cerebral artery occlusion (MCAo) and 22 h of reperfusion. METHODS Male Sprague-Dawley rats were anaesthetized with desflurane or halothane, intubated, and mechanically ventilated. Mean arterial pressure (MAP), blood gases, and pH were controlled. Body temperature was maintained at 37.5-38 degrees C. Animals were assigned to one of four groups according to the anaesthetic type (halothane or desflurane) and the duration of anaesthesia: "short-duration", during the preparation only; "long-duration", during both preparation and ischaemia. Twenty-four hours after MCAo, infarcts were visualized by staining with 2,3,5-triphenyltetrazolium chloride. Two additional groups of rats were subjected to the same protocol as that of long-duration halothane and long-duration desflurane with additional pericranial temperature measurements made. RESULTS Physiological parameters were comparable between the groups but MAP was higher (P<0.0001) in the short-duration groups. In the short-duration groups, cerebral infarct volumes were not significantly different between anaesthetics (short-duration halothane: 288 (61) mm(3), mean (SD); short-duration desflurane: 269 (71) mm(3), P>0.56). Compared with the awake state (short-duration groups), halothane and desflurane significantly reduced infarct volumes (long-duration halothane: 199 (54) mm(3), P<0.0047 vs short-duration halothane; long-duration desflurane: 121 (55) mm(3), P<0.0001 vs short-duration desflurane). The mean infarct volume in the long-duration desflurane group was significantly lower than that in the long-duration halothane group (P<0.0053). Pericranial temperatures were similar in the desflurane and halothane long-duration groups (P>0.17). CONCLUSIONS In rats, desflurane-induced neuroprotection against focal cerebral ischaemia was greater than that conferred by halothane.
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Affiliation(s)
- B Haelewyn
- Laboratory of Experimental Anaesthesiology and Cellular Physiology, University of Caen, UPRES EA 3212, Département d'Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU), Côte de Nacre, Caen, France
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20
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Fellahi JL, Bénard P, Daccache G, Mourgeon E, Gérard JL. [Vasodilatory septic shock refractory to catecholamines: is there a role for terlipressin?]. Ann Fr Anesth Reanim 2003; 22:631-4. [PMID: 12946495 DOI: 10.1016/s0750-7658(03)00218-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report two patients in vasodilatory septic shock refractory to catecholamines in which a continuous infusion of terlipressin was associated with a dramatic increase in systemic arterial blood pressure and short-term survival. Low doses of terlipressin were sufficient in both cases (0.01-0.0 mg h(-1)) to restore blood pressure by increase of systemic vascular resistances. The haemodynamic response was immediate, long-acting, dose-dependent and reversible in a few hours when the drug administration was stopped. A further increase in terlipressin dose regimen markedly decreased cardiac performance. Terlipressin simultaneously induced vasoconstriction within the cutaneous vascular territory, leading to local skin necrosis. The splanchnic vascular territory seemed to be constricted in the same way. Further studies are needed to better understand and precise the role of terlipressin in the treatment of vasodilatory septic shock refractory to catecholamines.
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Affiliation(s)
- J L Fellahi
- Service d'anesthésie-réanimation, centre hospitalier privé Saint-Martin, 18, rue des Roquemonts, 14050 Caen, France.
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21
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Yvon A, Hanouz JL, Terrien X, Ducouret P, Rouet R, Bricard H, Gérard JL. Electrophysiological effects of morphine in an in vitro model of the 'border zone' between normal and ischaemic-reperfused guinea-pig myocardium. Br J Anaesth 2002; 89:888-95. [PMID: 12453934 DOI: 10.1093/bja/aef283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Morphine is commonly used in clinical practice in pain management. Although morphine has been shown to precondition the myocardium, its effects on action potential parameters and ischaemia-reperfusion-induced arrhythmias and conduction blocks remain unknown. METHODS In a double-chamber bath, guinea-pig right ventricular muscle strips were subjected partly to normal conditions and partly to 30 min of simulated ischaemia (hypoxia, hyperkalaemia, acidosis, and lack of nutritional substrate) followed by 30 min of reperfusion. Action potential parameters were recorded continuously in the normal zone and in the ischaemic- reperfused zone. Spontaneous arrhythmias and conduction blocks were noted. The electro physiological effects of morphine were studied at 0.01 and 0.1 micro M. RESULTS In control conditions, morphine did not modify action potential parameters of resting membrane potential, maximal upstroke velocity (V(max)), action potential amplitude (APA) and action potential duration at 50 and 90% of repolarization. Morphine reduced ischaemia-induced depolarization and lessened the ischaemia-induced decrease in APA and V(max). Morphine significantly decreased the occurrence of conduction block during simulated ischaemia (20% at 0.01 and 0.1 micro M vs 67% in the control group, P<0.05) and reperfusion-induced arrhythmias (40% at 0.01 micro M and 30% at 0.1 micro M vs 92% in the control group, P<0.05). CONCLUSIONS In ischaemic-reperfused guinea-pig myocardium, morphine at clinically relevant concentrations decreased ischaemia-induced conduction blocks and reperfusion-induced ventricular arrhythmias.
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Affiliation(s)
- A Yvon
- Laboratory of Experimental Anesthesiology and Cellular Physiology, UPRES EA 3212, Centre Hospitalier Universitaire, Côte de Nacre, Caen, France
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Gérard JL, Desgranges P, Becquemin JP, Desse H, Mellière D. [Feasibility of ambulatory endovenous laser for the treatment of greater saphenous varicose veins: one-month outcome in a series of 20 outpatients]. J Mal Vasc 2002; 27:222-5. [PMID: 12457128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
The purpose of this feasibility study was to demonstrate that endovenous laser can be a useful alternative to conventional surgery for ambulatory treatment of advanced varicose veins. We assessed an open, non-randomized series of patients treated in one center by the same operator. The study protocol was approved by the local ethics committee. Twenty patients with stage II or III varicose veins in the Porter classification gave their informed consent to participate in the study. The patients were treated with endovenous laser by the first author in the outpatient clinic of the Henri Mondor University Hospital vascular surgery department. All procedures were conducted under local anesthesia. A 980 nm laser diode optic fiber was introduced into the vein percutaneously. Laser beams were fired from the sapheno-femoral junction to just under the genu, withdrawing the fiber 3 mm every 1.5 sec. Clinical evaluation with a quality-of-life questionnaire and duplex-scan was performed at days 3, 8 and 30 post-op. Complete occlusion and retraction of the treated vein was observed at day 3 and 30, from the point of introduction to the sapheno-femoral junction in 18 of the 20 patients. The branches of the greater saphenous vein remained patent with physiological flow in the stump which remained patent 1 to 2 cm upstream from the sapheno-femoral junction. The length of the patent stump dependend on the level of the anterior or posterior branch. There were no adverse effects related to the local anesthesia. Pain was low to mild during treatment and the days following the procedure, requiring 8 tablets of acetominophen at most. Hematomas were minimal and had completely resolved by the end of the first month. No work stoppage was required for the 14 patients with occupational activities. There were no cases of deep or superficial vein thrombosis. Complete occlusion and retraction of the varicose vein at one month suggests this treatment has a long-lasting effect. Long-term evaluation is required. Treatment of advanced varicose veins with endovenous laser can be an alternative to surgical treatment providing the advantage of outpatient ambulatory treatment.
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Affiliation(s)
- J L Gérard
- Service de Chirurgie Vasculaire, CHU Henri Mondor, 94010 Créteil (Paris XII), France.
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Hanouz JL, Yvon A, Guesne G, Eustratiades C, Babatasi G, Rouet R, Ducouret P, Khayat A, Bricard H, Gérard JL. The in vitro effects of remifentanil, sufentanil, fentanyl, and alfentanil on isolated human right atria. Anesth Analg 2001; 93:543-9. [PMID: 11524316 DOI: 10.1097/00000539-200109000-00005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Because some clinical studies have suggested that opioids used in anesthesia may have different deleterious hemodynamic effects, we compared the direct myocardial effects of cumulative concentrations of remifentanil, sufentanil, fentanyl, and alfentanil on inotropic and lusitropic variables of isolated human myocardium in vitro. Human right atrial trabeculae, obtained from patients scheduled for coronary bypass surgery or aortic valve replacement, were suspended vertically in an oxygenated (95% oxygen/5% CO(2)) Tyrode's modified solution ([Ca(2+)](o) = 2.0 mM, 37 degrees C, pH 7.40, stimulation frequency 1 Hz). The effects of cumulative concentrations (10(-11), 10(-10), 10(-9), 10(-8), 10(-7), and 10(-6) M) of remifentanil (n = 8), sufentanil (n = 8), fentanyl (n = 8), and alfentanil (n = 8) on inotropic and lusitropic variables of isometric twitches were measured. Remifentanil, sufentanil, and fentanyl did not modify active isometric force and peak of the positive force derivative as compared with the Control group. Alfentanil induced a dose-dependent decrease in active isometric force and peak of the positive force derivative. This effect was abolished in the presence of [Ca(2+)](o) = 4.0 mM. None of these opioids altered lusitropic variables.
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Affiliation(s)
- J L Hanouz
- Department of Anesthesiology, Center Hospitalier Universitaire, Caen, France.
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Hanouz JL, Yvon A, Guesne G, Eustratiades C, Babatasi G, Rouet R, Ducouret P, Khayat A, Bricard H, Gérard JL. The in vitro effects of remifentanil, sufentanil, fentanyl, and alfentanil on isolated human right atria. Anesth Analg 2001. [PMID: 11524316 DOI: 10.1097/00000539-200109000-00005.pubmed:11524316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Because some clinical studies have suggested that opioids used in anesthesia may have different deleterious hemodynamic effects, we compared the direct myocardial effects of cumulative concentrations of remifentanil, sufentanil, fentanyl, and alfentanil on inotropic and lusitropic variables of isolated human myocardium in vitro. Human right atrial trabeculae, obtained from patients scheduled for coronary bypass surgery or aortic valve replacement, were suspended vertically in an oxygenated (95% oxygen/5% CO(2)) Tyrode's modified solution ([Ca(2+)](o) = 2.0 mM, 37 degrees C, pH 7.40, stimulation frequency 1 Hz). The effects of cumulative concentrations (10(-11), 10(-10), 10(-9), 10(-8), 10(-7), and 10(-6) M) of remifentanil (n = 8), sufentanil (n = 8), fentanyl (n = 8), and alfentanil (n = 8) on inotropic and lusitropic variables of isometric twitches were measured. Remifentanil, sufentanil, and fentanyl did not modify active isometric force and peak of the positive force derivative as compared with the Control group. Alfentanil induced a dose-dependent decrease in active isometric force and peak of the positive force derivative. This effect was abolished in the presence of [Ca(2+)](o) = 4.0 mM. None of these opioids altered lusitropic variables.
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Affiliation(s)
- J L Hanouz
- Department of Anesthesiology, Center Hospitalier Universitaire, Caen, France.
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25
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Abstract
OBJECTIVES Measuring the incidence of intraoperative recall in our hospital. STUDY DESIGN Prospective study. PATIENTS AND METHODS Three hundred and twenty-six patients who underwent a general anaesthesia for elective surgery on selected sites (general, urology, ORL, gynaecology and obstetrical, vascular and cardiac, thoracic) were interviewed on the first or the second postoperative day using a standard questionnaire. When recall was suspected, the anaesthetist was consulted and the anaesthetic record was looked at in order to evaluate the authenticity of any recollections. RESULTS Four patients mentioned an anomaly evoking intra-operative recall. The reduction in the anaesthetic level would explain authentic recollection for one patient. The recollection of another patient could not be truly verified. The site was the same for these two cases and the anaesthetic protocol for digestive surgery comprised curare and droperidol. The recollections for the two other patients did not correspond to the intraoperative period. The incidence of this phenomenon on the totality of sites was 0.6 per cent. CONCLUSION This result conforms to other studies. This phenomenon is a quality indicator, but probably under estimated. Although retrospective, this evaluation is quick and easy. This research in post-operative period should be systematic in order to find the reason and to propose an early course of action for these patients. An analysis of the anaesthetic protocol is necessary when the frequency of intraoperative recall is too high.
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Affiliation(s)
- C Leclerc
- Département d'anesthésie-réanimation chirurgicale et de médecine d'urgence, centre hospitalier universitaire Côte-de-Nacre, 14033 Caen, France
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26
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Gérard JL. [Professional identity is hard to define]. Soins 2000:72-3. [PMID: 11081083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- J L Gérard
- L'Institut de formation des cadres de santé (IFCS), Tours
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27
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Abstract
We report an accidental perforation of the left iliac artery and vein during lumbar discectomy in the kneeling position. During the surgical procedure, a brief and transient hypotension occurred, although the surgeon did not observe any abnormal bleeding in the operating field. In the recovery room, arterial blood pressure decreased, and tachycardia, pallor, and abdominal pain occurred. Retroperitoneal bleeding was suspected. Immediate fluid resuscitation was initiated, anesthesia was continued, and red blood cells were ordered. The use of medical antishock trousers enabled temporization until vascular surgeons were ready. An emergent laparotomy was performed to repair vascular injuries. The delayed symptoms, use of medical antishock trousers, and implications for anesthetists are discussed.
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Affiliation(s)
- J L Hanouz
- Department of Anesthesiology and Surgical Intensive Care, CHRU of Caen, France.
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Rouet R, Picard S, Libersa C, Ghadanfar M, Alabaster C, Gérard JL. Electrophysiological effects of dofetilide in an in vitro model of "border zone" between normal and ischemic/reperfused myocardium. Circulation 2000; 101:86-93. [PMID: 10618309 DOI: 10.1161/01.cir.101.1.86] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To evaluate both class III activity and antiarrhythmic action of dofetilide at the level of the "border zone," we investigated its electrophysiological effects on guinea pig ventricular strips submitted partly to normoxia (normal zone, NZ) and partly to simulated severe ischemia, then reperfusion (altered zone, AZ). METHODS AND RESULTS Because of the differential class III effects of dofetilide in normal and ischemic regions, the dispersion of the action potential duration at 90% repolarization (APD(90)) between NZ and AZ was reduced by 5 nmol/L of drug during early ischemia (at 10 minutes, APD(90) NZ/APD(90) AZ was 1.68+/-0.22 versus 2.82+/-0.17 in control, P<0.05), whereas 50 nmol/L dofetilide worsened it during late ischemia (at 30 minutes, APD(90) NZ/APD(90) AZ was 4.62+/-0.76 versus 2.57+/-0.21 in control, P<0.05). Concomitantly, dofetilide at 5, 10, and 50 nmol/L abolished the early extrastimulus (ES)-induced arrhythmias, and at 10 and 50 nmol/L, it significantly enhanced the incidence of late spontaneous repetitive responses (in 86% and 75% of preparations treated with 10 and 50 nmol/L, respectively, versus 25% in control, P<0.05). During reperfusion, dofetilide at 5, 10, and 50 nmol/L exhibited concentration-dependent class III effects, as it did in the NZ, and did not modify the incidence of spontaneous arrhythmias. CONCLUSIONS Dofetilide 5 nmol/L decreased APD(90) dispersion between NZ and AZ and reduced the early ES-induced arrhythmias. However, dofetilide 50 nmol/L increased APD(90) dispersion, and at 10 and 50 nmol/L, it increased the late spontaneous arrhythmias.
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Affiliation(s)
- R Rouet
- Anesthésiologie Expérimentale et Physiologie Cellulaire, Université, Caen, France
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29
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Leclerc C, Fretigny M, Jehan C, Le Querrec A, Hanouz JL, Gérard JL, Bricard H. [Mesenteric vein and inferior vena cava thrombosis: disseminated intravascular coagulation and/or G 20210 A mutation of the prothrombin gene?]. Ann Fr Anesth Reanim 2000; 19:42-6. [PMID: 10751955 DOI: 10.1016/s0750-7658(00)00124-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
The authors report the case of a 30-year-old man who died from pulmonary embolism and multiorgan failure caused by mesenteric and inferior vena cava thrombosis. The patient was found heterozygous for the prothrombin gene variant (G 20210 A). The family study showed the same asymptomatic anomaly in his brother. This recently described mutation is associated with an increased risk for venous thrombosis. The investigations and treatment of mesenteric venous thrombosis are discussed.
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Affiliation(s)
- C Leclerc
- Département d'anesthésie-réanimation chirurgicale et médecine d'urgence, Centre hospitalier universitaire Côte-de-Nacre, Caen, France
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30
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Hanouz JL, Massetti M, Guesne G, Chanel S, Babatasi G, Rouet R, Ducouret P, Khayat A, Galateau F, Bricard H, Gérard JL. In vitro effects of desflurane, sevoflurane, isoflurane, and halothane in isolated human right atria. Anesthesiology 2000; 92:116-24. [PMID: 10638907 DOI: 10.1097/00000542-200001000-00022] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Direct myocardial effects of volatile anesthetics have been studied in various animal species in vitro. This study evaluated the effects of equianesthetic concentrations of desflurane, sevoflurane, isoflurane, and halothane on contractile parameters of isolated human atria in vitro. METHODS Human right atrial trabeculae, obtained from patients undergoing coronary bypass surgery, were studied in an oxygenated (95% O2-5% CO2) Tyrode's modified solution ([Ca2+]o = 2.0 mM, 30 degrees C, stimulation frequency 0.5 Hz). The effects of equianesthetic concentrations (0.5, 1, 1.5, 2, and 2.5 minimum alveolar concentration [MAC]) of desflurane, sevoflurane, isoflurane, and halothane on inotropic and lusitropic parameters of isometric twitches were measured. RESULTS Isoflurane, sevoflurane, and desflurane induced a moderate concentration-dependent decrease in active isometric force, which was significantly lower than that induced by halothane. In the presence of adrenoceptor blockade, the desflurane-induced decrease in peak of the positive force derivative and time to peak force became comparable to those induced by isoflurane. Halothane induced a concentration-dependent decrease in time to half-relaxation and a contraction-relaxation coupling parameter significantly greater than those induced by isoflurane, sevoflurane and desflurane. CONCLUSIONS In isolated human atrial myocardium, desflurane, sevoflurane, and isoflurane induced a moderate concentration-dependent negative inotropic effect. The effect of desflurane on time to peak force and peak of the positive force derivative could be related to intramyocardial catecholamine release. At clinically relevant concentrations, desflurane, sevoflurane, and isoflurane did not modify isometric relaxation.
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Affiliation(s)
- J L Hanouz
- Département d'Anesthésie-Réanimation, Centre Hospitalier Universitaire, Caen, France.
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31
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Picard S, Rouet R, Ducouret P, Puddu PE, Flais F, Criniti A, Monti F, Gérard JL. KATP channels and 'border zone' arrhythmias: role of the repolarization dispersion between normal and ischaemic ventricular regions. Br J Pharmacol 1999; 127:1687-95. [PMID: 10455327 PMCID: PMC1566150 DOI: 10.1038/sj.bjp.0702704] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
1. In order to investigate the role of KATP channel activation and repolarization dispersion on the 'border zone' arrhythmias induced by ischaemia-reperfusion, the effects of glibenclamide and bimakalim, agents modifying action potential (AP) duration, were studied in an in vitro model of myocardial 'border zone'. 2. The electrophysiological effects of 10 microM glibenclamide and 1 microM bimakalim (n=8 each), respectively KATP channel blocker and activator, were investigated on guinea-pig ventricular strips submitted partly to normal conditions (normal zone, NZ) and partly to simulated ischaemic then reperfused conditions (altered zone, AZ). 3. By preventing the ischaemia-induced AP shortening (P<0.0001), glibenclamide reduced the dispersion of AP duration 90% (APD90) between NZ and AZ (P<0.0001), and concomitantly inhibited the 'border zone' arrhythmias induced by an extrastimulus (ES), their absence being significantly related to the lessened APD90 dispersion (chi2=8.28, P<0.01). 4. Bimakalim, which also reduced the APD90 dispersion (P<0.005) due to differential AP shortening in normal and ischaemic tissues, decreased the incidence of myocardial conduction blocks (25% of preparations versus 83% in control, n=12, P<0.05) and favoured 'border zone' spontaneous arrhythmias (75% of preparations versus 25% in control, P<0.05). 5. During reperfusion, unlike bimakalim, glibenclamide inhibited the ES-induced arrhythmias and reduced the incidence of the spontaneous ones (12% of preparations versus 92% in control, P<0.05), this latter effect being significantly related (chi2=6.13, P<0.02) to the lessened ischaemia-induced AP shortening in the presence of glibenclamide (P<0.0001). 6. These results suggest that KATP blockade may protect the ischaemic-reperfused myocardium from 'border zone' arrhythmias concomitantly with a reduction of APD90 dispersion between normal and ischaemic regions. Conversely, KATP channel activation may modify the incidence of conduction blocks and exacerbate the ischaemia-induced 'border zone' arrhythmias.
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Affiliation(s)
- S Picard
- Laboratory of Experimental Anaesthesiology and Cellular Physiology, University of Caen, Caen, France
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32
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Mellière D, Gérard JL, Bitton L, Paris D, Becquemin JP. [Echo-doppler surveillance of revascularization of the legs in asymptomatic postoperative patients. Why? With what rhythm? How much time? How?]. J Mal Vasc 1999; 24:233-8. [PMID: 10467536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
AIM Routine duplex surveillance of patients following an arterial operation includes the scanning of symptomless patients. While the benefits of preventive correction of deteriorations, stenoses or dilatations, following aortic or lower limb arterial reconstruction are undisputed, there is no hard data on the effectiveness of this surveillance in terms of limb salvage, on its cost, and on the optimal frequency and duration. METHODS The AA review the literature on this subject and suggest a programme which reconciles the patients' interests with the best use of health care financial resources. RESULTS The possible complications depend on the type of operation. Some are symptomless. They occur mainly during the first year and less frequently, but regularly so, during the subsequent years. There is therefore no time limit for the duration of the surveillance. The effectiveness of this surveillance is low and thus the examination must be meticulous and its frequency adapted to the risks. Broadly speaking: During the first year, aorto-ilio-femoral reconstructions must be screened at one month, six months and one year; by-passes below the groin with no particular risk at six months and one year; by-passes at risk and those anastomosed to a lower leg or ankle artery require a further check-up at one month and three months. After the first year, aorto-ilio-femoral and similar by-passes must be checked annually; by-passes below the groin, when at risk, must be checked annually; in those without any particular risk, a check-up every two years seems to be sufficient. Any patient found to have a deterioration on screening must be checked every six months. CONCLUSION Careful screening is the only way of discovering a symptomless deterioration before the development of serious complications. As every arteriole reconstruction should be followed by a lifelong surveillance, in times of financial constraints the frequency of the check-ups must be tailored according to the risks present and the quality of the surveillance must be faultless.
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Affiliation(s)
- D Mellière
- Service de Chirurgie Vasculaire, CHU Henri Mondor, Créteil
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33
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Abstract
Rupture of the pericardium is a rare complication of blunt chest trauma. The diagnosis is difficult and if it remains unrecognized, severe complications such as heart herniation may occur. We report the case of a 19-year-old patient with a traumatic rupture of the pericardium. The diagnosis was suggested by a pneumopericardium seen on the chest radiograph and CT-scan. Emergency thoracotomy enabled localisation of the tear, assessment of its size, and reparation of the tear to prevent heart herniation.
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Affiliation(s)
- E Pondaven
- Département d'anesthésie-réanimation chirurgicale et de médecine d'urgence, centre hospitalier universitaire Côte-de-Nacre, Caen, France
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Picard S, Rouet R, Duval D, Chesnay F, Gérard JL. KATP channel modulators and myocardial damages induced by ischemia-reperfusion: membrane lipids injury and arrhythmias. J Mol Cell Cardiol 1998; 30:2613-21. [PMID: 9990533 DOI: 10.1006/jmcc.1998.0819] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although KATP channels have been proposed as playing a role in most types of myocardial damage associated with ischemia/reperfusion, the potential benefits of KATP channel modulators against the biochemical and electrical disturbances observed during ischemia remain unclear. We have thus studied the effects of glibenclamide and cromakalim, KATP channel blocker and opener respectively, on membrane lipid injury and arrhythmias, in a model of ischemic-reperfused guinea-pig myocardium. Ventricular strips were prelabeled with [3H] arachidonic acid, then subjected to normal conditions (Time-related Control) or to simulated ischemic-reperfused conditions in absence of drug (Control) or in presence of glibenclamide 10 microM or cromakalim 10 microM. The release of radioactive compounds was counted by liquid scintillation spectrometry, while action potentials (AP) were recorded with intracellular microelectrodes. Reperfusion induced a significant increase of arachidonic acid release (P < 0.05 versus Time-related Control). Glibenclamide inhibited the reperfusion-induced arachidonic acid release while cromakalim only delayed it (respectively 483 +/- 87 dpm/g, P < 0.05 and 790 +/- 143 dpm/g. NS versus 838 +/- 80 dpm/g for Control, after 30 min of reperfusion). Unlike glibenclamide, cromakalim was proarrhythmic during reperfusion (in 100% of preparations versus 33% in Control or in presence of glibenclamide, P < 0.05). This in vitro study shows that glibenclamide prevented the reperfusion-induced membrane arachidonic acid release, without proarrhythmic effect, whereas cromakalim, associated with proarrhythmicity, was unable to protect myocardium from cell lipid damage.
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Picard S, Rouet R, Flais F, Ducouret P, Babatasi G, Khayat A, Potier JC, Bricard H, Gérard JL. Proarrhythmic and antiarrhythmic effects of bupivacaine in an in vitro model of myocardial ischemia and reperfusion. Anesthesiology 1998; 88:1318-29. [PMID: 9605693 DOI: 10.1097/00000542-199805000-00024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bupivacaine may have toxic cardiovascular effects when accidentally administered by intravascular injection. However, its electrophysiologic effects in the presence of myocardial ischemia remain unknown. The authors evaluated the electrophysiologic and anti- and proarrhythmic effects of bupivacaine in an in vitro model of the ischemic and reperfused myocardium. METHODS In a double-chamber bath, a guinea pig right ventricular muscle strip was subjected partly to normal conditions and partly to simulated ischemia followed by reperfusion. The electrophysiologic effects of bupivacaine were studied at 1, 5, and 10 microM concentrations. RESULTS Bupivacaine (5 and 10 microM) decreased the maximal upstroke velocity of the action potential (Vmax) in normoxic conditions and further decreased (10 microM) the Vmax decrease induced by ischemic conditions. Bupivacaine reduced the mean occurrence time to the onset of myocardial conduction blocks (9 +/- 3 min; mean +/- SD; P < 0.005 with 5 and 10 microM, compared with 17 +/- 6 min during simulated ischemia with no drug or control), and it increased the number of preparations that became inexcitable to pacing (55% of preparations, with 1 microM and 100% with 5 and 10 microM, compared with 17% for the control group). The incidence of spontaneous arrhythmias was reduced by 5 and 10 microM bupivacaine during ischemia and reperfusion and was enhanced by 1 microM bupivacaine during the ischemic phase. CONCLUSIONS In guinea pig myocardium under ischemic conditions, bupivacaine induced a loss of excitability at concentrations of 5 and 10 microM. Proarrhythmic effects observed at 1 microM were considered as lower than the cardiotoxic range in normoxic conditions. The incidence of reperfusion arrhythmias was decreased at all concentrations.
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Affiliation(s)
- S Picard
- Laboratory of Experimental Anesthesiology and Cellular Physiology, University of Caen, France
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36
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Picard S, Rouet R, Monti F, Puddu PE, Ducouret P, Flais F, Libersa C, Gérard JL. Proarrhythmic effects of DL- and D-sotalol on the "border zone" between normal and ischemic regions of isolated ventricular myocardium and antiarrhythmic effects on reperfusion. J Cardiovasc Pharmacol 1998; 31:126-39. [PMID: 9456287 DOI: 10.1097/00005344-199801000-00018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Considering the Survival With ORal D-sotalol (SWORD) study results, in which mortality was higher in patients treated by the pure class III agent D-sotalol, we tested DL- and D-sotalol (5 and 10 microM) in an in vitro model of "border zone" arrhythmias. Isolated guinea-pig ventricular strips were partly exposed to normoxia ("Normal Zone," NZ) and partly to modified Tyrode's solution ("Ischemic Zone," IZ) for 15 or 30 min ("ischemia"), followed by return to normoxia for 30 min ("reperfusion"). Resting membrane potential, action potential (AP) amplitude, and maximal upstroke velocity of AP were not significantly modified. DL- And D-sotalol, 5 and 10 microM, lengthened AP duration 90% (APD90) in NZ (p < 0.05), whereas these drugs were unable to prevent ischemia-induced APD shortening. By using the accelerated failure time Weibull's model, and a large number of reference experiments to control random variability of analyzed covariates, DL- and D-sotalol increased significantly the incidence of spontaneous arrhythmias during ischemia (chi2 = 24.79; p = 0.0367): 83 (5 microM D- and DL-sotalol), 86, and 62% (10 microM D- and DL-sotalol, respectively) versus 32% of controls. During reperfusion, 10 microM DL-sotalol prevented the occurrence of spontaneous arrhythmias (chi2 = 46.74; p = 0.0001) similar to what seen with the beta-blocking agent propranolol (10 microM). These data, providing evidence for proarrhythmic effects of DL- and D-sotalol on border-zone arrhythmias, concomitant with differential class III actions on NZ versus IZ, might be considered for understanding the SWORD study results.
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Affiliation(s)
- S Picard
- Anesthésiologie Expérimentale et Physiologie Cellulaire, UFR de Médecine, Caen University, France
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37
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Gérard JL. [Diploma for psychiatric nurses. Parts of a difficult dossier]. Soins Psychiatr 1997:17-23. [PMID: 9239121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- J L Gérard
- Institut de formation des cadres de santé, SIRIF, Centre hospitalier Sainte-Anne, Paris
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38
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Payelle G, Maiza D, Coffin O, Alachkar F, Alweis S, Courtheoux P, Khayat MC, Gérard JL, Théron J. Pulsed transthrombotic fibrinolysis: technique and results in the management of occluded lower limb bypass grafts. Ann Vasc Surg 1997; 11:159-64. [PMID: 9181771 DOI: 10.1007/s100169900027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Between March 1987 and March 1993 we used pulsed transthrombotic fibrinolysis to treat 58 symptomatic thrombotic occlusions of lower limb bypass grafts in 45 patients. There were 17 suprainguinal grafts and 28 infrainguinal grafts. Treatment consisted of pulsed infusion of fibrinolytic agents into the thrombus followed by continuous infusion using an electric pump. Minor percutaneous or surgical procedures were often associated. The mean delay to treatment was 7 days. The mean duration of treatment was 150 +/- 66 minutes. Immediate patency was achieved in 88% of cases with no significant difference between suprainguinal and infrainguinal grafts. The clinical success rate was 55%. Actuarial patency at 1 year was 54% +/- 11% for suprainguinal grafts and 26% +/- 7% for infrainguinal grafts. The probability of patency was much lower in patients whose grafts had been implanted within 3 months before occlusion and in patients in whom an adjuvant procedure had not been performed. This study demonstrates that, in cases not requiring immediate surgery, pulsed transthrombotic fibrinolysis can achieve durable patency by treating both the bypass and distal arterial network. This technique allows identification of lesions causing thrombosis and adaptation of treatment specifically to these lesions.
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Affiliation(s)
- G Payelle
- Département d'Anesthésie, Côte de Nacre University Hospital, Caen, France
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39
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Babatasi G, Théron J, Massetti M, Gérard JL, Grollier G, Khayat A. [Associated carotid and coronary lesions: carotid endoluminal angioplasty before coronary surgery]. Presse Med 1996; 25:1623-6. [PMID: 8952681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE There is debate over the therapeutic strategy in patients with lesions of both the coronary arteries and the carotid arteries. Improvement in angioplasty techniques for the carotid artery would be a minimally invasive alternative. METHODS Between January 1993 and June 1995, 12 patients who underwent endoluminal angioplasty of the carotid artery before coronary bypass surgery (mean 17.9 days before) were included in the study. Mean age was 70 +/- 3.2 years. The carotid lesions were asymptomatic in all patients who had stable angina. RESULTS The mean number of bypasses was 2.9 per patient. Five patients had a contralateral stenosis of the internal carotid artery. Angioplasty was performed under cerebral protection using a three way coaxial catheter. A Strecker stent was required in 8 cases. One patient presented transient hemianopsia. All patients were seen again at 4 months for an angiogram then at 6 months for a Doppler examination. One patient needed complete redilatation with a stent and one other required dilatation of the stent. CONCLUSIONS Endoluminal angioplasty of the carotid arteries gave encouraging results in this high-risk population (underlying disease, age, bilateral carotid lesions, arterial coronary grafts). This technique should be used more widely for patients with severe multiple arterial lesions.
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Affiliation(s)
- G Babatasi
- Département de Chirurgie cardiovasculaire et thoracique, CHU Caen-Côte de Nacre
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40
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Babatasi G, Massetti M, Bhoyroo S, Cleron S, Agostini D, Lebreton P, Gérard JL, Zerr C, Scanu P, Grollier G, Potier JC, Khayat A. [Cardiac transplantation. Evaluation of a consecutive series of 75 grafts]. Ann Cardiol Angeiol (Paris) 1996; 45:249-55. [PMID: 8763644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The global results of various series of heart transplantation (HT) are essential to assess the life expectancy provided by this technique. Due to the increasing graft shortage, it appears essential to very strictly candidates for HT. METHODS From March 8, 1989 to December 7, 1994, 75 orthotopic Hts were performed in 62 men and 12 women (1 case of retransplantation). The mean age was 47.46 +/- 15.02 years (range: 2.5-66 years). Four patients were younger than 10 years and 22 were older than 60 years. Our series included more cases of ischaemic heart disease (36) than dilated cardiomyopathies (33), with a history of cardiac surgery in almost one quarter (20) of patients with ischaemic heart disease. RESULTS The immediate postoperative survival rate was 94.7% with 3 deaths attributable to refractory pulmonary hypertension associated with graft failure and one death related to postoperative tamponade. Five other patients died during the following 3 months, increasing the mean global survival to 88%. After a mean follow-up of 2.1 years (maximum 5.8 years), the actuarial 5-year survival rate was 56.8%. Eleven patients died between 4 and 38 months (mean: 18.2 months). Two deaths were due to cancers, 4 were due to septicaemia, another 4 were due to rejection and finally 1 was due to meningeal haemorrhage. The frequency (19) of reoperations for clot removal was due to the large number of patients with a history of previous heart surgery (20). CONCLUSION Strict recipient selection, possibly based on 123I-MIBG scintigraphy, the use of pulsatile circulatory assistance systems, improved CMV, morphometry and donor-recipient age matching, should optimize the results of a technique, whose efficacy is confirmed in this series.
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Affiliation(s)
- G Babatasi
- Service de Chirurgie Thoracique et Cardio-Vasculaire, CHU Caen Côte de Nacre, CAEN, France
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41
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Abstract
Prospective clinical studies on albumin and non human colloids, administered peroperatively, were analysed. Only those with a level of evidence I or II were considered. On the basis of the cost-effectiveness ratio, albumin should not be the first choice treatment for peroperative plasma volume expansion. Low molecular weight hydroxyethylstarch is as efficient for restoration and maintenance of volaemia and colloid osmotic pressure. Albumin is administered when other colloids are contra-indicated or when their upper limit of volume has been reached.
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Affiliation(s)
- J L Gérard
- Département d'anesthésie-réanimation chirurgicale et médecine d'urgence, CHU Côte-de-Nacre, Caen, France
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42
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Gérard JL. [Anthropology of pain. Notes after reading the work of David Le Breton]. Soins 1995:44-7. [PMID: 8715117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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43
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Laroche D, Dubois F, Gérard JL, Lefrançois C, André B, Vergnaud MC, Dubus L, Bricard H. Radioimmunoassay for plasma histamine: a study of false positive and false negative values. Br J Anaesth 1995; 74:430-7. [PMID: 7734264 DOI: 10.1093/bja/74.4.430] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In order to achieve a correct diagnosis of drug anaphylaxis using a radioimmunoassay devoid of interferences, we have studied factors leading to false positive or false negative values of plasma histamine. Different steps in sample collection were studied systematically in 30 normal volunteers. False positive values were found in haemolysed samples, with histamine concentrations being correlated with haemoglobin concentrations, and where plasma was aspirated from the white-cell layer. There was no significant increase when a tourniquet or vacuum tubes were used, or when blood tubes were left at 4 degrees C overnight. In 12 patients who experienced an anaphylactic reaction, histamine disappeared from blood 10 times more slowly than expected. False negative values were found in two pregnant women and one heparinized patient. Histamine was remarkably stable in vitro in blood or plasma samples, whereas it disappeared rapidly when plasma from a pregnant woman or a heparinized patient was added to the sample. We conclude that false positive and false negative values are rare when using this radioimmunoassay.
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Affiliation(s)
- D Laroche
- Service of Nuclear Medicine, Centre Hospitalier Régional Universitaire, Caen, France
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44
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Gérard JL. [From a helping relationship to a therapeutic one]. Soins Psychiatr 1994:28-34. [PMID: 7809725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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45
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Gérard JL. [Nursing diagnoses and nursing care of persons with psychotic disorders]. Soins Psychiatr 1993:58-63. [PMID: 8122163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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46
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Laroche D, Lefrançois C, Gérard JL, Dubois F, Vergnaud MC, Guéant JL, Bricard H. EARLY DIAGNOSIS OF ANAPHYLACTIC REACTIONS TO NEUROMUSCULAR BLOCKING DRUGS. Br J Anaesth 1992; 69:611-4. [PMID: 1366342 DOI: 10.1093/bja/69.6.611] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Neuromuscular blocking drugs (NMB) are involved in most of the anaphylactic reactions occurring during anaesthesia. Patients are evaluated usually 6 weeks after the reaction, by skin testing. In order to obtain an earlier diagnosis, we have measured plasma concentrations of histamine, tryptase and NMB-specific IgE antibodies in 14 patients after an anaphylactoid reaction. We have compared the results with those of skin tests and specific IgE obtained 8 weeks later. Good agreement was observed in all subjects between the results of skin tests and the values for histamine and tryptase, provided that both markers were measured simultaneously. Furthermore, there was no significant difference between the concentrations of NMB-specific IgE antibodies observed at the time of the reaction and 8 weeks later. Thus anaphylaxis to neuromuscular blocking drugs can be demonstrated at the time of the reaction by measuring plasma concentrations of histamine, tryptase and specific IgE. In the event of the patient's death, such measurements may be useful in identifying the likely cause.
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Affiliation(s)
- D Laroche
- Laboratory of Nuclear Medicine, Centre Hospitalier Régional Universitaire, Caen, France
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47
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Gérard JL. [Dimensions of psychiatric nursing care and the avatars of its theorization]. Soins Psychiatr 1992:51-6. [PMID: 1470952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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48
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Laroche D, Dubois F, Lefrançois C, Vergnaud MC, Gérard JL, Soufarapis H, Sillard B, Bricard H. [Early biological markers of anaphylactoid reactions occurring during anesthesia]. Ann Fr Anesth Reanim 1992; 11:613-8. [PMID: 1284403 DOI: 10.1016/s0750-7658(05)80779-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Three markers of in vivo histamine release, i.e. plasma histamine and tryptase, and urinary methylhistamine, were assessed using sensitive radioimmunoassays in 18 patients who had experienced an adverse reaction to an anaesthetic agent. Controls were obtained from 35 patients following a general anaesthetic, which included a muscle relaxant, and who remained free from any adverse reaction. A first blood sample was obtained from all 18 patients a mean 25 +/- 26 min after the reaction, and a second one in thirteen a mean 120 +/- 65 min after the reaction. Ten patients had had a life-threatening reaction. Plasma histamine levels were increased in all these cases, and tryptase concentrations in 9 out of 10. Urinary methylhistamine rarely reached pathological levels (4 out of 10). Skin tests were positive in the four tested patients. Plasma histamine concentration was still high in 8 cases thirty minutes after the reaction, and remained increased for more than 2 h in two patients. Among the other eight patients with a moderate reaction, 3 had high histamine levels, with normal or weakly increased tryptase concentrations, and normal urinary methylhistamine. Two of these patients had positive skin tests. There were no abnormal findings in any of the investigations carried out in the other five patients, except for a slightly positive skin test to atracurium in one patient. Plasma histamine had a higher sensitivity than tryptase levels. Methylhistamine concentrations were only rarely of interest. There were no false positives with the three investigated markers.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Laroche
- Service des Radio-Isotopes, CHU de Caen
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49
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Besnard M, Fauchon G, Thomassin C, Gérard JL, Locker B, Bricard H. [Efficacy and tolerance of Elohes 6% during peroperative normovolemic dilution]. Ann Fr Anesth Reanim 1992; 11:531-3. [PMID: 1476284 DOI: 10.1016/s0750-7658(05)80759-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study assessed the cardiovascular stability of intraoperative normovolaemic haemodilution carried out with 6% Elohes during the exchange, the intraoperative, recovery and postoperative periods, as well as its effects on coagulation and renal function. Ten patients, ranked ASA 1, were included. Patients were premedicated with 100 mg of hydroxyzine, and anaesthesia was induced with 2 mg.kg-1 propofol, 3 micrograms.kg-1 fentanyl, and 0.5 mg.kg-1 atracurium. Maintenance was obtained with propofol, fentanyl and 50% nitrous oxide in oxygen. Haemodilution, carried out with a peripheral venous catheter, size 14 G, consisted in the removal of 15 ml.kg-1 of blood and its simultaneous replacement with Elohes 6%. Heart rate, systolic, diastolic and mean blood pressures were recorded before anaesthetic induction, every 5 min during the haemodilution, and thereafter during surgery, recovery and postoperative periods, up to the third postoperative day. Blood haemoglobin, fibrinogen, prothrombin, sodium, potassium, urea and creatinine concentrations, haematocrit, platelet count, and bleeding and activated cephalin times were assessed before and immediately after haemodilution, and on postoperative days 1 and 3. A mean of 1,295 +/- 68 ml of blood were removed during a 32 +/- 2 min period, and replaced by 1,315 +/- 64 ml of Elohes. Haematocrit decreased from 44 +/- 1.1% to 29.7 +/- 0.8%. There were no significant alterations in other parameters, except for an increase in heart rate at the time of extubation. Cardiovascular parameters, as well as the haemodilution, were stable up to the end of the study period. It is concluded that replacing blood with Elohes for intentional haemodilution affords convenient cardiovascular stability.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Besnard
- Département d'Anesthésie-Réanimation, CHU, Caen
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50
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Gosgnach M, Gérard JL, Berdeaux A, Giudicelli JF. Compared peripheral vascular responses to intravenous and intra-arterial administrations of positive inotropic agents in conscious dogs. Fundam Clin Pharmacol 1991; 5:709-18. [PMID: 1783360 DOI: 10.1111/j.1472-8206.1991.tb00759.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In addition to their direct effects on cardiac contractility, a number of positive inotropic agents also induce, through direct peripheral vasodilation, a reduction in afterload which is of major importance in their beneficial effects in the treatment of congestive heart failure. However, the induced increase in cardiac output can indirectly improve perfusion of peripheral vessels through a flow-mediated mechanism. Thus, the goal of the present study was to compare the direct peripheral vasomotor effects assessed in the iliac vascular bed of four positive inotropic agents: DPI 201-106, ouabain, milrinone and dobutamine, in the presence and absence of simultaneous changes in cardiac function. These drugs were administered either through intravenous or intra-arterial (aorto-iliac catheter) routes in 6 conscious dogs, chronically instrumented for the measurement of heart rate, arterial pressure, left ventricular dP/dt, iliac artery blood flow and iliac artery diameter (sonomicrometry). Intravenous doses were selected as those inducing equipotent positive inotropic responses whereas intra-arterial doses were below those required to induce any significant change in systemic hemodynamics. Ouabain decreased and milrinone increased both iliac blood flow and diameter after either intravenous or intra-arterial administrations. In contrast, iliac blood flow did not change after intra-arterial administration of DPI 201-106 and dobutamine whereas iliac diameter was not modified by DPI 201-106 and even decreased with dobutamine. After intravenous administration, DPI 201-106 but not dobutamine, increased both iliac blood flow and diameter. Thus, this experimental preparation can differentiate inotropic agents with direct vasodilating (milrinone) or constricting (ouabain) properties and those (DPI 201-106 and dobutamine) with indirect vasodilating effects most likely mediated by the improvement in cardiac function.
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Affiliation(s)
- M Gosgnach
- Département de pharmacologie, Faculté de médecine Paris-Sud, Le Kremlin-Bicêtre, France
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