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1.
Br J Anaesth ; 101(4): 473-8, 2008 Oct.
Article in English | MEDLINE | ID: mdl-18653494

ABSTRACT

BACKGROUND: It is increasingly believed that acute microvascular alterations may be involved in the development of organ dysfunction in critically ill patients. Propofol significantly decreases vascular tone and venous return, which can induce arterial hypotension. However, little is known about the microcirculatory effects of propofol in healthy humans. METHODS: We conducted a prospective, open-labelled trial in 15 patients anaesthetized by propofol for transvaginal oocyte retrieval. The sublingual microcirculatory network was studied before, during, and after propofol infusion using orthogonal polarization spectral imaging. RESULTS: Mean (SD) calculated propofol effect-site concentration was 6.5 (1.8) microg ml(-1). During propofol administration, systemic haemodynamic and oxygenation variables were unchanged, but total microvascular density decreased by 9.1% (P<0.05). The venular density remained unchanged, but the density of perfused capillaries was significantly reduced by 16.7% (P<0.05). Microcirculatory alterations resolved 3 h after discontinuation of the propofol infusion. CONCLUSIONS: Propofol infusion for anaesthesia in man reduces capillary blood flow.


Subject(s)
Anesthetics, Intravenous/pharmacology , Microcirculation/drug effects , Propofol/pharmacology , Adult , Blood Pressure/drug effects , Capillaries/drug effects , Capillaries/pathology , Female , Heart Rate/drug effects , Humans , Microscopy, Polarization/methods , Prospective Studies , Tongue/blood supply
4.
Rev Med Brux ; 23 Suppl 2: 23-6, 2002.
Article in French | MEDLINE | ID: mdl-12584904

ABSTRACT

The Department of Anesthesiology and Reanimation is organised in units with clinical activities, which include the pre-operative care of patients, anesthesiological care and immediate post-operative supervision. Two post-operative treatment rooms also form part of the department. The main fields of research of the various units result from collaborations with other departments of Hôpital Erasme, in particular with regard to the development of advanced techniques or fit within the confines of the speciality.


Subject(s)
Anesthesia Department, Hospital , Anesthesia , Anesthetics , Belgium , Biomedical Research , Hospitals, University , Humans
6.
Rev Med Brux ; 21(4): A219-23, 2000 Sep.
Article in French | MEDLINE | ID: mdl-11068470

ABSTRACT

A wide range of invasive techniques are available for pain treatment. Treatment must be adapted to the severity of the underlying disease and the intensity of pain. Very few controlled studies concerning these techniques have been performed, and it is therefore difficult to assess their short and long term efficacy. Optimal effectiveness will be obtained if the indication is correct. This non exhaustive revue presents the indications, techniques and results of neural conduction blocks as peripheral blocks, Alcock canal block, zygapophysial joint blocks and also central blocks illustrated by epidural and intrathecal injections and finally sympathetic nervous system blocks as celiac plexus block, stellate ganglion block and intravenous blocks for complex regional pain syndromes. The indications, techniques and results of thermal neurolyse (radiofrequency, thermocoagulation), transcutaneous electrical nervous stimulation (TENS) and implant central stimulation are also presented. A multidisciplinary approach is used to evaluate the risk/benefit ratio of these invasive techniques for each patient.


Subject(s)
Pain Management , Catheter Ablation/adverse effects , Catheter Ablation/instrumentation , Catheter Ablation/methods , Chronic Disease , Humans , Nerve Block/adverse effects , Nerve Block/instrumentation , Nerve Block/methods , Patient Care Team , Patient Selection , Severity of Illness Index , Transcutaneous Electric Nerve Stimulation/adverse effects , Transcutaneous Electric Nerve Stimulation/instrumentation , Transcutaneous Electric Nerve Stimulation/methods , Treatment Outcome
7.
Acta Orthop Belg ; 65(1): 83-5, 1999 Mar.
Article in English | MEDLINE | ID: mdl-10217006

ABSTRACT

The authors tried to evaluate the benefit of sympathetic nerve blocks with guanethidine in 32 patients with a sympathetic dystrophy syndrome who failed to respond to conventional treatment.


Subject(s)
Autonomic Nerve Block , Pain Management , Reflex Sympathetic Dystrophy/therapy , Guanethidine/administration & dosage , Guanethidine/therapeutic use , Humans , Sympatholytics/administration & dosage , Sympatholytics/therapeutic use , Treatment Outcome
8.
Br J Anaesth ; 83(4): 564-70, 1999 Oct.
Article in English | MEDLINE | ID: mdl-10673870

ABSTRACT

Day-case anaesthesia requires rapidly eliminated anaesthetics which are relatively expensive. This multinational, multicentre European study assessed the relative costs of propofol or sevoflurane anaesthesia in 211 patients. Anaesthesia was induced and maintained with propofol in group 1, with propofol and sevoflurane in group 2, and with sevoflurane in group 3. Drug and delivery costs were calculated in US$. Induction of anaesthesia was fastest in groups 1 and 2, although spontaneous ventilation resumed earliest in group 3. Emergence times and times at which patients were fit for discharge were similar in all groups. Group 2 had the lowest costs based on actual drug use (mean $14.2 (SEM 0.8) vs $18.7 (0.8) and $17.3 (0.8) in groups 1 and 3, respectively). Anaesthetic drug wastage and disposable costs were highest in group 1 and lowest in group 3. Consequently, total costs were highest in group 1 ($31.9 (0.9)) compared with groups 2 ($19.7 (0.9)) and 3 ($18.8 (0.9)). Although we observed increased nausea and vomiting in groups 2 and 3 and reduced patient satisfaction in group 3, these differences should be balanced against the greater cost of propofol anaesthesia.


Subject(s)
Ambulatory Surgical Procedures/economics , Anesthetics, Inhalation/economics , Anesthetics, Intravenous/economics , Methyl Ethers/economics , Propofol/economics , Adolescent , Adult , Aged , Anesthesia, Inhalation/economics , Anesthesia, Intravenous/economics , Costs and Cost Analysis , Drug Costs , Female , Humans , Male , Middle Aged , Prospective Studies , Sevoflurane
9.
Anesth Analg ; 87(1): 185-9, 1998 Jul.
Article in English | MEDLINE | ID: mdl-9661571

ABSTRACT

UNLABELLED: We were looking for a clinical test to indicate a train-of-four (TOF) ratio of approximately 0.9. We compared the adductor pollicis muscle (AP) visually evaluated response to ulnar nerve 100-Hz, 5-s tetanus (RF100 Hz) with the measured AP TOF ratio in 30 ASA physical status I or II adult anesthetized (propofol, sufentanil, N2O/O2) patients. After the induction of anesthesia, the left ulnar nerve was stimulated at the wrist (single twitch and TOF) and the resultant isometric force was measured. When TOF was assessed, the independent investigators, unaware of the left AP-measured TOF ratios, visually evaluated the presence or absence of AP fading elicited by right ulnar nerve 100-Hz, 5-s tetanus. The 30 patients were randomly allocated to receive either 0.5 mg/kg atracurium (n = 15) or 0.1 mg/kg vecuronium (n = 15). The neuromuscular blockade was allowed to resolve spontaneously. A multiple logistic regression analysis was performed by computing the 771 visual observations. The probabilities of success of 100-Hz, 5-s tetanus to detect TOF ratios of 0.8, 0.85, and 0.9 were 99%, 96%, and 67%, respectively. The sensitivity and specificity of 100-Hz, 5-s tetanus as an indicator of TOF ratios of 0.85 and 0.9 are 100% and 75%, 54% and 67%, respectively. We conclude that RF100 Hz visual assessment seems to be highly sensitive in evaluating residual paralysis, as the absence of RF100 Hz visual fading at the AP is compatible with a TOF ratio > 0.85. IMPLICATIONS: After the administration of muscle relaxants, the absence of visual fading at the adductor pollicis, elicited in anesthetized patients by 100-Hz, 5-s tetanus, is compatible with a train-of four ratio > 0.85. Therefore, clinical observation of fading after 100-Hz, 5-s tetanus seems to be a highly sensitive test in evaluating residual paralysis.


Subject(s)
Anesthesia, General/methods , Electric Stimulation , Muscle, Skeletal/drug effects , Muscle, Skeletal/innervation , Ulnar Nerve/drug effects , Ulnar Nerve/physiology , Adult , Atracurium , Humans , Isometric Contraction/drug effects , Isometric Contraction/physiology , Middle Aged , Neuromuscular Nondepolarizing Agents , Vecuronium Bromide
10.
Acta Anaesthesiol Scand ; 40(5): 574-8, 1996 May.
Article in English | MEDLINE | ID: mdl-8792887

ABSTRACT

BACKGROUND: Since neostigmine was introduced for reversal of neuromuscular block, there has been controversy about the optimum dose for antagonizing neuromuscular block. The purpose of this study was to characterise recovery of neuromuscular transmission following a vecuronium-induced block 15 min after neostigmine administration using different stimulation patterns, and to determine the effects of different doses of neostigmine given at various pre-reversal twitch heights. METHODS: Adductor pollicis (AP) mechanical activity in response to low (0.1 and 2 Hz) and high (50 and 100 Hz) frequency stimulation, was recorded 15 min after 20, 40 and 80 micrograms/kg neostigmine, given to reverse a vecuronium-induced block at 10, 25 and 50% pre-reversal twitch height (TH). Fifty four ASA class I and II anaesthetised (methohexital, fentanyl, N2O/O2) young adult patients were studied and randomly allocated into 9 groups of 6 patients each. RESULTS: In contrast to twitch height (TH) and residual force after 50 Hz, 5 s tetanic stimulation (RF50Hz), the greater sensitivity of train-of-four (TOF) ratio and residual force after 100 Hz, 5 s tetanic stimulation (RF100Hz) points out the best reversal conditions (prereversal TH and the optimal neostigmine dose) (P < 0.001, two-way analysis of variance). The highest reversal scores (about 0.9 TOF ratio and RF100Hz) were obtained when 40 micrograms/kg of neostigmine was given at 25 and 50% TH. A 0.9 TOF ratio was also observed when 40 micrograms/kg of neostigmine was given at 10% TH, but, under these conditions, RF100Hz was only 0.6 (P < 0.05, Duncan test). CONCLUSION: To optimise the reversal action of neostigmine in order to obtain the highest neuromuscular transmission recovery (0.9 TOF ratio and RF100Hz) during a vecuronium-induced neuromuscular block, the 40 micrograms/kg dose has to be given at 25 to 50% recovery of TH.


Subject(s)
Cholinesterase Inhibitors/administration & dosage , Neostigmine/administration & dosage , Neuromuscular Blockade , Neuromuscular Nondepolarizing Agents/antagonists & inhibitors , Vecuronium Bromide/antagonists & inhibitors , Adolescent , Adult , Humans , Middle Aged , Neuromuscular Junction/drug effects , Neuromuscular Junction/physiology , Synaptic Transmission/drug effects
11.
Br J Anaesth ; 74(1): 12-5, 1995 Jan.
Article in English | MEDLINE | ID: mdl-7880697

ABSTRACT

We recorded adductor pollicis mechanical activity in response to low (0.1 and 2 Hz) and high (50 and 100 Hz) frequency stimulation 15 min after edrophonium 250, 500 and 1000 micrograms kg-1, given to antagonize vecuronium-induced block at 10, 25 and 50% pre-reversal twitch height. We studied 54 ASA class I and II anaesthetized (methohexitone, fentanyl, nitrous oxide) young adult patients allocated randomly to nine groups of six patients each. The greater sensitivity of train-of four (TOF) ratio and residual force after 100-Hz, 5-s tetanic stimulation (RF100) to residual deficit allowed discrimination more readily between the effects of edrophonium dose and pre-reversal twitch height (P < 0.001, two-way analysis of variance). The highest reversal scores (approximately 0.9 TOF ratio and 0.6 RF100) were obtained when edrophonium 500-1000 mg kg-1 was given at 50% twitch height (P < 0.05, Duncan's test).


Subject(s)
Edrophonium/pharmacology , Nerve Block , Neuromuscular Junction/drug effects , Transcutaneous Electric Nerve Stimulation , Vecuronium Bromide/antagonists & inhibitors , Adolescent , Adult , Dose-Response Relationship, Drug , Humans , Middle Aged , Muscle Contraction/drug effects , Muscle Contraction/physiology , Neuromuscular Junction/physiology , Synaptic Transmission
12.
Br J Anaesth ; 73(6): 791-4, 1994 Dec.
Article in English | MEDLINE | ID: mdl-7880668

ABSTRACT

In 24 ASA I-II adults anaesthetized with thiopentone, fentanyl and nitrous oxide in oxygen, we studied neuromuscular transmission with isometric adductor pollicis monitoring. Patients received mivacurium 0.2 mg kg-1 followed by an infusion lasting at least 60 min and adjusted to maintain twitch height at 1-5%. After termination of the mivacurium infusion, when twitch height spontaneously regained 25% of its control value, the patients were allocated to two groups of 12 patients each. In group NEO patients received neostigmine 40 micrograms kg-1 and atropine 15 micrograms kg-1 and in group SPO neuromuscular transmission was allowed to recover spontaneously. Twitch height was measured every 10 s and train-of-four (TOF) (2 Hz) every 3 min. After 15 min, residual force after tetanic stimulation (50 and 100 Hz, 5-s duration (RF50HZ, RF100HZ), 1 min apart) were recorded sequentially. At 15 min, mean TOF ratio was greater in group NEO (0.94 (SEM 0.01)) than in group SPO (0.87 (0.02)) (P < 0.01). All patients in group NEO recovered to a TOF ratio greater than 0.7 after 6 min compared with 15 min in group SPO (P < 0.005). A TOF ratio greater than 0.9 was observed in all patients in group NEO compared with only six in group SPO (P < 0.025). Nevertheless, RF50HZ and RF100HZ did not differ significantly (0.92 (0.01) (group NEO), 0.91 (0.01) (group SPO) and 0.83 (0.02) (group NEO), 0.78 (0.03) (group SPO), respectively).(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Isoquinolines , Neostigmine/administration & dosage , Nerve Block , Neuromuscular Junction/drug effects , Neuromuscular Nondepolarizing Agents , Adult , Analysis of Variance , Anesthesia Recovery Period , Elective Surgical Procedures , Fentanyl , Humans , Isometric Contraction , Leg/surgery , Mivacurium , Motor Endplate , Neostigmine/pharmacology , Nitrous Oxide , Synaptic Transmission , Thiopental
14.
Anaesthesia ; 44(1): 34-6, 1989 Jan.
Article in English | MEDLINE | ID: mdl-2564745

ABSTRACT

A 63-year-old male was admitted to hospital for a cholecystectomy, vagotomy and gastro-enterostomy. Muscle paralysis was induced with 70 micrograms/kg vecuronium, followed by increments of 20 micrograms/kg when the initial twitch height returned to 25% of control. The patient received 3 doses of 10 mg disopyramide intravenously, on account of supraventricular ectopic beats, followed by an infusion of 25 mg/hour. Paralysis was reversed using 0.75 mg atropine and 2.5 mg neostigmine once the twitch height had returned spontaneously to 25% of its initial value. Fifteen minutes later, twitch height had returned to control value and the train-of-four was above 85%, but the responses to tetanic stimulation at 100 Hz and 50 Hz remained severely depressed (10% and 45%, respectively). The patient's trachea was extubated after 20 minutes, but residual fade was still observed. This impairment of neuromuscular transmission, detected only with high frequency stimulation, was present with a measured concomitant plasma level of disopyramide of 5.1 micrograms/ml.


Subject(s)
Disopyramide/pharmacology , Intraoperative Care , Vecuronium Bromide/antagonists & inhibitors , Atropine/pharmacology , Drug Interactions , Humans , Male , Middle Aged , Muscle Contraction/drug effects , Neostigmine/pharmacology , Time Factors
16.
Ann Fr Anesth Reanim ; 6(6): 493-7, 1987.
Article in French | MEDLINE | ID: mdl-2894787

ABSTRACT

Thirty-six patients undergoing elective surgery were studied after obtaining their informed consent. They were randomly assigned to six series of six patients each. One hour before anaesthesia, all patients received 0.2 mg.kg-1 diazepam orally. After induction of anaesthesia with 1-1.5 mg.kg-1 methohexitone and 5 micrograms.kg-1 fentanyl, the patients were paralysed and ventilation was controlled manually (semi-open circuit; 50% N2O/50% O2). Each patient received a single dose of either 70 micrograms.kg-1 fazadinium, 70 micrograms.kg-1 pancuronium, 2,500 micrograms.kg-1 gallamine or 450 micrograms.kg-1 d-tubocurarine. Neuromuscular function was monitored by measuring the isometric contraction of the adductor pollicis muscle in response to supramaximal stimulations of the ulnar nerve at the wrist (square wave pulse of 0.2 ms duration at supramaximal intensity delivery at 0.1 Hz). Three parameters were measured: the time between the injection of the relaxant drug and recovery of the twitch height at 50% of its baseline (RT0-50); the time between the injection of the relaxant drug and recovery of the twitch height at 90% of its baseline (RT0-90); the time between the injection of the relaxant drug and recovery of the twitch height from 25 to 75% of its baseline (RT25-75). The values of the observed parameters were expressed in minutes (means +/- SEM).(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Anesthesia, General , Neuromuscular Blocking Agents , Neuromuscular Junction/drug effects , Adult , Aged , Atracurium , Clinical Trials as Topic , Double-Blind Method , Electromyography , Gallamine Triethiodide , Humans , Middle Aged , Pancuronium , Pyridinium Compounds , Random Allocation , Tubocurarine , Vecuronium Bromide
19.
Ann Fr Anesth Reanim ; 4(6): 492-4, 1985.
Article in French | MEDLINE | ID: mdl-2936288

ABSTRACT

The effects of age on the pharmacodynamics of atracurium have been studied in twenty-four consenting adult patients undergoing elective surgery. They were divided in three groups according to their age (mean +/- SEM): group 1 (n = 8; 26 +/- 3 yr), group 2 (n = 8; 53 +/- 2 yr) and group 3 (n = 8; 76 +/- 2 yr). Anaesthesia was induced with methohexitone (1 mg . kg-1) and fentanyl (5 micrograms . kg-1), and maintained with 66% N2O plus fentanyl on demand. Ventilation was controlled and adjusted to produce normocapnia. The isometric contraction of the adductor pollicis muscle in response to supramaximal cubital nerve stimulation delivered at 0.1 Hz was measured with a force displacement transducer. A loading dose of atracurium (0.3 mg . kg-1) was given before tracheal intubation. Thereafter, twitch height (TH) was maintained at 10% of its baseline reading by adjusting the flow of a Harvard syringe containing 0.5 mg . ml-1 of atracurium in saline. The amount of atracurium required to maintain a stable twitch height, calculated for a 60 min period, was 14.7 +/- 1 mg . m-2 . h-1 for group 1, 13.6 +/- 1.5 mg . m-2 . BSA-1 for group 2 and 15 +/- 2.1 mg . m-2 . BSA-1 for group 3. At the end of the infusion period, the TH25-75 recovery rates were not statistically different in the three groups: 15.4 +/- 1.9 min for group 1, 14.8 +/- 1.1 min for group 2 and 14.5 +/- 1.6 min for group 3.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Isoquinolines/pharmacology , Neuromuscular Junction/drug effects , Neuromuscular Nondepolarizing Agents/pharmacology , Adult , Aged , Anesthesia, General , Atracurium , Humans , Isoquinolines/metabolism , Middle Aged , Monitoring, Physiologic , Neuromuscular Nondepolarizing Agents/metabolism
20.
Acta Anaesthesiol Scand ; 26(3): 183-8, 1982 Jun.
Article in English | MEDLINE | ID: mdl-6126062

ABSTRACT

The Haemodynamic effects of flunitrazepam (FLU) 1.25 mg X m-2 administered intravenously were studied in 18 anaesthetized cardiac patients suffering from isolated mitral (MIT, n = 6), aortic (AOR, n = 6) or coronary (COR, n = 6) lesions. A placebo group of 18 clinically similar patients was used to assess the stability of the cardiovascular parameters under the conditions of the study. Heart rate, systemic arterial pressure, cardiac output and central venous pressure changes were measured 2, 5, 8 and 12 min after FLU or saline injection and compared with reference values collected before the start of the haemodynamic test. In the FLU group, the cardiovascular state of all the patients developed following the same pattern and the greatest differences were observed at 12 min post-injection. These differences, expressed as a percentage of the initial values were (* P less than 0.05; ** P less than 0.001; ns = non-significant): mean systemic arterial pressure: COR, -18% (**);MIT, -13% (*); AOR, -23% (**); heart rate: COR, 0% (ns); MIT, -10% (*); AOR, -12% (*); cardiac output: COR, -15% (**); MIT, -13% (*); AOR, -16% (**); stroke volume: COR, -12%(*);MIT, 0% (ns);AOR,-3%(ns). This shows some differences concerning the SV and heart rate changes in the valvular and COR patients. As compared to the data from the literature, most of the haemodynamic effects of FLU seem relatively independent of the initial level of consciousness.


Subject(s)
Anti-Anxiety Agents/pharmacology , Coronary Disease/physiopathology , Flunitrazepam/pharmacology , Heart Valve Diseases/physiopathology , Hemodynamics/drug effects , Adult , Anesthesia , Blood Pressure/drug effects , Cardiac Output/drug effects , Electrocardiography , Female , Heart Rate/drug effects , Humans , Male , Middle Aged , Stroke Volume/drug effects , Vascular Resistance/drug effects
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