Christian Jayr - Academia.edu (original) (raw)
Papers by Christian Jayr
Journal of Applied Physiology
The effect of removing pulmonary blood flow on the clearance of excess liquid and protein from th... more The effect of removing pulmonary blood flow on the clearance of excess liquid and protein from the air spaces and interstitium of the normal lung was studied in anesthetized ventilated sheep. To eliminate pulmonary blood flow to one lung, the left pulmonary artery was occluded. Autologous serum (3 ml/kg) with 125I-labeled albumin was then instilled into the left lower lobe. Hemodynamics and lung lymph were measured, and the lungs were removed after 4 h. Alveolar protein concentration over 4 h was used as the index of alveolar liquid clearance. Total lung liquid clearance was measured by the gravimetric method. The percent increase in alveolar protein concentration over baseline was similar between sheep without pulmonary blood flow (33.8 +/- 17.4) and with pulmonary blood flow (31.1 +/- 14.6); thus, alveolar liquid clearance was not changed by the absence of pulmonary blood flow. Also, in the absence of pulmonary blood flow, lung liquid clearance (as percent of instilled) over 4 h was 27.1 +/- 3.8 (n = 7), which was not significantly different from control experiments with pulmonary blood flow (26.4 +/- 7.1, n = 7). In the sheep without pulmonary blood flow, bronchopulmonary anastomotic flow was 41.5 +/- 21.3 ml/min. To further reduce blood flow to the lung, both the left pulmonary artery and the bronchoesophageal artery were occluded, which reduced bronchopulmonary anastomotic flow to the left lung to 12.0 +/- 9.3 ml/min. This further reduction in blood flow did not, however, change alveolar or lung liquid clearance. Even with this low blood flow to the left lung, the removal of 125I-albumin from the lung was not altered.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Applied Physiology
The primary objective of these studies was to test the contribution of ventilation and blood flow... more The primary objective of these studies was to test the contribution of ventilation and blood flow to the removal of excess liquid from the air spaces and interstitium of the lung. First, after eliminating ventilation by clamping the left main bronchus in anesthetized sheep, alveolar and lung liquid clearance was not altered over 4 h compared with control sheep that were ventilated normally. Thus, removal of excess liquid across the alveolar epithelium was independent of the change in the transalveolar hydrostatic pressure gradient produced by ventilation. Second, to determine the effect of removing all blood flow to the lung, we developed a new in situ sheep lung model in which lung lymph flow was measured over 4 h with or without ventilation after the sheep had been exsanguinated. Alveolar liquid clearance, as measured by the percent increase in alveolar protein concentration over 4 h, was similar between sheep without blood flow (31 +/- 18%) compared with sheep with normal blood flow to the lungs (31 +/- 17%). Lung lymph flow contributed to only 10-15% of the clearance of the excess alveolar liquid that was transported to the interstitium, indicating that nonlymphatic pathways accounted for most of the excess lung liquid clearance in the absence of microvascular filtration. Third, because ouabain completely inhibited alveolar liquid clearance in this in situ sheep lung model, these data provide evidence that alveolar liquid clearance depends on an intact Na(+)-K(+)-ATPase-dependent pump mechanisms. Finally, this in situ model represents a unique experimental preparation that can be used to study the alveolar epithelial barrier without blood flow or ventilation for a short time (4 h) interval.
Annales Françaises d Anesthésie et de Réanimation
Pulmonary complications are frequent after abdominal surgery. The object of this study was to eva... more Pulmonary complications are frequent after abdominal surgery. The object of this study was to evaluate the incidence and the predisposing factors of the postoperative pulmonary complications with a particular attention to their definitions. It included 146 patients. The respiratory complications were separated into clinical complications (bronchitis), radiological complications (atelectasis) and hypoxaemia (PaO2 less than 70 mmHg). Clinical complications (23%) were correlated neither with radiological complications (57%) nor hypoxaemia (46%). They particularly occurred in patients with a preoperative history of respiratory disease. Preoperative risk factors were males, low PaO2 and decreased FEV1. Radiological complications were strongly correlated with postoperative hypoxaemia. Their incidence was not affected by a previous history of respiratory disease. Both radiological complications and hypoxaemia were predicted by age.
Anesthesiology
Different types of analgesia have been proposed for the prevention of postoperative respiratory c... more Different types of analgesia have been proposed for the prevention of postoperative respiratory complications. The aim of this prospective, double-blind randomized study was to compare the impact of epidural bupivacaine and opioids versus parenteral opioids on respiratory complications in patients who had undergone major abdominal surgery. One hundred fifty-three patients undergoing abdominal surgery for cancer were randomly allocated to receive either general anesthesia with intravenous fentanyl and postoperative analgesia with subcutaneous morphine (SC group) or general anesthesia combined with epidural bupivacaine and epidural bupivacaine plus morphine for postoperative pain relief (EP group). Analgesia was tested on a visual analog pain scale. Pulmonary complications were evaluated according to clinical complications, chest radiographs, arterial blood gas analysis, and pulmonary function tests. The evaluation was carried out on the day before the operation and on the first 5 postoperative days. Particular attention also was paid to the episodes of arterial hypotension and hemoglobin oxygen desaturation during the 1st postoperative night. Pain relief was significantly better in the EP group than in the SC group (P < 0.05) especially during recovery and on the 1st and 2nd postoperative days. In the EP group, vital capacity decreased less on the 1st postoperative day (P < 0.05) and arterial oxygen tension was greater in the recovery room (P < 0.05). However, no statistically significant difference was observed between the SC and EP groups in the incidence of clinical pulmonary complications (31% and 27%, respectively) and radiographic chest abnormalities (52% and 46%, respectively). The EP group recovered intestinal function earlier (P < 0.05), but significantly more patients in this group had episodes of systolic hypotension (21% vs. 8%; P < 0.05) during the 1st postoperative night. The length of the hospital stay was similar in both groups of treatment. Epidural analgesia with a combination of local anesthetic and opioid improves patient comfort. However, this type of analgesia does not decrease the incidence of postoperative pulmonary complications, does not reduce the length of the hospital stay, and carries the risk of complications from episodic systemic hypotension.
The journal of pain : official journal of the American Pain Society, Jan 14, 2015
Alexithymia, the inability to identify and express emotions, and emotional repression, a defensiv... more Alexithymia, the inability to identify and express emotions, and emotional repression, a defensive mechanism aiming to avoid unpleasant emotional experience, have been associated with chronic pain and medical illness including breast cancer, but whether these constructs may predict pain after breast cancer surgery has not been assessed. The present study assessed the predictive value of alexithymia and emotional repression in postoperative pain. Anxiety, depression, catastrophizing and psychological adjustment were also assessed. Data were collected before surgery, and then two days and two, three, six, and twelve months after surgery. We included 100 pain-free women, 96% of whom were followed for up to 12 months. Separate multivariate analyses identified anxiety as a significant predictor of postsurgical pain at three and six months, alexithymia at three, six and twelve months while body image and catastrophizing predicted acute or sub-acute pain at two months. In contrast emotiona...
Surgery
In a prospective study, patients undergoing abdominal cancer surgery were randomly allocated to r... more In a prospective study, patients undergoing abdominal cancer surgery were randomly allocated to receive either general anesthesia with fentanyl intravenously and postoperative analgesia with parenteral morphine (GA group) or general anesthesia combined with epidural bupivacaine and epidural morphine for postoperative pain relief (EP group). Analgesia was tested on a visual pain scale. Pulmonary complications were evaluated by clinical complications, blood gas analysis, x-ray film changes, and pulmonary volumes (vital capacity, forced expiratory volume in 1 second). Measurements were performed on the day before the operation and on the first 5 postoperative days. In the EP group the pain relief was significantly better on the first day (p less than 0.03). Whatever the criteria used, the rates of pulmonary complications were similar in the two groups: clinical complications 21% versus 26%, radiologic complications 50% versus 64% for GA and EP groups, respectively. Postoperative PaO2 and spirometric values were similar in the two groups. Postoperative epidural analgesia may improve the patient's comfort but does not decrease the incidence of pulmonary complications.
Annales Françaises d Anesthésie et de Réanimation
Case report of an obese patient who suffered a bilateral rhabdomyolysis after major abdominal sur... more Case report of an obese patient who suffered a bilateral rhabdomyolysis after major abdominal surgery under general anaesthesia combined with thoracic epidural analgesia. The patient was in the lithotomy position during the ten hours time period of the surgery. As the patient was sedated in the intensive care unit, the diagnosis was made more difficult. Clinical signs consisted of pain, oedema and neurosensitive deficit in both legs. Creatinine kinase plasma concentration was increased. Treatment included fluid infusions and fasciotomy. The sequelae were major and consisted mainly in muscular deficiency of both legs. This complication is favoured by prolonged surgery and muscular compression elicited by non physiological positions.
Journal of Applied Physiology
Alveolar and lung liquid clearances were studied over 1, 4, and 6 h in intact anesthetized ventil... more Alveolar and lung liquid clearances were studied over 1, 4, and 6 h in intact anesthetized ventilated rats by instillation of 5% albumin solution with 1.5 microCi of 125I-labeled albumin (3 ml/kg into 1 lung or 6 ml/kg into both lungs). Alveolar protein clearance as measured by residual 125I-albumin in the lung over 6 h was similar to the slow rates measured in other species. Alveolar liquid clearance was estimated by the concentration of albumin in the air spaces. After 1 h, this concentration was 7.8 +/- 0.7 g/dl, which was significantly greater than the initial protein concentration of 5.3 +/- 0.2 g/dl (P < 0.05). Amiloride (10(-3) M) inhibited 45% of the basal alveolar liquid clearance, and ouabain (10(-3) M), instilled and intravenously infused (0.004 mg), inhibited 30% of the clearance. beta-Adrenergic agonist instillation increased alveolar liquid clearance to the fastest 1-h rate (48 +/- 3% of instilled volume) that we observed in any intact species. The removal of the instilled fluid from the lung (expressed as lung liquid clearance; 0.96 +/- 0.3 ml/h) was twice as fast as the rate of alveolar and lung liquid clearance reported in the isolated or in situ rat lung models. The rate of alveolar and lung liquid clearance in these intact rats was significantly faster than those in prior studies in dogs and sheep and was similar to the rates in rabbits.
Cahiers d'anesthésiologie
The analgesic and antipyretic efficacy of propacetamol is identical to paracetamol. Because the p... more The analgesic and antipyretic efficacy of propacetamol is identical to paracetamol. Because the propacetamol is injectable and its side effects are uncommon and mild, it is the drug commonly used in France for postoperative pain relief. The aim of this prospective study was to compare the analgesic efficacy of propacetamol after breast surgery or thyroidectomy when it was administered either systematically or on the patients demand. After informed consent, 119 patients having undergone breast surgery or thyroidectomy, having received the same general anaesthesia and scheduled for receiving propacetamol postoperatively, were included in the study. Two groups of patients were compared, those who received propacetamol on demand (D Group) and those who received propacetamol systematically (S Group). During the first 24 hours, analgesia was evaluated on a visual analogical scale graded from 0 to 100 mm, at rest and during mobilization; the efficacy was also evaluated by the amount of additional analgesic drug injected. Side effects were also compared between the 2 treatment groups. In the 2 groups, demographic data, type of anaesthesia and type of surgery were identical. Postoperative pain relief and supplemental injection of morphine were not statistically different between the 2 groups. Propacetamol doses were statistically higher in the S group than in the D group (7.8 +/- 0.7 g and 3.9 +/- 2.3 g respectively, p < 0.05). Pain during propacetamol infusion was more frequent in the D group than in the S group (30% and 13% respectively, p < 0.05). No other adverse effects were observed during the study. Propacetamol alone is sufficient for pain relief after peripheral surgery; more than 90% of patients need no supplemental analgesic, and adverse effects are rare.
AJP Lung Cellular and Molecular Physiology
ABSTRACT
The American journal of physiology
Alveolar epithelial fluid transport was studied 10 days after subacute lung injury had been induc... more Alveolar epithelial fluid transport was studied 10 days after subacute lung injury had been induced with intratracheal bleomycin (0.75 U). An isosmolar Ringer lactate solution with 5% bovine serum albumin and 125I-labeled albumin as the alveolar protein tracer was instilled into the right lung; the rats were then studied for either 1 or 4 h. Alveolar fluid clearance was increased in bleomycin-injured rats by 110% over 1 h and by 75% over 4 h compared with control rats (P < 0.05). The increase in alveolar fluid clearance was partially inhibited by amiloride (10(-3) M). Alveolar fluid clearance decreased toward normal levels in rats that were studied 60 days after bleomycin instillation. Remarkably, the measured increase in net alveolar fluid clearance occurred in the presence of a significant increase in alveolar epithelial permeability to protein. Moreover, the increase in alveolar epithelial fluid clearance occurred even though the mRNA for the alpha-subunit of the epithelial sodium channel was decreased in alveolar epithelial type II cells isolated from these rats. In addition, 22Na uptake by isolated alveolar epithelial type II cells from rats treated with bleomycin demonstrated a 52% decrease in uptake compared with type II cells from control rats. Morphological results demonstrated a significant hyperplasia of alveolar type II epithelial cells 10 days after bleomycin injury. Thus, these results provide evidence that proliferation of alveolar epithelial type II cells after acute lung injury may upregulate the transport capacity of the alveolar epithelium, even though the expression of epithelial sodium channels is reduced and the uptake of 22Na per cell is also reduced. These results may have clinical relevance for the resolution of alveolar edema in the subacute phase of lung injury.
Survey of Anesthesiology, 1989
ABSTRACT
Journal of applied physiology (Bethesda, Md. : 1985), 1999
Although keratinocyte growth factor (KGF) protects against experimental acute lung injury, the me... more Although keratinocyte growth factor (KGF) protects against experimental acute lung injury, the mechanisms for the protective effect are incompletely understood. Therefore, the time-dependent effects of KGF on alveolar epithelial fluid transport were studied in rats 48-240 h after intratracheal administration of KGF (5 mg/kg). There was a marked proliferative response to KGF, measured both by in vivo bromodeoxyuridine staining and by staining with an antibody to a type II cell antigen. In controls, alveolar liquid clearance (ALC) was 23 +/- 3%/h. After KGF pretreatment, ALC was significantly increased to 30 +/- 2%/h at 48 h, to 39 +/- 2%/h at 72 h, and to 36 +/- 3%/h at 120 h compared with controls (P < 0.05). By 240 h, ALC had returned to near-control levels (26 +/- 2%/h). The increase in ALC was explained primarily by the proliferation of alveolar type II cells, since there was a good correlation between the number of alveolar type II cells and the increase in ALC (r = 0.92, P =...
Cahiers d'anesthésiologie
Journal of applied physiology (Bethesda, Md. : 1985), 1991
Alveolar and lung liquid clearance were studied over 8 h in intact anesthetized ventilated rabbit... more Alveolar and lung liquid clearance were studied over 8 h in intact anesthetized ventilated rabbits by instillation of either isosmolar Ringer lactate (2 ml/kg) or autologous plasma (2 or 3 ml/kg) into one lower lobe. The half time for lung liquid clearance of the isosmolar Ringer lactate was 3.3 h and that for plasma clearance was 6 h. In the plasma experiments, the alveolar protein concentration after 1 h was 5.2 +/- 0.8 g/dl, which was significantly greater than the initial instilled protein concentration of 4.3 +/- 0.7 g/dl (P less than 0.05). Thus alveolar protein concentration increased by 21 +/- 12% over 1 h, which matched clearance from the entire lung of 19 +/- 11% of the instilled volume. Overall the rate of alveolar and lung liquid clearance in rabbits was significantly faster than in prior studies in dogs and sheep. The fast alveolar liquid clearance rate in rabbits was not due to higher endogenous catecholamine release, because intravenous and alveolar (5 x 10(-5) M) pro...
Douleurs : Evaluation - Diagnostic - Traitement, 2012
Annales de Chirurgie, 2006
ABSTRACT We reported the case of a patient presenting a rectal cancer of the upper part with a BM... more ABSTRACT We reported the case of a patient presenting a rectal cancer of the upper part with a BMI at 59 which was previously considered as a contraindication to surgery. To perform the operation we had to make as first step of the procedure a panniculectomy. The technique made possible the rectal resection under good conditions, without blood transfusion. The post-operative course was uneventful except a pulmonary embolism controlled with medical treatment. This procedure is feasible in colorectal surgery.
Critical Care Medicine, 1999
accomplished via an abdominal incision and can be used in the acute setting (as an alternative to... more accomplished via an abdominal incision and can be used in the acute setting (as an alternative to patch placement) to reconstruct large diaphragmatic defects because of the expediency with which it can be constructed. Beyond the use of local muscle flaps, hope for future surgical treatment alternatives may be gleaned from research efforts utilizing fetal tissue engineering for diaphragmatic replacement. 6 2. Rowe DH, Stolar CJ. Recurrent diaphragmatic hernia. Semin Pediatr Surg 2003;12(2):107-109. 3. Samarakkody U, Klaassen M, Nye B. Reconstruction of congenital agenesis of hemidiaphragm by combined reverse latissimus dorsi and serratus anterior muscle flaps. J Pediatr Surg 2001;36(11):1637-1640. 4. Lee SL, Poulos ND, Greenholz SK. Staged reconstruction of large congenital diaphragmatic defects with synthetic patch followed by reverse latissimus dorsi muscle. J Pediatr Surg 2002;37(3):367-370. 5. Scaife ER, Johnson DG, Meyers RL, et al. The split abdominal wall muscle flap -a simple, mesh-free approach to repair large diaphragmatic hernia. J Pediatr Surg 2003; 38(12):1748-1751. 6. Fuchs JR, Kaviani A, Oh JT, et al. Diaphragmatic reconstruction with autologous tendon engineered from mesenchymal amniocytes.
Journal of Applied Physiology
The effect of removing pulmonary blood flow on the clearance of excess liquid and protein from th... more The effect of removing pulmonary blood flow on the clearance of excess liquid and protein from the air spaces and interstitium of the normal lung was studied in anesthetized ventilated sheep. To eliminate pulmonary blood flow to one lung, the left pulmonary artery was occluded. Autologous serum (3 ml/kg) with 125I-labeled albumin was then instilled into the left lower lobe. Hemodynamics and lung lymph were measured, and the lungs were removed after 4 h. Alveolar protein concentration over 4 h was used as the index of alveolar liquid clearance. Total lung liquid clearance was measured by the gravimetric method. The percent increase in alveolar protein concentration over baseline was similar between sheep without pulmonary blood flow (33.8 +/- 17.4) and with pulmonary blood flow (31.1 +/- 14.6); thus, alveolar liquid clearance was not changed by the absence of pulmonary blood flow. Also, in the absence of pulmonary blood flow, lung liquid clearance (as percent of instilled) over 4 h was 27.1 +/- 3.8 (n = 7), which was not significantly different from control experiments with pulmonary blood flow (26.4 +/- 7.1, n = 7). In the sheep without pulmonary blood flow, bronchopulmonary anastomotic flow was 41.5 +/- 21.3 ml/min. To further reduce blood flow to the lung, both the left pulmonary artery and the bronchoesophageal artery were occluded, which reduced bronchopulmonary anastomotic flow to the left lung to 12.0 +/- 9.3 ml/min. This further reduction in blood flow did not, however, change alveolar or lung liquid clearance. Even with this low blood flow to the left lung, the removal of 125I-albumin from the lung was not altered.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Applied Physiology
The primary objective of these studies was to test the contribution of ventilation and blood flow... more The primary objective of these studies was to test the contribution of ventilation and blood flow to the removal of excess liquid from the air spaces and interstitium of the lung. First, after eliminating ventilation by clamping the left main bronchus in anesthetized sheep, alveolar and lung liquid clearance was not altered over 4 h compared with control sheep that were ventilated normally. Thus, removal of excess liquid across the alveolar epithelium was independent of the change in the transalveolar hydrostatic pressure gradient produced by ventilation. Second, to determine the effect of removing all blood flow to the lung, we developed a new in situ sheep lung model in which lung lymph flow was measured over 4 h with or without ventilation after the sheep had been exsanguinated. Alveolar liquid clearance, as measured by the percent increase in alveolar protein concentration over 4 h, was similar between sheep without blood flow (31 +/- 18%) compared with sheep with normal blood flow to the lungs (31 +/- 17%). Lung lymph flow contributed to only 10-15% of the clearance of the excess alveolar liquid that was transported to the interstitium, indicating that nonlymphatic pathways accounted for most of the excess lung liquid clearance in the absence of microvascular filtration. Third, because ouabain completely inhibited alveolar liquid clearance in this in situ sheep lung model, these data provide evidence that alveolar liquid clearance depends on an intact Na(+)-K(+)-ATPase-dependent pump mechanisms. Finally, this in situ model represents a unique experimental preparation that can be used to study the alveolar epithelial barrier without blood flow or ventilation for a short time (4 h) interval.
Annales Françaises d Anesthésie et de Réanimation
Pulmonary complications are frequent after abdominal surgery. The object of this study was to eva... more Pulmonary complications are frequent after abdominal surgery. The object of this study was to evaluate the incidence and the predisposing factors of the postoperative pulmonary complications with a particular attention to their definitions. It included 146 patients. The respiratory complications were separated into clinical complications (bronchitis), radiological complications (atelectasis) and hypoxaemia (PaO2 less than 70 mmHg). Clinical complications (23%) were correlated neither with radiological complications (57%) nor hypoxaemia (46%). They particularly occurred in patients with a preoperative history of respiratory disease. Preoperative risk factors were males, low PaO2 and decreased FEV1. Radiological complications were strongly correlated with postoperative hypoxaemia. Their incidence was not affected by a previous history of respiratory disease. Both radiological complications and hypoxaemia were predicted by age.
Anesthesiology
Different types of analgesia have been proposed for the prevention of postoperative respiratory c... more Different types of analgesia have been proposed for the prevention of postoperative respiratory complications. The aim of this prospective, double-blind randomized study was to compare the impact of epidural bupivacaine and opioids versus parenteral opioids on respiratory complications in patients who had undergone major abdominal surgery. One hundred fifty-three patients undergoing abdominal surgery for cancer were randomly allocated to receive either general anesthesia with intravenous fentanyl and postoperative analgesia with subcutaneous morphine (SC group) or general anesthesia combined with epidural bupivacaine and epidural bupivacaine plus morphine for postoperative pain relief (EP group). Analgesia was tested on a visual analog pain scale. Pulmonary complications were evaluated according to clinical complications, chest radiographs, arterial blood gas analysis, and pulmonary function tests. The evaluation was carried out on the day before the operation and on the first 5 postoperative days. Particular attention also was paid to the episodes of arterial hypotension and hemoglobin oxygen desaturation during the 1st postoperative night. Pain relief was significantly better in the EP group than in the SC group (P &amp;lt; 0.05) especially during recovery and on the 1st and 2nd postoperative days. In the EP group, vital capacity decreased less on the 1st postoperative day (P &amp;lt; 0.05) and arterial oxygen tension was greater in the recovery room (P &amp;lt; 0.05). However, no statistically significant difference was observed between the SC and EP groups in the incidence of clinical pulmonary complications (31% and 27%, respectively) and radiographic chest abnormalities (52% and 46%, respectively). The EP group recovered intestinal function earlier (P &amp;lt; 0.05), but significantly more patients in this group had episodes of systolic hypotension (21% vs. 8%; P &amp;lt; 0.05) during the 1st postoperative night. The length of the hospital stay was similar in both groups of treatment. Epidural analgesia with a combination of local anesthetic and opioid improves patient comfort. However, this type of analgesia does not decrease the incidence of postoperative pulmonary complications, does not reduce the length of the hospital stay, and carries the risk of complications from episodic systemic hypotension.
The journal of pain : official journal of the American Pain Society, Jan 14, 2015
Alexithymia, the inability to identify and express emotions, and emotional repression, a defensiv... more Alexithymia, the inability to identify and express emotions, and emotional repression, a defensive mechanism aiming to avoid unpleasant emotional experience, have been associated with chronic pain and medical illness including breast cancer, but whether these constructs may predict pain after breast cancer surgery has not been assessed. The present study assessed the predictive value of alexithymia and emotional repression in postoperative pain. Anxiety, depression, catastrophizing and psychological adjustment were also assessed. Data were collected before surgery, and then two days and two, three, six, and twelve months after surgery. We included 100 pain-free women, 96% of whom were followed for up to 12 months. Separate multivariate analyses identified anxiety as a significant predictor of postsurgical pain at three and six months, alexithymia at three, six and twelve months while body image and catastrophizing predicted acute or sub-acute pain at two months. In contrast emotiona...
Surgery
In a prospective study, patients undergoing abdominal cancer surgery were randomly allocated to r... more In a prospective study, patients undergoing abdominal cancer surgery were randomly allocated to receive either general anesthesia with fentanyl intravenously and postoperative analgesia with parenteral morphine (GA group) or general anesthesia combined with epidural bupivacaine and epidural morphine for postoperative pain relief (EP group). Analgesia was tested on a visual pain scale. Pulmonary complications were evaluated by clinical complications, blood gas analysis, x-ray film changes, and pulmonary volumes (vital capacity, forced expiratory volume in 1 second). Measurements were performed on the day before the operation and on the first 5 postoperative days. In the EP group the pain relief was significantly better on the first day (p less than 0.03). Whatever the criteria used, the rates of pulmonary complications were similar in the two groups: clinical complications 21% versus 26%, radiologic complications 50% versus 64% for GA and EP groups, respectively. Postoperative PaO2 and spirometric values were similar in the two groups. Postoperative epidural analgesia may improve the patient's comfort but does not decrease the incidence of pulmonary complications.
Annales Françaises d Anesthésie et de Réanimation
Case report of an obese patient who suffered a bilateral rhabdomyolysis after major abdominal sur... more Case report of an obese patient who suffered a bilateral rhabdomyolysis after major abdominal surgery under general anaesthesia combined with thoracic epidural analgesia. The patient was in the lithotomy position during the ten hours time period of the surgery. As the patient was sedated in the intensive care unit, the diagnosis was made more difficult. Clinical signs consisted of pain, oedema and neurosensitive deficit in both legs. Creatinine kinase plasma concentration was increased. Treatment included fluid infusions and fasciotomy. The sequelae were major and consisted mainly in muscular deficiency of both legs. This complication is favoured by prolonged surgery and muscular compression elicited by non physiological positions.
Journal of Applied Physiology
Alveolar and lung liquid clearances were studied over 1, 4, and 6 h in intact anesthetized ventil... more Alveolar and lung liquid clearances were studied over 1, 4, and 6 h in intact anesthetized ventilated rats by instillation of 5% albumin solution with 1.5 microCi of 125I-labeled albumin (3 ml/kg into 1 lung or 6 ml/kg into both lungs). Alveolar protein clearance as measured by residual 125I-albumin in the lung over 6 h was similar to the slow rates measured in other species. Alveolar liquid clearance was estimated by the concentration of albumin in the air spaces. After 1 h, this concentration was 7.8 +/- 0.7 g/dl, which was significantly greater than the initial protein concentration of 5.3 +/- 0.2 g/dl (P &amp;lt; 0.05). Amiloride (10(-3) M) inhibited 45% of the basal alveolar liquid clearance, and ouabain (10(-3) M), instilled and intravenously infused (0.004 mg), inhibited 30% of the clearance. beta-Adrenergic agonist instillation increased alveolar liquid clearance to the fastest 1-h rate (48 +/- 3% of instilled volume) that we observed in any intact species. The removal of the instilled fluid from the lung (expressed as lung liquid clearance; 0.96 +/- 0.3 ml/h) was twice as fast as the rate of alveolar and lung liquid clearance reported in the isolated or in situ rat lung models. The rate of alveolar and lung liquid clearance in these intact rats was significantly faster than those in prior studies in dogs and sheep and was similar to the rates in rabbits.
Cahiers d'anesthésiologie
The analgesic and antipyretic efficacy of propacetamol is identical to paracetamol. Because the p... more The analgesic and antipyretic efficacy of propacetamol is identical to paracetamol. Because the propacetamol is injectable and its side effects are uncommon and mild, it is the drug commonly used in France for postoperative pain relief. The aim of this prospective study was to compare the analgesic efficacy of propacetamol after breast surgery or thyroidectomy when it was administered either systematically or on the patients demand. After informed consent, 119 patients having undergone breast surgery or thyroidectomy, having received the same general anaesthesia and scheduled for receiving propacetamol postoperatively, were included in the study. Two groups of patients were compared, those who received propacetamol on demand (D Group) and those who received propacetamol systematically (S Group). During the first 24 hours, analgesia was evaluated on a visual analogical scale graded from 0 to 100 mm, at rest and during mobilization; the efficacy was also evaluated by the amount of additional analgesic drug injected. Side effects were also compared between the 2 treatment groups. In the 2 groups, demographic data, type of anaesthesia and type of surgery were identical. Postoperative pain relief and supplemental injection of morphine were not statistically different between the 2 groups. Propacetamol doses were statistically higher in the S group than in the D group (7.8 +/- 0.7 g and 3.9 +/- 2.3 g respectively, p &amp;lt; 0.05). Pain during propacetamol infusion was more frequent in the D group than in the S group (30% and 13% respectively, p &amp;lt; 0.05). No other adverse effects were observed during the study. Propacetamol alone is sufficient for pain relief after peripheral surgery; more than 90% of patients need no supplemental analgesic, and adverse effects are rare.
AJP Lung Cellular and Molecular Physiology
ABSTRACT
The American journal of physiology
Alveolar epithelial fluid transport was studied 10 days after subacute lung injury had been induc... more Alveolar epithelial fluid transport was studied 10 days after subacute lung injury had been induced with intratracheal bleomycin (0.75 U). An isosmolar Ringer lactate solution with 5% bovine serum albumin and 125I-labeled albumin as the alveolar protein tracer was instilled into the right lung; the rats were then studied for either 1 or 4 h. Alveolar fluid clearance was increased in bleomycin-injured rats by 110% over 1 h and by 75% over 4 h compared with control rats (P &amp;amp;amp;lt; 0.05). The increase in alveolar fluid clearance was partially inhibited by amiloride (10(-3) M). Alveolar fluid clearance decreased toward normal levels in rats that were studied 60 days after bleomycin instillation. Remarkably, the measured increase in net alveolar fluid clearance occurred in the presence of a significant increase in alveolar epithelial permeability to protein. Moreover, the increase in alveolar epithelial fluid clearance occurred even though the mRNA for the alpha-subunit of the epithelial sodium channel was decreased in alveolar epithelial type II cells isolated from these rats. In addition, 22Na uptake by isolated alveolar epithelial type II cells from rats treated with bleomycin demonstrated a 52% decrease in uptake compared with type II cells from control rats. Morphological results demonstrated a significant hyperplasia of alveolar type II epithelial cells 10 days after bleomycin injury. Thus, these results provide evidence that proliferation of alveolar epithelial type II cells after acute lung injury may upregulate the transport capacity of the alveolar epithelium, even though the expression of epithelial sodium channels is reduced and the uptake of 22Na per cell is also reduced. These results may have clinical relevance for the resolution of alveolar edema in the subacute phase of lung injury.
Survey of Anesthesiology, 1989
ABSTRACT
Journal of applied physiology (Bethesda, Md. : 1985), 1999
Although keratinocyte growth factor (KGF) protects against experimental acute lung injury, the me... more Although keratinocyte growth factor (KGF) protects against experimental acute lung injury, the mechanisms for the protective effect are incompletely understood. Therefore, the time-dependent effects of KGF on alveolar epithelial fluid transport were studied in rats 48-240 h after intratracheal administration of KGF (5 mg/kg). There was a marked proliferative response to KGF, measured both by in vivo bromodeoxyuridine staining and by staining with an antibody to a type II cell antigen. In controls, alveolar liquid clearance (ALC) was 23 +/- 3%/h. After KGF pretreatment, ALC was significantly increased to 30 +/- 2%/h at 48 h, to 39 +/- 2%/h at 72 h, and to 36 +/- 3%/h at 120 h compared with controls (P < 0.05). By 240 h, ALC had returned to near-control levels (26 +/- 2%/h). The increase in ALC was explained primarily by the proliferation of alveolar type II cells, since there was a good correlation between the number of alveolar type II cells and the increase in ALC (r = 0.92, P =...
Cahiers d'anesthésiologie
Journal of applied physiology (Bethesda, Md. : 1985), 1991
Alveolar and lung liquid clearance were studied over 8 h in intact anesthetized ventilated rabbit... more Alveolar and lung liquid clearance were studied over 8 h in intact anesthetized ventilated rabbits by instillation of either isosmolar Ringer lactate (2 ml/kg) or autologous plasma (2 or 3 ml/kg) into one lower lobe. The half time for lung liquid clearance of the isosmolar Ringer lactate was 3.3 h and that for plasma clearance was 6 h. In the plasma experiments, the alveolar protein concentration after 1 h was 5.2 +/- 0.8 g/dl, which was significantly greater than the initial instilled protein concentration of 4.3 +/- 0.7 g/dl (P less than 0.05). Thus alveolar protein concentration increased by 21 +/- 12% over 1 h, which matched clearance from the entire lung of 19 +/- 11% of the instilled volume. Overall the rate of alveolar and lung liquid clearance in rabbits was significantly faster than in prior studies in dogs and sheep. The fast alveolar liquid clearance rate in rabbits was not due to higher endogenous catecholamine release, because intravenous and alveolar (5 x 10(-5) M) pro...
Douleurs : Evaluation - Diagnostic - Traitement, 2012
Annales de Chirurgie, 2006
ABSTRACT We reported the case of a patient presenting a rectal cancer of the upper part with a BM... more ABSTRACT We reported the case of a patient presenting a rectal cancer of the upper part with a BMI at 59 which was previously considered as a contraindication to surgery. To perform the operation we had to make as first step of the procedure a panniculectomy. The technique made possible the rectal resection under good conditions, without blood transfusion. The post-operative course was uneventful except a pulmonary embolism controlled with medical treatment. This procedure is feasible in colorectal surgery.
Critical Care Medicine, 1999
accomplished via an abdominal incision and can be used in the acute setting (as an alternative to... more accomplished via an abdominal incision and can be used in the acute setting (as an alternative to patch placement) to reconstruct large diaphragmatic defects because of the expediency with which it can be constructed. Beyond the use of local muscle flaps, hope for future surgical treatment alternatives may be gleaned from research efforts utilizing fetal tissue engineering for diaphragmatic replacement. 6 2. Rowe DH, Stolar CJ. Recurrent diaphragmatic hernia. Semin Pediatr Surg 2003;12(2):107-109. 3. Samarakkody U, Klaassen M, Nye B. Reconstruction of congenital agenesis of hemidiaphragm by combined reverse latissimus dorsi and serratus anterior muscle flaps. J Pediatr Surg 2001;36(11):1637-1640. 4. Lee SL, Poulos ND, Greenholz SK. Staged reconstruction of large congenital diaphragmatic defects with synthetic patch followed by reverse latissimus dorsi muscle. J Pediatr Surg 2002;37(3):367-370. 5. Scaife ER, Johnson DG, Meyers RL, et al. The split abdominal wall muscle flap -a simple, mesh-free approach to repair large diaphragmatic hernia. J Pediatr Surg 2003; 38(12):1748-1751. 6. Fuchs JR, Kaviani A, Oh JT, et al. Diaphragmatic reconstruction with autologous tendon engineered from mesenchymal amniocytes.