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ABSTRACT: ObjectifComparer ľeffet de la rachianalgésie à la morphine (M) et au sufentanil (S) à la péridurale thoracique sur ľanalgésie et la
fonction respiratoire après chirurgie thoracique.
Matériel et méthodesQuarante-cinq patients de 58,4 ± 13 ans ďâge moyen subissant une thoracotomie postéro-latérale ont été divisés en deux groupes.
Les patients du Groupe I (n = 27) ont reçu une rachianalgésie lombaire (5 μg de S et 0,5 mg de M) une heure avant ľinduction.
Groupe II (n = 28) a reçu après ľinduction, 10 à 20 mL ďune solution de bupivacaine (B) 0.25 % et fentanyl (F) 2 μg·mL-1 à travers un cathéter péridural installé entre T5 et T8 avant ľinduction. Une perfusion continue de cette solution a été
administrée en période peropératoire. Après chirurgie et pendant 48 h, une perfusion de B 0.1 % et F 2 μg·mL-1 a été administrée avec des bolus toutes les 15 min si nécessaire. Les variables étudiées sont: la fréquence cardiaque (FC),
la pression artérielle moyenne (PAM), la saturation périphérique en O2 (SpO2), la fréquence respiratoire (FR), la pression artérielle en O2 (PaCO2), le volume expiratoire maximal à la première seconde, la capacité vitale fonctionnelle, le débit expiratoire maximal et
ľéchelle visuelle analogique (EVA) de la douleur au repos et au mouvement et ceci à différents temps allant de la veille de
la chirurgie à T48 = 48 h après chirurgie.
RésultatsĽEVA au repos et au mouvement, la FC, la PAM, la SpO2, la PaCO2, la FR et les variations des tests pulmonaires sont comparables dans les deux groupes.
ConclusionLa rachianalgésie à la M et au S a des effets comparables à la péridurale thoracique à la B et au F sur ľanalgésie et la fonction
respiratoire après chirurgie thoracique.
PurposeTo compare in a prospective randomized trial the effects of thoracic epidural infusions of fentanyl (F) and bupivacaine (B)
to intrathecal morphine (M) and sufentanil (S) on analgesia and respiratory function following thoracotomy.
Patients and methods55 patients undergoing an elective posterolateral thoracotomy were randomly assigned to one of two groups: Group I (n = 27):
received intrathecal S (5 μg) and M (0.5 mg) one hour before surgery. Group II (n = 28) received, after induction of anesthesia,
an initial dose of 10 to 20 mL of a solution of B 0.25% and F 2 μg·mL-1 via an epidural thoracic catheter previously inserted between T5 and T8. The same solution was infused during surgery. After
surgery, patients received a continuous infusion of B 0.1% and F 2 μg·mL-1 with a bolus every 15 min if needed. Heart rate (HR), mean arterial pressure (MAP), SpO2, PaCO2, respiratory rate (RR), forced expiratory volume in one second, peak expiratory flow rate and forced vital capacity were
recorded at different times from the day before surgery till T48 = 48 hr after surgery. Subjective pain was assessed using
a 10 cm visual analogue scale (VAS) scoring at rest and during cough.
ResultsNo significant difference was noted between both groups concerning VAS, HR, MAP, SpO2, PaCO2 and RR. Variations of the respiratory function tests were identical in both groups.
ConclusionThis study shows that intrathecal M and S offer analgesia comparable to thoracic epidural infusion of B and F.
Canadian Journal of Anaesthesia 04/2012; 52(7):710-716. · 2.35 Impact Factor
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ABSTRACT: To assess the ability of pulse pressure variation to predict fluid responsiveness in mechanically ventilated elderly patients after coronary artery bypass graft surgery.
A prospective, interventional study.
An academic, tertiary referral hospital.
Sixty patients >70 years old and mechanically ventilated after coronary artery bypass graft surgery.
Intravascular volume expansion using 6% hydroxyethyl starch solution, 7 mL/kg over 20 minutes.
Heart rate, arterial blood pressure, pulse pressure variation, central venous pressure, pulmonary artery occlusion pressure, and stroke volume index were measured immediately before and after volume expansion. Fluid responsiveness was defined as an increase in stroke volume index ≥ 15% after volume expansion. Forty-one patients were fluid responders and 19 patients were nonresponders. In contrast to central venous pressure or pulmonary artery occlusion pressure, pulse pressure variation was higher in the responders than in the nonresponders (22 ± 6% v 9.3 ± 3%, p = 0.001) and correlated with the percent changes in the stroke volume index after volume expansion (r = 0.47, p = 0.001). The area under the receiver operating characteristic curve for pulse pressure variation was 0.85 (95% confidence interval 0.75-0.94). The threshold value of 11.5% allowed the discrimination between responders and nonresponders with a sensitivity of 80% and a specificity of 74%.
Pulse pressure variation is a reliable predictor of fluid responsiveness in mechanically ventilated elderly patients after coronary artery bypass graft surgery.
Journal of cardiothoracic and vascular anesthesia 11/2011; 26(3):387-90. · 1.06 Impact Factor
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Tony E Abdel-Massih,
Antoine Sarkis,
Ghassan Sleilaty,
Issam El Rassi,
Chucralla Chamandi,
Nicole Karam,
Fadia Haddad,
Alexandre Yazigi, Samia Madi-Jebara,
Patricia Yazbeck,
Bechara El Asmar,
Ramzi Ashoush,
Victor Jebara
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ABSTRACT: The effects of magnesium loading on the incidence of atrial fibrillation following coronary artery bypass graft surgery (CAGB) are equivocal. None of the previous studies assessed the influence of myocardial extraction of magnesium in these settings. The current trial aims to elucidate whether the incidence of atrial fibrillation following CABG is affected by the preoperative rate of myocardial extraction of magnesium.
The ethical committee approved the study protocol. 113 patients (94 male, mean age 63±11years) planned for elective CABG surgery under normothermic cardiopulmonary bypass were prospectively included. Preoperative independent variables included preoperative treatment, electrocardiographic abnormalities, left ventricular ejection fraction estimation, left atrial size, creatinine clearance and assays of plasma and intracellular magnesium, calcium, albumin, potassium and ionized calcium, drawn preoperatively from the coronary sinus and the aortic root. The covariates - including the rate of myocardial extraction of magnesium - were entered in a logistic regression model to predict the odds of atrial fibrillation.
The incidence of post operative atrial fibrillation was 16%. A rate of myocardial extraction of intracellular magnesium ≥7% increases fivefold the multivariate risk of postoperative atrial fibrillation (p<.01). Advanced age was also significantly associated to postoperative atrial fibrillation.
This study suggests that a preoperative rate of myocardial extraction of intracellular magnesium ≥7% could be a new and a potent predictive factor for postoperative atrial fibrillation.
International journal of cardiology 05/2011; 160(2):114-8. · 7.08 Impact Factor
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Journal of cardiothoracic and vascular anesthesia 04/2011; 25(2):386-7. · 1.06 Impact Factor
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The Journal of trauma 04/2011; 70(4):1014-5; author reply 1015-6. · 2.48 Impact Factor
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Critical care medicine 04/2010; 38(4):1231. · 6.37 Impact Factor
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ABSTRACT: Aortic thrombosis has been described in the medical literature as a rare and catastrophic complication of abdominal aortic aneurysms. However, it has only been reported once in cardiac surgical settings. We report a unique case of thrombosis of an abdominal aortic aneurysms during the course of cardiac surgery, in a fully anticoagulated patient on cardiopulmonary bypass. Prompt diagnosis and immediate surgical management were critical for a successful outcome.
The Annals of thoracic surgery 11/2009; 88(5):1670-1. · 3.74 Impact Factor
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ABSTRACT: Mesenteric ischemia following cardiac surgery is a life-threatening complication. Early identification of patients may help optimizing management and improving outcome. Between January 2000 and July 2007, surgical exploration was realized when mesenteric ischemia was suspected after coronary-artery bypass grafts (CABG). Patients were divided in two groups according to diagnosis confirmation upon laparotomy. Peri-operative predictors of complication and death were analyzed. Of 1634 consecutive patients, 13 (0.8%) developed acute abdomen with suspicion of mesenteric ischemia. Seven (0.4%) underwent resection for ischemic lesions (group 1), of whom two were during a second look laparotomy. The other six patients had normal bowel (group 2). Both groups were comparable according to preoperative status, clinical signs, biological and radiological findings. Delays to laparotomy were 13.7+/-19.0 and 51.4+/-29.0 h in group 1 and 2, respectively (P=0.02). Mortality rates were 46.1% (6/13) overall, 42.8% for group 1 and 50% for group 2. All deaths occurred within the first nine postoperative days. Mesenteric ischemia following CABG is a fatal complication in almost half the cases. Diagnostic tools and timely laparotomy still need to be optimized. Low threshold-based strategy for prompt surgical intervention is efficient for both diagnosis and treatment.
Interactive cardiovascular and thoracic surgery 10/2008; 7(6):1079-83.
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ABSTRACT: Postoperative atrial fibrillation (AF) occurs in up to 50% of patients undergoing coronary artery bypass (CABG) surgery and is associated with complications. Amiodarone and beta blockers are effective as prophylaxis for AF after CABG. The purpose of this study was to compare oral amiodarone versus oral bisoprolol for prevention of AF after CABG.
In this randomized study, 200 patients admitted for elective CABG were given oral amiodarone (n=98 patients) or oral bisoprolol (n=102 patients) beginning 6 h after surgery. Amiodarone patients received 15 mg/Kg then 7 mg/Kg/day for one month. Bisoprolol patients received 2.5 mg then 2.5 mg bid indefinitely.
Postoperative AF occurred in 15.3% of the patients in the amiodarone group and 12.7% of the patients in the bisoprolol group (p=0.60). Maximal ventricular rate tended to be lower in the bisoprolol group (125+/-6 beats/min) compared with the amiodarone group (144+/-7 beats/min, p=.06). Preoperative beta blockage did not affect AF incidence in either study group. There was no difference between the 2 groups for the onset time of AF episodes, total AF duration, AF recurrence and postoperative length of hospital stay. No serious postoperative complications occurred in the two study groups. Two reversible low cardiac output cases occurred with bisoprolol.
Postoperative oral bisoprolol and amiodarone are equally effective for prophylaxis of AF after CABG. Treatment with bisoprolol resulted in a trend to lower ventricular response rate in AF cases. Both regimens were well tolerated.
International journal of cardiology 09/2008; 137(2):116-22. · 7.08 Impact Factor
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Journal of cardiothoracic and vascular anesthesia 09/2008; 23(3):444. · 1.06 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the safety of femoral arterial pressure monitoring in cardiac surgery.
Prospective, observational study.
Cardiac surgery unit (CSU) in a university hospital.
Of a total of 2,350 consecutive patients scheduled for elective cardiac surgery with cardiopulmonary bypass, 2,264 patients with femoral artery pressure monitoring were included.
A femoral arterial catheter was inserted percutaneously before the induction of anesthesia. The catheter was withdrawn 40 to 96 hours after surgery. It was replaced by a radial artery catheter in patients staying for more than 4 days in the CSU or in case of pulse loss or lower limb ischemia. The catheter was removed and sent for cultures whenever it showed local changes, discharge, or if sepsis was suspected.
Pain on insertion ranged from 0 to 20 mm on the 100-mm visual analog scale. Complications related to femoral artery cannulation were recorded. No cases of femoral artery thrombosis, lower extremity ischemia, or hematoma requiring surgery were noted. Small hematomas were observed in 3.3% of patients. The incidence of oozing was 2.1% after the insertion of the catheter and 4.9% after its removal. Three cases (0.13%) of serious bleeding occurred; 2 required surgery. Eight percent of catheter tips were sent for culture, and positive bacterial growth was recorded in 18.6% of them. Catheter-related blood stream infection occurred in 0.5% of the total patient population included.
Femoral artery pressure monitoring was associated with a low complication rate and, therefore, it can be used routinely in cardiac surgery.
Journal of cardiothoracic and vascular anesthesia 07/2008; 22(3):418-22. · 1.06 Impact Factor
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ABSTRACT: The Freeman-Sheldon syndrome (FSS) is a rare congenital myopathy and dysplasia. The musculoskeletal and soft-tissue manifestations of FSS often require orthopedic and plastic reconstructive surgery. We report a case of a 7-year-old girl with FSS operated for lower limb malformation during spinal anesthesia.
Journal of Clinical Anesthesia 10/2007; 19(6):460-2. · 1.21 Impact Factor
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ABSTRACT: Combined coronary artery bypass graft (CABG) surgery and carotid endarterectomy (CEA) are performed in an attempt to reduce the risk of postoperative stroke after CABG surgery in patients with significant or symptomatic carotid artery stenosis. The choice between regional and general anesthesia for CEA is still under debate. Regional anesthesia offers an excellent monitoring technique of the neurologic status of the awake patient during carotid clamping. In an attempt to improve monitoring of the neurologic status and avoid the use of temporary shunting in patients undergoing the combined procedure, a different approach is described combining regional anesthesia for CEA followed immediately by general anesthesia for CABG surgery.
Prospective nonrandomized case series.
University hospital.
Twenty patients scheduled for combined CEA and CABG surgery underwent a "staged" anesthetic approach from January to December 2004.
Pulmonary, femoral artery, and urinary catheters were inserted under local anesthesia. A deep cervical plexus block was then performed and supplemented by a superficial cervical plexus block. The patient was draped for standard combined CEA and CABG surgery. CEA was then performed using standard techniques. Without altering the surgical field, general anesthesia was given and endotracheal intubation performed following the successful CEA. Coronary revascularization was then completed.
CEA and CABG surgery were completed successfully in all patients. There was no need for conversion from local to general anesthesia. Endotracheal intubation was easily performed in all patients. There was no hospital mortality in this series. No neurologic events were observed during the CEA. A reversible ischemic stroke, ipsilateral to the CEA, occurred postoperatively on awakening from CABG surgery in 1 patient.
This staged anesthetic approach for combined CABG and CEA surgery is an alternative in this complex subset of patients.
Journal of Cardiothoracic and Vascular Anesthesia 01/2007; 20(6):803-6. · 1.64 Impact Factor
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ABSTRACT: The aim of this clinical report is to describe the use of sequential regional and general anesthesia for concomitant carotid and abdominal aortic surgery. We performed, in a 70-year-old man, a cervical plexus block for carotid endarterectomy (CEA) followed immediately by general anesthesia for resection of an abdominal aortic aneurysm. This anesthetic approach provided adequate surgical conditions. Intraoperative neurological status and cardiovascular parameters were stable and postoperative course was uneventful. Sequential regional and general anesthesia may be an alternative to general anesthesia for concomitant carotid and abdominal aortic surgery. This approach offers an adequate neurological monitoring during the CEA phase of the combined surgery and the opportunity to postpone the aortic surgery should the CEA be associated with a non-reversible neurological deficit.
Middle East journal of anaesthesiology 11/2006; 18(6):1165-70.
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Journal of Cardiothoracic and Vascular Anesthesia 11/2006; 20(5):760-1. · 1.64 Impact Factor
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Anesthesia & Analgesia 02/2004; 98(1):264; author reply 264. · 3.29 Impact Factor
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Journal of Thoracic and Cardiovascular Surgery 02/2004; 127(1):304; author reply 304-5. · 3.41 Impact Factor
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Middle East journal of anaesthesiology 11/2003; 17(3):481-3.
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Journal of Clinical Anesthesia 12/2002; 14(7):558-9. · 1.21 Impact Factor
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Journal of Cardiothoracic and Vascular Anesthesia 11/2002; 16(5):665-6. · 1.64 Impact Factor
