H Iskandar

Publications (3)4.12 Total impact

• Article: The enhancement of sensory blockade by clonidine selectively added to mepivacaine after midhumeral block.

  H Iskandar, E Guillaume, F Dixmérias, B Binje, S Rakotondriamihary, R Thiebaut, P Maurette
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  ABSTRACT: Clonidine added to local anesthetics results in an increased duration of anesthesia or analgesia after brachial plexus block. We investigated the effect of selective application of clonidine to the median and musculocutaneous nerves during midhumeral block, a technique allowing selective nerve blocks with the use of different local anesthetics. Initially, 58 patients scheduled for hand surgery were prospectively enrolled to receive a midhumeral block. These patients were randomly allocated into two groups. The Control group (n = 28) received 10 mL of plain mepivacaine 1.5% for each nerve (median, musculocutaneous, ulnar, and radial). The Clonidine group (n = 30) received 10 mL of plain mepivacaine 1.5% for each nerve, but the median and musculocutaneous nerves also received a dose of 50 microg clonidine. One patient in the Control group and two patients in the Clonidine group with a failed block were therefore excluded from the analysis. The onset time of surgical anesthesia was recorded. The durations of sensory and motor blocks were checked every 15 min. The plasma mepivacaine concentration was analyzed from 10 patients in each group. Onset times for complete sensory block were similar between the two groups. Adding 50 microg clonidine to the median and musculocutaneous nerves resulted in a significant increase in the duration of sensory block in these nerves (P < 0.0001). Recovery of motor block was not different between the two groups. No significant difference was found between the two groups in the mean plasma mepivacaine concentration.
  Anesthesia & Analgesia 10/2001; 93(3):771-5. · 3.29 Impact Factor
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  Available from: nih.gov

  Article: Description of local adaptation of national guidelines and of active feedback for rationalising preoperative screening in patients at low risk from anaesthetics in a French university hospital.

  E Capdenat Saint-Martin, P Michel, J M Raymond, H Iskandar, C Chevalier, M N Petitpierre, L Daubech, M Amouretti, P Maurette
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  ABSTRACT: To describe the effect of local adaptation of national guidelines combined with active feedback and organisational analysis on the ordering of preoperative investigations for patients at low risk from anaesthetics. Assessment of preoperative tests ordered over one month, before and after local adaptation of guidelines and feedback of results, combined with an organisational analysis. Motivated anaesthetists in 15 surgical wards of Bordeaux University Hospital, Region Aquitain, France. 42 anaesthetists, 60 surgeons, and their teams. Number and type of preoperative tests ordered in June 1993 and 1994, and the estimated savings. Of 536 patients at low risk from anaesthetics studied in 1993 before the intervention 80% had at least one preoperative test. Most (70%) tests were ordered by anaesthetists. Twice the number of preoperative tests were ordered than recommended by national guidelines. Organisational analysis indicated lack of organised consultations and communication within teams. Changes implemented included scheduling of anaesthetic consultations; regular formal multidisciplinary meetings for all staff; preoperative ordering decision charts. Of 516 low risk patients studied in 1994 after the intervention only 48% had one or more preoperative tests ordered (p < 0.05). Estimated mean (SD) saving for one year if changes were applied to all patients at low risk from anaesthesia in the hospital 3.04 (1.23) mFF. A sharp decrease in tests ordered in low risk patients was found. The likely cause was the package of changes that included local adaptation of national guidelines, feedback, and organisational change.
  Quality in Health Care 04/1998; 7(1):5-11.
• Article: [Analgesia using continuous axillary block after surgery of severe hand injuries: self-administration versus continuous injection].

  H Iskandar, S Rakotondriamihary, F Dixmérias, B Binje, P Maurette
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  ABSTRACT: To compare analgesia produced after surgery for severe hand trauma, by a continuous axillary block obtained either with a continuous injection (CA) or controlled by the patient (PCA). Prospective, randomized study. Forty-two ASA physical class 1 and 2 patients were enrolled over a twelve-month period and randomly allocated either into the CA or the PCA group. After recovery from the surgical block, the axillary plexus was located using a nerve stimulator and a 20 G catheter (Contiplex B Braun) inserted over 5 centimeters into the axillary sheath. In the CA group (n = 21) patients received 0.1 mL.kg-1.h-1 of 0.25% bupivacaine and in the PCA group (n = 21) patients received 0.1 mL.kg-1 boluses of 0.25% bupivacaine with a one hour lock-out period. Data collected were pain intensity rated according to he visual analog scale (VAS), the total volume of bupivacaine injected, the quantity of nalbuphine administered as 10 mg boluses when VAS was = 5, and the patient's satisfaction after removal of the catheter. Statistical analysis used Student t test, ANOVA and chi 2 test. The mean duration of catheter use was 5 +/- 3 days. During this period the amount of bupivacaine was significantly reduced in the PCA group when compared to the CA group (P < 0.001). Similarly, the PCA group required significantly less nalbuphine. Finally, in this group, the satisfaction index was higher than in the CA group (95 versus 52% respectively, P < 0.01). Continuous axillary plexus blockade provides safe and effective postoperative analgesia. With the PCA technique results a lower quantity of bupivacaine is required and patient's satisfaction better.
  Annales Françaises d Anesthésie et de Réanimation 02/1998; 17(9):1099-103. · 0.84 Impact Factor