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14. Comparative Pharmacokinetic Study of Fentanyl and Sufentanil after Single High-Bolus Doses.

Author

Fischler, M., Brusset, A., Levron, J.C., Olivier, P., Schlumberger, S., Le Moing, J.P., Dubois, C., Guilmet, D., Valide, L., and Guenoun, T.

Subjects
FENTANYL, PHARMACOKINETICS, LIPIDS
Abstract

Objective: To investigate and compare the pharmacokinetic parameters of sufentanil and fentanyl during a prolonged period after single bolus administration, and to detect and compare the occurrence of secondary peaks of opioid plasma concentration. Design: This was a prospective, double-blind, randomised study in surgical patients. Patients: Forty-one patients, aged ≥35 years, undergoing coronary artery bypass graft surgery, were randomised to anaesthesia with sufentanil/O (n = 20) or fentanyl/O (n = 21). Methods: Arterial blood samples were taken up to 24 hours after administration for determination of plasma opioid concentrations, and haemodynamic parameters were monitored during and after the surgical procedure. Pharmacokinetic data were analysed by compartmental analysis and by population analysis using a nonlinear mixed-effect modelling approach. Results: There were no significant differences in demographics, features of the surgical procedure or haemodynamic parameters between the two groups. By population analysis, the terminal elimination half-life (t) of fentanyl was 20.7 hours, total body clearance (CL) was 4.7 ml/min/kg and volume of distribution at steady state (V) was 5.2 L/kg. For sufentanil, t was 37.7 hours, CL was 7.4 ml/min/kg and V was 13.9 L/kg. No correlation was observed between demographic data and pharmacokinetic parameters for sufentanil, whereas for fentanyl significant correlations were revealed between age and V, t and the intercompartmental transfer rate constant k. Significant differences were observed in the occurrence of secondary peaks, which occurred in nine patients receiving fentanyl (with two patients exhibiting double secondary peaks) and in one patient receiving sufentanil (p = 0.02). Conclusions: Our study allowed a better determination of the pharmacokinetic parameters of high-dose sufentanil administered as a single bolus, and we demonstrated a clear pharmacokinetic difference between fentanyl and sufentanil in terms of higher CL and larger V for sufentanil. These pharmacokinetic differences have not had clinically relevant consequences in our study. However, the occurrence of secondary peaks, which have been considered as a risk factor in the postoperative period, is significantly reduced with sufentanil compared with fentanyl. [ABSTRACT FROM AUTHOR]

Published
1999

15. Liste des auteurs

Author

Abadie, Y., Abou-Ayache, R., Adhoum, A., Adib-Conquy, M., Adnet, F., Ait Hssain, A., Albanese, J., Alquier, P., Amstutz, P., Anglicheau, D., Annane, D., Annat, G., Ansart, S., Antoun, S., Anxionnat, R., Appéré de Vecchi, C., Argaud, L., Arich, C., Arrault, X., Arrivé, L., Asfar, P., Attaix, D., Aumeran, C., Auneau, J.-C., Ayem, M.-L., Azoulay, E., Barbar, S., Barnoud, D., Baron, D., Barouk, D., Barraud, D., Barry, B., Barthélémy, A., Bastien, O., Baud, F., Baudin, F., Bauwens, M., Bazin, C., Beague, S., †Beaufrère, B., Bedock, B., Bedon-Carte, S., Bédos, J.-P., Bédry, R., Bégueret, H., Belaouchi, F., Belle, E., Benali, A., Bengler, C., Benyamina, M., Bernardin, G., Berré, J., Bertrand, J.-C., Bilbault, P., Binoche, A., Biour, M., Bismuth, C., Blackwell, F., Blanc, P.-L., Blanchard, E., Bleichner, G., Blettery, B., Blivet, S., Blot, F., Bobin, S., Boccheciampe, N., Bohé, J., Boiteau, R., Boncompain-Gérard, M., Bonmarchand, G., Bonnaud, I., Bonnet, N., Bouadma, L., Bouchet, M.-F., Bouffandeau, B., Boulain, T., Boulard, G., Boulétreau, P., Boulo, M., Bourgoin, A., Boussat, S., Boussuges, A., Boyer, A., Bracard, S., Briand, E., Bridoux, F., Brivet, F., Brocas, E., Brochard, L., Bruder, N., Bruel, C., Brun-Buisson, C., Bruneel, F., Brun-Vézinet, F., Bumsel, F., Camou, F., Camus, C., Camus, Y., Canaud, B., Cannesson, M., Capellier, G., Capron, F., Carbonell, N., Cariou, A., Carlet, J., Carpentier, F., Carrat, F., Carrat, X., Cartier, F., Cary, E., Castaing, Y., Castelain, V., Cavaillon, J.-M., Cha, O., Chambrier, C., Chambrin, M.-C., Chanard, J., Chapplain, J.-M., Charbonneau, P., Chastre, J., Chaumoitre, K., Chemla, D., Chenine, L., Chevrolet, J.-C., Chiche, J.-D., Chiras, J., Chopin, C., Chouchane, N., Choukroun, M.-L., Clair, B., Clavier, B., Clec'h, C., Cluzel, P., Cochereau, I., Cohadon, F., Cohen, Y., Combe, C., Combes, A., Cordonnier, C., Coriat, P., Corne, P., Coulange, M., Cros, A.-M., Crozier, S., Dailland, P., Danel, V., Darmon, M., Darnal, E., David, S., de Cagny, B., De Deyne, C., De Jonghe, B., Decousus, H., Deklunder, G., Delabranche, X., Delafosse, B., Delahaye, A., Delarue, J., de Montalembert, M., Demoule, A., Dequin, P.-F., Deray, G., Deriaz, H., Descamps, J.-M., Devictor, D., Deye, N., Dhainaut, J.-F., di Costanzo, J., Diehl, J.-L., Dingemans, G., Djibré, M., Doise, J.-M., Dolz, M., Donati, S.Y., Dreyfuss, D., Drizenko, A., Du Cheyron, D., Ducloy-Bouthors, A.-S., Dugernier, T., Duguet, A., Durand, F., Duranteau, J., Durocher, A., Dussaule, J.-C., Eckert, Ph., Edouard, D., El Esper, N., Essig, M., Esteban, C., Eurin, B., Fagon, J.-Y., Faisy, C., Fangio, P., Fartoukh, M., Faurisson, F., Favarel-Garrigues, J.-C., Feihl, F., Ferrand, E., Ferry, T., Fialon, P., Fischer, E., Flamant, M., Flamens, C., Flesch, F., Folscheid, D., Forget, A.-P., Fourel, D., Fournier, A., Fournier, G., Fourrier, F., François, B., Francoz, C., Frat, J.-P., Frederic, M., Friedlander, G., Frossard, J.-L., Gabinski, C., Gainnier, M., Gajdos, P., Gamelin, L., Garo, B., Garot, J., Garré, M., Garrouste-Orgeas, M., Gastinne, H., Gbikpi-Benissan, G., †Gehanno, P., Gelas, P., Genestal, M., Gerbeaux, P., †Gibert, C., Gibot, S., Girault, C., Girot, M., Goarin, J.-P., Godeau, B., Goetghebeur, D., Goldgran-Toledano, D., Gonzalez, F., Goulenok, C., †Goulon, M., Grimaldi, D., Grosdidier, G., Gruson, D., Guenoun, T., Guérin, C., Guérin, J.-M., Guérot, E., Guervilly, C., Gueye, P., Guglielminotti, J., Guiavarch, M., Guidet, B., Guyomarc'h, S., Hallynck, C., Hamzaoui, O., Haniez, F., Harlay, M.-L., Harrois, A., Harry, P., Hasselmann, M., Hattab, A., Hébuterne, X., Heng, A.-É., Hertig, A., Hervé, P., Hilbert, G., Himbert, D., Holzapfel, L., Hommel, S., Houhou, N., Houillier, P., Hours, S., Hurel, D., Ichaï, P., Isnard-Bagnis, C., Jacobs, F., Jaffrelot, M., Jaffuel, S., Janvier, G., Jardel, B., Jardin, F., Jarrin, I., Jars-Guincestre, M.-C., Joly, L.-M., Joly-Guillou, M.-L., Jonquet, O., Joseph, T., Jourdain, M., Journois, D., Jung, B., Kahn, D., Kanfer, A., Karie-Guigues, S., Kerlan, V., Khalil, A., Koffel, J.-C., Kopferschmitt, J., Korach, J.-M., Kummerlen, C., L'Her, E., Laaban, J.-P., Laarbaui, F., Labrousse, J., Lacroix, D., Lachérade, J.-C., Lambert, H., Lanceleur, A., Langeron, O., Langevin, B., Lannes, B., Lapostolle, F., Larmignat, P., Laterre, P.-F., Laurent, C.h., Lautrette, A., Lavaux, T., Laxenaire, M.-C., Le Conte, P., Le Corre, B., Le Gall, C., Le Gall, G., Le Gall, J.-R., Le Prado, D., Le Tulzo, Y., Lebranchu, Y., Leclerc, F., Leclerc, X., Leclercq, R., Lefevre, M., Legendre, C., Leger, P., Legras, A., Lellouche, F., Lemaire, F., Lemiale, V., Lemonnier, M.-P., Léon, A., Léone, M., Leprince, P., Leray-Moragues, H., Lerebours, E., Leverve, X., Lévy, B., Lévy, Ph., Leys, D., Lheureux, P., Lienhart, A., Lissac, J., Loirat, P., Loubières, Y., Lucet, J.-C., Lutun, P., Luyt, C.-E., Maillet, J.-M., Mainardi, J.-L., Mancebo, J., Manel, J., Mangiapan, G., Manier, G., Manzon, C., Manzo-Silberman, S., Marek, A., Marit, G., Markowicz, P., Marqué, S., Marquette, C.-H., Marthan, R., Martin, C., Martin, O., Mathien, C., Mathieu, D., Mattéi, M., Maury, E., Maxime, V., Mayaud, C., Mayeur, C., Mazighi, M., Mégarbane, B., Melchior, J.-C., Mélot, C., Mentec, H., Mercat, A., Mertes, P.-M., Meyer, G., Meziani, F., Michelet, C., Micheletti, G., Mignon, A., Mira, J.-P., Mira, L., Mismetti, P., Misset, B., Monchi, M., Monnet, X., Monnier-Cholley, L., Moriconi, M., Morinière, P., Moritz, F., Mortier, E., Mottier, D., Mourvillier, B., Nace, L., Naeije, R., Nicolas, F., Nicolas-Chanoine, M.-H., Nitenberg, A., Nitenberg, G., Nousbaum, J.-B., Noyon, V., Obadia, E., Oger, E., Onimus, Th., Orizet, C., Ould Ahmed, M., Outin, H., Ozier, Y., Page, Y., Paillard, M., Pairault, M., Pajot, O., Papazian, L., Parer, S., Parquin, F., Parrot, A., Pavie, A., Pène, F., Penouil, F., Peraldi, M.-N., Perrin-Gachadoat, D., Perrotin, D., Petitjean, T., Philippart, F., Philit, F., Picard, L., Picart-Jacq, J.-Y., Pichené, C., Pillet, O., Pinsard, M., Plantefeve, G., Pochard, F., Pocidalo, M.-A., Podglajen, I., Pointet, P., Pourrat, O., Prat, G., Préveraud de Vaumas, C., Pruvo, J.-P., Puntous, M., Rabaud, C., Rabbat, A., Rackelboom, T., Racy, E., Raherison, C., Ralec, B., Ramakers, M., Rambaud, L., Rameix, S., Raphaël, J.-C., Ramon, P., Raynard, B., Régnier, B., Renault, A., Revest, M., Reynaert, M.-S., Reynaud, J., Ribaud, P., Ricard, J.-D., Richalet, J.-P., Richard, C., Richard, J.-C.M., Ricome, J.-L., Ricot, J., Ridel, C., Rigolet, A., Robert, D., Robert, R., Roger, I., Rondeau, E., Roques, S., Rossert, J., Roujeau, J.-C., Rozenberg, A., Rugeri, L., Rusterholtz, T., Sab, J.-M., Safran, D., Saïkhali, E., †Sainty, J.-M., Saissy, J.-M., Saliba, F., Samuel, D., Sauder, P., Saumon, G., Savineau, J.-P., Savoye, G., Schabanel, J.-C., Schaeffer, A., Schaller, M.-D., Schiano, P., Schlemmer, B., Schlossmacher, P., Schneider, F., Schneider, S.-M., Schortgen, F., Schwartz, A., Segouin, C., Seguin, Th., Seknadji, P., Serre-Sapin, A.-F., Sharshar, T., Silleran-Chassany, J., Similowski, T., Simonneau, G., Sitbon, O., Slama, M., Sollet, J.-P., Somme, D., Sonneville, R., Soubrier, S., Soufir, L., Souweine, B., Spaulding, C., Squara, P., Steg, P.-G., Stéphanazzi, J., Sterkers, G., Straus, C., Subtil, D., Sztrymf, B., Tabah, A., Taboulet, P., Tamion, F., Tardy, B., Tardy-Poncet, B., Taright, N., Tasseau, F., Tattevin, P., Tauzin-Fin, P., Teboul, J.-L., Tempé, J.-D., Tenaillon, A., Terzi, N., Tesnière, A., Textoris, J., Thabut, D., Thaler, F., Théodore, J., Thierry, A., Thille, A.W., Thirion, M., Thomas, R., Thuong, M., Timsit, J.-F., Tissières, P., Touchard, G., Tournoud, C., Tournoys, A., Tourtier, Y., Tranchant, C., Troché, G., Trouillet, J.-L., Trzeciak, M.-C., Tunon de Lara, J.-M., Ubeaud-Séquier, G., Vachon, F., Valatx, J.-L., Valentin, J.-M., Vallée, F., Vallet, B., Van de Louw, A., Vargas, F., Venet, C., Verdon, R., Vergier, B., Vésin, A., Vial, A., Viale, J.-P., Viau, F., Vieillard-Baron, A., Vignon, P., Villers, D., Vinatier, I., Vincent, B., Vinsonneau, C., Wassermann, D., Wattel, F., Willems, V., Woimant, F., Wysocki, M., Yéni, P., Zahar, J.-R., and Zelter, M.

Published
2009
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16. Management of patients with suspected penetrating cardiac injury

Author

Guenoun, T, Hernot, S, Nasser, E, Debauchez, M, Philip, I, and Desmonts, JM

Abstract

Le diagnostic de plaie du cœur est a` e´voquer devant toute plaie me´diastinale. L'e´chocardiographie doit e^tre syste´matiquement re´alise´e en urgence, essentiellement a` la recherche d'un e´panchement pe´ricardique. Notre premie`re observation illustre la gravite´ de la me´connaissance du diagnostic, qui a conduit a` une tamponnade aigue¨. L'e´chocardiographie n'avait pas e´te´ re´alise´e en raison de l'absence de l'e´chocardiographiste, et de la ne´cessite´ d'explorer une plaie cervicale au bloc ope´ratoire. Du fait de la de´gradation he´modynamique brutale et se´ve`re, une ponction pe´ricardique a du^ e^tre effectue´e pour restaurer un e´tat he´modynamique stable, en attendant l'he´mostase chirurgicale. Dans la deuxie`me observation, le patient avait e´te´ ope´re´ en urgence en raison d'un e´panchement pe´ricardique assez abondant a` l'e´chocardiographie, malgre´ un e´tat clinique rassurant. La gravite´ des le´sions trouve´es (he´mope´ricarde, atteinte de l'arte`re coronaire interventriculaire ante´rieure et de la face infe´rieure du cœur) contrastait avec l'apparente stabilite´ he´modynamique, ce qui souligne l'importance d'une prise en charge rapide de ce type de patient. Au total, chez tout blesse´ suspect de plaie cardiaque et stable sur le plan he´modynamique, seule une e´chocardiographie, re´alise´e dans des conditions techniques parfaites et e´liminant de fa c¸on formelle un e´panchement pe´ricardique, permet de surseoir a` une exploration chirurgicale pratique´e en urgence.

Published
1996
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18. Safety and Efficacy of Percutaneous Morton Neuroma Cryoneurolysis Under Ultrasound Guidance.

Author

Moulin B, Angelopoulos G, Sarrazin JL, Romano S, Vignaux O, Guenoun T, Di Primio M, and Hakime A

Subjects
Humans, Female, Male, Retrospective Studies, Middle Aged, Adult, Aged, Treatment Outcome, Pain Measurement, Ultrasonography, Interventional methods, Cryosurgery methods, Cryosurgery adverse effects, Morton Neuroma therapy, Morton Neuroma surgery, Morton Neuroma diagnostic imaging
Abstract

Purpose: To assess the technical success, safety and early efficacy of Morton neuroma (MN) cryoneurolysis., Materials and Methods: Retrospective review of 54 consecutive patients with MN treated with cryoneurolysis after failure of conservative treatment, from September 2022 to June 2023. Outcomes measurements included technical success (defined a successful ultrasound-guided placement of the cryoprobe), procedural safety according to Cirse classification and change in 6 months post-procedure by pain numeric rating scale (pNRS)., Results: A total of 59 MN were treated during 55 procedures. Mean procedure duration was 47 min, all patients were discharged 2 h after the intervention. Technical success was 98.1%. No Cirse grade 3, 4 or 5 complication was reported. Three grade 2 complication occurred, including two chilblain-type lesions and one bone insufficiency fracture. At 6 months post-procedure, pNRS score was significantly decreased (2.7 ± 2.2 vs 7.1 ± 1.1) (p < 0.0001), with a mean score decrease of 4.1points. Thirty-two patients (60.4%) reported a complete pain relief, 15 (28.3%) a partial pain relief and 6 (11.3%) no pain relief, or increased pain., Conclusion: Cryoneurolysis seems to be safe for the treatment of Morton neuroma. Six-month pain relief is promising and needs to be confirmed at long term., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Published
2024
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19. Representations of Sexuality among Persons with Intellectual Disability, as Perceived by Professionals in Specialized Institutions: A Systematic Review.

Author

Guenoun T, Smaniotto B, Clesse C, Mauran-Mignorat M, Veyron-Lacroix E, Ciccone A, and Essadek A

Subjects
Gender Identity, Humans, Sexual Behavior, Sexuality psychology, Intellectual Disability psychology, Persons with Mental Disabilities
Abstract

The objective of this systematic review is to make an inventory of the representations of the professionals of specialized institutions on the sexuality of persons with intellectual disabilities. The scientific studies were identified according to the PRISMA protocol using 18 databases, with keywords on sexuality and parenthood. Studies were reviewed through a methodological assessment and then a thematic analysis. Twenty-four studies were reviewed and three themes were identified: professionals' representations of gender, sexuality, and consent; professionals' perceptions of their role in supporting people's sexual lives; and the ways in which professionals construct representations of people's sexual lives. This corpus highlights deep paradoxes in the representations of professionals concerning the socio-affective needs and sexuality of people with intellectual disabilities, creating what we could define as a "system of incompatibility" and leading to difficulties in positioning. Support is still too random and subject to control logics in the name of protecting users, who are perceived as vulnerable. Training and new ways of teamwork appear to be central to supporting the evolution of the representations and practices of professionals. Future research anchored in practices and involving users as well as professionals is necessary to better understand the paradoxical aspects of professionals' representations and to draw alternative ways of constructing these representations.

Published
2022
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20. Perianesthetic concerns for the non-COVID-19 patients requiring surgery during the COVID-19 pandemic outbreak: An observational study.

Author

Boccara G, Cassagnol D, Bargues L, Guenoun T, Aubier B, Goldstein I, Romano S, and Longrois D

Subjects
COVID-19, Coronavirus Infections epidemiology, Disease Outbreaks, Humans, Pneumonia, Viral epidemiology, Anesthesia methods, Coronavirus Infections prevention & control, Pandemics prevention & control, Perioperative Care methods, Pneumonia, Viral prevention & control, Surgical Procedures, Operative methods
Abstract

Competing Interests: Declaration of competing interest None.

Published
2020
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21. Anesthetic implications for robot-assisted transaxillary thyroid and parathyroid surgery: a report of twenty cases.

Author

Boccara G, Guenoun T, and Aidan P

Subjects
Adult, Aged, Axilla, Female, Humans, Intraoperative Period, Male, Middle Aged, Monitoring, Intraoperative methods, Pain, Postoperative prevention & control, Parathyroidectomy adverse effects, Patient Positioning methods, Robotics instrumentation, Thyroidectomy adverse effects, Young Adult, Anesthesia, General methods, Parathyroidectomy methods, Robotics methods, Thyroidectomy methods
Abstract

Gasless transaxillary robot-assisted endoscopic thyroid surgery has recently been proposed and developed in South Korea and the United States. Perianesthetic implications and their evolution for 20 patients scheduled to undergo this innovative surgical technique are presented. The anesthetic considerations focus on the length of surgery due to the learning curve, the risk of the ipsilateral arm posture, and postoperative pain evaluation and management., (© 2013 Elsevier Inc. All rights reserved.)

Published
2013
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22. [Perianaesthetic concerns for the new robot-assisted transaxillary thyroid surgery: a report of seven first cases].

Author

Boccara G, Guenoun T, Cohen B, and Aidan P

Subjects
Adult, Axilla, Humans, Middle Aged, Anesthesia methods, Parathyroidectomy methods, Robotics methods, Thyroidectomy methods
Abstract

The gasless transaxillary robot-assisted endoscopic thyroid surgery is recently proposed and developed in South Corea and USA. We reported the perianaesthestic concerns for the seven first patients scheduled to undergo this innovative surgical technique in France. The anaesthetic considerations focused on the length of surgery according to the learning curve, the risk of the arm posture and the postoperative painful evaluation and relief., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Published
2011
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23. Pressure-controlled ventilation improves oxygenation during laparoscopic obesity surgery compared with volume-controlled ventilation.

Author

Cadi P, Guenoun T, Journois D, Chevallier JM, Diehl JL, and Safran D

Subjects
Adult, Blood Pressure, Carbon Dioxide blood, Female, Heart Rate, Humans, Laparoscopy, Male, Middle Aged, Obesity, Morbid physiopathology, Partial Pressure, Positive-Pressure Respiration, Prospective Studies, Pulmonary Gas Exchange, Respiratory Mechanics, Gastroplasty methods, Obesity, Morbid surgery, Oxygen blood, Respiration, Artificial methods
Abstract

Background: We compared pressure and volume-controlled ventilation (PCV and VCV) in morbidly obese patients undergoing laparoscopic gastric banding surgery., Methods: Thirty-six patients, BMI>35 kg m(-2), no major obstructive or restrictive respiratory disorder, and Pa(CO(2))<6.0 kPa, were randomized to receive either VCV or PCV during the surgery. Ventilation settings followed two distinct algorithms aiming to maintain end-tidal CO(2) (E'(CO(2))) between 4.40 and 4.66 kPa and plateau pressure (P(plateau)) as low as possible. Primary outcome variable was peroperative P(plateau). Secondary outcomes were Pa(O(2)) (Fi(O(2)) at 0.6 in each group) and Pa(CO(2)) during surgery and 2 h after extubation. Pressure, flow, and volume time curves were recorded., Results: There were no significant differences in patient characteristics and co-morbidity in the two groups. Mean pH, Pa(O(2)), Sa(O(2)), and the Pa(O(2))/Fi(O(2)) ratio were higher in the PCV group, whereas Pa(CO(2)) and the E'(CO(2))-Pa(CO(2)) gradient were lower (all P<0.05). Ventilation variables, including plateau and mean airway pressures, anaesthesia-related variables, and postoperative cardiovascular variables, blood gases, and morphine requirements after the operation were similar., Conclusions: The changes in oxygenation can only be explained by an improvement in the lungs ventilation/perfusion ratio. The decelerating inspiratory flow used in PCV generates higher instantaneous flow peaks and may allow a better alveolar recruitment. PCV improves oxygenation without any side-effects.

Published
2008
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24. Effects of laparoscopic pneumoperitoneum and changes in position on arterial pulse pressure wave-form: comparison between morbidly obese and normal-weight patients.

Author

Guenoun T, Aka EJ, Journois D, Philippe H, Chevallier JM, and Safran D

Subjects
Adult, Body Mass Index, Female, Head-Down Tilt, Humans, Monitoring, Intraoperative, Obesity, Morbid surgery, Respiratory Mechanics, Supine Position, Blood Pressure, Gastroplasty, Laparoscopy, Obesity, Morbid physiopathology, Pneumoperitoneum, Artificial, Posture
Abstract

Background: Laparoscopic adjustable gastric banding (LAGB) is commonly indicated in morbidly obese patients. There is controversy regarding the hemodynamic effects of pneumoperitoneum (PNP) in obese patients. PNP and changes in body posture have complex effects on venous return that may be detected by respiratory changes in the arterial pressure waveform. The aim of this study was to compare pneumoperitoneum-induced and reverse Trendelenburg (RT) changes in arterial pulse pressure in obese and normal-weight patients., Methods: 15 morbidly obese patients undergoing LAGB were compared to 15 normal-weight patients undergoing laparoscopic surgery. Arterial pressure was non-invasively recorded using an arterial tonometer. Respiratory changes in pulse pressure (deltaPp) were recorded in the supine position without and with PNP, and in RT position with pneumoperitoneum., Results: PNP increased deltaPp values in normal weight (P<0.001), but not in obese patients. RT position increased deltaPp values in obese patients, but did not cause additional changes in normal-weight patients., Conclusions: Unlike normal-weight patients, PNP in the supine position has minimal effect on the arterial pulse-pressure wave-form in obese patients. This observation may reflect physiological differences in total blood volume and loading conditions of the heart between morbidly obese and normal-weight patients, which affect venous return during PNP. Differences in abdominal vascular zone conditions between obese and normal weight-patients may explain these results.

Published
2006
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25. [European normative recommendations for medical gas pipeline systems].

Author

Guenoun T, Journois D, Aka EJ, Philippe H, Cazalaà JB, and Safran D

Subjects
Anesthetics, Inhalation, Equipment Failure, European Union, France, Guidelines as Topic, Hospitals, Anesthesiology instrumentation, Anesthesiology standards, Gases
Abstract

Several recent decisions have been made in order to increase the security of medical gases delivery in French hospitals. These different changes affect: 1) the hospital itself with the creation of working groups in charge of both monitoring and maintenance of gases networks; 2) the pharmaceutical regulation with promotion of several gases to the status of drugs or need of CE marking for the whole gas network. European rules onset required to give up French former norms (NF) to the profit of "NF EN" rules. Nevertheless, the new norm NF EN 737-3 which concerns medical gases distribution systems does not affect principal clauses of the previous NF S 90-155. It introduces new elements allowing to deploy two types of medical gases networks: the double pressure level used in France and the single pressure level used in the rest of Europe. This new norm, which attempts to harmonize alarm control systems in both types of networks, suffers from important limitations describing the double pressure level systems. Lastly, the final checking proposed by this new norm is very different from the previous one, and is likely to be problematic for the final users within the hospital.

Published
2006
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26. Impaired alpha1-adrenergic responses in aged rat hearts.

Author

Montagne O, Le Corvoisier P, Guenoun T, Laplace M, and Crozatier B

Subjects
Adrenergic alpha-Agonists pharmacology, Animals, Calcium Signaling drug effects, Cell Separation, Electric Stimulation, Heart drug effects, Imidazoles pharmacology, Male, Myocytes, Cardiac drug effects, Organ Size drug effects, Phenylephrine pharmacology, Protein Kinase C metabolism, Rats, Rats, Wistar, Aging physiology, Heart physiology, Receptors, Adrenergic, alpha-1 drug effects
Abstract

To determine age-related changes in the cardiac effect of alpha1-adrenergic stimulation, both cardiomyocyte Ca2+-transient and cardiac protein kinase C (PKC) activity were measured in 3-month- (3MO) and 24-month- (24MO) old Wistar rats. Ca2+ transients obtained under 1 Hz pacing by microfluorimetry of cardiomyocyte loaded with indo-1 (405/480 nm fluorescence ratio) were compared in control conditions (Kreb's solution alone) and after alpha1-adrenergic stimulation (phenylephrine or cirazoline, an alpha1-specific agonist). PKC activity and PKC translocation index (particulate/total activity) were also assayed before and after alpha1-adrenergic stimulation. In 3MO, cirazoline induced a significant increase in Ca2+ transient for a 10(-9) M concentration which returned to control values for larger concentrations. In contrast, in 24MO, we observed a constant negative effect of cirazoline on the Ca2+ transient with a significant decrease at 10(-6) M compared with both baseline and Kreb's solution. Preliminary experiments showed that, in a dose-response curve to phenylephrine, the response of Ca2+ transient was maximal at 10(-7) M. This concentration induced a significant increase in Ca2+ transient in 3MO and a significant decrease in 24MO. The same concentration was chosen to perform PKC activity measurements under alpha1-adrenergic stimulation. In the basal state, PKC particulate activity was higher in 24MO than that in 3MO but was not different in cytosolic fractions; so that the translocation index was higher in 24MO (P < 0.01). After phenylephrine, a translocation of PKC toward the particulate fraction was observed in 3MO but not in 24MO. In conclusion, cardiac alpha1-adrenoceptor response was found to be impaired in aged hearts. The negative effect of alpha1-adrenergic stimulation on Ca2+ transient in cardiomyocytes obtained from old rats can be related to an absence of alpha1-adrenergic-induced PKC translocation.

Published
2005
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27. Airway management using the intubating laryngeal mask airway for the morbidly obese patient.

Author

Frappier J, Guenoun T, Journois D, Philippe H, Aka E, Cadi P, Silleran-Chassany J, and Safran D

Subjects
Adult, Anesthesia, General, Body Mass Index, Female, Humans, Male, Middle Aged, Oropharynx anatomy & histology, Oropharynx physiology, Predictive Value of Tests, Respiration, Artificial, Intubation, Intratracheal adverse effects, Laryngeal Masks adverse effects, Obesity, Morbid complications
Abstract

Unlabelled: We studied the effectiveness of the intubating laryngeal mask airway (ILMA) in morbidly obese patients scheduled for bariatric surgery. We included 118 consecutive morbidly obese patients (body mass index, 45 +/- 5 kg/m(2)). After the induction of general anesthesia, the laryngeal view was classified by the first observer according to the method of Cormack and Lehane. The ILMA was then inserted, and the trachea was intubated through the ILMA by a second observer. The rate of successful tracheal intubation with ILMA was 96.3%. The success rate, the number of attempts, and the total duration of the procedure were not different among patients with low-grade (Cormack 1-2) and patients with high-grade (Cormack 3-4) laryngeal views. The time required for insertion of the ILMA was slightly longer in patients with high-grade laryngeal views. Failures of the technique were not explained by the experience of the practitioner or airway characteristics. No adverse effect related to the technique was reported. Results of this study suggest that using the ILMA provides an additional technique for airway management of morbidly obese patients., Implications: The intubating laryngeal mask airway (ILMA) provides an additional technique for airway management of morbidly obese patients. The best choice of the primary technique (laryngoscopy or ILMA) for tracheal intubation of an adult obese patient remains to be determined.

Published
2003
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28. The clinical relevance of systolic pressure variations in anesthetized nonhypotensive patients.

Author

Dalibon N, Guenoun T, Journois D, Frappier J, Safran D, and Fischler M

Subjects
Echocardiography, Transesophageal, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology, Hemodynamics drug effects, Humans, Predictive Value of Tests, Prospective Studies, ROC Curve, Respiration, Artificial, Sensitivity and Specificity, Surgical Procedures, Operative, Ventricular Function, Left physiology, Anesthesia, General adverse effects, Blood Pressure drug effects, Hypovolemia diagnosis
Abstract

Objective: To assess the accuracy of respiratory-induced systolic pressure variation and its components to detect low left ventricular preload., Design: Prospective study., Setting: University hospital., Participants: Sixty-seven patients undergoing major surgery under general anesthesia., Interventions: Transesophageal echocardiographic measurements during apnea and mechanical ventilation., Measurements and Main Results: Respiratory-induced systolic pressure variation and its components and left ventricular end-diastolic area obtained by transesophageal echocardiography were noted simultaneously. Arterial pressure indices did not allow a reliable diagnosis of a low left ventricular end-diastolic area using a cut-off value of 7.9 cm(2)/m(2) (inferior boundary of the interquartile range of the areas measured in the authors' group)., Conclusions: These results suggest that systolic pressure variations noticed after induction of general anesthesia do not reflect low left ventricular preload in nonhypotensive patients., (Copyright 2003 Elsevier Inc. All rights reserved.)

Published
2003
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29. Role of creatine kinase in cardiac excitation-contraction coupling: studies in creatine kinase-deficient mice.

Author

Crozatier B, Badoual T, Boehm E, Ennezat PV, Guenoun T, Su J, Veksler V, Hittinger L, and Ventura-Clapier R

Subjects
Adrenergic beta-Agonists pharmacology, Animals, Caffeine pharmacology, Calcium metabolism, Cells, Cultured, Culture Techniques, Heart drug effects, Heart physiology, Heart Rate drug effects, Isoproterenol pharmacology, Kinetics, Male, Mice, Mice, Inbred C57BL, Mice, Knockout, Muscle Fibers, Skeletal drug effects, Muscle Fibers, Skeletal metabolism, Myocardium cytology, Myocardium metabolism, Rats, Rats, Wistar, Stimulation, Chemical, Ventricular Function drug effects, Creatine Kinase genetics, Creatine Kinase physiology, Myocardial Contraction drug effects, Myocardium enzymology
Abstract

To understand the role of creatine kinase (CK) in cardiac excitation-contraction coupling, CK-deficient mice (CK-/-) were studied in vitro and in vivo. In skinned fibers, the kinetics of caffeine-induced release of Ca2+ was markedly slowed in CK-/- mice with a partial restoration when glycolytic substrates were added. These abnormalities were almost compensated for at the cellular level: the responses of Ca2+ transient and cell shortening to an increased pacing rate from 1 Hz to 4 Hz were normal with a normal post-rest potentiation of shortening. However, the post-rest potentiation of the Ca2+ transient was absent and the cellular contractile response to isoprenaline was decreased in CK-/- mice. In vivo, echocardiographically determined cardiac function was normal at rest but the response to isoprenaline was blunted in CK-/- mice. Previously described compensatory pathways (glycolytic pathway and closer sarcoplasmic reticulum-mitochondria interactions) allow a quasi-normal SR function in isolated cells and a normal basal in vivo ventricular function, but are not sufficient to cope with a large and rapid increase in energy demand produced by beta-adrenergic stimulation. This shows the specific role of CK in excitation-contraction coupling in cardiac muscle that cannot be compensated for by other pathways.

Published
2002
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30. Prediction of arterial oxygen tension during one-lung ventilation: analysis of preoperative and intraoperative variables.

Author

Guenoun T, Journois D, Silleran-Chassany J, Frappier J, D'attellis N, Salem A, and Safran D

Subjects
Adult, Aged, Analysis of Variance, Anesthesia, General, Blood Pressure, Cohort Studies, Female, Humans, Male, Middle Aged, Multivariate Analysis, Prospective Studies, Regression Analysis, Respiratory Mechanics, Oxygen blood, Respiration, Artificial methods, Thoracic Surgical Procedures
Abstract

Objective: To determine whether currently available preoperative and intraoperative variables related to arterial oxygen tension (PaO(2)) can be used as predictors for low PaO(2) during one-lung ventilation (OLV)., Design: A prospective cohort study., Setting: Primary university hospital., Participants: Adult patients (n = 92) undergoing thoracic surgery requiring OLV., Interventions: Preoperative and intraoperative data, including past medical history, physical examination, and usual preoperative and intraoperative tests, were collected and used as explanatory variables for PaO(2) during OLV by univariate and multivariate analysis. A stepwise logistic regression including the same independent variables was used to identify patients who should be expected to develop arterial hypoxemia (PaO(2) <70 mmHg). Arterial blood gas samples were analyzed 15 minutes after the onset of OLV and after thoracotomy to determine the lowest PaO(2) value during OLV., Measurements and Main Results: Preoperative (age, hematocrit, relative perfusion of the nondependent lung) and intraoperative (PaO(2) during 2-lung ventilation and mean arterial pressure at the lowest PaO(2)) variables were identified as independent factors affecting PaO(2) in OLV. PaO(2) during 2-lung ventilation was the only independent variable accounting for arterial hypoxemia when multivariate logistic regression was performed., Conclusion: The PaO(2) during OLV can be predicted using routinely available preoperative and intraoperative data. From a clinical point of view, this study failed to identify patients at risk of arterial hypoxemia when OLV is instituted because mainly intraoperative independent variables are involved in the decrease of PaO(2) in this situation., (Copyright 2002, Elsevier Science (USA). All rights reserved.)

Published
2002
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31. Propofol-induced modifications of cardiomyocyte calcium transient and sarcoplasmic reticulum function in rats.

Author

Guenoun T, Montagne O, Laplace M, and Crozatier B

Subjects
Animals, Calcium metabolism, Cell Separation, Chelating Agents, Electric Stimulation, Fat Emulsions, Intravenous pharmacology, Fluorometry, Heart drug effects, In Vitro Techniques, Indoles, Male, Myocardial Contraction drug effects, Myocardium cytology, Myocardium ultrastructure, Rats, Rats, Wistar, Sarcoplasmic Reticulum drug effects, Anesthetics, Intravenous pharmacology, Calcium Signaling drug effects, Myocardium metabolism, Propofol pharmacology, Sarcoplasmic Reticulum metabolism
Abstract

Background: Propofol is considered to be an anesthetic agent with few or no negative inotropic effects. This study evaluated a possible direct depressant effect of propofol on sarcoplasmic reticulum Ca2+ accumulation and cardiomyocytes., Methods: The effects of propofol on intracellular Ca2+ transients were evaluated in isolated rat cardiomyocytes using a microfluorometric technique with Indo-1. Sarcoplasmic reticulum function was also assessed by measuring the oxalate-stimulated Ca2+ uptake from homogenates of rat ventricles., Results: The Ca2+ uptake capacity of the sarcoplasmic reticulum was decreased by propofol (10(-4) M). Large concentrations of propofol decreased the rate of decrease of the intracellular Ca2+ transient, which resulted in an increase of diastolic Ca2+ when the diastolic interval was decreased. The increased diastolic Ca2+ also resulted in a decrease in Ca2+ transient. This effect appeared for lower doses (10(-5) M) after a short diastolic pause rather than after a long (2- to 3-min) rest (appearing at 10(-4) M)., Conclusions: For doses more than 10(-5) M, propofol induces a Ca2+ uptake capacity impairment of the sarcoplasmic reticulum. This is probably responsible for a slowing of the decrease of the Ca2+ transient, which in turn increases the diastolic Ca2+ for high heart rate. These diastolic modifications may participate in the slight negative inotropic effect of the drug.

Published
2000
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32. Cytosolic myocardial calcium modulation by ATP-dependent potassium channel openers and NO donors.

Author

Laplace M, Guenoun T, Montagne O, Roser F, and Crozatier B

Subjects
Animals, Cardiac Pacing, Artificial, Cytosol, Glyburide pharmacology, Heart Ventricles cytology, Heart Ventricles drug effects, Heart Ventricles metabolism, Hypoglycemic Agents pharmacology, Male, Molsidomine analogs & derivatives, Molsidomine pharmacology, Myocardium cytology, Nicorandil pharmacology, Picolines pharmacology, Pyrans pharmacology, Rats, Rats, Wistar, Vasodilator Agents pharmacology, Adenosine Triphosphate pharmacology, Calcium metabolism, Myocardium metabolism, Nitric Oxide Donors pharmacology, Potassium Channels drug effects
Abstract

The goal of this study was to evaluate, in rat cardiomyocytes, the effects on cytosolic calcium of a pure K-adenosine triphosphate (ATP) channel opener, aprikalim, and those of nicorandil, a dual-acting agent that increases cyclic guanosine monophosphate (cGMP) levels and opens K-ATP channels. These effects were compared with those of a pure NO donor, 3-morpholino-sydnonimine (Sin-1). Ventricular myocytes were isolated from the hearts of adult rats. Changes in cytosolic calcium concentration ([Ca2+]i) were measured by using a Ca2+ indicator, indo-1/AM. Alterations in indo-1 fluorescence were recorded during regular electrical stimulation. After 10 min of pacing, end-diastolic [Ca2+]i was significantly increased as compared with control without significant changes in calcium transient. For doses of 10(-7) to 10(-4) M, aprikalim and nicorandil did not affect significantly the calcium transient. Sin-1 produced a significant decrease in calcium transient (by approximately 20%), which was already maximal at 10(-7) M. When given with the potassium channel antagonist glibenclamide (10(-5) M), nicorandil induced the same effects as those observed with Sin-1. We conclude that potassium channel openers aprikalim and nicorandil do not not decrease calcium transient. Thus the NO-donor properties of nicorandil are not apparent when given alone but appear when ATP-dependent potassium channels are blocked.

Published
1999
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33. [Hemofiltration during severe sepsis or multiorgan failure syndrome].

Author

Guenoun T, Journois D, and Safran D

Subjects
Cytokines physiology, Humans, Hemofiltration, Multiple Organ Failure therapy, Sepsis therapy
Abstract

Continuous renal replacement therapy (CRRT) has been used in intensive care units particularly in patients with sepsis or multiorgan failure. In comparison to intermittent haemodialysis, hemofiltration techniques offers an improved hemodynamic tolerance, related to the absence of osmotic pressure gradient. Indeed, hemofiltration is based on the physical principle of convection to remove substances from the plasma. The removal of substances that are released during sepsis, acute respiratory distress syndrome or multiorgan failure may be of particular interest. Several human studies have demonstrated that hemofiltration removes various inflammatory mediators, but the clinical significance of this removal remains questionable. If this removal occurs predominantly by convection, interest in hemofiltration will focus on high volume hemofiltration in order to obtain maximal ultrafiltrate flows. Patients with sepsis or multiorgan failure require close monitoring of most vital functions. The use of a CRRT technique emphasizes the importance of this monitoring and adds new monitoring issues relative to fluid balance, anticoagulation, hypothermia or drug removal.

Published
1998

34. [Management of suspected heart injuries].

Author

Guenoun T, Hernot S, Nasser E, Debauchez M, Philip I, and Desmonts JM

Subjects
Adult, Echocardiography, Emergencies, Heart Injuries complications, Heart Injuries diagnosis, Humans, Male, Middle Aged, Pericardial Effusion etiology, Pericardial Window Techniques, Wounds, Penetrating complications, Wounds, Penetrating therapy, Heart Injuries therapy
Abstract

Penetrating cardiac injury has to be ruled out in any patients with penetrating thoracic injuries, even in those with no alterations in vital functions. Undelayed echocardiography should be performed to screen for the presence of pericardial effusion. The first case underlines the risk of cardiac tamponade if the diagnosis is missed. Echocardiography was not performed because no echocardiographist was present at the time, and a high suspicion of a neck vascular injury existed. Sudden deterioration due to the onset of acute tamponade was only reversed by an immediate pericardiocentesis followed by surgical haemostasis. The second patient, although stable, had a large echographic pericardial effusion. Emergent sternotomy revealed a large amount of blood in the pericardial space and two cardiac wounds with one on a coronary artery. Penetrating wounds in proximity to the heart, even in a stable patient, require aggressive attempts at ruling out a cardiac injury. Immediate echocardiography should be systematically performed to screen for pericardial fluid.

Published
1996
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