Background: assessing the fluid status of pediatric surgical patients is still a difficult task Objectives: assessing fluid shifts pre- and postoperatively in pediatric patients undergoing general anesthesia using bioimpedance spectrometry (BIS) and assessing BIS in practice as a tool for fluid research in the anesthetic setting. Design: single center prospective pilot study Method: we included pediatric surgical patients age 2-16 yrs, the Total Body Water (TBW) was measured using the Body Composition Monitor (BCM, Fresenius Kabi) pre- and postoperatively. anesthetic management was otherwise routine. All patients were fasted following the ESA Guidelines (2011) and were allowed to have oral intake postoperatively. IV Fluid maintenance rate was calculated by the “4/2/1”rule (Holiday and Segar), fluid boluses were given when necessary. A fluid balance was calculated for each patient. Results: 88 patients were screened, 28 included. 71% where male, median age (y) was 6 (IQR 3). 71% were in ambulatory setting. Median total fluid balance (ml/kg) was 27.3 (IQR 14), non-normally distributed. Mean TBW preop was 14.9 (95% CI:13.3;16.4) L and mean TBW postop was 14.4 (95% Ci: 12.8;15.9) L . the difference in TBW pre- and postop was non-significant (paired T test; 95% CI. p=0, 93; -0.33,1.36). There was no correlation between Total fluid balance and the TBW difference using Pearson correlation test (P= 0.32, 95% CI (-0.19, 0.52)). Discussion: the BCM was not usable in the operating theatre due to electronic interference, limiting it’s perioperative usage. It is however easy and comfortable to use in pediatric patients on the ward. Sample size was smaller than anticipated limiting the power of the study. Most surgeries were performed in ambulatory setting with limited blood loss, short IV running time and no fluid resuscitation resulting in no significant difference in TBW pre- and postoperatively. Conclusion: the BCM is not usable in the OR environment, but further research in more fluid demanding surgeries are needed.
{"title":"Assessing fluid shifts in the pediatric surgical patient: is bioimpedance a promising tool","authors":"S Stevens, M Scheuerman, K Van Hoeck, V Saldien","doi":"10.56126/74.3.18","DOIUrl":"https://doi.org/10.56126/74.3.18","url":null,"abstract":"Background: assessing the fluid status of pediatric surgical patients is still a difficult task Objectives: assessing fluid shifts pre- and postoperatively in pediatric patients undergoing general anesthesia using bioimpedance spectrometry (BIS) and assessing BIS in practice as a tool for fluid research in the anesthetic setting. Design: single center prospective pilot study Method: we included pediatric surgical patients age 2-16 yrs, the Total Body Water (TBW) was measured using the Body Composition Monitor (BCM, Fresenius Kabi) pre- and postoperatively. anesthetic management was otherwise routine. All patients were fasted following the ESA Guidelines (2011) and were allowed to have oral intake postoperatively. IV Fluid maintenance rate was calculated by the “4/2/1”rule (Holiday and Segar), fluid boluses were given when necessary. A fluid balance was calculated for each patient. Results: 88 patients were screened, 28 included. 71% where male, median age (y) was 6 (IQR 3). 71% were in ambulatory setting. Median total fluid balance (ml/kg) was 27.3 (IQR 14), non-normally distributed. Mean TBW preop was 14.9 (95% CI:13.3;16.4) L and mean TBW postop was 14.4 (95% Ci: 12.8;15.9) L . the difference in TBW pre- and postop was non-significant (paired T test; 95% CI. p=0, 93; -0.33,1.36). There was no correlation between Total fluid balance and the TBW difference using Pearson correlation test (P= 0.32, 95% CI (-0.19, 0.52)). Discussion: the BCM was not usable in the operating theatre due to electronic interference, limiting it’s perioperative usage. It is however easy and comfortable to use in pediatric patients on the ward. Sample size was smaller than anticipated limiting the power of the study. Most surgeries were performed in ambulatory setting with limited blood loss, short IV running time and no fluid resuscitation resulting in no significant difference in TBW pre- and postoperatively. Conclusion: the BCM is not usable in the OR environment, but further research in more fluid demanding surgeries are needed.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136265705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N Coosemans, J Janssen, J Klein, T Schepens, W Verbrugghe, P Jorens
Background: Herpes simplex virus type 1 (HSV-1) reactivation in the airways is a common finding among patients admitted to the intensive care unit and has been more recently been reported in critically ill COVID-19 patients. Evidence suggests that HSV-1 reactivation in critically ill patients may be associated with higher morbidity and mortality rates. However, there is conflicting data about whether treatment with acyclovir impacts outcomes. Objectives: The primary aim of this study is to assess whether acyclovir improves survival in critically ill COVID-19 patients with concomitant HSV-1 reactivation. Additionally, we explore the effect of acyclovir on cardiorespiratory instability, biochemical markers of inflammation and renal function. Incidence, potential risk factors and outcomes of HSV-1 reactivation in COVID-19 ICU patients are studied last. Methods: A retrospective single-center cohort study set in a Belgian tertiary-care university hospital. All COVID-19 patients admitted to the ICU between March 1st, 2020, and April 15th, 2021, and were tested for HSV-1 using real-time PCR in airway samples were included for analysis. The administration of acyclovir for patients with HSV-1 reactivation was not randomized. Mortality and various markers of morbidity (cardiorespiratory instability, biochemical markers of inflammation, and renal function) were compared between patients that had received acyclovir and those that had not. Secondary outcome measures were respiratory and inflammatory markers of disease severity. Results: 34.7% (42/121) of patients had HSV-1 reactivation, of which 67% (28/42) received acyclovir. ICU mortality was 36% (n = 10) in the acyclovir group versus 0% in the untreated group. Multivariate analysis resulted in OR 3.82 (95% CI 1.37 – 10.68) for ICU mortality in the treated group. Patients treated with acyclovir had a longer length of stay (41.8 vs. 26.8 days, p = .018), longer duration of invasive mechanical ventilation (33.4 vs. 21.8 days, p = .050), and lower PaO2/FiO2 ratio (59.9 vs. 73.4 mmHg, p = .008). Conclusions: The role of acyclovir in patients with HSV-1 reactivation in the ICU remains controversial. According to this study, respiratory HSV-1 reactivation for this specific patient group might be better left untreated. Treatment selection bias, however, could not be fully excluded.
背景:呼吸道中1型单纯疱疹病毒(HSV-1)再激活在重症监护病房住院患者中很常见，最近在COVID-19危重患者中也有报道。有证据表明，1型单纯疱疹病毒在危重患者中的再激活可能与较高的发病率和死亡率有关。然而，关于阿昔洛韦治疗是否会影响结果，存在相互矛盾的数据。目的:本研究的主要目的是评估阿昔洛韦是否能改善合并HSV-1再激活的COVID-19危重患者的生存。此外，我们还探讨了阿昔洛韦对心肺不稳定、炎症生化指标和肾功能的影响。最后研究了COVID-19 ICU患者HSV-1再激活的发生率、潜在危险因素和结局。方法:在比利时某大学三级医院进行回顾性单中心队列研究。纳入2020年3月1日至2021年4月15日期间入住ICU的所有COVID-19患者，并在气道样本中使用实时PCR检测HSV-1进行分析。对于HSV-1再激活的患者，阿昔洛韦的给药并不是随机的。比较接受阿昔洛韦治疗和未接受阿昔洛韦治疗的患者的死亡率和各种发病率指标(心肺不稳定、炎症生化指标和肾功能)。次要结局指标是疾病严重程度的呼吸和炎症标志物。结果:34.7%(42/121)的患者发生HSV-1再激活，其中67%(28/42)的患者接受了阿昔洛韦治疗。阿昔洛韦组ICU死亡率为36% (n = 10)，而未治疗组为0%。多因素分析结果显示，治疗组ICU死亡率OR为3.82 (95% CI 1.37 - 10.68)。使用阿昔洛韦治疗的患者住院时间更长(41.8天比26.8天，p = 0.018)，有创机械通气持续时间更长(33.4天比21.8天，p = 0.050)， PaO2/FiO2比更低(59.9天比73.4 mmHg, p = 0.008)。结论:阿昔洛韦在重症监护室HSV-1再激活患者中的作用仍存在争议。根据这项研究，呼吸道HSV-1再激活对这一特定患者群体可能最好不进行治疗。然而，不能完全排除治疗选择偏倚。
{"title":"Herpes simplex virus reactivation among severe COVID-19 patients: to treat or not to treat?","authors":"N Coosemans, J Janssen, J Klein, T Schepens, W Verbrugghe, P Jorens","doi":"10.56126/74.3.19","DOIUrl":"https://doi.org/10.56126/74.3.19","url":null,"abstract":"Background: Herpes simplex virus type 1 (HSV-1) reactivation in the airways is a common finding among patients admitted to the intensive care unit and has been more recently been reported in critically ill COVID-19 patients. Evidence suggests that HSV-1 reactivation in critically ill patients may be associated with higher morbidity and mortality rates. However, there is conflicting data about whether treatment with acyclovir impacts outcomes. Objectives: The primary aim of this study is to assess whether acyclovir improves survival in critically ill COVID-19 patients with concomitant HSV-1 reactivation. Additionally, we explore the effect of acyclovir on cardiorespiratory instability, biochemical markers of inflammation and renal function. Incidence, potential risk factors and outcomes of HSV-1 reactivation in COVID-19 ICU patients are studied last. Methods: A retrospective single-center cohort study set in a Belgian tertiary-care university hospital. All COVID-19 patients admitted to the ICU between March 1st, 2020, and April 15th, 2021, and were tested for HSV-1 using real-time PCR in airway samples were included for analysis. The administration of acyclovir for patients with HSV-1 reactivation was not randomized. Mortality and various markers of morbidity (cardiorespiratory instability, biochemical markers of inflammation, and renal function) were compared between patients that had received acyclovir and those that had not. Secondary outcome measures were respiratory and inflammatory markers of disease severity. Results: 34.7% (42/121) of patients had HSV-1 reactivation, of which 67% (28/42) received acyclovir. ICU mortality was 36% (n = 10) in the acyclovir group versus 0% in the untreated group. Multivariate analysis resulted in OR 3.82 (95% CI 1.37 – 10.68) for ICU mortality in the treated group. Patients treated with acyclovir had a longer length of stay (41.8 vs. 26.8 days, p = .018), longer duration of invasive mechanical ventilation (33.4 vs. 21.8 days, p = .050), and lower PaO2/FiO2 ratio (59.9 vs. 73.4 mmHg, p = .008). Conclusions: The role of acyclovir in patients with HSV-1 reactivation in the ICU remains controversial. According to this study, respiratory HSV-1 reactivation for this specific patient group might be better left untreated. Treatment selection bias, however, could not be fully excluded.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136265359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Implementing a Surgical Safety Checklist (SSC) poses several challenges. Operating room (OR) professionals’ opinions on SSC determine whether it is used. Additionally, OR professionals often complain of pressure for execution and presence of inappropriate components in the SSC. Objectives: This study aimed to investigate whether the use of and opinions on SSC improved, and whether feelings of pressure and opinions on the appropriateness of the items changed. Design: Repeated cross-sectional study. Setting: An online survey was sent to all Belgian OR professionals (nurses, surgeons, and anesthesiologists) in 2016 and 2021. Methods: Respondent characteristics were summarized using the proportions of discrete variables. Other data were analyzed using Pearson’s chi-squared test or Fisher’s exact test. A p-value (0.01) was considered statistically significant. Results: In 2021, participation increased from 1419 to 2166 OR professionals. More participants stated that they used SSC, and that its use was more systematic. Opinions about SSC revealed a significant change in patients’ appreciation of SSC use (more positive) and signs of a lack of knowledge of the patient file (less negative). More negative feelings were observed when the SSC was not used. The OR staff experienced less time pressure to complete the SSC. Surgeons, anesthesiologists, and colleagues exerted more pressure on SSC use. The pressure for not using the SSC was low. Seven of the 22 SSC components were judged more appropriate by 2021. ‘Time Out’ improved more than ‘Sign In’ or ‘Sign Out’. Team member introduction remained the least-supported component. Conclusion: SSC was used more often in 2021. Most of the opinions were positive. There was more pressure to use SSC. Most components were considered appropriate, except for team introduction. Local adjustments can align needs with the staff’s opinions. However, crucial components must be maintained.
{"title":"The WHO Surgical Safety Checklist in Belgian hospitals: Changes in use, knowledge, opinions and perception of pressure among operating room professionals between 2016 and 2021","authors":"L Huyghe, W Swinnen, H Peleman","doi":"10.56126/74.3.15","DOIUrl":"https://doi.org/10.56126/74.3.15","url":null,"abstract":"Background: Implementing a Surgical Safety Checklist (SSC) poses several challenges. Operating room (OR) professionals’ opinions on SSC determine whether it is used. Additionally, OR professionals often complain of pressure for execution and presence of inappropriate components in the SSC. Objectives: This study aimed to investigate whether the use of and opinions on SSC improved, and whether feelings of pressure and opinions on the appropriateness of the items changed. Design: Repeated cross-sectional study. Setting: An online survey was sent to all Belgian OR professionals (nurses, surgeons, and anesthesiologists) in 2016 and 2021. Methods: Respondent characteristics were summarized using the proportions of discrete variables. Other data were analyzed using Pearson’s chi-squared test or Fisher’s exact test. A p-value (0.01) was considered statistically significant. Results: In 2021, participation increased from 1419 to 2166 OR professionals. More participants stated that they used SSC, and that its use was more systematic. Opinions about SSC revealed a significant change in patients’ appreciation of SSC use (more positive) and signs of a lack of knowledge of the patient file (less negative). More negative feelings were observed when the SSC was not used. The OR staff experienced less time pressure to complete the SSC. Surgeons, anesthesiologists, and colleagues exerted more pressure on SSC use. The pressure for not using the SSC was low. Seven of the 22 SSC components were judged more appropriate by 2021. ‘Time Out’ improved more than ‘Sign In’ or ‘Sign Out’. Team member introduction remained the least-supported component. Conclusion: SSC was used more often in 2021. Most of the opinions were positive. There was more pressure to use SSC. Most components were considered appropriate, except for team introduction. Local adjustments can align needs with the staff’s opinions. However, crucial components must be maintained.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136265358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Brachial plexopathy is a rare but debilitating injury associated with cardiac surgery. The reported incidence varies widely. Several risk factors have been described, including both patient and surgical factors. Objectives: The aim of this study is to (1) investigate the incidence of brachial plexus injury in cardiac surgery in a three-year period in our hospital, (2) give an overview of risk factors and possible mechanisms of brachial plexopathy, and (3) consider the legal ramifications of these injuries. Design and setting: single centre retrospective study Methods: Data were collected retrospectively from all patients undergoing cardiac surgery in a major hospital in a three-year year period (N = 1305). Hospital records were screened for patients who underwent an electromyography after their surgery. Those cases were further investigated for brachial plexus injury. Patient characteristics and data applying to known risk factors for peroperative nerve injury were obtained. Results: Brachial plexus injury was observed in 7 out of 1305 patients (0.54%). All patients with brachial plexus injury underwent coronary artery bypass surgery with internal mammary artery harvesting at the side of the injury. No further analysis concerning risk factors was performed since only seven cases were identified and underreporting was suspected. Conclusion: Our data suggest that brachial plexus injury in cardiac surgery might be associated with asymmetrical sternal retraction during internal mammary artery harvesting. These findings correspond with previous reports, although it would be interesting to further investigate the importance of the exact placement and type of retractor used.
{"title":"Incidence of brachial plexus injury after cardiac surgery: a retrospective study","authors":"J Heirbaut, H Gutermann, T Fret","doi":"10.56126/74.3.16","DOIUrl":"https://doi.org/10.56126/74.3.16","url":null,"abstract":"Background: Brachial plexopathy is a rare but debilitating injury associated with cardiac surgery. The reported incidence varies widely. Several risk factors have been described, including both patient and surgical factors. Objectives: The aim of this study is to (1) investigate the incidence of brachial plexus injury in cardiac surgery in a three-year period in our hospital, (2) give an overview of risk factors and possible mechanisms of brachial plexopathy, and (3) consider the legal ramifications of these injuries. Design and setting: single centre retrospective study Methods: Data were collected retrospectively from all patients undergoing cardiac surgery in a major hospital in a three-year year period (N = 1305). Hospital records were screened for patients who underwent an electromyography after their surgery. Those cases were further investigated for brachial plexus injury. Patient characteristics and data applying to known risk factors for peroperative nerve injury were obtained. Results: Brachial plexus injury was observed in 7 out of 1305 patients (0.54%). All patients with brachial plexus injury underwent coronary artery bypass surgery with internal mammary artery harvesting at the side of the injury. No further analysis concerning risk factors was performed since only seven cases were identified and underreporting was suspected. Conclusion: Our data suggest that brachial plexus injury in cardiac surgery might be associated with asymmetrical sternal retraction during internal mammary artery harvesting. These findings correspond with previous reports, although it would be interesting to further investigate the importance of the exact placement and type of retractor used.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136265706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Minimally invasive cardiac surgery via mini-thoracotomy reduces surgical trauma compared to full sternotomy. However, thoracotomy can cause severe postoperative pain. Managing postoperative pain is challenging but critical for fast rehabilitation and avoidance of chronic pain. Our objective was to compare the efficacy of analgesia of a bolus in combination with continuous local anaesthetics using a serratus anterior plane block (SAPB) catheter versus a wound infiltration catheter (CWI) in patients after minimally invasive cardiac surgery. Design and setting: We conducted a monocentric, prospective, randomized controlled trial between January 2021 and August 2022. The study was performed at Ghent University Hospital, Belgium. Methods: Patients scheduled for minimally invasive cardiac surgery via thoracoscopy and mini-thoracotomy were randomized to receive either a SABP or a CWI catheter. Postoperatively, continuous ropivacaine 0.2% was started at 10ml/h, and a supplementary bolus of 30ml ropivacaine 0.5% was administered one hour before detubation. The catheter remained in place for at least 24 hours. The primary endpoint was opioid consumption during the first 48 hours postdetubation. Secondary endpoints were anti-emetic consumption, Numerical Analogue Score for 48 hours, length of stay in the Intensive Care Unit and hospital, and incidence of chronic pain. Qualitative data were compared using the Chi – Square test, quantitative data were analyzed with the Student’s t-test. Results: During the study period, a total of 21 patients received a SAPB catheter and 26 patients received a CWI catheter. No statistical significant differences were seen in baseline characteristics. In the first 48 hours postdetubation, morphine equivalent consumption was similar in both groups (p= 0.52), with no differences observed in the early, mid- or late postoperative phases. The total morphine equivalent dose was 21.8 mg in the SAPB and 18.6 mg in the CWI group. There were no significant differences in postoperative vomiting and nausea, length of stay in the Intensive Care Unit and in the hospital and chronic thoracic pain (23% and 33% for the SAPB and CWI group, respectively, p=0.54). Conclusion: This prospective study found no significant difference in postoperative opioid consumption between patients who received a serratus anterior plane block catheter and those who received a wound catheter with bolus and continuous ropivacaine, following minimally invasive cardiac surgery via right thoracoscopy and mini-thoracotomy.
{"title":"Catheter-based serratus anterior plane block vs. continuous wound infiltration for postoperative pain control following minimally invasive atrioventricular valve surgery : a randomized, prospective trial","authors":"B Vanden Bussche, M Vandenheuvel, A Moerman","doi":"10.56126/74.3.17","DOIUrl":"https://doi.org/10.56126/74.3.17","url":null,"abstract":"Background: Minimally invasive cardiac surgery via mini-thoracotomy reduces surgical trauma compared to full sternotomy. However, thoracotomy can cause severe postoperative pain. Managing postoperative pain is challenging but critical for fast rehabilitation and avoidance of chronic pain. Our objective was to compare the efficacy of analgesia of a bolus in combination with continuous local anaesthetics using a serratus anterior plane block (SAPB) catheter versus a wound infiltration catheter (CWI) in patients after minimally invasive cardiac surgery. Design and setting: We conducted a monocentric, prospective, randomized controlled trial between January 2021 and August 2022. The study was performed at Ghent University Hospital, Belgium. Methods: Patients scheduled for minimally invasive cardiac surgery via thoracoscopy and mini-thoracotomy were randomized to receive either a SABP or a CWI catheter. Postoperatively, continuous ropivacaine 0.2% was started at 10ml/h, and a supplementary bolus of 30ml ropivacaine 0.5% was administered one hour before detubation. The catheter remained in place for at least 24 hours. The primary endpoint was opioid consumption during the first 48 hours postdetubation. Secondary endpoints were anti-emetic consumption, Numerical Analogue Score for 48 hours, length of stay in the Intensive Care Unit and hospital, and incidence of chronic pain. Qualitative data were compared using the Chi – Square test, quantitative data were analyzed with the Student’s t-test. Results: During the study period, a total of 21 patients received a SAPB catheter and 26 patients received a CWI catheter. No statistical significant differences were seen in baseline characteristics. In the first 48 hours postdetubation, morphine equivalent consumption was similar in both groups (p= 0.52), with no differences observed in the early, mid- or late postoperative phases. The total morphine equivalent dose was 21.8 mg in the SAPB and 18.6 mg in the CWI group. There were no significant differences in postoperative vomiting and nausea, length of stay in the Intensive Care Unit and in the hospital and chronic thoracic pain (23% and 33% for the SAPB and CWI group, respectively, p=0.54). Conclusion: This prospective study found no significant difference in postoperative opioid consumption between patients who received a serratus anterior plane block catheter and those who received a wound catheter with bolus and continuous ropivacaine, following minimally invasive cardiac surgery via right thoracoscopy and mini-thoracotomy.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136265712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caesarean section is the most performed surgical intervention worldwide. A proportion of these caesarean deliveries will necessitate emergency care for maternal and fetal compromise. Anaes-thetic management in these situations can be challenging and a short decision to delivery interval is burning. Current evidence suggests that multidisciplinary communication is essential to support anaesthetic management and optimise team performance. Communication should be supported by using a standardised classification of urgency tool. The four-grade classification scale has increasingly been adopted internationally. While neuraxial techniques are favoured for caesarean sections, gen-eral anaesthesia has an essential role in category 1 caesarean section (defined as a caesarean section in which there is an immediate threat to life for the mother or fetus). The risks and benefits of general and neuraxial anaesthesia for the woman and her baby must be carefully weighed on an individual base. Beyond the delivery of anaesthesia, other practical strategies, such as multidiscipli-nary team training, can contribute to improved maternal and neonatal outcomes.
{"title":"Anaesthaesia for Category-1 urgency Ceasarean section","authors":"S Devroe, M Dhankhar, N Lucas","doi":"10.56126/74.3.20","DOIUrl":"https://doi.org/10.56126/74.3.20","url":null,"abstract":"Caesarean section is the most performed surgical intervention worldwide. A proportion of these caesarean deliveries will necessitate emergency care for maternal and fetal compromise. Anaes-thetic management in these situations can be challenging and a short decision to delivery interval is burning. Current evidence suggests that multidisciplinary communication is essential to support anaesthetic management and optimise team performance. Communication should be supported by using a standardised classification of urgency tool. The four-grade classification scale has increasingly been adopted internationally. While neuraxial techniques are favoured for caesarean sections, gen-eral anaesthesia has an essential role in category 1 caesarean section (defined as a caesarean section in which there is an immediate threat to life for the mother or fetus). The risks and benefits of general and neuraxial anaesthesia for the woman and her baby must be carefully weighed on an individual base. Beyond the delivery of anaesthesia, other practical strategies, such as multidiscipli-nary team training, can contribute to improved maternal and neonatal outcomes.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Artificial intelligence (AI) is rapidly evolving and gaining attention in the medical world. Our aim is to provide readers with insights into this quickly changing medical landscape and the role of clinicians in the middle of this popular technology. In this review, our aim is to explain some of the increasingly frequently used AI terminology explicitly for physicians. Next, we give a summation, an overview of currently existing applications, future possibilities for AI in the medical field of anesthesiology and thoroughly highlight possible problems that could arise from implementing this technology in daily practice. Therefore, we conducted a literature search, including all types of articles published between the first of January 2010 and the 1st of May 2023, written in English, and having a free full text available. We searched Pubmed, Medline, and Embase using “artificial intelligence”, “machine learning”, “deep learning”, “neural networks” and “anesthesiology” as MESH terms. To structure these findings, we divided the results into five categories: preoperatively, perioperatively, postoperatively, AI in the intensive care unit and finally, AI used for teaching purposes. In the first category, we found AI applications for airway assessment, risk prediction, and logistic support. Secondly, we made a summation of AI applications used during the operation. AI can predict hypotensive events, delivering automated anesthesia, reducing false alarms, and aiding in the analysis of ultrasound anatomy in locoregional anesthesia and echocardiography. Thirdly, namely postoperatively, AI can be applied in predicting acute kidney injury, pulmonary complications, postoperative cognitive dysfunction and can help to diagnose postoperative pain in children. At the intensive care unit, AI tools discriminate acute respiratory distress syndrome (ARDS) from pulmonary oedema in pleural ultrasound, predict mortality and sepsis more accurately, and predict survival rates in severe Coronavirus-19 (COVID-19). Finally, AI has been described in training residents in spinal ultrasound, simulation, and plexus block anatomy. Several concerns must be addressed regarding the use of AI. Firstly, this software does not explain its decision process (i.e., the ‘black box problem’). Secondly, to develop AI models and decision support systems, we need big and accurate datasets, unfortunately with potential unknown bias. Thirdly, we need an ethical and legal framework before implementing this technology. At the end of this paper, we discuss whether this technology will be able to replace the clinician one day. This paper adds value to already existing literature because it not only offers a summation of existing literature on AI applications in anesthesiology but also gives clear definitions of AI itself and critically assesses implementation of this technology.
{"title":"Artificial intelligence in anesthesiology","authors":"F Gheysen, S Rex","doi":"10.56126/75.3.21","DOIUrl":"https://doi.org/10.56126/75.3.21","url":null,"abstract":"Artificial intelligence (AI) is rapidly evolving and gaining attention in the medical world. Our aim is to provide readers with insights into this quickly changing medical landscape and the role of clinicians in the middle of this popular technology. In this review, our aim is to explain some of the increasingly frequently used AI terminology explicitly for physicians. Next, we give a summation, an overview of currently existing applications, future possibilities for AI in the medical field of anesthesiology and thoroughly highlight possible problems that could arise from implementing this technology in daily practice. Therefore, we conducted a literature search, including all types of articles published between the first of January 2010 and the 1st of May 2023, written in English, and having a free full text available. We searched Pubmed, Medline, and Embase using “artificial intelligence”, “machine learning”, “deep learning”, “neural networks” and “anesthesiology” as MESH terms. To structure these findings, we divided the results into five categories: preoperatively, perioperatively, postoperatively, AI in the intensive care unit and finally, AI used for teaching purposes. In the first category, we found AI applications for airway assessment, risk prediction, and logistic support. Secondly, we made a summation of AI applications used during the operation. AI can predict hypotensive events, delivering automated anesthesia, reducing false alarms, and aiding in the analysis of ultrasound anatomy in locoregional anesthesia and echocardiography. Thirdly, namely postoperatively, AI can be applied in predicting acute kidney injury, pulmonary complications, postoperative cognitive dysfunction and can help to diagnose postoperative pain in children. At the intensive care unit, AI tools discriminate acute respiratory distress syndrome (ARDS) from pulmonary oedema in pleural ultrasound, predict mortality and sepsis more accurately, and predict survival rates in severe Coronavirus-19 (COVID-19). Finally, AI has been described in training residents in spinal ultrasound, simulation, and plexus block anatomy. Several concerns must be addressed regarding the use of AI. Firstly, this software does not explain its decision process (i.e., the ‘black box problem’). Secondly, to develop AI models and decision support systems, we need big and accurate datasets, unfortunately with potential unknown bias. Thirdly, we need an ethical and legal framework before implementing this technology. At the end of this paper, we discuss whether this technology will be able to replace the clinician one day. This paper adds value to already existing literature because it not only offers a summation of existing literature on AI applications in anesthesiology but also gives clear definitions of AI itself and critically assesses implementation of this technology.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder among surgical patients and is associated with an increased risk of perioperative cardiopulmonary complications leading to increased health expenses. Therefore, preoperative OSA screening should be instituted to inform patients of their increased perioperative risk and measures can be taken in to decrease this risk. Meanwhile ERAS (Enhanced recovery after surgery) guidelines are becoming standard of care and being widely implemented. The purpose of these recovery programs is to standardize medical care, enhance outcomes and decrease health care expenses using evidence-based protocols. According to the current evidence it is unclear if OSA patients could benefit from these protocols. The first part of this narrative review states the current evidence on OSA definition, classification, pathophysiology and risk factors, postoperative complications, endotypes and their relevance for the anesthesiologist. The second part investigated the feasibility of ERAS measures within the OSA-population. Preoperatively there are many parallels to be drawn between the ERAS measures and Society of Anesthesia and Sleep Medicine (SASM) guidelines on OSA management: Risk stratification by OSA-screening, information counselling on the increased perioperative risk and optimization of preoperative health conditions by initiation of CPAP-therapy. Perioperatively the use short acting anesthetics allows for both early mobilization and avoid postoperative respiratory compromise by sustained drug effect. ERAS measures to maintain the patient in the zone of normovolaemia are advantageous for OSA patients as excessive fluid administration can worsen OSA. The use of multimodal analgesia sparing opioids might be the most important element beneficial for OSA patients they are more prone to develop opioid induced respiratory depression (OIRD). As OSA patients are at risk for venous thromboembolism appropriate thromboprophylaxis should be applied. Postoperatively OSA patients should be closely monitored in the prevention of OIRD. In conclusion many ERAS measures seem to be applicable or of benefit for OSA patients. However, large prospective randomized controlled trials are needed to evaluate if these patients can be managed within an ERAS protocol.
{"title":"Can the OSA patient be managed within an ERAS protocol? A narrative review","authors":"M Ramselaar, A Neyrinck","doi":"10.56126/74.3.23","DOIUrl":"https://doi.org/10.56126/74.3.23","url":null,"abstract":"Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder among surgical patients and is associated with an increased risk of perioperative cardiopulmonary complications leading to increased health expenses. Therefore, preoperative OSA screening should be instituted to inform patients of their increased perioperative risk and measures can be taken in to decrease this risk. Meanwhile ERAS (Enhanced recovery after surgery) guidelines are becoming standard of care and being widely implemented. The purpose of these recovery programs is to standardize medical care, enhance outcomes and decrease health care expenses using evidence-based protocols. According to the current evidence it is unclear if OSA patients could benefit from these protocols. The first part of this narrative review states the current evidence on OSA definition, classification, pathophysiology and risk factors, postoperative complications, endotypes and their relevance for the anesthesiologist. The second part investigated the feasibility of ERAS measures within the OSA-population. Preoperatively there are many parallels to be drawn between the ERAS measures and Society of Anesthesia and Sleep Medicine (SASM) guidelines on OSA management: Risk stratification by OSA-screening, information counselling on the increased perioperative risk and optimization of preoperative health conditions by initiation of CPAP-therapy. Perioperatively the use short acting anesthetics allows for both early mobilization and avoid postoperative respiratory compromise by sustained drug effect. ERAS measures to maintain the patient in the zone of normovolaemia are advantageous for OSA patients as excessive fluid administration can worsen OSA. The use of multimodal analgesia sparing opioids might be the most important element beneficial for OSA patients they are more prone to develop opioid induced respiratory depression (OIRD). As OSA patients are at risk for venous thromboembolism appropriate thromboprophylaxis should be applied. Postoperatively OSA patients should be closely monitored in the prevention of OIRD. In conclusion many ERAS measures seem to be applicable or of benefit for OSA patients. However, large prospective randomized controlled trials are needed to evaluate if these patients can be managed within an ERAS protocol.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"198 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Preoperative anxiety is common among children, resulting in negative postoperative behavior and increased postoperative pain. This review focuses on the practical use, safety, and efficacy of pharmacological strategies to reduce perioperative anxiety in children. The PubMed® database was searched using MeSH terms: ((care, preoperative) AND (children) AND (anti-anxiety drugs); (medication, preanesthetic) AND (child, preschool). An in-dept assessment was performed after which 85 articles were retrieved. Benzodiazepines (midazolam, diazepam), zolpidem, melatonin, opioids (fentanyl, butorphanol), alpha-2-adrenergic receptor agonists (clonidine, dexmedetomidine), ketamine and antihistamines (hydroxyzine, promethazine) were reviewed. Their pharmacological properties, routes of administration, doses, efficacy and (dis)advantages are discussed in this review. Based upon the results of our review, some suggestions can be made. Oral midazolam, oral clonidine, intranasally dexmedetomidine and the combination of oral ketamine and midazolam are recommendable products. Some other products like oral diazepam, butorphanol, ketamine intranasal s-ketamine + midazolam and hydroxyzine can be considered because of their proper safety profile and benefits. Further research should focus on patient selection for specific pharmacological and non-pharmacological interventions to achieve a tailored approach. Standardized assessment of anxiety, clinical significancy and feasibility should be included in the objectives of these studies.
{"title":"Pharmacological strategies to reduce perioperative anxiety in children – a narrative review","authors":"D Knaeps, P Van de Putte, M Van de Velde","doi":"10.56126/74.3.22","DOIUrl":"https://doi.org/10.56126/74.3.22","url":null,"abstract":"Preoperative anxiety is common among children, resulting in negative postoperative behavior and increased postoperative pain. This review focuses on the practical use, safety, and efficacy of pharmacological strategies to reduce perioperative anxiety in children. The PubMed® database was searched using MeSH terms: ((care, preoperative) AND (children) AND (anti-anxiety drugs); (medication, preanesthetic) AND (child, preschool). An in-dept assessment was performed after which 85 articles were retrieved. Benzodiazepines (midazolam, diazepam), zolpidem, melatonin, opioids (fentanyl, butorphanol), alpha-2-adrenergic receptor agonists (clonidine, dexmedetomidine), ketamine and antihistamines (hydroxyzine, promethazine) were reviewed. Their pharmacological properties, routes of administration, doses, efficacy and (dis)advantages are discussed in this review. Based upon the results of our review, some suggestions can be made. Oral midazolam, oral clonidine, intranasally dexmedetomidine and the combination of oral ketamine and midazolam are recommendable products. Some other products like oral diazepam, butorphanol, ketamine intranasal s-ketamine + midazolam and hydroxyzine can be considered because of their proper safety profile and benefits. Further research should focus on patient selection for specific pharmacological and non-pharmacological interventions to achieve a tailored approach. Standardized assessment of anxiety, clinical significancy and feasibility should be included in the objectives of these studies.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Fluid management strategies are one of the potential strategies to prevent spinal induced hypotension in parturients scheduled for caesarean section. Objectives: This review will assess the current evidence on fluid strategies as a prophylactic measure for spinal induced hypotension. Methods: A narrative review was conducted where Pubmed, Embase and the Cochrane library were searched in November 2021 for RCTs, meta-analyses and systematic reviews, that compared different fluid regimen in ASA classification one or two women scheduled for elective caesarean section. Results: 77 studies were selected from initial screening, based on titles and abstracts. Out of the 77 initial studies, 37 were considered eligible for inclusion. Crystalloid preloading seemed ineffective in the prevention of spinal hypotension. Crystalloid co-loading, colloid pre- and co-loading all proved to reduce the incidence of spinal hypotension, as well as the incidence of nausea and vomiting and vasopressor use. There was no significant difference in neonatal outcome, regardless of the fluid regimen. Conclusion: Crystalloid co-loading, colloid co-loading and colloid preloading all have been shown to be effective in the prevention of spinal hypotension.
{"title":"Fluid co-loading or preloading for the prevention of hypotension during spinal anesthesia for C-section: a narrative review","authors":"N Decuyper, M Van De Velde","doi":"10.56126/74.1.09","DOIUrl":"https://doi.org/10.56126/74.1.09","url":null,"abstract":"Background: Fluid management strategies are one of the potential strategies to prevent spinal induced hypotension in parturients scheduled for caesarean section. Objectives: This review will assess the current evidence on fluid strategies as a prophylactic measure for spinal induced hypotension. Methods: A narrative review was conducted where Pubmed, Embase and the Cochrane library were searched in November 2021 for RCTs, meta-analyses and systematic reviews, that compared different fluid regimen in ASA classification one or two women scheduled for elective caesarean section. Results: 77 studies were selected from initial screening, based on titles and abstracts. Out of the 77 initial studies, 37 were considered eligible for inclusion. Crystalloid preloading seemed ineffective in the prevention of spinal hypotension. Crystalloid co-loading, colloid pre- and co-loading all proved to reduce the incidence of spinal hypotension, as well as the incidence of nausea and vomiting and vasopressor use. There was no significant difference in neonatal outcome, regardless of the fluid regimen. Conclusion: Crystalloid co-loading, colloid co-loading and colloid preloading all have been shown to be effective in the prevention of spinal hypotension.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135142406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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