Up to 1% of pregnant women require general anesthesia and maternal non-obstetric surgery during pregnancy, of which urgent abdominal procedures are most commonly indicated. This narrative review summarizes several dogmas and myths on the management of general anesthesia during pregnancy and the corresponding evidence. While historical studies found delayed gastric emptying during pregnancy, recent evidence concluded that gastric emptying remains nearly normal during the entire pregnancy until the onset of labor. To correctly estimate the aspiration risk, gastric ultrasound should be increasingly performed. Based on the available evidence, the application of cricoid pressure should be discouraged during rapid sequence induction of pregnant women. A cuffed endotracheal tube is traditionally recommended, but laryngeal masks have been used in > 9000 patients undergoing cesarean section without observation of aspiration. All material to manage a difficult airway should be available as difficult intubation remains an ongoing concern in obstetrics. Risk factors for difficult intubation are nonobstetric in nature. Due to the lack of evidence for hemodynamic management, it is not possible to make an evidence-based recommendation. We recommend to adhere to the expert opinion of maintaining maternal blood pressure close to the normal physiologic value by using (15°-)30° left lateral tilt position, intravenous fluids and noradrenaline or phenylephrine. Most recent clinical observational studies suggested to consider laparoscopic over open surgery as a standard treatment for abdominal surgery. While animal studies observed impaired fetal brain development after prenatal anesthesia exposure, this could not be confirmed by an observational clinical study.
{"title":"General anesthesia for maternal surgery during pregnancy: dogmas, myths and evidence, a narrative review","authors":"T. Bleeser, M. Van de Velde, S. Rex, S. Devroe","doi":"10.56126/75.1.08","DOIUrl":"https://doi.org/10.56126/75.1.08","url":null,"abstract":"Up to 1% of pregnant women require general anesthesia and maternal non-obstetric surgery during pregnancy, of which urgent abdominal procedures are most commonly indicated. This narrative review summarizes several dogmas and myths on the management of general anesthesia during pregnancy and the corresponding evidence. While historical studies found delayed gastric emptying during pregnancy, recent evidence concluded that gastric emptying remains nearly normal during the entire pregnancy until the onset of labor. To correctly estimate the aspiration risk, gastric ultrasound should be increasingly performed. Based on the available evidence, the application of cricoid pressure should be discouraged during rapid sequence induction of pregnant women. A cuffed endotracheal tube is traditionally recommended, but laryngeal masks have been used in > 9000 patients undergoing cesarean section without observation of aspiration. All material to manage a difficult airway should be available as difficult intubation remains an ongoing concern in obstetrics. Risk factors for difficult intubation are nonobstetric in nature. Due to the lack of evidence for hemodynamic management, it is not possible to make an evidence-based recommendation. We recommend to adhere to the expert opinion of maintaining maternal blood pressure close to the normal physiologic value by using (15°-)30° left lateral tilt position, intravenous fluids and noradrenaline or phenylephrine. Most recent clinical observational studies suggested to consider laparoscopic over open surgery as a standard treatment for abdominal surgery. While animal studies observed impaired fetal brain development after prenatal anesthesia exposure, this could not be confirmed by an observational clinical study.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140466330","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}
L. Vanginderhuysen, B. Janssen, G. Vingerhoets, X. Willaert, A. Creemers, D. Mesotten, S. Thiessen
Background: COVID-19 acute respiratory distress syndrome (C-ARDS) survivors suffer from long-term physical complications. However, at the time of this study limited data are available on possible long-term cognitive impairment. Objectives: We hypothesized that COVID-19 ICU patients perform worse on cognitive tasks 6 months after admission, in comparison to reference values of a healthy population. Design: Two-center cohort study with a six months’ time horizon. Patients: Patients admitted to the ICU for COVID-19 associated respiratory failure between March and June 2020. Setting: Post-ICU follow up. Methods and main outcome measures: The primary measure was the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) score (with lower values indicating worse global cognition). The secondary outcome measure was the Trail Making Test (TMT) Part B (population age-, sex-, and education-adjusted mean score, 50±10, with lower scores indicating worse executive functions). The Short Form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE, on a scale from 1.0 to 5.0, with 5.0 indicating severe cognitive impairment) was taken for not patients not fluent in Dutch. Results: 117 COVID-19 patients were admitted to the ICU, of whom 32 patients (27%) died within 6 months. 67/85 (79%) patients participated in the cohort study. COVID-19 survivors had lower total RBANS cognition scores than the age-adjusted population norms (n=45). Fifteen (33%) patients had a global cognition score 1.5 SD below the population means. RBANS-subscale performance showed that both memory (immediate and delayed recall) and attention were at minus 1 SD below normative means, while language and visuospatial cognition were unaffected. Median TMT B score was 40 (IQR 10-65) (n=45). There were elevated scores of the short form IQCODE (mean 3.4 (SD 0.4). Conclusions: Our results suggests that COVID-19 ARDS negatively affects long-term cognitive function. Trial registration: ClinicalTrials.gov NCT04593069.
{"title":"Long-term cognitive dysfunction after COVID ARDS","authors":"L. Vanginderhuysen, B. Janssen, G. Vingerhoets, X. Willaert, A. Creemers, D. Mesotten, S. Thiessen","doi":"10.56126/75.1.05","DOIUrl":"https://doi.org/10.56126/75.1.05","url":null,"abstract":"Background: COVID-19 acute respiratory distress syndrome (C-ARDS) survivors suffer from long-term physical complications. However, at the time of this study limited data are available on possible long-term cognitive impairment.\u0000\u0000Objectives: We hypothesized that COVID-19 ICU patients perform worse on cognitive tasks 6 months after admission, in comparison to reference values of a healthy population.\u0000\u0000Design: Two-center cohort study with a six months’ time horizon.\u0000\u0000Patients: Patients admitted to the ICU for COVID-19 associated respiratory failure between March and June 2020.\u0000\u0000Setting: Post-ICU follow up.\u0000\u0000Methods and main outcome measures: The primary measure was the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) score (with lower values indicating worse global cognition). The secondary outcome measure was the Trail Making Test (TMT) Part B (population age-, sex-, and education-adjusted mean score, 50±10, with lower scores indicating worse executive functions). The Short Form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE, on a scale from 1.0 to 5.0, with 5.0 indicating severe cognitive impairment) was taken for not patients not fluent in Dutch.\u0000\u0000Results: 117 COVID-19 patients were admitted to the ICU, of whom 32 patients (27%) died within 6 months. 67/85 (79%) patients participated in the cohort study. COVID-19 survivors had lower total RBANS cognition scores than the age-adjusted population norms (n=45). Fifteen (33%) patients had a global cognition score 1.5 SD below the population means. RBANS-subscale performance showed that both memory (immediate and delayed recall) and attention were at minus 1 SD below normative means, while language and visuospatial cognition were unaffected. Median TMT B score was 40 (IQR 10-65) (n=45). There were elevated scores of the short form IQCODE (mean 3.4 (SD 0.4).\u0000\u0000Conclusions: Our results suggests that COVID-19 ARDS negatively affects long-term cognitive function.\u0000\u0000Trial registration: ClinicalTrials.gov NCT04593069.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462363","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}
S. Proesmans, K. Vermeylen, C. Olyslaegers, B. De Tavernier, S. Casaer
Peripheral nerve blocks (PNBs) for hip fractures are standard of care in many countries at the emergency department and sometimes even in the prehospital setting. This type of analgesic care is however not standard in Belgium. The structural implementation of PNBs at the emergency department depends on the availability of personnel trained in regional anesthesia and a correct informed consent. Given the professionalization of emergency medicine in Belgium since 2005, anesthesiologists have become less involved in most emergency departments. This might cause a potential lack of personnel trained in regional anesthesia. In this article the authors propose a practical guideline with a decision tree to guide better analgesic care for patients with hip fractures in Belgium.
{"title":"Clinical guideline for the use of peripheral nerve block in hip fractures at the emergency department in Belgium","authors":"S. Proesmans, K. Vermeylen, C. Olyslaegers, B. De Tavernier, S. Casaer","doi":"10.56126/75.1.06","DOIUrl":"https://doi.org/10.56126/75.1.06","url":null,"abstract":"Peripheral nerve blocks (PNBs) for hip fractures are standard of care in many countries at the emergency department and sometimes even in the prehospital setting. This type of analgesic care is however not standard in Belgium. The structural implementation of PNBs at the emergency department depends on the availability of personnel trained in regional anesthesia and a correct informed consent. Given the professionalization of emergency medicine in Belgium since 2005, anesthesiologists have become less involved in most emergency departments. This might cause a potential lack of personnel trained in regional anesthesia. In this article the authors propose a practical guideline with a decision tree to guide better analgesic care for patients with hip fractures in Belgium.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140467404","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: Anesthesia practice has traditionally focused on technical skills and medical knowledge, but the importance of effective doctor-patient communication and patient-centered care is increasingly recognized. In this context, the nocebo effect is an important concept to be aware of as it can be associated with negative outcomes. Objective: This review summarizes the neurobiological and psychological factors underlying the formation of nocebo effects. Additionally, the implications of nocebo effects in clinical practice will be explored. Finally, we will provide a brief overview of communication concepts relevant to the physician-patient relationship that can help minimize nocebo effects and serve as a useful guide for anesthetists to improve their communication skills and provide better care to their patients. Methods: PubMed, Ovid and Cochrane library were searched using keywords related to “nocebo effect”, “anesthesia” and “communication”. In addition, we added articles found in references of identified articles relevant for our research. Results: Nocebo effects can arise from a variety of factors, including negative expectations, negative wording and suggestions, and a poor doctor-patient relationship. While nocebo effects can deteriorate health outcomes, appropriate verbal and non-verbal communication can improve patient satisfaction and subsequently health outcomes. Conclusion: In recent years, there has been an increasing recognition of the importance of doctor-patient communication in anesthesia practice. Communication strategies such as active listening, empathy, and positive language should be incorporated into anesthesia training programs. More research is needed to fully understand the impact of the nocebo effect on health outcomes and to develop effective strategies to mitigate its negative effects.
{"title":"Clinical relevance of nocebo effects in anesthesia practice: a narrative review","authors":"L. Cuyx, S. Rex","doi":"10.56126/75.1.07","DOIUrl":"https://doi.org/10.56126/75.1.07","url":null,"abstract":"Background: Anesthesia practice has traditionally focused on technical skills and medical knowledge, but the importance of effective doctor-patient communication and patient-centered care is increasingly recognized. In this context, the nocebo effect is an important concept to be aware of as it can be associated with negative outcomes.\u0000\u0000Objective: This review summarizes the neurobiological and psychological factors underlying the formation of nocebo effects. Additionally, the implications of nocebo effects in clinical practice will be explored. Finally, we will provide a brief overview of communication concepts relevant to the physician-patient relationship that can help minimize nocebo effects and serve as a useful guide for anesthetists to improve their communication skills and provide better care to their patients.\u0000\u0000Methods: PubMed, Ovid and Cochrane library were searched using keywords related to “nocebo effect”, “anesthesia” and “communication”. In addition, we added articles found in references of identified articles relevant for our research.\u0000\u0000Results: Nocebo effects can arise from a variety of factors, including negative expectations, negative wording and suggestions, and a poor doctor-patient relationship. While nocebo effects can deteriorate health outcomes, appropriate verbal and non-verbal communication can improve patient satisfaction and subsequently health outcomes.\u0000\u0000Conclusion: In recent years, there has been an increasing recognition of the importance of doctor-patient communication in anesthesia practice. Communication strategies such as active listening, empathy, and positive language should be incorporated into anesthesia training programs. More research is needed to fully understand the impact of the nocebo effect on health outcomes and to develop effective strategies to mitigate its negative effects.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140466914","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}
S. Pissens, L. Cavens, G. P. Joshi, M.P. Bonnet, A. Sauter, J. Raeder, M. Van de Velde
Hip fracture is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and length of stay. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after hip fracture. A systematic review utilising procedure specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials, systematic reviews and meta-analysis published in the English language between 04 April 2005 and 12 May 2021, evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane Databases. A total of 60 studies met the inclusion criteria. For patients having hip fracture, pre, intra and postoperative paracetamol and non-steroidal anti-inflammatory drugs or COX-2 inhibitors are recommended. A single shot femoral nerve block or a single shot fascia iliaca compartment block are recommended. Continuous catheter techniques should be used only in specific circumstances. The choice between femoral nerve block or a fascia iliaca compartment block should be made according to local expertise. The postoperative regimen should include regular paracetamol, non-steroidal anti-inflammatory drugs and COX-2 inhibitors with opioids used for rescue. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations, while other interventions were not recommended due to insufficient, inconsistent or lack of evidence.
{"title":"Pain management after hip fracture repair surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations","authors":"S. Pissens, L. Cavens, G. P. Joshi, M.P. Bonnet, A. Sauter, J. Raeder, M. Van de Velde","doi":"10.56126/75.1.04","DOIUrl":"https://doi.org/10.56126/75.1.04","url":null,"abstract":"Hip fracture is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and length of stay. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after hip fracture. A systematic review utilising procedure specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials, systematic reviews and meta-analysis published in the English language between 04 April 2005 and 12 May 2021, evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane Databases. A total of 60 studies met the inclusion criteria. For patients having hip fracture, pre, intra and postoperative paracetamol and non-steroidal anti-inflammatory drugs or COX-2 inhibitors are recommended. A single shot femoral nerve block or a single shot fascia iliaca compartment block are recommended. Continuous catheter techniques should be used only in specific circumstances. The choice between femoral nerve block or a fascia iliaca compartment block should be made according to local expertise. The postoperative regimen should include regular paracetamol, non-steroidal anti-inflammatory drugs and COX-2 inhibitors with opioids used for rescue. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations, while other interventions were not recommended due to insufficient, inconsistent or lack of evidence.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140469167","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}
Purpose: This study aims to investigate the trend of female representation in publishing in the Acta Anaesthesiologica Belgica (AAB) from 2005 to 2021. In recent years, there has been an increased focus on gender equality and disparity. However, as far as we know, an evaluation of the Belgian literature in this regard has not been undertaken before. Methods: The study’s main objective is on determining the gender of the first author, with the gender of the second and last authorship position being secondary outcomes. Additionally, the study aimed to investigate whether other variables, such as the field in which the article was published, study type, the country of origin (of the first author), the first author’s academic degree, the number of authors, and coauthors’ gender, are related to these outcomes. Results: In total 475 manuscripts were included for data collection, of which 146 (30.7%) had a female first author, 94 (19.8%) had a female second author, and 61 (12.8%) had a female last authorship position. We demonstrated a trend towards greater gender equality in the AAB over time, with more women occupying first and second authorship positions. However, we observed a stagnation in female last authorship positions, with only a small increase of last female authorship of 1.16% reaching 7.41% in 2021. Further analysis showed that female last authorship affected first female authorship. As the number of authors increases, the representation of women (particularly for the last author) diminishes compared to their male colleagues. Lastly, the analysis of gender in relation to the number of coauthors showed that male authors are more likely to publish alone (as a single author) compared to their female colleagues. The AAB predominantly published case reports, observational studies, and narrative reviews, all of which had a higher number of male authors than female authors. The study also uncovered the absence of female first authors in the four systematic reviews published. Conclusion: From 2005 to 2021, the number of female first authors in the AAB has increased, and there has been a small but steady rise in female last authorship position. However, articles published in the AAB still exhibit a lower representation of female first authors. It is crucial to conduct further research and raise attention to gender disparity in anesthetic – and per extension in scientific - literature.
{"title":"Trends in female authorship in Acta Anaesthesiologica Belgica from 2005 to 2021","authors":"T. Eggermont, S. De Hert, A. Moerman","doi":"10.56126/75.1.03","DOIUrl":"https://doi.org/10.56126/75.1.03","url":null,"abstract":"Purpose: This study aims to investigate the trend of female representation in publishing in the Acta Anaesthesiologica Belgica (AAB) from 2005 to 2021. In recent years, there has been an increased focus on gender equality and disparity. However, as far as we know, an evaluation of the Belgian literature in this regard has not been undertaken before.\u0000\u0000Methods: The study’s main objective is on determining the gender of the first author, with the gender of the second and last authorship position being secondary outcomes. Additionally, the study aimed to investigate whether other variables, such as the field in which the article was published, study type, the country of origin (of the first author), the first author’s academic degree, the number of authors, and coauthors’ gender, are related to these outcomes.\u0000\u0000Results: In total 475 manuscripts were included for data collection, of which 146 (30.7%) had a female first author, 94 (19.8%) had a female second author, and 61 (12.8%) had a female last authorship position. We demonstrated a trend towards greater gender equality in the AAB over time, with more women occupying first and second authorship positions. However, we observed a stagnation in female last authorship positions, with only a small increase of last female authorship of 1.16% reaching 7.41% in 2021. Further analysis showed that female last authorship affected first female authorship. As the number of authors increases, the representation of women (particularly for the last author) diminishes compared to their male colleagues. Lastly, the analysis of gender in relation to the number of coauthors showed that male authors are more likely to publish alone (as a single author) compared to their female colleagues. The AAB predominantly published case reports, observational studies, and narrative reviews, all of which had a higher number of male authors than female authors. The study also uncovered the absence of female first authors in the four systematic reviews published.\u0000\u0000Conclusion: From 2005 to 2021, the number of female first authors in the AAB has increased, and there has been a small but steady rise in female last authorship position. However, articles published in the AAB still exhibit a lower representation of female first authors. It is crucial to conduct further research and raise attention to gender disparity in anesthetic – and per extension in scientific - literature.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140464439","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}
{"title":"Gender equality and equity in anaesthesia research: Why are we still talking about numbers?","authors":"V. Neskovic","doi":"10.56126/75.1.01","DOIUrl":"https://doi.org/10.56126/75.1.01","url":null,"abstract":"","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140467396","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: 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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}
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