S. Casaer, T. Sebrechts, P. Van Houwe, W. Rattenberry
During the COVID-19 pandemic, multiple guidelines have been issued on hospital safety and protection measures to prevent transmission to healthcare workers and to other patients. The operating room is a high-risk environment where enhanced precautions are required. The guidelines differ and practical implementation between hospitals can also vary, according to interpretation and budget. Staff at risk may question if the local policies are sufficient and correct. This article provides an overview and theoretical background to the additional safety measures required in the operating room during a viral pandemic like the COVID-19 pandemic. This may serve as a touchstone and tool for anesthetists and OR managers.
{"title":"Organizing a safe operating room during a pandemic. What did we learn from COVID-19?","authors":"S. Casaer, T. Sebrechts, P. Van Houwe, W. Rattenberry","doi":"10.56126/71.3.3","DOIUrl":"https://doi.org/10.56126/71.3.3","url":null,"abstract":"During the COVID-19 pandemic, multiple guidelines have been issued on hospital safety and protection measures to prevent transmission to healthcare workers and to other patients. The operating room is a high-risk environment where enhanced precautions are required. The guidelines differ and practical implementation between hospitals can also vary, according to interpretation and budget. Staff at risk may question if the local policies are sufficient and correct. This article provides an overview and theoretical background to the additional safety measures required in the operating room during a viral pandemic like the COVID-19 pandemic. This may serve as a touchstone and tool for anesthetists and OR managers.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42488915","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":"A dedication to neuroanesthesia, research, and mentorship","authors":"V. Bonhomme, C. Franssen, M. Lamy","doi":"10.56126/71.3.1","DOIUrl":"https://doi.org/10.56126/71.3.1","url":null,"abstract":"","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49489861","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}
M. Desmet, S. Bindelle, M. Breebaart, H. Camerlynck, S. Casaer, K. Fourneau, P. Gautier, P. Goffin, J. Lecoq, I. Lenders, I. Leunen, D. Van Aken, P. Van Houwe, S. Van Hooreweghe, K. Vermeylen, I. Sermeus
The Peripheral Nerve Block working group of the Belgian Association for Regional Anesthesia has revised and updated the “Clinical guidelines for the practice of peripheral nerve block in the adult” which were published in 2013.
比利时区域麻醉协会的周围神经阻滞工作组修订并更新了2013年发布的“成人周围神经阻滞临床指南”。
{"title":"Guidelines for the safe clinical practice of peripheral nerve blocks in the adult patient","authors":"M. Desmet, S. Bindelle, M. Breebaart, H. Camerlynck, S. Casaer, K. Fourneau, P. Gautier, P. Goffin, J. Lecoq, I. Lenders, I. Leunen, D. Van Aken, P. Van Houwe, S. Van Hooreweghe, K. Vermeylen, I. Sermeus","doi":"10.56126/71.3.9","DOIUrl":"https://doi.org/10.56126/71.3.9","url":null,"abstract":"The Peripheral Nerve Block working group of the Belgian Association for Regional Anesthesia has revised and updated the “Clinical guidelines for the practice of peripheral nerve block in the adult” which were published in 2013.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41578810","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}
Pub Date : 2020-07-30DOI: 10.21203/rs.3.rs-50910/v1
Twan Aalbers, S. Heuvel, E. Bronkhorst, A. V. Esch, G. Scheffer, M. Vaneker
Background: Procedural sedation and analgesia (PSA) is used during colonoscopy to facilitate the procedure and relieve patient’s discomfort. The foremost risk of PSA is respiratory depression. Lidocaine could be a promising additional analgesic in IBD patients to minimise side effects of PSA.Our primary objective was to investigate whether i.v. lidocaine reduces the amount of alfentanil used during PSA in IBD patients. Additionally, we investigated whether lidocaine reduces cardiorespiratory incidents and the amount of propofol required during the procedure.Methods: A randomised, double-blind, placebo controlled study was performed at the endoscopy unit of the Radboud University Medical Centre from November 2016 to December 2018. Seventy-six patients with IBD, ASA 1 or 2, between 18 and 65 years, scheduled for colonoscopy with PSA were included. Patients received lidocaine 1.5 mg kg-1 followed by a continuous infusion of 2 mg kg-1 h-1 (intervention group, n=38) or 0.9% saline in equivalent volumes (control group, n=38) during colonoscopy.Results: There was a reduction in the use of alfentanil (327µg (95%CI=-31-505, p=0.082)), and propofol (39 mg (95%CI=-5-83, p=0.083)) in the lidocaine group compared with the control group. Ten patients (26%) in the control group and 8 patients in the lidocaine group (21%) experienced a period of hypoxia (p=0.788). In both groups, no periods of hypotension were noted.Conclusion: Our investigation has shown a reduction in the use of propofol and alfentanil in patients undergoing colonoscopy with PSA. The differences were not statistically significant. Lidocaine did not reduces the incidence of cardiorespiratory events.Trial registration:EudraCT, 2016-002210-46, registered 19 may 2016,https://www.clinicaltrialsregister.eu/ctr-search/trial/2016-002210-46/resultsISRCTN, ISRCTN47787339, retrospectively registered 6 February 2019, http://www.isrctn.com/ISRCTN47787339
{"title":"Effects of Intravenous Lidocaine on Alfentanil Consumption During Procedural Sedation for Colonoscopy in Patients With Inflammatory Bowel Disease: a Randomized Controlled Trial","authors":"Twan Aalbers, S. Heuvel, E. Bronkhorst, A. V. Esch, G. Scheffer, M. Vaneker","doi":"10.21203/rs.3.rs-50910/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-50910/v1","url":null,"abstract":"\u0000 Background: Procedural sedation and analgesia (PSA) is used during colonoscopy to facilitate the procedure and relieve patient’s discomfort. The foremost risk of PSA is respiratory depression. Lidocaine could be a promising additional analgesic in IBD patients to minimise side effects of PSA.Our primary objective was to investigate whether i.v. lidocaine reduces the amount of alfentanil used during PSA in IBD patients. Additionally, we investigated whether lidocaine reduces cardiorespiratory incidents and the amount of propofol required during the procedure.Methods: A randomised, double-blind, placebo controlled study was performed at the endoscopy unit of the Radboud University Medical Centre from November 2016 to December 2018. Seventy-six patients with IBD, ASA 1 or 2, between 18 and 65 years, scheduled for colonoscopy with PSA were included. Patients received lidocaine 1.5 mg kg-1 followed by a continuous infusion of 2 mg kg-1 h-1 (intervention group, n=38) or 0.9% saline in equivalent volumes (control group, n=38) during colonoscopy.Results: There was a reduction in the use of alfentanil (327µg (95%CI=-31-505, p=0.082)), and propofol (39 mg (95%CI=-5-83, p=0.083)) in the lidocaine group compared with the control group. Ten patients (26%) in the control group and 8 patients in the lidocaine group (21%) experienced a period of hypoxia (p=0.788). In both groups, no periods of hypotension were noted.Conclusion: Our investigation has shown a reduction in the use of propofol and alfentanil in patients undergoing colonoscopy with PSA. The differences were not statistically significant. Lidocaine did not reduces the incidence of cardiorespiratory events.Trial registration:EudraCT, 2016-002210-46, registered 19 may 2016,https://www.clinicaltrialsregister.eu/ctr-search/trial/2016-002210-46/resultsISRCTN, ISRCTN47787339, retrospectively registered 6 February 2019, http://www.isrctn.com/ISRCTN47787339","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44423243","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}
Transanal total mesorectal excision (TaTME), a new approach for rectal cancers, requires transanal carbon dioxide (CO2) high-flow insufflation to create a workplace. Two patients scheduled for TaTME experienced CO2 embolism during the anterior mesorectal dissection in contact with the prostate. CO2 embolism resulted in a sudden drop of end-tidal CO2, preceded by a short increase in one patient, and in oxygen desaturation. Hemodynamic alterations were minor. We report these two cases and discuss the pathophysiology of CO2 embolism and risk factors that promote CO2 embolism during TaTME to warn anesthetists of this serious complication, often unexpected and misdiagnosed.
{"title":"Carbon dioxide embolism during transanal total mesorectal excision (TaTME): two case reports","authors":"O. Lempereur, E. Decker, J. Joris","doi":"10.56126/71.2.8","DOIUrl":"https://doi.org/10.56126/71.2.8","url":null,"abstract":"Transanal total mesorectal excision (TaTME), a new approach for rectal cancers, requires transanal carbon dioxide (CO2) high-flow insufflation to create a workplace. Two patients scheduled for TaTME experienced CO2 embolism during the anterior mesorectal dissection in contact with the prostate. CO2 embolism resulted in a sudden drop of end-tidal CO2, preceded by a short increase in one patient, and in oxygen desaturation. Hemodynamic alterations were minor. We report these two cases and discuss the pathophysiology of CO2 embolism and risk factors that promote CO2 embolism during TaTME to warn anesthetists of this serious complication, often unexpected and misdiagnosed.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42164406","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}
M. Kapoor, T. Salwan, S. Garg, Anisha Puri, V. Gupta
Background: Inappropriate endotracheal tube placement depth may be associated with complications. Objective: To determine whether the accurate alignment of the indicator ring on the endotracheal tube at the level of the vocal cords, results in its appropriate placement. Design: Prospective observational study. Patients: 98 adult patients scheduled for general anesthesia with orotracheal intubation. Interventions: The indicator band mark on the endotracheal tube was accurately placed at the vocal cords level under video-laryngoscope view. The tube length at the right upper incisor and the distance between its tip and the carina was measured using fibreoptic bronchoscope. Data to validate methods to predict insertion depth was collected and evaluated. Main Outcome: To determine the distance between the tip of the endotracheal tube and the carina. Results: The endotracheal tube tip depth was inap- propriate in 46.94% cases and was <3 cm above the carina in 41.64% cases. This difference in this distance was similar (p = 0.246) in the two genders. A correlation was noted between topographic length and insertion depth in females only (r2 = 0.201 and p = 0.001). The mean tracheal length was 12.66 + 1.35 cm in males and 12.04 + 1.26 cm in females. Conclusion: We found a high incidence of endo- tracheal tube tip malposition despite the accurate placement of the indicator band at the vocal cords level. We suggest that international endotracheal tube design standards be defined and endotracheal tube manufacturers modify the standard intratracheal length.
{"title":"An observational study to determine whether alignment of endotracheal tube indicator line with the vocal cords results in appropriate depth of intubation","authors":"M. Kapoor, T. Salwan, S. Garg, Anisha Puri, V. Gupta","doi":"10.56126/71.2.5","DOIUrl":"https://doi.org/10.56126/71.2.5","url":null,"abstract":"Background: Inappropriate endotracheal tube placement depth may be associated with complications.\u0000\u0000Objective: To determine whether the accurate alignment of the indicator ring on the endotracheal tube at the level of the vocal cords, results in its appropriate placement.\u0000\u0000Design: Prospective observational study.\u0000\u0000Patients: 98 adult patients scheduled for general anesthesia with orotracheal intubation.\u0000\u0000Interventions: The indicator band mark on the endotracheal tube was accurately placed at the vocal cords level under video-laryngoscope view. The tube length at the right upper incisor and the distance between its tip and the carina was measured using fibreoptic bronchoscope. Data to validate methods to predict insertion depth was collected and evaluated.\u0000\u0000Main Outcome: To determine the distance between the tip of the endotracheal tube and the carina.\u0000\u0000Results: The endotracheal tube tip depth was inap- propriate in 46.94% cases and was <3 cm above the carina in 41.64% cases. This difference in this distance was similar (p = 0.246) in the two genders. A correlation was noted between topographic length and insertion depth in females only (r2 = 0.201 and p = 0.001). The mean tracheal length was 12.66 + 1.35 cm in males and 12.04 + 1.26 cm in females.\u0000\u0000Conclusion: We found a high incidence of endo- tracheal tube tip malposition despite the accurate placement of the indicator band at the vocal cords level. We suggest that international endotracheal tube design standards be defined and endotracheal tube manufacturers modify the standard intratracheal length.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43252761","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}
R. Foubert, S. Devroe, L. Foubert, M. Van de Velde, S. Rex
Background: Exposure to general anesthesia (GA) in early life is known to be neurotoxic to animals. Objectives: To evaluate the risk of GA inducing long-term neurodevelopmental deficits in human children. Design: Systematic review. Methods: We included observational and randomized studies that compared the long-term neurodevelopment of postnatal children exposed to GA to the long-term neurodevelopment of children not exposed to GA. We searched MEDLINE, Embase and Web of Science for relevant studies published in the year 2000 or later. We screened all the identified studies on predetermined inclusion and exclusion criteria. A risk of bias assessment was made for each included study. We identified 9 neurodevelopmental domains for which a sub-analysis was made: intelligence; memory; learning; language/speech; motor function; visuospatial skills; development/emotions/behavior; ADHD/attention; autistic disorder. Results: We included 26 studies involving 605.391 participants. Based on AHRQ-standards 11 studies were of poor quality, 7 studies were of fair quality and 8 studies were of good quality. The major causes of potential bias were selection and comparability bias. On 2 neurodevelopmental domains (visuospatial skills and autistic disorder), the available evidence showed no association with exposure to GA. On 7 other neurodevelopmental domains, the available evidence showed mixed results. The 4 studies that used a randomized or sibling-controlled design showed no association between GA and neurodevelopmental deficits in their primary endpoints. Limitations: The absence of a meta-analysis and funnel plot. Conclusions: Based on observational studies, we found an association between GA in childhood and neuro-developmental deficits in later life. Randomized and sibling-matched observational studies failed to show the same association and therefore no evidence of a causal relationship exists at present. Since GA seems to be a marker, but not a cause of worse neurodevelopment, we argue against delaying or avoiding interventional or diagnostic procedures requiring GA in childhood based on the argument of GA-induced neurotoxicity.
背景：众所周知，早期全身麻醉对动物具有神经毒性。目的：评估GA诱导人类儿童长期神经发育缺陷的风险。设计：系统审查。方法：我们纳入了观察性和随机研究，比较了暴露于GA的出生后儿童的长期神经发育与未暴露于GA儿童的长期神经元发育。我们在MEDLINE、Embase和Web of Science上搜索了2000年或更晚发表的相关研究。我们根据预先确定的纳入和排除标准筛选了所有已确定的研究。对每项纳入的研究进行偏倚风险评估。我们确定了9个神经发育领域，并对其进行了子分析：智力；记忆力学习语言/言语；运动功能；视觉空间技能；发展/情绪/行为；ADHD/注意力；自闭症。结果：我们纳入了26项研究，涉及605.391名参与者。根据AHRQ标准，11项研究质量较差，7项研究质量尚可，8项研究质量良好。潜在偏差的主要原因是选择和可比性偏差。在2个神经发育领域（视觉空间技能和自闭症），现有证据显示与GA暴露无关。在其他7个神经发育方面，现有证据表明结果喜忧参半。使用随机或兄弟姐妹对照设计的4项研究显示，GA与主要终点的神经发育缺陷之间没有关联。局限性：缺乏荟萃分析和漏斗图。结论：基于观察性研究，我们发现儿童期GA与晚年神经发育缺陷之间存在关联。随机和兄弟姐妹匹配的观察性研究未能显示出相同的关联，因此目前没有证据表明存在因果关系。由于GA似乎是一种标志物，但不是神经发育恶化的原因，我们反对基于GA诱导的神经毒性的论点，推迟或避免儿童期需要GA的介入或诊断程序。
{"title":"Anesthetic neurotoxicity in the pediatric population: a systematic review of the clinical evidence","authors":"R. Foubert, S. Devroe, L. Foubert, M. Van de Velde, S. Rex","doi":"10.56126/71.2.2","DOIUrl":"https://doi.org/10.56126/71.2.2","url":null,"abstract":"Background: Exposure to general anesthesia (GA) in early life is known to be neurotoxic to animals.\u0000\u0000Objectives: To evaluate the risk of GA inducing long-term neurodevelopmental deficits in human children.\u0000\u0000Design: Systematic review.\u0000\u0000Methods: We included observational and randomized studies that compared the long-term neurodevelopment of postnatal children exposed to GA to the long-term neurodevelopment of children not exposed to GA. We searched MEDLINE, Embase and Web of Science for relevant studies published in the year 2000 or later. We screened all the identified studies on predetermined inclusion and exclusion criteria. A risk of bias assessment was made for each included study. We identified 9 neurodevelopmental domains for which a sub-analysis was made: intelligence; memory; learning; language/speech; motor function; visuospatial skills; development/emotions/behavior; ADHD/attention; autistic disorder.\u0000\u0000Results: We included 26 studies involving 605.391 participants. Based on AHRQ-standards 11 studies were of poor quality, 7 studies were of fair quality and 8 studies were of good quality. The major causes of potential bias were selection and comparability bias. On 2 neurodevelopmental domains (visuospatial skills and autistic disorder), the available evidence showed no association with exposure to GA. On 7 other neurodevelopmental domains, the available evidence showed mixed results. The 4 studies that used a randomized or sibling-controlled design showed no association between GA and neurodevelopmental deficits in their primary endpoints.\u0000\u0000Limitations: The absence of a meta-analysis and funnel plot.\u0000\u0000Conclusions: Based on observational studies, we found an association between GA in childhood and neuro-developmental deficits in later life. Randomized and sibling-matched observational studies failed to show the same association and therefore no evidence of a causal relationship exists at present. Since GA seems to be a marker, but not a cause of worse neurodevelopment, we argue against delaying or avoiding interventional or diagnostic procedures requiring GA in childhood based on the argument of GA-induced neurotoxicity.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49085286","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: Patient controlled epidural analgesia has been associated with marked maternal satisfaction. Combination of local anesthetics with various adjuvants have been tried to ensure optimum analgesia with no or negligible fetomaternal side effects. Aim: To compare fentanyl, clonidine or dexmedetomidine as adjuvants with ropivacaine for labor epidural analgesia (LEA) using a PCEA pump with the objective to assess fetomaternal outcome in terms of analgesic effect, success rate of vaginal delivery, complications, neonatal APGAR score and maternal satisfaction. Materials and methods: Sixty full term laboring women received 10 ml 0.2% ropivacaine followed by continuous infusion of 0.1% ropivacaine with 2 μg/ml of either dexmedetomidine, fentanyl or clonidine respectively in Groups A, B, and C at 6 ml/hr. demand bolus setting was 2 ml with a lock out interval of 15 minutes. At full cervical dilatation another 10 ml bolus of respective solution were given. Parturients were monitored at 0, 10, 20, 30 min after giving 1st epidural bolus dose and then at 30 min interval for ongoing labor for pain relief (VAS), motor blockade (Bromage score), progress of labor (duration of 1st stage and 2nd stage), mode of delivery, fetal APGAR score (at 1 min and 5 min), vitals (HR, NIBP, RR, SpO2), overall patient satisfaction and complications. The statistical analysis was done both qualitatively (Fisher-exact test/Chi-square test) and quantitatively (one-way analysis of variance test with post-hoc intergroup comparisons using Bonferroni’s correction). Results: Onset of pain relief was earlier in fentanyl group, however after 1 h all three groups showed comparable pain relief (P>0.05). There was a significant reduction in HR in group C and B compared to group A (P<0.001) and MAP in group C compared to groups A and B. The motor- blocking potency was slightly higher in dexmedetomidine group, however no significant motor weakness observed in any parturient. Mean demand bolus need was more in group C compared to A and B (P<0.001). There was no significant difference in mode of delivery (either SVD or cesarean) in between the groups. There was not a single case of fetal distress and most of the parturients showed satisfactory response to PCEA. Conclusion: All three study drugs produced equipotent analgesia in combination with ropivacaine 0.1%. There was absolute pain relief without significant motor blockade or any increase in instrumentation/cesarean deliveries or any adverse fetal outcomes.
{"title":"A comparison of fetomaternal outcome in PCEA using fentanyl, clonidine and dexmedetomidine as adjuvants with Ropivacaine in painless labor: a prospective, double blinded randomized study","authors":"A. Kumar, Reena","doi":"10.56126/71.2.4","DOIUrl":"https://doi.org/10.56126/71.2.4","url":null,"abstract":"Background: Patient controlled epidural analgesia has been associated with marked maternal satisfaction. Combination of local anesthetics with various adjuvants have been tried to ensure optimum analgesia with no or negligible fetomaternal side effects.\u0000\u0000Aim: To compare fentanyl, clonidine or dexmedetomidine as adjuvants with ropivacaine for labor epidural analgesia (LEA) using a PCEA pump with the objective to assess fetomaternal outcome in terms of analgesic effect, success rate of vaginal delivery, complications, neonatal APGAR score and maternal satisfaction.\u0000\u0000Materials and methods: Sixty full term laboring women received 10 ml 0.2% ropivacaine followed by continuous infusion of 0.1% ropivacaine with 2 μg/ml of either dexmedetomidine, fentanyl or clonidine respectively in Groups A, B, and C at 6 ml/hr. demand bolus setting was 2 ml with a lock out interval of 15 minutes. At full cervical dilatation another 10 ml bolus of respective solution were given. Parturients were monitored at 0, 10, 20, 30 min after giving 1st epidural bolus dose and then at 30 min interval for ongoing labor for pain relief (VAS), motor blockade (Bromage score), progress of labor (duration of 1st stage and 2nd stage), mode of delivery, fetal APGAR score (at 1 min and 5 min), vitals (HR, NIBP, RR, SpO2), overall patient satisfaction and complications. The statistical analysis was done both qualitatively (Fisher-exact test/Chi-square test) and quantitatively (one-way analysis of variance test with post-hoc intergroup comparisons using Bonferroni’s correction).\u0000\u0000Results: Onset of pain relief was earlier in fentanyl group, however after 1 h all three groups showed comparable pain relief (P>0.05). There was a significant reduction in HR in group C and B compared to group A (P<0.001) and MAP in group C compared to groups A and B. The motor- blocking potency was slightly higher in dexmedetomidine group, however no significant motor weakness observed in any parturient. Mean demand bolus need was more in group C compared to A and B (P<0.001). There was no significant difference in mode of delivery (either SVD or cesarean) in between the groups. There was not a single case of fetal distress and most of the parturients showed satisfactory response to PCEA.\u0000\u0000Conclusion: All three study drugs produced equipotent analgesia in combination with ropivacaine 0.1%. There was absolute pain relief without significant motor blockade or any increase in instrumentation/cesarean deliveries or any adverse fetal outcomes.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49027032","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}
Knotting is a well-known but rare complication of the use of epidural catheters. We report the case of a knotted catheter successfully removed by simple traction, after determining its ultimate tensile strength. We reviewed the case reports published since 1979. We assessed the prevalence of this complication, the impact of placement technique on a knot’s occurrence, the value of the different imaging modalities, and the one of various techniques used for catheter removal. A knotted catheter can often be removed intact with steady and gentle traction. Before pulling on an entrapped catheter and to avoid breakage, it may be useful to assess its ultimate tensile strength on its free extremity or another identical catheter. Limiting the length of a catheter threaded in the epidural space during its insertion seems to be the best way to avoid knots.
{"title":"Knotted epidural catheter: the role of determining a catheter’s ultimate tensile strength before pulling on it. A case report and literature review","authors":"A. Orfi, P. Dewandre, J. Brichant","doi":"10.56126/71.2.7","DOIUrl":"https://doi.org/10.56126/71.2.7","url":null,"abstract":"Knotting is a well-known but rare complication of the use of epidural catheters. We report the case of a knotted catheter successfully removed by simple traction, after determining its ultimate tensile strength. We reviewed the case reports published since 1979. We assessed the prevalence of this complication, the impact of placement technique on a knot’s occurrence, the value of the different imaging modalities, and the one of various techniques used for catheter removal. A knotted catheter can often be removed intact with steady and gentle traction. Before pulling on an entrapped catheter and to avoid breakage, it may be useful to assess its ultimate tensile strength on its free extremity or another identical catheter. Limiting the length of a catheter threaded in the epidural space during its insertion seems to be the best way to avoid knots.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47620169","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}
A direct laryngoscopy is currently the standard method for diagnosing RLN (Recurrent Laryngeal Nerve) paralysis after thyroid or parathyroid surgery but this procedure can be uncomfortable for patients and may cause undesirable changes in vital signs. A 40 years old female after a total thyroidectomy was assumed to have a bilateral vocal cord palsy on direct laryngoscopy after surgery. Patient was shifted to intensive care unit (ICU) on ventilatory support. We used serial transcutaneous laryngeal ultrasonography in the ICU for assessing the vocal cord functions along with conservative management. After 3 days, we were able to safely extubate the trachea and tracheostomy was avoided.
{"title":"Serial transcutaneous laryngeal ultrasonography in intensive care unit for assessment of vocal cord palsy: a case report","authors":"N. Kumar, A. Kumar","doi":"10.56126/71.2.6","DOIUrl":"https://doi.org/10.56126/71.2.6","url":null,"abstract":"A direct laryngoscopy is currently the standard method for diagnosing RLN (Recurrent Laryngeal Nerve) paralysis after thyroid or parathyroid surgery but this procedure can be uncomfortable for patients and may cause undesirable changes in vital signs. A 40 years old female after a total thyroidectomy was assumed to have a bilateral vocal cord palsy on direct laryngoscopy after surgery. Patient was shifted to intensive care unit (ICU) on ventilatory support. We used serial transcutaneous laryngeal ultrasonography in the ICU for assessing the vocal cord functions along with conservative management. After 3 days, we were able to safely extubate the trachea and tracheostomy was avoided.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44729167","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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