Introduction: Histidine-tryptophan-ketoglutarate (HTK) cardioplegia is used to induce cardiac arrest during cardiopulmonary bypass (CPB) in cardiac surgery. HTK cardioplegia is hyponatremic (15 mmol/L) and slightly hyperosmolar (310 mOsm/kg) and can induce hyponatremia when it enters systemic circulation. The purpose of this study is to investigate the effect of HTK cardioplegia, cannulation strategy and intraoperative correction of sodium levels on postoperative sodium concentration. Secondly, the effect of the sodium concentrations on postoperative agitation is evaluated. Methods: Patients who underwent cardiac surgery using CPB and HTK cardioplegia were included in this retrospective study. Sodium concentrations of arterial blood gases (ABG) and laboratory blood samples were analyzed at multiple points in time. It was recorded if the perfusionist corrected intraoperative hyponatremia with hypertonic saline or sodium bicarbonate 8.4%. Characteristics of the patients, intraoperative data and the patient’s Richmond Agitation-Sedation Scale (RASS) score were collected. Results: The median sodium concentration on ABG [IQR] decreased from 139 mmol/L [138-140] to 125.5 mmol/L [122-130] (p < 0.001) after the administration of HTK cardioplegia. The median sodium concentration after the administration of HTK cardioplegia was significantly lower in the group with single cannulation than with double cannulation (123 mmol/L [121-125] vs. 130 mmol/L [128-133]; p<0.001). The median sodium concentration increased to 134 mmol/L [133-136] (p=0.007) at T6. There was no significant difference in postoperative sodium concentration between patients who received correction intraoperatively and those who did not, or between patients who had agitation and those who had not. Conclusions: The administration of HTK cardioplegia induced acute hyponatremia during cardiac surgery mainly in patients with single venous cannulation. Postoperatively, a normalization of sodium concentrations can be observed. No difference in postoperative sodium concentration was observed with or without intraoperative correction of sodium. Intraoperative correction of hyponatremia shows no benefit or harm on postoperative sodium concentrations. Hyponatremia could be avoided or at least diminished by using double venous cannulation.
{"title":"Postoperative sodium concentrations after cardiac surgery using histidine- tryptophan-ketoglutarate cardioplegia and cardiopulmonary bypass – a retrospective study","authors":"Y Devrieze, P Mertens, N Mintjens, V Saldien","doi":"10.56126/74.2.10","DOIUrl":"https://doi.org/10.56126/74.2.10","url":null,"abstract":"Introduction: Histidine-tryptophan-ketoglutarate (HTK) cardioplegia is used to induce cardiac arrest during cardiopulmonary bypass (CPB) in cardiac surgery. HTK cardioplegia is hyponatremic (15 mmol/L) and slightly hyperosmolar (310 mOsm/kg) and can induce hyponatremia when it enters systemic circulation. The purpose of this study is to investigate the effect of HTK cardioplegia, cannulation strategy and intraoperative correction of sodium levels on postoperative sodium concentration. Secondly, the effect of the sodium concentrations on postoperative agitation is evaluated. Methods: Patients who underwent cardiac surgery using CPB and HTK cardioplegia were included in this retrospective study. Sodium concentrations of arterial blood gases (ABG) and laboratory blood samples were analyzed at multiple points in time. It was recorded if the perfusionist corrected intraoperative hyponatremia with hypertonic saline or sodium bicarbonate 8.4%. Characteristics of the patients, intraoperative data and the patient’s Richmond Agitation-Sedation Scale (RASS) score were collected. Results: The median sodium concentration on ABG [IQR] decreased from 139 mmol/L [138-140] to 125.5 mmol/L [122-130] (p < 0.001) after the administration of HTK cardioplegia. The median sodium concentration after the administration of HTK cardioplegia was significantly lower in the group with single cannulation than with double cannulation (123 mmol/L [121-125] vs. 130 mmol/L [128-133]; p<0.001). The median sodium concentration increased to 134 mmol/L [133-136] (p=0.007) at T6. There was no significant difference in postoperative sodium concentration between patients who received correction intraoperatively and those who did not, or between patients who had agitation and those who had not. Conclusions: The administration of HTK cardioplegia induced acute hyponatremia during cardiac surgery mainly in patients with single venous cannulation. Postoperatively, a normalization of sodium concentrations can be observed. No difference in postoperative sodium concentration was observed with or without intraoperative correction of sodium. Intraoperative correction of hyponatremia shows no benefit or harm on postoperative sodium concentrations. Hyponatremia could be avoided or at least diminished by using double venous cannulation.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"22 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":"135144171","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: Previous studies have shown that frontline healthcare workers (HCWs) have higher rates of pre-existing mental health problems and may be therefore at risk for worsening of mental health problems during the COVID-19 pandemic. This includes an increased prevalence for anxiety, depression, acute stress and post- traumatic stress disorders. The aim of this study was to assess the subjective and professional burden of the HCWs working in frontline departments of our hospital. Objective: The aim was primarily to identify the psychological and professional impact of the COVID-19 pandemic on HCWs working in the frontline during the first two waves. Design and setting: This was a single-centre multidisciplinary survey. Methods: A printed survey was distributed to all HCWs (N=240) working in the intensive care unit and emergency department during the first and second COVID-19 outbreak. We evaluated the subjective and professional burden using 4-point Likert scale questions. Three-group comparisons based on years of work experience were made using Kruskal-Wallis tests. Comparisons per participant between two successive waves were made using Wilcoxon signed rank tests. Results: A total number of 171 HCWs (71.3%) participated in the survey. Participants mainly feared infecting their family and friends. A majority of the participants showed a high motivation working in the COVID- zone. More than half of the participants reported that their quality of sleep was unaffected by the pandemic. Despite a higher workload, work performance and interactions with colleagues were not negatively affected by the pandemic. No significant difference was found based on years of work experience. Participants had an overall decrease in personal impact during the second wave. However, work motivation decreased (p<0.001). Participants felt better protected by the offered equipment (p=0.004), but felt less appreciated (p=0.01). Conclusions: The pandemic appeared to have affected the subjective and professional burden of our participants. However, they were not as severely impacted as HCWs in some other studies. Acquired knowledge should be utilized in developing preventive and interventional strategies to support HCWs affected by the COVID-19 pandemic and potential pandemics in the future.
{"title":"Impact of the COVID-19 pandemic on healthcare workers in the frontline","authors":"T De Gaaij, N De Mey, A Moerman","doi":"10.56126/74.2.11","DOIUrl":"https://doi.org/10.56126/74.2.11","url":null,"abstract":"Background: Previous studies have shown that frontline healthcare workers (HCWs) have higher rates of pre-existing mental health problems and may be therefore at risk for worsening of mental health problems during the COVID-19 pandemic. This includes an increased prevalence for anxiety, depression, acute stress and post- traumatic stress disorders. The aim of this study was to assess the subjective and professional burden of the HCWs working in frontline departments of our hospital. Objective: The aim was primarily to identify the psychological and professional impact of the COVID-19 pandemic on HCWs working in the frontline during the first two waves. Design and setting: This was a single-centre multidisciplinary survey. Methods: A printed survey was distributed to all HCWs (N=240) working in the intensive care unit and emergency department during the first and second COVID-19 outbreak. We evaluated the subjective and professional burden using 4-point Likert scale questions. Three-group comparisons based on years of work experience were made using Kruskal-Wallis tests. Comparisons per participant between two successive waves were made using Wilcoxon signed rank tests. Results: A total number of 171 HCWs (71.3%) participated in the survey. Participants mainly feared infecting their family and friends. A majority of the participants showed a high motivation working in the COVID- zone. More than half of the participants reported that their quality of sleep was unaffected by the pandemic. Despite a higher workload, work performance and interactions with colleagues were not negatively affected by the pandemic. No significant difference was found based on years of work experience. Participants had an overall decrease in personal impact during the second wave. However, work motivation decreased (p<0.001). Participants felt better protected by the offered equipment (p=0.004), but felt less appreciated (p=0.01). Conclusions: The pandemic appeared to have affected the subjective and professional burden of our participants. However, they were not as severely impacted as HCWs in some other studies. Acquired knowledge should be utilized in developing preventive and interventional strategies to support HCWs affected by the COVID-19 pandemic and potential pandemics in the future.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"9 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":"135142619","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}
Objectives: In this systematic review and meta-analysis, we assessed the association between right ventricular-pulmonary arterial (RV-PA) coupling and mortality in coronavirus disease 2019 (COVID-19). Methods: We performed a systematic literature search using MEDLINE (PubMed), Embase, Cochrane and Web of Science. We only included observational studies and randomized controlled trials in which, right ventricular function and pulmonary pressures were investigated, in adult patients with COVID-19. The primary outcome was mortality. The secondary outcome was pulmonary embolism (PE). Random-effects meta-analysis was performed. Mean differences (MD) and unadjusted hazard ratios (HRs) were pooled. Results: 21 studies were included in our systematic review for qualitative analysis, and eight of them qualified for quantitative analysis. Tricuspid annular plane systolic excursion (TAPSE) over pulmonary artery systolic pressure (PASP) (TAPSE/PASP) ratio was significantly lower in non-survivors compared with survivors (mean difference = – 0.28 [–0.38, –0.17], p < 0.00001; I2: 61%, p < 0.08). TAPSE was significantly lower in non- survivors compared with survivors (mean difference = – 3.53 [–4.72, –2.33], p < 0.00001; I2: 77%, p < 0.0005). Lower TAPSE was associated with increased mortality (HR = 0.77 [0.63, 0.94], p < 0.010; I2: 77%, p = 0.01). PASP was significantly higher in non-survivors compared with survivors (mean difference = 9.14 [6.67, 11.61], p < 0.00001; I2: 37%, p=0.18). One study demonstrated a higher risk of mortality for lower TAPSE/PASP in both intensive care unit (ICU) and non-ICU patients and, one study showed that TAPSE/PASP was significantly associated with a higher risk of PE. Conclusion: COVID-19 non-survivors have a significantly worse RV-PA coupling as compared to survivors.
目的:在这项系统回顾和荟萃分析中，我们评估了2019冠状病毒病(COVID-19)患者右心室-肺动脉(RV-PA)偶联与死亡率之间的关系。方法:使用MEDLINE (PubMed)、Embase、Cochrane和Web of Science进行系统的文献检索。我们只纳入了观察性研究和随机对照试验，其中调查了COVID-19成年患者的右心室功能和肺动脉压。主要结局是死亡率。次要结局是肺栓塞(PE)。进行随机效应荟萃分析。汇总平均差异(MD)和未调整风险比(hr)。结果:我们的系统综述纳入了21项研究进行定性分析，其中8项研究符合定量分析的条件。三尖瓣环平面收缩偏移(TAPSE)比肺动脉收缩压(PASP) (TAPSE/PASP)比在非幸存者中显著低于幸存者(平均差异= - 0.28 [- 0.38，- 0.17]，p <0.00001;I2: 61%， p <0.08)。非幸存者的TAPSE明显低于幸存者(平均差异= - 3.53 [- 4.72，- 2.33]，p <0.00001;I2: 77%， p <0.0005)。较低的TAPSE与死亡率增加相关(HR = 0.77 [0.63, 0.94]， p <0.010;I2: 77%， p = 0.01)。非幸存者的PASP明显高于幸存者(平均差异= 9.14 [6.67,11.61]，p <0.00001;I2: 37%， p=0.18)。一项研究表明，在重症监护病房(ICU)和非ICU患者中，较低的TAPSE/PASP死亡率更高，一项研究表明，TAPSE/PASP与较高的PE风险显著相关。结论:与幸存者相比，COVID-19非幸存者的RV-PA耦合明显更差。
{"title":"Right ventricular-pulmonary arterial coupling in patients with COVID-19: A systematic review and meta-analysis","authors":"A Vora, L Al Tmimi, D Van Beersel, S Rex","doi":"10.56126/74.2.13","DOIUrl":"https://doi.org/10.56126/74.2.13","url":null,"abstract":"Objectives: In this systematic review and meta-analysis, we assessed the association between right ventricular-pulmonary arterial (RV-PA) coupling and mortality in coronavirus disease 2019 (COVID-19). Methods: We performed a systematic literature search using MEDLINE (PubMed), Embase, Cochrane and Web of Science. We only included observational studies and randomized controlled trials in which, right ventricular function and pulmonary pressures were investigated, in adult patients with COVID-19. The primary outcome was mortality. The secondary outcome was pulmonary embolism (PE). Random-effects meta-analysis was performed. Mean differences (MD) and unadjusted hazard ratios (HRs) were pooled. Results: 21 studies were included in our systematic review for qualitative analysis, and eight of them qualified for quantitative analysis. Tricuspid annular plane systolic excursion (TAPSE) over pulmonary artery systolic pressure (PASP) (TAPSE/PASP) ratio was significantly lower in non-survivors compared with survivors (mean difference = – 0.28 [–0.38, –0.17], p < 0.00001; I2: 61%, p < 0.08). TAPSE was significantly lower in non- survivors compared with survivors (mean difference = – 3.53 [–4.72, –2.33], p < 0.00001; I2: 77%, p < 0.0005). Lower TAPSE was associated with increased mortality (HR = 0.77 [0.63, 0.94], p < 0.010; I2: 77%, p = 0.01). PASP was significantly higher in non-survivors compared with survivors (mean difference = 9.14 [6.67, 11.61], p < 0.00001; I2: 37%, p=0.18). One study demonstrated a higher risk of mortality for lower TAPSE/PASP in both intensive care unit (ICU) and non-ICU patients and, one study showed that TAPSE/PASP was significantly associated with a higher risk of PE. Conclusion: COVID-19 non-survivors have a significantly worse RV-PA coupling as compared to survivors.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"64 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":"135142411","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: Perioperative respiratory adverse events are among the most common critical incidents in pediatric anesthesia. Three risk prediction models have been developed to predict occurrence of such adverse events in children. However, these tools were only internally validated, limiting generalization. The Perioperative Respiratory Adverse Events in Pediatric Ambulatory Anesthesia risk prediction tool developed by Subramanyam et al. consists of five predictors: age ≤ 3 years, ASA physical status II and III, morbid obesity, preexisting pulmonary disorder, and surgery. Aims and Methods: We aimed to evaluate the suitability of Subramanyam’s model in predicting the occurrence of perioperative respiratory adverse events in a more general tertiary care pediatric population, including anesthesia for both outpatient and inpatient procedures. Therefore we validated this scoring system in a tertiary care cohort of 204 children included in the APRICOT study at our hospital through retrospective analysis of this data. Secondarily, we aimed to study the incidence of perioperative respiratory adverse events in our hospital. Results: Overall incidence of perioperative respiratory adverse events in our sample was 19,6%. Applying Subramanyam’s prediction model to our cohort, we found no patients categorized as low risk, 76 patients as intermediate risk and 128 patients as high risk. Discriminatory ability of the risk scoring system was modest, with AUC of the simplified model 0,65 (95% CI 0,57-0,74) and AUC of the original logistic regression model 0,66 (95% CI 0,57-0,75). Calibration of the simplified model was rather poor, with Brier score 0,49. The original logistic regression model calibrated better, with Brier score 0,18. A subgroup analysis considering solely ambulant patients in Ghent-APRICOT yielded comparable results. Conclusions: We conclude that the overall performance of Subramanyam’s risk prediction tool in our cohort was moderate. Modest discrimination and calibration suggest that the risk score may not reliably predict perioperative respiratory adverse events in individual patients in our tertiary care pediatric population. Therefore the clinical relevance of the implementation of this scoring system in our tertiary hospital would be negligible, which leaves us with the lack of good scoring systems to predict perioperative respiratory adverse events in our population. In addition, we found the incidence of these adverse events in our hospital to be markedly higher as compared to the sample of Subramanyam.
{"title":"Evaluation of risk prediction model for perioperative respiratory adverse events in pediatric anesthesia","authors":"A D’Haene, A Bauters, B Heyse, P Wyffels","doi":"10.56126/74.2.08","DOIUrl":"https://doi.org/10.56126/74.2.08","url":null,"abstract":"Background: Perioperative respiratory adverse events are among the most common critical incidents in pediatric anesthesia. Three risk prediction models have been developed to predict occurrence of such adverse events in children. However, these tools were only internally validated, limiting generalization. The Perioperative Respiratory Adverse Events in Pediatric Ambulatory Anesthesia risk prediction tool developed by Subramanyam et al. consists of five predictors: age ≤ 3 years, ASA physical status II and III, morbid obesity, preexisting pulmonary disorder, and surgery. Aims and Methods: We aimed to evaluate the suitability of Subramanyam’s model in predicting the occurrence of perioperative respiratory adverse events in a more general tertiary care pediatric population, including anesthesia for both outpatient and inpatient procedures. Therefore we validated this scoring system in a tertiary care cohort of 204 children included in the APRICOT study at our hospital through retrospective analysis of this data. Secondarily, we aimed to study the incidence of perioperative respiratory adverse events in our hospital. Results: Overall incidence of perioperative respiratory adverse events in our sample was 19,6%. Applying Subramanyam’s prediction model to our cohort, we found no patients categorized as low risk, 76 patients as intermediate risk and 128 patients as high risk. Discriminatory ability of the risk scoring system was modest, with AUC of the simplified model 0,65 (95% CI 0,57-0,74) and AUC of the original logistic regression model 0,66 (95% CI 0,57-0,75). Calibration of the simplified model was rather poor, with Brier score 0,49. The original logistic regression model calibrated better, with Brier score 0,18. A subgroup analysis considering solely ambulant patients in Ghent-APRICOT yielded comparable results. Conclusions: We conclude that the overall performance of Subramanyam’s risk prediction tool in our cohort was moderate. Modest discrimination and calibration suggest that the risk score may not reliably predict perioperative respiratory adverse events in individual patients in our tertiary care pediatric population. Therefore the clinical relevance of the implementation of this scoring system in our tertiary hospital would be negligible, which leaves us with the lack of good scoring systems to predict perioperative respiratory adverse events in our population. In addition, we found the incidence of these adverse events in our hospital to be markedly higher as compared to the sample of Subramanyam.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"11 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":"135142620","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: Post-dural puncture headache (PDPH) is a well-known iatrogenic complication of lumbar puncture. The main modifiable risk factors of PDPH appear to be needle size and design, which have been extensively modified in an effort to lower the incidence of PDPH. Currently, there is no consensus on the ideal needle tip for lumbar puncture. Therefore, we have conducted this narrative review of literature to provide a more definite answer regarding the impact of spinal needle size and design on PDPH. Methods: Relevant literature was obtained by searching the scientific literature using PubMed, EMBASE, ISI Web of Knowledge, and Google Scholar for from 1990 to July 2022. Results: Both size and design have been extensively researched in numerous randomized controlled trials. A total of seven systematic reviews published since 2016 were reviewed: Five combined with meta-analyses of which two also with a meta-regression analysis, one combined with a network meta-analysis, and one Cochrane review. Discussion and Conclusion: The evidence presented in this review consistently shows that the atraumatic design is less likely to cause PDPH than the traumatic design. There is no simple linear correlation between smaller needle size and lower incidence of PDPH in either needle type. In lumbar puncture for spinal anesthesia we advise the 26G atraumatic spinal needle as the preferred choice, as it is the least likely to cause PDPH and the most likely to enable successful insertion. If unavailable, the 27-gauge atraumatic needle is the next best choice.
背景:硬脊膜穿刺后头痛(PDPH)是腰椎穿刺后常见的医源性并发症。PDPH的主要可改变的危险因素似乎是针头的大小和设计，这已经被广泛地修改，以降低PDPH的发病率。目前，对于腰椎穿刺的理想针尖尚无共识。因此，我们对文献进行了叙述性回顾，以提供关于脊髓针尺寸和设计对PDPH影响的更明确的答案。方法:通过PubMed、EMBASE、ISI Web of Knowledge和Google Scholar检索1990年至2022年7月的科学文献，获得相关文献。结果:在大量的随机对照试验中，对大小和设计进行了广泛的研究。共回顾了自2016年以来发表的7篇系统综述:5篇结合元分析，其中2篇还结合元回归分析，1篇结合网络元分析，1篇Cochrane综述。讨论和结论:本综述提供的证据一致表明，非创伤设计比创伤设计更不容易引起PDPH。在两种针型中，较小的针型与较低的PDPH发生率之间没有简单的线性关系。在腰椎穿刺脊髓麻醉时，我们建议首选26G无伤性脊髓针，因为它最不可能引起PDPH，并且最有可能成功插入。如果没有，27号自动针是下一个最好的选择。
{"title":"Impact of spinal needle size and design on post-dural puncture headache: A narrative review of literature","authors":"J Van der Auwera, K Paemeleire, M Coppens","doi":"10.56126/74.2.14","DOIUrl":"https://doi.org/10.56126/74.2.14","url":null,"abstract":"Background: Post-dural puncture headache (PDPH) is a well-known iatrogenic complication of lumbar puncture. The main modifiable risk factors of PDPH appear to be needle size and design, which have been extensively modified in an effort to lower the incidence of PDPH. Currently, there is no consensus on the ideal needle tip for lumbar puncture. Therefore, we have conducted this narrative review of literature to provide a more definite answer regarding the impact of spinal needle size and design on PDPH. Methods: Relevant literature was obtained by searching the scientific literature using PubMed, EMBASE, ISI Web of Knowledge, and Google Scholar for from 1990 to July 2022. Results: Both size and design have been extensively researched in numerous randomized controlled trials. A total of seven systematic reviews published since 2016 were reviewed: Five combined with meta-analyses of which two also with a meta-regression analysis, one combined with a network meta-analysis, and one Cochrane review. Discussion and Conclusion: The evidence presented in this review consistently shows that the atraumatic design is less likely to cause PDPH than the traumatic design. There is no simple linear correlation between smaller needle size and lower incidence of PDPH in either needle type. In lumbar puncture for spinal anesthesia we advise the 26G atraumatic spinal needle as the preferred choice, as it is the least likely to cause PDPH and the most likely to enable successful insertion. If unavailable, the 27-gauge atraumatic needle is the next best choice.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"8 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":"135142410","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: Postspinal hypotension is a frequent maternal complication in caesarean delivery under neuraxial anesthesia. Anesthesiologists have been using different vasopressors to maintain hemodynamics. Recent studies suggested beneficial effects of norepinephrine on maternal blood pressure and cardiac output, but little evidence exist on the neonatal outcome. Objectives: This systematic review summarises recent evidence on neonatal outcome, such as umbilical arterial pH and base excess, after administration of norepinephrine during caesarean section. Methods: A literature search on PubMed from 2010 to 2022 was performed and every article was reviewed on neonatal outcome, as primary endpoint and on maternal hemodynamics, as secondary endpoint. A total of 15 randomised controlled trials were included. Results: Studies using a prophylactic infusion of norepinephrine show normal fetal blood gases. No evidence of fetal stress (pH < 7,20, base excess < -6) was assessed in the studies. Norepinephrine succeed in maintaining maternal hemodynamics. It is responsible for less bradycardia than phenylephrine and less tachycardia than ephedrine. Conclusion: Our study suggests that norepinephrine, preferably as prophylactic infusion, is a safe vasopressor to prevent postspinal hypotension in caesarean section. No signs of fetal acidosis could be demonstrated in the recent studies.
{"title":"Hemodynamic maintenance with norepinephrine in caesarean section under spinal anesthesia and its fetal outcome: a systematic review","authors":"S De Deckere, V Saldien, H Coppejans","doi":"10.56126/74.2.12","DOIUrl":"https://doi.org/10.56126/74.2.12","url":null,"abstract":"Background: Postspinal hypotension is a frequent maternal complication in caesarean delivery under neuraxial anesthesia. Anesthesiologists have been using different vasopressors to maintain hemodynamics. Recent studies suggested beneficial effects of norepinephrine on maternal blood pressure and cardiac output, but little evidence exist on the neonatal outcome. Objectives: This systematic review summarises recent evidence on neonatal outcome, such as umbilical arterial pH and base excess, after administration of norepinephrine during caesarean section. Methods: A literature search on PubMed from 2010 to 2022 was performed and every article was reviewed on neonatal outcome, as primary endpoint and on maternal hemodynamics, as secondary endpoint. A total of 15 randomised controlled trials were included. Results: Studies using a prophylactic infusion of norepinephrine show normal fetal blood gases. No evidence of fetal stress (pH < 7,20, base excess < -6) was assessed in the studies. Norepinephrine succeed in maintaining maternal hemodynamics. It is responsible for less bradycardia than phenylephrine and less tachycardia than ephedrine. Conclusion: Our study suggests that norepinephrine, preferably as prophylactic infusion, is a safe vasopressor to prevent postspinal hypotension in caesarean section. No signs of fetal acidosis could be demonstrated in the recent studies.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"155 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":"135142407","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}
D. Verbeke, J. Jouwena, A. D. de Wolf, J. Hendrickx
{"title":"When to replace a CO2 absorber?","authors":"D. Verbeke, J. Jouwena, A. D. de Wolf, J. Hendrickx","doi":"10.56126/74.1.06","DOIUrl":"https://doi.org/10.56126/74.1.06","url":null,"abstract":"","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42120376","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. V. Van Loo, X. Iturriagagoitia, J. van Limmen, M. Vandenheuvel, S. De Hert
In critically ill patients, elevated lactate levels are often used as a marker of illness severity. There is a vast body of literature correlating lactate with an overall worse outcome, however, it is important to remember that correlation does not necessarily imply causality. Furthermore, it is not yet clear whether giving a therapeutic implication to elevated lactate levels will improve patient outcome. Moreover, more recent literature suggests possible protective qualities of the lactate molecule against further injury. In this narrative review, we address these issues by comparing the contemporary literature to the classic view of lactate as a metabolic waste product and marker of shock severity. Firstly, the metabolism of lactate will be described. Then, the causes of elevated lactate levels are reviewed and finally, the prognostic implications of elevated lactate and the evidence surrounding the use of lactate as a guide for therapeutic interventions will be discussed. The acid-base abnormalities resulting from lactate acidosis will not be reviewed in this article.
{"title":"Lactate and hyperlactatemia revisited: an overview","authors":"M. V. Van Loo, X. Iturriagagoitia, J. van Limmen, M. Vandenheuvel, S. De Hert","doi":"10.56126/74.1.07","DOIUrl":"https://doi.org/10.56126/74.1.07","url":null,"abstract":"In critically ill patients, elevated lactate levels are often used as a marker of illness severity. There is a vast body of literature correlating lactate with an overall worse outcome, however, it is important to remember that correlation does not necessarily imply causality. Furthermore, it is not yet clear whether giving a therapeutic implication to elevated lactate levels will improve patient outcome. Moreover, more recent literature suggests possible protective qualities of the lactate molecule against further injury. In this narrative review, we address these issues by comparing the contemporary literature to the classic view of lactate as a metabolic waste product and marker of shock severity. Firstly, the metabolism of lactate will be described. Then, the causes of elevated lactate levels are reviewed and finally, the prognostic implications of elevated lactate and the evidence surrounding the use of lactate as a guide for therapeutic interventions will be discussed. The acid-base abnormalities resulting from lactate acidosis will not be reviewed in this article.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44898303","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":"Intraoperative opioids: Reduce but not refuse!","authors":"S. Ordies, S. Rex","doi":"10.56126/74.1.02","DOIUrl":"https://doi.org/10.56126/74.1.02","url":null,"abstract":"","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49616721","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":"Standardized training in perioperative Point-of-Care Ultrasound (PoCUS): what are we waiting for?","authors":"M. Momeni, V. Bonhomme, P. Wouters","doi":"10.56126/74.1.01","DOIUrl":"https://doi.org/10.56126/74.1.01","url":null,"abstract":"","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42975845","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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