Background: Brachial plexopathy is a rare but debilitating injury associated with cardiac surgery. The reported incidence varies widely. Several risk factors have been described, including both patient and surgical factors. Objectives: The aim of this study is to (1) investigate the incidence of brachial plexus injury in cardiac surgery in a three-year period in our hospital, (2) give an overview of risk factors and possible mechanisms of brachial plexopathy, and (3) consider the legal ramifications of these injuries. Design and setting: single centre retrospective study Methods: Data were collected retrospectively from all patients undergoing cardiac surgery in a major hospital in a three-year year period (N = 1305). Hospital records were screened for patients who underwent an electromyography after their surgery. Those cases were further investigated for brachial plexus injury. Patient characteristics and data applying to known risk factors for peroperative nerve injury were obtained. Results: Brachial plexus injury was observed in 7 out of 1305 patients (0.54%). All patients with brachial plexus injury underwent coronary artery bypass surgery with internal mammary artery harvesting at the side of the injury. No further analysis concerning risk factors was performed since only seven cases were identified and underreporting was suspected. Conclusion: Our data suggest that brachial plexus injury in cardiac surgery might be associated with asymmetrical sternal retraction during internal mammary artery harvesting. These findings correspond with previous reports, although it would be interesting to further investigate the importance of the exact placement and type of retractor used.
{"title":"Incidence of brachial plexus injury after cardiac surgery: a retrospective study","authors":"J Heirbaut, H Gutermann, T Fret","doi":"10.56126/74.3.16","DOIUrl":"https://doi.org/10.56126/74.3.16","url":null,"abstract":"Background: Brachial plexopathy is a rare but debilitating injury associated with cardiac surgery. The reported incidence varies widely. Several risk factors have been described, including both patient and surgical factors. Objectives: The aim of this study is to (1) investigate the incidence of brachial plexus injury in cardiac surgery in a three-year period in our hospital, (2) give an overview of risk factors and possible mechanisms of brachial plexopathy, and (3) consider the legal ramifications of these injuries. Design and setting: single centre retrospective study Methods: Data were collected retrospectively from all patients undergoing cardiac surgery in a major hospital in a three-year year period (N = 1305). Hospital records were screened for patients who underwent an electromyography after their surgery. Those cases were further investigated for brachial plexus injury. Patient characteristics and data applying to known risk factors for peroperative nerve injury were obtained. Results: Brachial plexus injury was observed in 7 out of 1305 patients (0.54%). All patients with brachial plexus injury underwent coronary artery bypass surgery with internal mammary artery harvesting at the side of the injury. No further analysis concerning risk factors was performed since only seven cases were identified and underreporting was suspected. Conclusion: Our data suggest that brachial plexus injury in cardiac surgery might be associated with asymmetrical sternal retraction during internal mammary artery harvesting. These findings correspond with previous reports, although it would be interesting to further investigate the importance of the exact placement and type of retractor used.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":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":"136265706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Minimally invasive cardiac surgery via mini-thoracotomy reduces surgical trauma compared to full sternotomy. However, thoracotomy can cause severe postoperative pain. Managing postoperative pain is challenging but critical for fast rehabilitation and avoidance of chronic pain. Our objective was to compare the efficacy of analgesia of a bolus in combination with continuous local anaesthetics using a serratus anterior plane block (SAPB) catheter versus a wound infiltration catheter (CWI) in patients after minimally invasive cardiac surgery. Design and setting: We conducted a monocentric, prospective, randomized controlled trial between January 2021 and August 2022. The study was performed at Ghent University Hospital, Belgium. Methods: Patients scheduled for minimally invasive cardiac surgery via thoracoscopy and mini-thoracotomy were randomized to receive either a SABP or a CWI catheter. Postoperatively, continuous ropivacaine 0.2% was started at 10ml/h, and a supplementary bolus of 30ml ropivacaine 0.5% was administered one hour before detubation. The catheter remained in place for at least 24 hours. The primary endpoint was opioid consumption during the first 48 hours postdetubation. Secondary endpoints were anti-emetic consumption, Numerical Analogue Score for 48 hours, length of stay in the Intensive Care Unit and hospital, and incidence of chronic pain. Qualitative data were compared using the Chi – Square test, quantitative data were analyzed with the Student’s t-test. Results: During the study period, a total of 21 patients received a SAPB catheter and 26 patients received a CWI catheter. No statistical significant differences were seen in baseline characteristics. In the first 48 hours postdetubation, morphine equivalent consumption was similar in both groups (p= 0.52), with no differences observed in the early, mid- or late postoperative phases. The total morphine equivalent dose was 21.8 mg in the SAPB and 18.6 mg in the CWI group. There were no significant differences in postoperative vomiting and nausea, length of stay in the Intensive Care Unit and in the hospital and chronic thoracic pain (23% and 33% for the SAPB and CWI group, respectively, p=0.54). Conclusion: This prospective study found no significant difference in postoperative opioid consumption between patients who received a serratus anterior plane block catheter and those who received a wound catheter with bolus and continuous ropivacaine, following minimally invasive cardiac surgery via right thoracoscopy and mini-thoracotomy.
{"title":"Catheter-based serratus anterior plane block vs. continuous wound infiltration for postoperative pain control following minimally invasive atrioventricular valve surgery : a randomized, prospective trial","authors":"B Vanden Bussche, M Vandenheuvel, A Moerman","doi":"10.56126/74.3.17","DOIUrl":"https://doi.org/10.56126/74.3.17","url":null,"abstract":"Background: Minimally invasive cardiac surgery via mini-thoracotomy reduces surgical trauma compared to full sternotomy. However, thoracotomy can cause severe postoperative pain. Managing postoperative pain is challenging but critical for fast rehabilitation and avoidance of chronic pain. Our objective was to compare the efficacy of analgesia of a bolus in combination with continuous local anaesthetics using a serratus anterior plane block (SAPB) catheter versus a wound infiltration catheter (CWI) in patients after minimally invasive cardiac surgery. Design and setting: We conducted a monocentric, prospective, randomized controlled trial between January 2021 and August 2022. The study was performed at Ghent University Hospital, Belgium. Methods: Patients scheduled for minimally invasive cardiac surgery via thoracoscopy and mini-thoracotomy were randomized to receive either a SABP or a CWI catheter. Postoperatively, continuous ropivacaine 0.2% was started at 10ml/h, and a supplementary bolus of 30ml ropivacaine 0.5% was administered one hour before detubation. The catheter remained in place for at least 24 hours. The primary endpoint was opioid consumption during the first 48 hours postdetubation. Secondary endpoints were anti-emetic consumption, Numerical Analogue Score for 48 hours, length of stay in the Intensive Care Unit and hospital, and incidence of chronic pain. Qualitative data were compared using the Chi – Square test, quantitative data were analyzed with the Student’s t-test. Results: During the study period, a total of 21 patients received a SAPB catheter and 26 patients received a CWI catheter. No statistical significant differences were seen in baseline characteristics. In the first 48 hours postdetubation, morphine equivalent consumption was similar in both groups (p= 0.52), with no differences observed in the early, mid- or late postoperative phases. The total morphine equivalent dose was 21.8 mg in the SAPB and 18.6 mg in the CWI group. There were no significant differences in postoperative vomiting and nausea, length of stay in the Intensive Care Unit and in the hospital and chronic thoracic pain (23% and 33% for the SAPB and CWI group, respectively, p=0.54). Conclusion: This prospective study found no significant difference in postoperative opioid consumption between patients who received a serratus anterior plane block catheter and those who received a wound catheter with bolus and continuous ropivacaine, following minimally invasive cardiac surgery via right thoracoscopy and mini-thoracotomy.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":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":"136265712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caesarean section is the most performed surgical intervention worldwide. A proportion of these caesarean deliveries will necessitate emergency care for maternal and fetal compromise. Anaes-thetic management in these situations can be challenging and a short decision to delivery interval is burning. Current evidence suggests that multidisciplinary communication is essential to support anaesthetic management and optimise team performance. Communication should be supported by using a standardised classification of urgency tool. The four-grade classification scale has increasingly been adopted internationally. While neuraxial techniques are favoured for caesarean sections, gen-eral anaesthesia has an essential role in category 1 caesarean section (defined as a caesarean section in which there is an immediate threat to life for the mother or fetus). The risks and benefits of general and neuraxial anaesthesia for the woman and her baby must be carefully weighed on an individual base. Beyond the delivery of anaesthesia, other practical strategies, such as multidiscipli-nary team training, can contribute to improved maternal and neonatal outcomes.
{"title":"Anaesthaesia for Category-1 urgency Ceasarean section","authors":"S Devroe, M Dhankhar, N Lucas","doi":"10.56126/74.3.20","DOIUrl":"https://doi.org/10.56126/74.3.20","url":null,"abstract":"Caesarean section is the most performed surgical intervention worldwide. A proportion of these caesarean deliveries will necessitate emergency care for maternal and fetal compromise. Anaes-thetic management in these situations can be challenging and a short decision to delivery interval is burning. Current evidence suggests that multidisciplinary communication is essential to support anaesthetic management and optimise team performance. Communication should be supported by using a standardised classification of urgency tool. The four-grade classification scale has increasingly been adopted internationally. While neuraxial techniques are favoured for caesarean sections, gen-eral anaesthesia has an essential role in category 1 caesarean section (defined as a caesarean section in which there is an immediate threat to life for the mother or fetus). The risks and benefits of general and neuraxial anaesthesia for the woman and her baby must be carefully weighed on an individual base. Beyond the delivery of anaesthesia, other practical strategies, such as multidiscipli-nary team training, can contribute to improved maternal and neonatal outcomes.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Artificial intelligence (AI) is rapidly evolving and gaining attention in the medical world. Our aim is to provide readers with insights into this quickly changing medical landscape and the role of clinicians in the middle of this popular technology. In this review, our aim is to explain some of the increasingly frequently used AI terminology explicitly for physicians. Next, we give a summation, an overview of currently existing applications, future possibilities for AI in the medical field of anesthesiology and thoroughly highlight possible problems that could arise from implementing this technology in daily practice. Therefore, we conducted a literature search, including all types of articles published between the first of January 2010 and the 1st of May 2023, written in English, and having a free full text available. We searched Pubmed, Medline, and Embase using “artificial intelligence”, “machine learning”, “deep learning”, “neural networks” and “anesthesiology” as MESH terms. To structure these findings, we divided the results into five categories: preoperatively, perioperatively, postoperatively, AI in the intensive care unit and finally, AI used for teaching purposes. In the first category, we found AI applications for airway assessment, risk prediction, and logistic support. Secondly, we made a summation of AI applications used during the operation. AI can predict hypotensive events, delivering automated anesthesia, reducing false alarms, and aiding in the analysis of ultrasound anatomy in locoregional anesthesia and echocardiography. Thirdly, namely postoperatively, AI can be applied in predicting acute kidney injury, pulmonary complications, postoperative cognitive dysfunction and can help to diagnose postoperative pain in children. At the intensive care unit, AI tools discriminate acute respiratory distress syndrome (ARDS) from pulmonary oedema in pleural ultrasound, predict mortality and sepsis more accurately, and predict survival rates in severe Coronavirus-19 (COVID-19). Finally, AI has been described in training residents in spinal ultrasound, simulation, and plexus block anatomy. Several concerns must be addressed regarding the use of AI. Firstly, this software does not explain its decision process (i.e., the ‘black box problem’). Secondly, to develop AI models and decision support systems, we need big and accurate datasets, unfortunately with potential unknown bias. Thirdly, we need an ethical and legal framework before implementing this technology. At the end of this paper, we discuss whether this technology will be able to replace the clinician one day. This paper adds value to already existing literature because it not only offers a summation of existing literature on AI applications in anesthesiology but also gives clear definitions of AI itself and critically assesses implementation of this technology.
{"title":"Artificial intelligence in anesthesiology","authors":"F Gheysen, S Rex","doi":"10.56126/75.3.21","DOIUrl":"https://doi.org/10.56126/75.3.21","url":null,"abstract":"Artificial intelligence (AI) is rapidly evolving and gaining attention in the medical world. Our aim is to provide readers with insights into this quickly changing medical landscape and the role of clinicians in the middle of this popular technology. In this review, our aim is to explain some of the increasingly frequently used AI terminology explicitly for physicians. Next, we give a summation, an overview of currently existing applications, future possibilities for AI in the medical field of anesthesiology and thoroughly highlight possible problems that could arise from implementing this technology in daily practice. Therefore, we conducted a literature search, including all types of articles published between the first of January 2010 and the 1st of May 2023, written in English, and having a free full text available. We searched Pubmed, Medline, and Embase using “artificial intelligence”, “machine learning”, “deep learning”, “neural networks” and “anesthesiology” as MESH terms. To structure these findings, we divided the results into five categories: preoperatively, perioperatively, postoperatively, AI in the intensive care unit and finally, AI used for teaching purposes. In the first category, we found AI applications for airway assessment, risk prediction, and logistic support. Secondly, we made a summation of AI applications used during the operation. AI can predict hypotensive events, delivering automated anesthesia, reducing false alarms, and aiding in the analysis of ultrasound anatomy in locoregional anesthesia and echocardiography. Thirdly, namely postoperatively, AI can be applied in predicting acute kidney injury, pulmonary complications, postoperative cognitive dysfunction and can help to diagnose postoperative pain in children. At the intensive care unit, AI tools discriminate acute respiratory distress syndrome (ARDS) from pulmonary oedema in pleural ultrasound, predict mortality and sepsis more accurately, and predict survival rates in severe Coronavirus-19 (COVID-19). Finally, AI has been described in training residents in spinal ultrasound, simulation, and plexus block anatomy. Several concerns must be addressed regarding the use of AI. Firstly, this software does not explain its decision process (i.e., the ‘black box problem’). Secondly, to develop AI models and decision support systems, we need big and accurate datasets, unfortunately with potential unknown bias. Thirdly, we need an ethical and legal framework before implementing this technology. At the end of this paper, we discuss whether this technology will be able to replace the clinician one day. This paper adds value to already existing literature because it not only offers a summation of existing literature on AI applications in anesthesiology but also gives clear definitions of AI itself and critically assesses implementation of this technology.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder among surgical patients and is associated with an increased risk of perioperative cardiopulmonary complications leading to increased health expenses. Therefore, preoperative OSA screening should be instituted to inform patients of their increased perioperative risk and measures can be taken in to decrease this risk. Meanwhile ERAS (Enhanced recovery after surgery) guidelines are becoming standard of care and being widely implemented. The purpose of these recovery programs is to standardize medical care, enhance outcomes and decrease health care expenses using evidence-based protocols. According to the current evidence it is unclear if OSA patients could benefit from these protocols. The first part of this narrative review states the current evidence on OSA definition, classification, pathophysiology and risk factors, postoperative complications, endotypes and their relevance for the anesthesiologist. The second part investigated the feasibility of ERAS measures within the OSA-population. Preoperatively there are many parallels to be drawn between the ERAS measures and Society of Anesthesia and Sleep Medicine (SASM) guidelines on OSA management: Risk stratification by OSA-screening, information counselling on the increased perioperative risk and optimization of preoperative health conditions by initiation of CPAP-therapy. Perioperatively the use short acting anesthetics allows for both early mobilization and avoid postoperative respiratory compromise by sustained drug effect. ERAS measures to maintain the patient in the zone of normovolaemia are advantageous for OSA patients as excessive fluid administration can worsen OSA. The use of multimodal analgesia sparing opioids might be the most important element beneficial for OSA patients they are more prone to develop opioid induced respiratory depression (OIRD). As OSA patients are at risk for venous thromboembolism appropriate thromboprophylaxis should be applied. Postoperatively OSA patients should be closely monitored in the prevention of OIRD. In conclusion many ERAS measures seem to be applicable or of benefit for OSA patients. However, large prospective randomized controlled trials are needed to evaluate if these patients can be managed within an ERAS protocol.
{"title":"Can the OSA patient be managed within an ERAS protocol? A narrative review","authors":"M Ramselaar, A Neyrinck","doi":"10.56126/74.3.23","DOIUrl":"https://doi.org/10.56126/74.3.23","url":null,"abstract":"Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder among surgical patients and is associated with an increased risk of perioperative cardiopulmonary complications leading to increased health expenses. Therefore, preoperative OSA screening should be instituted to inform patients of their increased perioperative risk and measures can be taken in to decrease this risk. Meanwhile ERAS (Enhanced recovery after surgery) guidelines are becoming standard of care and being widely implemented. The purpose of these recovery programs is to standardize medical care, enhance outcomes and decrease health care expenses using evidence-based protocols. According to the current evidence it is unclear if OSA patients could benefit from these protocols. The first part of this narrative review states the current evidence on OSA definition, classification, pathophysiology and risk factors, postoperative complications, endotypes and their relevance for the anesthesiologist. The second part investigated the feasibility of ERAS measures within the OSA-population. Preoperatively there are many parallels to be drawn between the ERAS measures and Society of Anesthesia and Sleep Medicine (SASM) guidelines on OSA management: Risk stratification by OSA-screening, information counselling on the increased perioperative risk and optimization of preoperative health conditions by initiation of CPAP-therapy. Perioperatively the use short acting anesthetics allows for both early mobilization and avoid postoperative respiratory compromise by sustained drug effect. ERAS measures to maintain the patient in the zone of normovolaemia are advantageous for OSA patients as excessive fluid administration can worsen OSA. The use of multimodal analgesia sparing opioids might be the most important element beneficial for OSA patients they are more prone to develop opioid induced respiratory depression (OIRD). As OSA patients are at risk for venous thromboembolism appropriate thromboprophylaxis should be applied. Postoperatively OSA patients should be closely monitored in the prevention of OIRD. In conclusion many ERAS measures seem to be applicable or of benefit for OSA patients. However, large prospective randomized controlled trials are needed to evaluate if these patients can be managed within an ERAS protocol.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Preoperative anxiety is common among children, resulting in negative postoperative behavior and increased postoperative pain. This review focuses on the practical use, safety, and efficacy of pharmacological strategies to reduce perioperative anxiety in children. The PubMed® database was searched using MeSH terms: ((care, preoperative) AND (children) AND (anti-anxiety drugs); (medication, preanesthetic) AND (child, preschool). An in-dept assessment was performed after which 85 articles were retrieved. Benzodiazepines (midazolam, diazepam), zolpidem, melatonin, opioids (fentanyl, butorphanol), alpha-2-adrenergic receptor agonists (clonidine, dexmedetomidine), ketamine and antihistamines (hydroxyzine, promethazine) were reviewed. Their pharmacological properties, routes of administration, doses, efficacy and (dis)advantages are discussed in this review. Based upon the results of our review, some suggestions can be made. Oral midazolam, oral clonidine, intranasally dexmedetomidine and the combination of oral ketamine and midazolam are recommendable products. Some other products like oral diazepam, butorphanol, ketamine intranasal s-ketamine + midazolam and hydroxyzine can be considered because of their proper safety profile and benefits. Further research should focus on patient selection for specific pharmacological and non-pharmacological interventions to achieve a tailored approach. Standardized assessment of anxiety, clinical significancy and feasibility should be included in the objectives of these studies.
{"title":"Pharmacological strategies to reduce perioperative anxiety in children – a narrative review","authors":"D Knaeps, P Van de Putte, M Van de Velde","doi":"10.56126/74.3.22","DOIUrl":"https://doi.org/10.56126/74.3.22","url":null,"abstract":"Preoperative anxiety is common among children, resulting in negative postoperative behavior and increased postoperative pain. This review focuses on the practical use, safety, and efficacy of pharmacological strategies to reduce perioperative anxiety in children. The PubMed® database was searched using MeSH terms: ((care, preoperative) AND (children) AND (anti-anxiety drugs); (medication, preanesthetic) AND (child, preschool). An in-dept assessment was performed after which 85 articles were retrieved. Benzodiazepines (midazolam, diazepam), zolpidem, melatonin, opioids (fentanyl, butorphanol), alpha-2-adrenergic receptor agonists (clonidine, dexmedetomidine), ketamine and antihistamines (hydroxyzine, promethazine) were reviewed. Their pharmacological properties, routes of administration, doses, efficacy and (dis)advantages are discussed in this review. Based upon the results of our review, some suggestions can be made. Oral midazolam, oral clonidine, intranasally dexmedetomidine and the combination of oral ketamine and midazolam are recommendable products. Some other products like oral diazepam, butorphanol, ketamine intranasal s-ketamine + midazolam and hydroxyzine can be considered because of their proper safety profile and benefits. Further research should focus on patient selection for specific pharmacological and non-pharmacological interventions to achieve a tailored approach. Standardized assessment of anxiety, clinical significancy and feasibility should be included in the objectives of these studies.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Fluid management strategies are one of the potential strategies to prevent spinal induced hypotension in parturients scheduled for caesarean section. Objectives: This review will assess the current evidence on fluid strategies as a prophylactic measure for spinal induced hypotension. Methods: A narrative review was conducted where Pubmed, Embase and the Cochrane library were searched in November 2021 for RCTs, meta-analyses and systematic reviews, that compared different fluid regimen in ASA classification one or two women scheduled for elective caesarean section. Results: 77 studies were selected from initial screening, based on titles and abstracts. Out of the 77 initial studies, 37 were considered eligible for inclusion. Crystalloid preloading seemed ineffective in the prevention of spinal hypotension. Crystalloid co-loading, colloid pre- and co-loading all proved to reduce the incidence of spinal hypotension, as well as the incidence of nausea and vomiting and vasopressor use. There was no significant difference in neonatal outcome, regardless of the fluid regimen. Conclusion: Crystalloid co-loading, colloid co-loading and colloid preloading all have been shown to be effective in the prevention of spinal hypotension.
{"title":"Fluid co-loading or preloading for the prevention of hypotension during spinal anesthesia for C-section: a narrative review","authors":"N Decuyper, M Van De Velde","doi":"10.56126/74.1.09","DOIUrl":"https://doi.org/10.56126/74.1.09","url":null,"abstract":"Background: Fluid management strategies are one of the potential strategies to prevent spinal induced hypotension in parturients scheduled for caesarean section. Objectives: This review will assess the current evidence on fluid strategies as a prophylactic measure for spinal induced hypotension. Methods: A narrative review was conducted where Pubmed, Embase and the Cochrane library were searched in November 2021 for RCTs, meta-analyses and systematic reviews, that compared different fluid regimen in ASA classification one or two women scheduled for elective caesarean section. Results: 77 studies were selected from initial screening, based on titles and abstracts. Out of the 77 initial studies, 37 were considered eligible for inclusion. Crystalloid preloading seemed ineffective in the prevention of spinal hypotension. Crystalloid co-loading, colloid pre- and co-loading all proved to reduce the incidence of spinal hypotension, as well as the incidence of nausea and vomiting and vasopressor use. There was no significant difference in neonatal outcome, regardless of the fluid regimen. Conclusion: Crystalloid co-loading, colloid co-loading and colloid preloading all have been shown to be effective in the prevention of spinal hypotension.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135142406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}
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