R. Pandey, Jayaram A. Ankur Sharma, V. Darlong, R. Sinha, J. Punj, Sudershan Khokhar, A. Chowdhury, P. Singh
Background: Emergence delirium in pediatric patients is a significant cause of increased anxiety among parents. The incidence of emergence delirium in children varies mainly according to the anesthetic agents used. Methods: In this prospective, double-blind, randomized trial, 152 children of age group 1-6 years were randomized into two groups after induction of anesthesia: Group S received Sevoflurane, and Group D received Desflurane. Children in the S group were further randomized into subgroup S- Dex (receiving dexmedetomidine 0.3 mcg/kg in 5 ml saline) and subgroup S-Saline (receiving saline 5 ml). Similarly, Group D was also randomized into two subgroups; D-Dex and D-Saline. We compared perioperative hemodynamic variables, postoperative emergence delirium, recovery profile, pain scoring, the requirement of rescue analgesics, and time to discharge. Results: At 5, 15, and 30 minutes, the incidence of emergence delirium was significantly higher in S-Saline and D-Saline groups than S-Dex and D-Dex groups. Both PAED and FLACC scores were significantly higher in the S-Saline group than the S-Dex group and the D-Saline group compared to the D-Dex group (P<0.05). Significantly more patients required analgesia in the S-Saline group than in the S-Dex group (P<0.05). No significant difference for analgesia was present between D-Saline and D-Dex groups. (p = 0.153). Discharge time was significantly longer in S-Dex and D-Dex groups as compared to S-Saline and D-saline groups. Conclusions: Dexmedetomidine effectively reduced the incidence of emergence delirium and postoperative pain in pediatric patients undergoing surgery using Sevoflurane and Desflurane anesthesia.
{"title":"Effect of dexmedetomidine on emergence delirium and recovery parameters with sevoflurane and desflurane anaesthesia in children : a double randomized study","authors":"R. Pandey, Jayaram A. Ankur Sharma, V. Darlong, R. Sinha, J. Punj, Sudershan Khokhar, A. Chowdhury, P. Singh","doi":"10.56126/73.1.05","DOIUrl":"https://doi.org/10.56126/73.1.05","url":null,"abstract":"Background: Emergence delirium in pediatric patients is a significant cause of increased anxiety among parents. The incidence of emergence delirium in children varies mainly according to the anesthetic agents used.\u0000\u0000Methods: In this prospective, double-blind, randomized trial, 152 children of age group 1-6 years were randomized into two groups after induction of anesthesia: Group S received Sevoflurane, and Group D received Desflurane. Children in the S group were further randomized into subgroup S- Dex (receiving dexmedetomidine 0.3 mcg/kg in 5 ml saline) and subgroup S-Saline (receiving saline 5 ml). Similarly, Group D was also randomized into two subgroups; D-Dex and D-Saline. We compared perioperative hemodynamic variables, postoperative emergence delirium, recovery profile, pain scoring, the requirement of rescue analgesics, and time to discharge.\u0000\u0000Results: At 5, 15, and 30 minutes, the incidence of emergence delirium was significantly higher in S-Saline and D-Saline groups than S-Dex and D-Dex groups. Both PAED and FLACC scores were significantly higher in the S-Saline group than the S-Dex group and the D-Saline group compared to the D-Dex group (P<0.05). Significantly more patients required analgesia in the S-Saline group than in the S-Dex group (P<0.05). No significant difference for analgesia was present between D-Saline and D-Dex groups. (p = 0.153). Discharge time was significantly longer in S-Dex and D-Dex groups as compared to S-Saline and D-saline groups.\u0000\u0000Conclusions: Dexmedetomidine effectively reduced the incidence of emergence delirium and postoperative pain in pediatric patients undergoing surgery using Sevoflurane and Desflurane anesthesia.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43162492","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":"Anesthesia specialty training in Belgium anno 2022 – time for revamping","authors":"A. Moerman, W. Degrève, S. De Hert","doi":"10.56126/73.1.01","DOIUrl":"https://doi.org/10.56126/73.1.01","url":null,"abstract":"","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43314957","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}
High frequency percussive ventilation (HFPV) is a ventilation mode that combines positive pressure ventilation with some advantages of high frequency ventilation. During HFPV, a pulsatile flow is generated with high frequency and low volumes. HFPV has been used in the intensive care unit (ICU) for several decades, in case of insufficient conventional positive pressure ventilation. However, literature on its use in intraoperative care is scarce. We hypothesize that HFPV might be a better alternative to existing ventilation modi during selected operative procedures or in patients with severely compromised pulmonary and/or cardiac function. In this paper, we explain the HFPV system, we zoom in on the physiological effects of HFPV, and we describe its potential role in the intraoperative setting. Results of existing studies show that, compared to other conventional ventilation modes, HFPV improves oxygenation and ventilation without jeopardizing hemodynamics. However, because of the low quality evidence regarding physiological effects and clinical effectiveness, and due to the complicated design and set-up of the HFPV ventilator, the use of HFPV in intraoperative care is currently very limited. We conclude that HFPV could potentially be an interesting ventilation mode for procedures requiring minimal respiratory motion or low airway pressures, however larger (comparative) study trials are required to evaluate its usability in the operating room in patients with compromised pulmonary and/or cardiac function.
{"title":"High frequency percussive ventilation: An asset to existing ventilation modi in intraoperative care?","authors":"L. Rijckaert, A. Moerman, M. Vandenheuvel","doi":"10.56126/73.1.03","DOIUrl":"https://doi.org/10.56126/73.1.03","url":null,"abstract":"High frequency percussive ventilation (HFPV) is a ventilation mode that combines positive pressure ventilation with some advantages of high frequency ventilation. During HFPV, a pulsatile flow is generated with high frequency and low volumes. HFPV has been used in the intensive care unit (ICU) for several decades, in case of insufficient conventional positive pressure ventilation. However, literature on its use in intraoperative care is scarce. We hypothesize that HFPV might be a better alternative to existing ventilation modi during selected operative procedures or in patients with severely compromised pulmonary and/or cardiac function. In this paper, we explain the HFPV system, we zoom in on the physiological effects of HFPV, and we describe its potential role in the intraoperative setting. Results of existing studies show that, compared to other conventional ventilation modes, HFPV improves oxygenation and ventilation without jeopardizing hemodynamics. However, because of the low quality evidence regarding physiological effects and clinical effectiveness, and due to the complicated design and set-up of the HFPV ventilator, the use of HFPV in intraoperative care is currently very limited. We conclude that HFPV could potentially be an interesting ventilation mode for procedures requiring minimal respiratory motion or low airway pressures, however larger (comparative) study trials are required to evaluate its usability in the operating room in patients with compromised pulmonary and/or cardiac function.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45072836","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: The objective of this study was to analyze an oral administration of midazolam with two different doses of dexmedetomidine for premedication in paediatric patients. Methods: A prospective, randomized, double blind study. Three hundred patients, aged 1-7 years, undergoing elective surgery under general anesthesia were recruited for the study. Patients were randomized into three groups to receive oral midazolam 0.5mg/kg (group M), oral dexmedetomidine 2 µg/kg (group D2) and oral dexmedetomidine 4 µg/kg (group D4) for premedication. An observer blinded to the patient group allocation assessed level of sedation at 30 minutes after giving the premedication, ease of parental separation was assessed while shifting the patients to the operating room, mask acceptance during induction and postoperative agitation scores in post anesthesia care unit. Results: The sedation score of group D4 was significantly higher than group D2 and group M [ group D4- 4 (4,3), group D2- 2(2,2) and group M -2(3,2), H statistics = 80.4718, p < 0.00001]. The parental separation score, mask acceptance score and postoperative was also significantly better for group D4 compared to the other two group. Conclusion: These results suggest that oral dexmedetomidine 4 µg/kg is more effective than oral midazolam 0.5mg/kg and oral dexmedetomidine 2 µg/kg for premedication in children.
{"title":"A comparison of midazolam, dexmedetomidine 2µg/kg and dexmedetomidine 4µg/kg as oral premedication in children, a randomized double-blinded clinical triall","authors":"D. Lalin, S. Singh, V. Thakur","doi":"10.56126/73.1.07","DOIUrl":"https://doi.org/10.56126/73.1.07","url":null,"abstract":"Background: The objective of this study was to analyze an oral administration of midazolam with two different doses of dexmedetomidine for premedication in paediatric patients.\u0000\u0000Methods: A prospective, randomized, double blind study. Three hundred patients, aged 1-7 years, undergoing elective surgery under general anesthesia were recruited for the study. Patients were randomized into three groups to receive oral midazolam 0.5mg/kg (group M), oral dexmedetomidine 2 µg/kg (group D2) and oral dexmedetomidine 4 µg/kg (group D4) for premedication. An observer blinded to the patient group allocation assessed level of sedation at 30 minutes after giving the premedication, ease of parental separation was assessed while shifting the patients to the operating room, mask acceptance during induction and postoperative agitation scores in post anesthesia care unit.\u0000\u0000Results: The sedation score of group D4 was significantly higher than group D2 and group M [ group D4- 4 (4,3), group D2- 2(2,2) and group M -2(3,2), H statistics = 80.4718, p < 0.00001]. The parental separation score, mask acceptance score and postoperative was also significantly better for group D4 compared to the other two group.\u0000\u0000Conclusion: These results suggest that oral dexmedetomidine 4 µg/kg is more effective than oral midazolam 0.5mg/kg and oral dexmedetomidine 2 µg/kg for premedication in children.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44384374","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}
J. Segers, A. Hadzic, S. van Boxstael, I. Van Herreweghe, O. De Fré
Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by an acute, diffuse inflammation leading to pulmonary edema and hypoxemia. The pathophysiology of the lung failure in COVID- 19 ARDS is a combination of the viral infection and the immune response of the host. ARDS due to COVID-19 appears to be similar to the non-COVID-19 ARDS, with exception of hypercoagulability. The mortality due to ARDS remains high and the treatment focuses on supportive measures, such as lung-protective ventilation strategy with small tidal volumes, low driving pressures and PEEP-titration, early consideration of prone positioning and a restrictive fluid management. Oxygen should be titrated, and permissive hypercapnia might be necessary to achieve lung-protective ventilation. The use of extracorporeal membrane oxygenation (ECMO) in COVID-19 ARDS is restricted as a rescue therapy in patients who remain hypoxemic. ECMO should be reserved to experienced ECMO centers. Prophylactic anticoagulant therapy is indicated to reduce the formation of thrombi in the microcirculation of organs, especially in the pulmonary microvasculature. Steroids may reduce the host’s immune response and improve mortality in patients requiring oxygen supplementation or invasive ventilation.
{"title":"Management of Acute Respiratory Distress Syndrome in COVID-19 Patients","authors":"J. Segers, A. Hadzic, S. van Boxstael, I. Van Herreweghe, O. De Fré","doi":"10.56126/73.1.02","DOIUrl":"https://doi.org/10.56126/73.1.02","url":null,"abstract":"Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by an acute, diffuse inflammation leading to pulmonary edema and hypoxemia. The pathophysiology of the lung failure in COVID- 19 ARDS is a combination of the viral infection and the immune response of the host. ARDS due to COVID-19 appears to be similar to the non-COVID-19 ARDS, with exception of hypercoagulability. The mortality due to ARDS remains high and the treatment focuses on supportive measures, such as lung-protective ventilation strategy with small tidal volumes, low driving pressures and PEEP-titration, early consideration of prone positioning and a restrictive fluid management. Oxygen should be titrated, and permissive hypercapnia might be necessary to achieve lung-protective ventilation. The use of extracorporeal membrane oxygenation (ECMO) in COVID-19 ARDS is restricted as a rescue therapy in patients who remain hypoxemic. ECMO should be reserved to experienced ECMO centers. Prophylactic anticoagulant therapy is indicated to reduce the formation of thrombi in the microcirculation of organs, especially in the pulmonary microvasculature. Steroids may reduce the host’s immune response and improve mortality in patients requiring oxygen supplementation or invasive ventilation.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41246165","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 : Raised intracranial pressure (ICP) needs to be investigated in various situations, especially in traumatic brain injury (TBI). Ultra-sonographic (US) measurement of the optic nerve sheath diameter (ONSD) is a promising noninvasive tool for assessing elevated ICP. Objectives : This narrative review aimed to explain the history of and indications forUS measurement of ONSD. We focused on the detection of elevated ICP after TBI and discussed the possible improvements in detection methods. Conclusions : US measurement of ONSD in TBI cases provides a qualitative but no quantitative assessment of ICP. Current studies usually calculate their own optimum cutoff value for detecting raised ICP based on the balance between sensitivity and specificity of the method when compared with invasive methods. There is no universally accepted threshold. We did not find any paper focusing on the prognosis of patients benefiting from it when compared with usual care. Another limitation is the lack of standardization. US measurement of ONSD cannot be used as the sole technique to detect elevated ICP and monitor its evolution, but it can be a useful tool in a multimodal protocol and it might help to determine the prognosis of patients in various situations.
{"title":"Ultrasound measurement of the optic nerve sheath diameter in traumatic brain injury: a narrative review","authors":"M. Natile, O. Simonet, F. Vallot, M. de Kock","doi":"10.56126/72.4.1","DOIUrl":"https://doi.org/10.56126/72.4.1","url":null,"abstract":"Background : Raised intracranial pressure (ICP) needs to be investigated in various situations, especially in traumatic brain injury (TBI). Ultra-sonographic (US) measurement of the optic nerve sheath diameter (ONSD) is a promising noninvasive tool for assessing elevated ICP.\u0000\u0000Objectives : This narrative review aimed to explain the history of and indications forUS measurement of ONSD. We focused on the detection of elevated ICP after TBI and discussed the possible improvements in detection methods.\u0000\u0000Conclusions : US measurement of ONSD in TBI cases provides a qualitative but no quantitative assessment of ICP. Current studies usually calculate their own optimum cutoff value for detecting raised ICP based on the balance between sensitivity and specificity of the method when compared with invasive methods. There is no universally accepted threshold. We did not find any paper focusing on the prognosis of patients benefiting from it when compared with usual care. Another limitation is the lack of standardization. US measurement of ONSD cannot be used as the sole technique to detect elevated ICP and monitor its evolution, but it can be a useful tool in a multimodal protocol and it might help to determine the prognosis of patients in various situations.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45631952","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}
I. Gruyters, Björn Stessel, A. Yilmaz, K. Vekemans, S. Heye, P. Timmermans, J. Vandenbrande
Introduction : Pheochromocytoma, a rare catecholamine-producing tumor, has been described to provoke stress-induced Takotsubo-like cardiomyopathy and even severe refractory cardiogenic shock. In this case report, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was used for hemodynamic stabilization and was continued during the resection of a large neuroendocrine tumor. Description : A 69-year old male, recently diagnosed with a pheochromocytoma, was referred to our center because of severe cardiogenic shock after induction of anesthesia for resection of the mass. Despite adequate alpha-and beta-adrenergic blockade for one month, he developed malignant hypertension with subsequently hemodynamic collapse. After successful cardiopulmonary resusci-tation he developed pulmonary oedema with severe hypoxemia and persistent hemodynamic lability. On arrival in our hospital, echocardiography revealed significant left ventricular impairment. Decision was made to commence him on VA-ECMO for a refractory cardiogenic shock with severe pulmonary oedema. Because of persistent blood pressure swings despite VA-ECMO and beta-adrenergic blockade, we decided to remove the tumor on mechanical circulatory support by an open surgical approach the next day. After clamping of the adrenal circulation, the patient experienced profound hypotension requiring high doses of epinephrine and a methylene blue infusion. Surgical resection was successful but complicated by a postoperative bleeding for which the patient underwent an emergent endovascular embolization of an adrenal artery. Over the next days, there was progressive cardiac recovery and the patient was weaned off VA-ECMO on the fourth postoperative day. The patient was discharged from the intensive care 27 days after admission and left the hospital on day 30. Discussion: VA-ECMO seems to be a feasible last resort therapy in refractory cardiogenic shock induced by pheochromocytoma crisis as suggested by a high survival rate in literature. Despite its support benefit during this type of shock, surgical removal of the tumor is rarely done with mechanical circulatory support and heparinization.
{"title":"Surgical adrenalectomy during rescue Extracorporeal Life Support for pheochromocytoma induced cardiogenic shock: a case report","authors":"I. Gruyters, Björn Stessel, A. Yilmaz, K. Vekemans, S. Heye, P. Timmermans, J. Vandenbrande","doi":"10.56126/72.4.4","DOIUrl":"https://doi.org/10.56126/72.4.4","url":null,"abstract":"Introduction : Pheochromocytoma, a rare catecholamine-producing tumor, has been described to provoke stress-induced Takotsubo-like cardiomyopathy and even severe refractory cardiogenic shock. In this case report, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was used for hemodynamic stabilization and was continued during the resection of a large neuroendocrine tumor.\u0000\u0000Description : A 69-year old male, recently diagnosed with a pheochromocytoma, was referred to our center because of severe cardiogenic shock after induction of anesthesia for resection of the mass. Despite adequate alpha-and beta-adrenergic blockade for one month, he developed malignant hypertension with subsequently hemodynamic collapse. After successful cardiopulmonary resusci-tation he developed pulmonary oedema with severe hypoxemia and persistent hemodynamic lability. On arrival in our hospital, echocardiography revealed significant left ventricular impairment. Decision was made to commence him on VA-ECMO for a refractory cardiogenic shock with severe pulmonary oedema. Because of persistent blood pressure swings despite VA-ECMO and beta-adrenergic blockade, we decided to remove the tumor on mechanical circulatory support by an open surgical approach the next day. After clamping of the adrenal circulation, the patient experienced profound hypotension requiring high doses of epinephrine and a methylene blue infusion. Surgical resection was successful but complicated by a postoperative bleeding for which the patient underwent an emergent endovascular embolization of an adrenal artery. Over the next days, there was progressive cardiac recovery and the patient was weaned off VA-ECMO on the fourth postoperative day. The patient was discharged from the intensive care 27 days after admission and left the hospital on day 30.\u0000\u0000Discussion: VA-ECMO seems to be a feasible last resort therapy in refractory cardiogenic shock induced by pheochromocytoma crisis as suggested by a high survival rate in literature. Despite its support benefit during this type of shock, surgical removal of the tumor is rarely done with mechanical circulatory support and heparinization.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42025845","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. S. Moharari, B. M. Davani, P. Pourfakhr, R. Y. Nooraie, M. Khajavi, F. Etezadi, A. Najafi
Background: The decision to transfuse blood products to patients during surgery is critical, due to the potential complications and costs of transfusion. Measuring hemoglobin level by spectrophotometry (SpHb) plays an important role in making this decision. The accuracy of SpHb depends on the finger perfusion. Since digital nerve blocks (DNB) can enhance blood circulation, we aimed at investigating DNB effects on the accuracy of SpHb. Methods: Patients undergoing spine surgery were randomly assigned to two groups. Group A received DNB in the left hand, and group B received DNB in the right hand. In each group, the other hand was considered as the control. Rainbow adult ReSposable sensors were attached to the patients’ both hands. Before surgical incision and every 1.5 hours, the SpHb values of both hands and the perfusion index were recorded. Concomitantly, arterial blood samples were drawn and sent to the lab for hemoglobin concentration measurement. This served as the gold standard for assessing hemoglobin levels (labHb). We used a mixed-effects generalized linear model to test the effect of independent variables on the difference between SpHb and labHb at each time point. Results: The SpHb displayed higher hemoglobin levels than those assessed by the lab. For lower labHb values, the SpHb-labHb differences were larger. A one-unit decrease in labHb increased the difference between SpHb and labHb by 0.56 g dL -1 , which was statistically significant. DNB significantly increased the difference between SpHb and labHb by 0.42 g dL -1 . The effect of DNB on the difference between SpHb and labHb was significant up to three hours after the beginning of surgery (0.58 g dL -1 difference between blocked and non-blocked hands). Conclusion: This study shows that, when hemoglobin levels are low, the accuracy of spectrophotometry decreases. Although DNB increases finger perfusion, it leads to an overestimation of hemoglobin levels by SpHb.
背景：由于输血的潜在并发症和成本，在手术期间向患者输血的决定至关重要。通过分光光度法测量血红蛋白水平（SpHb）在做出这一决定中起着重要作用。SpHb的准确性取决于手指的灌注。由于指神经阻滞（DNB）可以增强血液循环，我们旨在研究DNB对SpHb准确性的影响。方法：将接受脊柱手术的患者随机分为两组。A组左手接受DNB，B组右手接受DNB。在每组中，另一只手被视为对照。Rainbow成人ReSposable传感器连接在患者的双手上。在手术切口前和每1.5小时，记录双手的SpHb值和灌注指数。同时，抽取动脉血样并送往实验室进行血红蛋白浓度测量。这是评估血红蛋白水平（labHb）的金标准。我们使用混合效应广义线性模型来测试自变量对每个时间点SpHb和labHb之间差异的影响。结果：SpHb显示出比实验室评估的血红蛋白水平更高的血红蛋白水平。对于较低的labHb值，SpHb和labHb的差异更大。labHb降低一个单位，SpHb和labHb之间的差异增加了0.56 g dL-1，这在统计学上是显著的。DNB显著增加SpHb和labHb之间的差异0.42gdL-1。DNB对SpHb和labHb之间差异的影响在手术开始后三小时内是显著的（阻塞和未阻塞的手之间的差异为0.58 g dL-1）。结论：本研究表明，当血红蛋白水平较低时，分光光度法的准确性会降低。尽管DNB增加了手指灌注，但它会导致SpHb对血红蛋白水平的高估。
{"title":"The effect of digital nerve block on the accuracy of hemoglobin monitoring during surgery: A randomized clinical trial","authors":"R. S. Moharari, B. M. Davani, P. Pourfakhr, R. Y. Nooraie, M. Khajavi, F. Etezadi, A. Najafi","doi":"10.56126/72.4.3","DOIUrl":"https://doi.org/10.56126/72.4.3","url":null,"abstract":"Background: The decision to transfuse blood products to patients during surgery is critical, due to the potential complications and costs of transfusion. Measuring hemoglobin level by spectrophotometry (SpHb) plays an important role in making this decision. The accuracy of SpHb depends on the finger perfusion. Since digital nerve blocks (DNB) can enhance blood circulation, we aimed at investigating DNB effects on the accuracy of SpHb.\u0000\u0000Methods: Patients undergoing spine surgery were randomly assigned to two groups. Group A received DNB in the left hand, and group B received DNB in the right hand. In each group, the other hand was considered as the control. Rainbow adult ReSposable sensors were attached to the patients’ both hands. Before surgical incision and every 1.5 hours, the SpHb values of both hands and the perfusion index were recorded. Concomitantly, arterial blood samples were drawn and sent to the lab for hemoglobin concentration measurement. This served as the gold standard for assessing hemoglobin levels (labHb). We used a mixed-effects generalized linear model to test the effect of independent variables on the difference between SpHb and labHb at each time point.\u0000\u0000Results: The SpHb displayed higher hemoglobin levels than those assessed by the lab. For lower labHb values, the SpHb-labHb differences were larger. A one-unit decrease in labHb increased the difference between SpHb and labHb by 0.56 g dL -1 , which was statistically significant.\u0000DNB significantly increased the difference between SpHb and labHb by 0.42 g dL -1 . The effect of DNB on the difference between SpHb and labHb was significant up to three hours after the beginning of surgery (0.58 g dL -1 difference between blocked and non-blocked hands).\u0000\u0000Conclusion: This study shows that, when hemoglobin levels are low, the accuracy of spectrophotometry decreases. Although DNB increases finger perfusion, it leads to an overestimation of hemoglobin levels by SpHb.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48552306","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}
We report the case of a 43-year-old male patient who experienced cardiac arrest during two elective laparoscopies for cholecystectomy. The first procedure was prematurely interrupted after the return of spontaneous circulation (ROSC) while the other was continued under intravenous (IV) perfusion of nitrates (isosorbide dinitrate). At each time, after a cycle of cardiopulmonary resuscitation (CPR) and injection of atropine 0.5 mg, sinus rhythm was restored. Only 3-lead electrocardiogram (ECG) outlines were recorded, showing ST-elevation in lead II. During the first incident, a coronary angiography was performed showing a vasospasm of the left anterior descending (LAD) coronary artery, reversible upon intracoronary injection of nitrates. ECG during catheterization showed ST-elevation in the anterior coronary territory. Calcium-channel blockers (CCB) were prescribed, and oral nitrates were added after the second episode. Cardiovascular prevention consisted in smoking cessation, aspirin and statins. Reporting this case seems to be relevant due to its unusual presentation: Prinzmetal’s angina is usually described as morning chest pains, and it rarely concerns Caucasian men. Moreover, the vasospasm was associated with cardiac arrest and ECG changes suggestive of ST-elevation myocardial infarction (STEMI). The final diagnosis was myocardial infarction with non-obstructive coronary arteries (MINOCA) due to coronary vasospasm, a few minutes after insufflation of pneumoperitoneum. So far, few cases have been described during non-cardiac surgery, and even fewer during laparoscopy. Sharing our experience seems important to attract attention to cardiovascular events that can occur under general anesthesia, especially when clinical presentation is rare.
{"title":"Prinzmetal’s variant angina during laparoscopy: a case report of vasospasm in the context of cardiac arrest","authors":"C. Houbotte, L. Hankenne","doi":"10.56126/72.4.6","DOIUrl":"https://doi.org/10.56126/72.4.6","url":null,"abstract":"We report the case of a 43-year-old male patient who experienced cardiac arrest during two elective laparoscopies for cholecystectomy. The first procedure was prematurely interrupted after the return of spontaneous circulation (ROSC) while the other was continued under intravenous (IV) perfusion of nitrates (isosorbide dinitrate). At each time, after a cycle of cardiopulmonary resuscitation (CPR) and injection of atropine 0.5 mg, sinus rhythm was restored. Only 3-lead electrocardiogram (ECG) outlines were recorded, showing ST-elevation in lead II. During the first incident, a coronary angiography was performed showing a vasospasm of the left anterior descending (LAD) coronary artery, reversible upon intracoronary injection of nitrates. ECG during catheterization showed ST-elevation in the anterior coronary territory. Calcium-channel blockers (CCB) were prescribed, and oral nitrates were added after the second episode. Cardiovascular prevention consisted in smoking cessation, aspirin and statins. Reporting this case seems to be relevant due to its unusual presentation: Prinzmetal’s angina is usually described as morning chest pains, and it rarely concerns Caucasian men. Moreover, the vasospasm was associated with cardiac arrest and ECG changes suggestive of ST-elevation myocardial infarction (STEMI). The final diagnosis was myocardial infarction with non-obstructive coronary arteries (MINOCA) due to coronary vasospasm, a few minutes after insufflation of pneumoperitoneum. So far, few cases have been described during non-cardiac surgery, and even fewer during laparoscopy. Sharing our experience seems important to attract attention to cardiovascular events that can occur under general anesthesia, especially when clinical presentation is rare.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42964891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Samalea Suarez, C. Hallet, F. Lois, J. Joris, J. Brichant
Background: Preoperative anxiety in day surgery is associated with a higher incidence of post-operative complications such as postoperative nausea and vomiting, pain or unplanned admission. Objectives: To evaluate the effect of walking to the operating room (OR) on anxiety in ambulatory patients undergoing minimal invasive laser therapy for venous insufficiency. Design and setting: Randomized study in a tertiary hospital between May and November 2019. Methods: 100 patients scheduled for ambulatory laser therapy for venous insufficiency were included. Patients were randomized to walk to the OR (study group, n=50) on even weeks or to lie in a bed to the OR (control group, n=50) on odd weeks. Main outcome measures: Baseline anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and Numerical Rating Scale of anxiety (anxiety-NRS) from 0 to 10 when prepared for departure to OR. Preoperative anxiety-NRS assessment was performed upon arrival in the OR. Results: Patients’ characteristics were similar in both groups. Baseline anxiety-NRS was significantly lower in the study group than in the control group: 2 (1-3) vs. 4 (2-6.5) (p=.013) respectively. No difference was observed between the groups for preoperative anxiety-NRS. A significant reduction in anxiety-NRS on arrival at the OR was observed in the control group compared with the study group (p=.019). Conclusion: Walking to the OR does not reduce anxiety in ambulatory patients undergoing minimal invasive laser therapy for venous insufficiency. But, preparing them to walk to the OR could possibly reduce baseline anxiety while waiting for surgery.
{"title":"Effect of walking to the operating room on preoperative anxiety in patients scheduled for outpatient laser therapy for venous insufficiency. A monocentric randomized study","authors":"N. Samalea Suarez, C. Hallet, F. Lois, J. Joris, J. Brichant","doi":"10.56126/72.4.2","DOIUrl":"https://doi.org/10.56126/72.4.2","url":null,"abstract":"Background: Preoperative anxiety in day surgery is associated with a higher incidence of post-operative complications such as postoperative nausea and vomiting, pain or unplanned admission.\u0000\u0000Objectives: To evaluate the effect of walking to the operating room (OR) on anxiety in ambulatory patients undergoing minimal invasive laser therapy for venous insufficiency.\u0000\u0000Design and setting: Randomized study in a tertiary hospital between May and November 2019.\u0000\u0000Methods: 100 patients scheduled for ambulatory laser therapy for venous insufficiency were included. Patients were randomized to walk to the OR (study group, n=50) on even weeks or to lie in a bed to the OR (control group, n=50) on odd weeks.\u0000\u0000Main outcome measures: Baseline anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and Numerical Rating Scale of anxiety (anxiety-NRS) from 0 to 10 when prepared for departure to OR. Preoperative anxiety-NRS assessment was performed upon arrival in the OR.\u0000\u0000Results: Patients’ characteristics were similar in both groups. Baseline anxiety-NRS was significantly lower in the study group than in the control group: 2 (1-3) vs. 4 (2-6.5) (p=.013) respectively. No difference was observed between the groups for preoperative anxiety-NRS. A significant reduction in anxiety-NRS on arrival at the OR was observed in the control group compared with the study group (p=.019).\u0000\u0000Conclusion: Walking to the OR does not reduce anxiety in ambulatory patients undergoing minimal invasive laser therapy for venous insufficiency. But, preparing them to walk to the OR could possibly reduce baseline anxiety while waiting for surgery.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42305927","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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