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":" ","pages":""},"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":" ","pages":""},"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":" ","pages":""},"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}
S. Boccar, R. Rubay, M. Richard, P. Reper, G. Horlait, A. Goussen, V. De Moor, P. Bulpa
Obstructive shock usually has an intrathoracic origin, such as pneumothorax, pericardial tamponade or pulmonary embolism. We report a case of hemo- dynamic shock in a 74-year-old patient four days after esophagectomy, just after the start of mechanical ventilation for bilateral pneumonia. The sudden onset of severe abdominal distension and the presence of air in the intra-abdominal drain suggested tension pneumoperitoneum, confirmed by radiography. No pneumothorax was associated. Urgent decompression was required to improve hemodynamics. Perforation of the gastrointestinal tract was ruled out. The cause was a bronchopleural fistula opened by mechanical ventilation. Rarely, cardiorespiratory failure may occur after tension pneumoperitoneum by reducing lung volume and cardiac preload, similar to obstructive shock from the usual intrathoracic causes or acting as an abdominal compartment syndrome (ACS). Its recognition and abdominal decompression are key steps in the patient’s recovery. Tension pneumoperitoneum related to mechanical ventilation and airway injury without associated pneumothorax is exceptional and, to our knowledge, has never been reported as a postoperative complication of esophagectomy.
{"title":"Unusual cause of obstructive shock following esophagectomy: a case report","authors":"S. Boccar, R. Rubay, M. Richard, P. Reper, G. Horlait, A. Goussen, V. De Moor, P. Bulpa","doi":"10.56126/72.4.5","DOIUrl":"https://doi.org/10.56126/72.4.5","url":null,"abstract":"Obstructive shock usually has an intrathoracic origin, such as pneumothorax, pericardial tamponade or pulmonary embolism. We report a case of hemo- dynamic shock in a 74-year-old patient four days after esophagectomy, just after the start of mechanical ventilation for bilateral pneumonia. The sudden onset of severe abdominal distension and the presence of air in the intra-abdominal drain suggested tension pneumoperitoneum, confirmed by radiography. No pneumothorax was associated. Urgent decompression was required to improve hemodynamics. Perforation of the gastrointestinal tract was ruled out. The cause was a bronchopleural fistula opened by mechanical ventilation. Rarely, cardiorespiratory failure may occur after tension pneumoperitoneum by reducing lung volume and cardiac preload, similar to obstructive shock from the usual intrathoracic causes or acting as an abdominal compartment syndrome (ACS). Its recognition and abdominal decompression are key steps in the patient’s recovery. Tension pneumoperitoneum related to mechanical ventilation and airway injury without associated pneumothorax is exceptional and, to our knowledge, has never been reported as a postoperative complication of esophagectomy.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44348470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Doucet, S. Hoflack, L. Van Slambrouck, P. Lormans
The use of methylprednisolone in patients with Coronavirus disease 2019 (COVID-19) requiring intensive care hospitalization: a longitudinal observational study. Background : For a long time, the use of corticosteroids in critically ill patients with coronavirus disease 2019 (COVID-19) has been a controversial treatment. How- ever, given the conflicting evidence on this topic, we studied the effects of methylprednisolone on critically ill patients and - share here our experience on laboratory findings and the Pa02/FiO2 ratio (ratio of partial oxygen concentration on arterial blood gas sample to fraction of inspired oxygen). Methods : In a population of 68 patients hospitalized in the intensive care unit due because of COVID-19 infection, 28 patients with severe respiratory failure received methylprednisolone on a fixed 12-day regimen (125 mg IV for 2 days, followed by 2x0.5 mg/kg IV twice daily for 5 days, and then a decreasing regimen for 4 days until discontinuation). After day 5 and day 10, we analyzed the levels of CRP (C-reactive protein), lymphocytosis, D-dimer, LDH (lactate dehydrogenase) and PaO 2 /FiO 2 ratio of our patients. Results : We observed a significant decrease in median CRP levels between day 0 (start of methylprednisolone treatment) and day 5 (p=0.001), and between day 0 and day 10 (p=0.005). No decrease was seen between day 5 and 10 (p=0.352). The same increase in PaO 2 /FiO 2 was recorded between day 0 and day 5 (p=0.009), and between 0 and day 10 (p=0.019). For D-dimer, only a significant difference was found between day 0 and day 10 (p=0.018). No significant difference could be observed for lymphocytosis and LDH levels between the beginning of the treatment and day 5 or day 10. Conclusion : There is a strong and sustained significant decrease in CRP levels and a tilt in the PaO2/FiO2 ratio after starting methylprednisolone. A slower, but also significant decrease was found for D-dimer. Further research and control group analyses are needed to confirm that this effect is due to corticostreoid treatment. However, this indicates that methylprednisolone may play a very important role in the treatment of the severely ill COVID-19 patients requiring ICU admission.
{"title":"The use of methylprednisolone in patients with Coronavirus disease 2019 (COVID-19) requiring intensive care hospitalization: a longitudinal observational study","authors":"L. Doucet, S. Hoflack, L. Van Slambrouck, P. Lormans","doi":"10.56126/72.3.4","DOIUrl":"https://doi.org/10.56126/72.3.4","url":null,"abstract":"The use of methylprednisolone in patients with Coronavirus disease 2019 (COVID-19) requiring intensive care hospitalization: a longitudinal observational study.\u0000\u0000Background : For a long time, the use of corticosteroids in critically ill patients with coronavirus disease 2019 (COVID-19) has been a controversial treatment. How- ever, given the conflicting evidence on this topic, we studied the effects of methylprednisolone on critically ill patients and - share here our experience on laboratory findings and the Pa02/FiO2 ratio (ratio of partial oxygen concentration on arterial blood gas sample to fraction of inspired oxygen).\u0000\u0000Methods : In a population of 68 patients hospitalized in the intensive care unit due because of COVID-19 infection, 28 patients with severe respiratory failure received methylprednisolone on a fixed 12-day regimen (125 mg IV for 2 days, followed by 2x0.5 mg/kg IV twice daily for 5 days, and then a decreasing regimen for 4 days until discontinuation). After day 5 and day 10, we analyzed the levels of CRP (C-reactive protein), lymphocytosis, D-dimer, LDH (lactate dehydrogenase) and PaO 2 /FiO 2 ratio of our patients.\u0000\u0000Results : We observed a significant decrease in median CRP levels between day 0 (start of methylprednisolone treatment) and day 5 (p=0.001), and between day 0 and day 10 (p=0.005). No decrease was seen between day 5 and 10 (p=0.352). The same increase in PaO 2 /FiO 2 was recorded between day 0 and day 5 (p=0.009), and between 0 and day 10 (p=0.019). For D-dimer, only a significant difference was found between day 0 and day 10 (p=0.018). No significant difference could be observed for lymphocytosis and LDH levels between the beginning of the treatment and day 5 or day 10.\u0000\u0000Conclusion : There is a strong and sustained significant decrease in CRP levels and a tilt in the PaO2/FiO2 ratio after starting methylprednisolone. A slower, but also significant decrease was found for D-dimer. Further research and control group analyses are needed to confirm that this effect is due to corticostreoid treatment. However, this indicates that methylprednisolone may play a very important role in the treatment of the severely ill COVID-19 patients requiring ICU admission.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41317277","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. Gharae, E. Roofthooft, N. Fileticci, S. Devroe, P. Vanhove, S. Rex, M. Van de Velde
Cesarean section (CS) is the most frequently performed surgical intervention worldwide. Post- cesarean pain is often underestimated and undertreated and can impair rapid maternal recovery, mother and child bonding and breastfeeding. Recently, PROSPECT recommendations on postoperative pain for CS were published and they include systematic paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), intravenous dexamethasone, neuraxial morphine/dia- morphine or an abdominal wall block or wound infiltration, abdominal wall binders, non-closure of the peritoneum and a Joel-Cohen incision. Opioids are administered as rescue. In UZ Leuven, these PROSPECT recommendations were implemented at the end of 2020. To evaluate the efficacy of these PROSPECT recommendations, a prospective audit was performed from January 1 st , 2021 till April 30 th , 2021. All patients with a CS were prospectively followed for correct implementation of the pain protocol and for pain scores in rest and at mobilization. Rescue opioid consumption as well as patient satisfaction were recorded. 185 consecutive patients that had undergone a CS were included in the audit. In 55 patients the pain protocol was not followed mostly due to no or reduced administration of NSAIDs. Patient satisfaction was high, especially in patients in which the protocol was followed. Pain scores at rest and at mobilization were low and the percentage of patients having pain scores above 30 mm VAS remained low. Rescue opioid consumption was low. We conclude that the implementation of the PROSPECT based pain protocol after CS was effective in controlling pain, reducing opioid consumption and resulted in high patient satisfaction especially if the protocol was correctly followed. Omission of NSAIDs is occurring relatively frequent, but mostly because of valid medical reasons to omit NSAIDs.
{"title":"Postoperative pain after cesarean section: an audit of practice after implementation of the PROSPECT recommendations","authors":"N. Gharae, E. Roofthooft, N. Fileticci, S. Devroe, P. Vanhove, S. Rex, M. Van de Velde","doi":"10.56126/72.3.1","DOIUrl":"https://doi.org/10.56126/72.3.1","url":null,"abstract":"Cesarean section (CS) is the most frequently performed surgical intervention worldwide. Post- cesarean pain is often underestimated and undertreated and can impair rapid maternal recovery, mother and child bonding and breastfeeding. Recently, PROSPECT recommendations on postoperative pain for CS were published and they include systematic paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), intravenous dexamethasone, neuraxial morphine/dia- morphine or an abdominal wall block or wound infiltration, abdominal wall binders, non-closure of the peritoneum and a Joel-Cohen incision. Opioids are administered as rescue. In UZ Leuven, these PROSPECT recommendations were implemented at the end of 2020. To evaluate the efficacy of these PROSPECT recommendations, a prospective audit was performed from January 1 st , 2021 till April 30 th , 2021. All patients with a CS were prospectively followed for correct implementation of the pain protocol and for pain scores in rest and at mobilization. Rescue opioid consumption as well as patient satisfaction were recorded. 185 consecutive patients that had undergone a CS were included in the audit. In 55 patients the pain protocol was not followed mostly due to no or reduced administration of NSAIDs. Patient satisfaction was high, especially in patients in which the protocol was followed. Pain scores at rest and at mobilization were low and the percentage of patients having pain scores above 30 mm VAS remained low. Rescue opioid consumption was low. We conclude that the implementation of the PROSPECT based pain protocol after CS was effective in controlling pain, reducing opioid consumption and resulted in high patient satisfaction especially if the protocol was correctly followed. Omission of NSAIDs is occurring relatively frequent, but mostly because of valid medical reasons to omit NSAIDs.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42860420","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}
Placement of central venous catheters in the internal jugular vein is a frequently performed procedure. We present the case of a patient with venous valves causing an unexpected anatomic hindrance in the placement of a central venous catheter in the internal jugular vein. Venous valves are common in the internal jugular vein and can hinder cannulation. Ultrasound can be of use in the proper placement of a central venous line in a patient where cannulation is complicated by venous valves.
{"title":"Internal jugular vein valves complicating central venous catheter placement: a case report","authors":"S. Pissens, M. Peetermans, A. Wilmer","doi":"10.56126/72.3.6","DOIUrl":"https://doi.org/10.56126/72.3.6","url":null,"abstract":"Placement of central venous catheters in the internal jugular vein is a frequently performed procedure. We present the case of a patient with venous valves causing an unexpected anatomic hindrance in the placement of a central venous catheter in the internal jugular vein. Venous valves are common in the internal jugular vein and can hinder cannulation. Ultrasound can be of use in the proper placement of a central venous line in a patient where cannulation is complicated by venous valves.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46528687","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}
C. Moerman, T. Van Havenbergh, P. Van Houwe, S. Casaer
The reported case describes a patient with hereditary neuropathy with liability to pressure palsies (HNPP) requiring a neurosurgical laminotomy procedure for an arachnoid cyst with medullary compression. HNPP is a rare pathology requiring meticulous anesthetic and surgical management. We give a detailed overview of the planning, simulation, and performance of the anesthesia procedure in order to minimize all potential risk factors for perioperative nerve injury. During the preparation of this case, where the positioning was extremely challenging, we reviewed the available literature for guidance. A few papers report the use of neuraxial anesthesia in patients previously diagnosed with HNPP. No reports could be found on the management of general anesthesia and positioning for major surgery in those patients.
{"title":"Management of anesthesia for surgery in prone position for a patient with hereditary neuropathy with liability to pressure palsies. A case report and narrative literature review","authors":"C. Moerman, T. Van Havenbergh, P. Van Houwe, S. Casaer","doi":"10.56126/72.3.7","DOIUrl":"https://doi.org/10.56126/72.3.7","url":null,"abstract":"The reported case describes a patient with hereditary neuropathy with liability to pressure palsies (HNPP) requiring a neurosurgical laminotomy procedure for an arachnoid cyst with medullary compression. HNPP is a rare pathology requiring meticulous anesthetic and surgical management. We give a detailed overview of the planning, simulation, and performance of the anesthesia procedure in order to minimize all potential risk factors for perioperative nerve injury. During the preparation of this case, where the positioning was extremely challenging, we reviewed the available literature for guidance. A few papers report the use of neuraxial anesthesia in patients previously diagnosed with HNPP. No reports could be found on the management of general anesthesia and positioning for major surgery in those patients.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43776201","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}
Aim: To compare transdiscal and transaortic techniques of neurolytic celiac plexus block for upper gastrointestinal cancer patients. Methods: In this prospective randomized study 60 patients with upper gastrointestinal malignancies were included and randomly divided into two groups, group TD and group TA, receiving neurolytic celiac plexus blocks via transdiscal and transaortic techniques, respectively. The primary outcome was quality of life (QoL) as assessed by WHOQOL BREF questionnaire and secondary outcomes were pain relief using visual analogue scale (VAS), and occurrence of complications like hypotension, loose motion, bleeding and discitis. Result: QoL and VAS score were significantly improved in both groups post procedure. Transdiscal approach is more effective in improving VAS score than transaortic approach (1 vs 3) after 1 week and the relief of pain was better in TD group (3 vs 6) at the end of 2 months. Transdiscal approach was found to be more effective in improving QoL (227.00±28.85 vs 191.17±35.78) as compared to transaortic approach. However, post-procedural QoL improved in both groups when compared to pre-procedural QoL (p<0.05). Hypotension, diarrhea and bleeding from aorta were higher in TA group; however, no serious complications were seen in any of the groups. Conclusion: Transdiscal technique is better in terms of adequate pain relief and improving QoL as compared to transaortic technique of NCPB in patients of upper GI malignancies and is associated with lesser incidences of complications.
目的：比较上消化道癌症患者腹腔神经丛阻滞的经椎间盘和经皮质技术。方法：在这项前瞻性随机研究中，60名上消化道恶性肿瘤患者被纳入并随机分为两组，TD组和TA组，分别通过经椎间和经皮质技术接受腹腔神经丛阻滞。主要结果是通过WHOQOL BREF问卷评估的生活质量（QoL），次要结果是使用视觉模拟量表（VAS）缓解疼痛，以及低血压、松动、出血和椎间盘炎等并发症的发生。结果：两组患者术后生活质量和VAS评分均有明显改善。1周后，经椎间盘入路在改善VAS评分方面比经皮质入路（1比3）更有效，并且在2个月结束时，TD组的疼痛缓解效果更好（3比6）。与经皮质入路相比，经椎间盘入路在改善生活质量方面更有效（227.00±28.85 vs 191.17±35.78）。但与术前相比，两组术后生活质量均有改善（p<0.05）。TA组低血压、腹泻和主动脉出血率较高；然而，在任何一组中都没有发现严重的并发症。结论：在上消化道恶性肿瘤患者中，与经皮质NCPB技术相比，经椎间盘技术在充分缓解疼痛和改善生活质量方面更好，并且并发症发生率更低。
{"title":"A comparative study of transdiscal versus transaortic celiac plexus neurolytic block for upper gastrointestinal cancer patients. A prospective, randomized control study","authors":"A. Rath, Reena, A. Paswan, M. Tewari","doi":"10.56126/72.3.3","DOIUrl":"https://doi.org/10.56126/72.3.3","url":null,"abstract":"Aim: To compare transdiscal and transaortic techniques of neurolytic celiac plexus block for upper gastrointestinal cancer patients.\u0000\u0000Methods: In this prospective randomized study 60 patients with upper gastrointestinal malignancies were included and randomly divided into two groups, group TD and group TA, receiving neurolytic celiac plexus blocks via transdiscal and transaortic techniques, respectively. The primary outcome was quality of life (QoL) as assessed by WHOQOL BREF questionnaire and secondary outcomes were pain relief using visual analogue scale (VAS), and occurrence of complications like hypotension, loose motion, bleeding and discitis.\u0000\u0000Result: QoL and VAS score were significantly improved in both groups post procedure. Transdiscal approach is more effective in improving VAS score than transaortic approach (1 vs 3) after 1 week and the relief of pain was better in TD group (3 vs 6) at the end of 2 months. Transdiscal approach was found to be more effective in improving QoL (227.00±28.85 vs 191.17±35.78) as compared to transaortic approach. However, post-procedural QoL improved in both groups when compared to pre-procedural QoL (p<0.05). Hypotension, diarrhea and bleeding from aorta were higher in TA group; however, no serious complications were seen in any of the groups.\u0000\u0000Conclusion: Transdiscal technique is better in terms of adequate pain relief and improving QoL as compared to transaortic technique of NCPB in patients of upper GI malignancies and is associated with lesser incidences of complications.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47361240","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 and Aims: Spinal anesthesia is a technique often associated with side effects like hypotension and bradycardia. Recent studies have shown that the use of ondansetron leads to a decreased incidence of hypotension induced by spinal anesthesia. This prospective, randomized, controlled, double-blind study was done to compare the efficacy of the prophylactic use of intravenous (IV) ondansetron and mephentermine on post-spinal hypotension. Methods: A total of 130 patients were randomly allocated to one of two groups: Group O received 4 mg IV ondansetron and Group M received 6 mg of IV mephentermine. All patients received spinal anesthesia using 3 mL of 0.5% hyperbaric bupivacaine. Assessment of blood pressure and heart rate (HR) was done for 30 minutes after spinal anesthesia was performed. Quantitative data were analyzed using ANOVA tests and qualitative data were analyzed using the Chi-square tests. Results: Both groups were comparable regarding demographic data. Mean arterial blood pressure (MAP) in Group O was lower than Group M at 5 to 25 minutes and difference of MAP between the two groups was > 20% of baseline values (p < 0.05). HR was comparable between groups. No statistically significant differences were seen in side effects between the two groups. Conclusion: Our study shows that the preemptive use of both ondansetron and mephentermine significantly decreases the incidence of post-spinal hypotension.
{"title":"Comparison between mephentermine and ondansetron for the prevention of post spinal hypotension: a prospective randomized trial","authors":"K. Shah, P. Dubey, A. Bharti, S. Singh","doi":"10.56126/72.3.5","DOIUrl":"https://doi.org/10.56126/72.3.5","url":null,"abstract":"Background and Aims: Spinal anesthesia is a technique often associated with side effects like hypotension and bradycardia. Recent studies have shown that the use of ondansetron leads to a decreased incidence of hypotension induced by spinal anesthesia. This prospective, randomized, controlled, double-blind study was done to compare the efficacy of the prophylactic use of intravenous (IV) ondansetron and mephentermine on post-spinal hypotension.\u0000\u0000Methods: A total of 130 patients were randomly allocated to one of two groups: Group O received 4 mg IV ondansetron and Group M received 6 mg of IV mephentermine. All patients received spinal anesthesia using 3 mL of 0.5% hyperbaric bupivacaine. Assessment of blood pressure and heart rate (HR) was done for 30 minutes after spinal anesthesia was performed. Quantitative data were analyzed using ANOVA tests and qualitative data were analyzed using the Chi-square tests.\u0000\u0000Results: Both groups were comparable regarding demographic data. Mean arterial blood pressure (MAP) in Group O was lower than Group M at 5 to 25 minutes and difference of MAP between the two groups was > 20% of baseline values (p < 0.05). HR was comparable between groups. No statistically significant differences were seen in side effects between the two groups.\u0000\u0000Conclusion: Our study shows that the preemptive use of both ondansetron and mephentermine significantly decreases the incidence of post-spinal hypotension.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46992364","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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