Background : To evaluate effectiveness of intranasal dexmedetomidine for attenuation of hemo-dynamic response to laryngoscopy and intubation in adults. Design and setting : This prospective randomized study included 90 American Society of Anesthesiologists (ASA) status I, adult patients of either sex, aged between 18-60 years, and undergoing elective surgery under general anesthesia requiring endotracheal intubation. Methods : Patients were randomly assigned to one of three groups of 30 each, to receive either intranasal saline (Group C), intranasal dexmedetomidine 1µg/kg (Group D 1 ) or intranasal dexmedetomidine 2µg/kg (Group D 2) , administered 30 minutes before the induction of anesthesia. Anesthesia technique was standardized for all patients taking part in the study. Main outcome measures : Primary outcome studied was attenuation of hemodynamic response to laryngoscopy and intubation. Secondary parameters studied were sedation score and dose of propofol required at induction. Results : There was a statistically significant rise in heart rate and systolic, diastolic and mean arterial pressures at 1, 3, and 5 minutes of intubation in group C as compared to groups D 1 and D 2 . Sedation score was significantly higher in groups D 1 and D 2 (p<0.0001). Propofol requirement was significantly lower in groups D 1 and D 2 (p<0.0001). Intranasal dexmedetomidine 2µg/kg was associated with higher a incidence of bradycardia. Conclusion : Intranasal dexmedetomidine (1µg/kg and 2µg/kg) effectively diminishes hemodynamic changes associated with laryngoscopy and intubation in adult patients undergoing elective surgery. Intranasal dex-medetomidine 2µg/kg is associated with significant bradycardia. Intranasal dexmedetomidine also provides effective preoperative sedation and decreases the dose of propofol required for induction of anesthesia.
{"title":"Intranasal dexmedetomidine for attenuation of hemodynamic response to laryngoscopy and intubation in adults","authors":"A. Kochhar, P. Panjiar, K. Mohd Butt","doi":"10.56126/72.1.1","DOIUrl":"https://doi.org/10.56126/72.1.1","url":null,"abstract":"Background : To evaluate effectiveness of intranasal dexmedetomidine for attenuation of hemo-dynamic response to laryngoscopy and intubation in adults.\u0000\u0000Design and setting : This prospective randomized study included 90 American Society of Anesthesiologists (ASA) status I, adult patients of either sex, aged between 18-60 years, and undergoing elective surgery under general anesthesia requiring endotracheal intubation.\u0000\u0000Methods : Patients were randomly assigned to one of three groups of 30 each, to receive either intranasal saline (Group C), intranasal dexmedetomidine 1µg/kg (Group D 1 ) or intranasal dexmedetomidine 2µg/kg (Group D 2) , administered 30 minutes before the induction of anesthesia. Anesthesia technique was standardized for all patients taking part in the study.\u0000\u0000Main outcome measures : Primary outcome studied was attenuation of hemodynamic response to laryngoscopy and intubation. Secondary parameters studied were sedation score and dose of propofol required at induction.\u0000\u0000Results : There was a statistically significant rise in heart rate and systolic, diastolic and mean arterial pressures at 1, 3, and 5 minutes of intubation in group C as compared to groups D 1 and D 2 . Sedation score was significantly higher in groups D 1 and D 2 (p<0.0001). Propofol requirement was significantly lower in groups D 1 and D 2 (p<0.0001). Intranasal dexmedetomidine 2µg/kg was associated with higher a incidence of bradycardia.\u0000\u0000Conclusion : Intranasal dexmedetomidine (1µg/kg and 2µg/kg) effectively diminishes hemodynamic changes associated with laryngoscopy and intubation in adult patients undergoing elective surgery. Intranasal dex-medetomidine 2µg/kg is associated with significant bradycardia. Intranasal dexmedetomidine also provides effective preoperative sedation and decreases the dose of propofol required for induction of anesthesia.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49668857","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}
Y. Giladi, D. Shatalin, C. Weiniger, R. Ifraimov, S. Orbach-Zinger, P. Heesen, A. Ioscovich
Background : Epidural augmentation to convert analgesia to emergency cesarean delivery anesthesia is a common practice. In this survey we examined the common augmentation practices in different hospitals in Israel. We investigated whether practices vary by hospital size and if written protocols for conversion correlate with intra-hospital homogeneity. Methods : A questionnaire containing 39 questions was sent to obstetric anesthesia unit heads and to four additional anesthesiologists (attending and residents) in 24 obstetric anesthesia units nationwide. Answers were received online anonymously using web-based survey site. Results : 99/120 participants responded to the survey. 80% of large hospitals have a detailed epidural augmentation protocol. The existence of a written protocol does not affect intrahospital management variability. Overall, 18 different drug mixtures for epidural augmentation were reported, and the most used drug combination is lidocaine, fentanyl and bicarbonate. In large hospitals, 72% add epinephrine and 96% initiate augmentation before operating room arrival. Most respondents reported a final administered total volume of 15-20 ml. In most hospitals there is no maternal or fetal monitoring during patient transfer from delivery room to the operating room, lasting 3.68 minutes on average, with a relative low risk of significant complication as a result of augmentation. Conclusion : We report variations in common practices, depending on hospital size. We recognized low rate of intra-hospital concordance between centers with or without a written protocol of augmentation. Regarding points for improvement, we would recommend adhering to the accepted institutional protocol.
{"title":"Epidural augmentation for urgent Cesarean Section : a nationwide Israeli survey","authors":"Y. Giladi, D. Shatalin, C. Weiniger, R. Ifraimov, S. Orbach-Zinger, P. Heesen, A. Ioscovich","doi":"10.56126/72.1.4","DOIUrl":"https://doi.org/10.56126/72.1.4","url":null,"abstract":"Background : Epidural augmentation to convert analgesia to emergency cesarean delivery anesthesia is a common practice. In this survey we examined the common augmentation practices in different hospitals in Israel. We investigated whether practices vary by hospital size and if written protocols for conversion correlate with intra-hospital homogeneity.\u0000\u0000Methods : A questionnaire containing 39 questions was sent to obstetric anesthesia unit heads and to four additional anesthesiologists (attending and residents) in 24 obstetric anesthesia units nationwide. Answers were received online anonymously using web-based survey site.\u0000\u0000Results : 99/120 participants responded to the survey. 80% of large hospitals have a detailed epidural augmentation protocol. The existence of a written protocol does not affect intrahospital management variability. Overall, 18 different drug mixtures for epidural augmentation were reported, and the most used drug combination is lidocaine, fentanyl and bicarbonate. In large hospitals, 72% add epinephrine and 96% initiate augmentation before operating room arrival. Most respondents reported a final administered total volume of 15-20 ml. In most hospitals there is no maternal or fetal monitoring during patient transfer from delivery room to the operating room, lasting 3.68 minutes on average, with a relative low risk of significant complication as a result of augmentation.\u0000\u0000Conclusion : We report variations in common practices, depending on hospital size. We recognized low rate of intra-hospital concordance between centers with or without a written protocol of augmentation. Regarding points for improvement, we would recommend adhering to the accepted institutional protocol.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44571677","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}
The Hyperosmolar Hyperglycaemia State (HHS) is an endocrine emergency with a mortality rate between 10 and 50%. The mainstay for the treatment of this condition is vigorous IV fluid replacement with close monitoring of blood glucose, serum osmolality, and electrolytes. However, after initial resuscitation, patients can develop hypernatremia and raised serum osmolality, which have deleterious consequences. While hypernatremia in HHS can be treated with infusions of 0.45% saline or 5% dextrose, alternate measures such as intravenous (IV) hypotonic fluid infusion [e.g. 0.18% sodium chloride (NaCl) containing 4% dextrose and 0.15% potassium chloride (KCl)], or free water administration through a nasogastric (NG) tube can be used. We report the case of a 70-year-old man, who was initially admitted to a medical high care ward (MHC) with HHS, and was transferred to the ICU 72 hours later with an altered level of consciousness and severe hypernatremia. His treatment consisted in an IV hypotonic 0.18% NaCl infusion containing 4% dextrose and 0.15% KCl. He also received free water through a NG tube at a rate that was calculated to correct natremia at an average rate of 0.55 meq L-1 hr-1 over 72 hours. A multipronged approach was instituted to manage this patient, including, in addition to natremia correction, blood glucose control with insulin, appropriate IV antibiotics to treat infected foot ulcers, adequate analgesic medications, low-molecular-weight- heparin (LMWH) for thromboprophylaxis, proton- pump inhibitors, and continuation of patient’s ongoing antidepressant drugs at the time of his Glasgow Coma Score improvement. This case report demonstrates the feasibility and success of IV hypotonic fluid (0.18% NaCl - 4% dextrose - 0.15% KCl), alongside NG free water for correcting sodium levels with lower fluid volumes than would have been otherwise required if corrected with 0.45% saline. This treatment seems to be a reasonable choice for correcting sodium levels and osmolality in HHS patients who present with hypernatremia after an initial resuscitation, insofar as it avoids fluid overload and provides dextrose as an energy substrate, in addition to potassium ions. However, while correcting natremia with hypotonic fluid, other aspects of management should not be ignored.
{"title":"Case Report : Severe Hypernatremia following treatment for Hyperosmolar Hyperglycaemic State : A pragmatic approach used to manage hypernatremia","authors":"O.M. Shah, A. Ziarkowski","doi":"10.56126/71.4.5","DOIUrl":"https://doi.org/10.56126/71.4.5","url":null,"abstract":"The Hyperosmolar Hyperglycaemia State (HHS) is an endocrine emergency with a mortality rate between 10 and 50%. The mainstay for the treatment of this condition is vigorous IV fluid replacement with close monitoring of blood glucose, serum osmolality, and electrolytes. However, after initial resuscitation, patients can develop hypernatremia and raised serum osmolality, which have deleterious consequences. While hypernatremia in HHS can be treated with infusions of 0.45% saline or 5% dextrose, alternate measures such as intravenous (IV) hypotonic fluid infusion [e.g. 0.18% sodium chloride (NaCl) containing 4% dextrose and 0.15% potassium chloride (KCl)], or free water administration through a nasogastric (NG) tube can be used. We report the case of a 70-year-old man, who was initially admitted to a medical high care ward (MHC) with HHS, and was transferred to the ICU 72 hours later with an altered level of consciousness and severe hypernatremia. His treatment consisted in an IV hypotonic 0.18% NaCl infusion containing 4% dextrose and 0.15% KCl. He also received free water through a NG tube at a rate that was calculated to correct natremia at an average rate of 0.55 meq L-1 hr-1 over 72 hours. A multipronged approach was instituted to manage this patient, including, in addition to natremia correction, blood glucose control with insulin, appropriate IV antibiotics to treat infected foot ulcers, adequate analgesic medications, low-molecular-weight- heparin (LMWH) for thromboprophylaxis, proton- pump inhibitors, and continuation of patient’s ongoing antidepressant drugs at the time of his Glasgow Coma Score improvement. This case report demonstrates the feasibility and success of IV hypotonic fluid (0.18% NaCl - 4% dextrose - 0.15% KCl), alongside NG free water for correcting sodium levels with lower fluid volumes than would have been otherwise required if corrected with 0.45% saline. This treatment seems to be a reasonable choice for correcting sodium levels and osmolality in HHS patients who present with hypernatremia after an initial resuscitation, insofar as it avoids fluid overload and provides dextrose as an energy substrate, in addition to potassium ions. However, while correcting natremia with hypotonic fluid, other aspects of management should not be ignored.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42475486","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}
Critical care centers around the world have faced a shortage of intravenous sedatives caused by the coronavirus pandemic. Many patients infected with SARS-CoV-2 virus develop severe Acute Respiratory Distress syndrome (ARDS) for which some of them are supported by extra corporeal membrane oxygenation. Under these circumstances, the pharmacokinetics of the sedatives is modified. We observed that many of our COVID-19 infected patients receiving Extracorporeal Membrane Oxygenator (ECMO) require high doses of intravenous drugs. Continuous sedation with halogenated gases in the intensive care unit has shown many benefits on systemic inflammation and offers the possibility of a rapid recovery of consciousness. In this article we describe 3 cases that show the feasibility of sedation with sevoflurane via AnaConDa (Sedana Medical AB, Danderyd, Sweden) for Covid-19 patients under ECMO. Halogenated drugs could be considered as an interesting alternative to intravenous sedatives especially in the context of drug shortage.
由于冠状病毒大流行，世界各地的重症监护中心都面临着静脉注射镇静剂短缺的问题。许多感染严重急性呼吸系统综合征冠状病毒2型的患者会发展为严重急性呼吸窘迫综合征（ARDS），其中一些患者得到了体外膜氧合的支持。在这种情况下，镇静剂的药代动力学发生了改变。我们观察到，许多接受体外膜氧合器（ECMO）治疗的新冠肺炎感染患者需要高剂量的静脉注射药物。在重症监护室中用卤化气体持续镇静对全身炎症有很多好处，并提供了快速恢复意识的可能性。在这篇文章中，我们描述了3个案例，这些案例表明通过AnaConDa（瑞典丹德里德Sedana Medical AB）对新冠肺炎患者在ECMO下使用七氟醚镇静的可行性。卤化药物可以被认为是静脉注射镇静剂的一种有趣的替代品，尤其是在药物短缺的情况下。
{"title":"Feasibility of sedation with sevoflurane inhalation via AnaConDa for Covid-19 patients under venovenous extracorporeal membrane oxygenation","authors":"P. Paccaud, M. Dechamps, L. Jacquet","doi":"10.56126/71.4.4","DOIUrl":"https://doi.org/10.56126/71.4.4","url":null,"abstract":"Critical care centers around the world have faced a shortage of intravenous sedatives caused by the coronavirus pandemic. Many patients infected with SARS-CoV-2 virus develop severe Acute Respiratory Distress syndrome (ARDS) for which some of them are supported by extra corporeal membrane oxygenation. Under these circumstances, the pharmacokinetics of the sedatives is modified. We observed that many of our COVID-19 infected patients receiving Extracorporeal Membrane Oxygenator (ECMO) require high doses of intravenous drugs. Continuous sedation with halogenated gases in the intensive care unit has shown many benefits on systemic inflammation and offers the possibility of a rapid recovery of consciousness. In this article we describe 3 cases that show the feasibility of sedation with sevoflurane via AnaConDa (Sedana Medical AB, Danderyd, Sweden) for Covid-19 patients under ECMO. Halogenated drugs could be considered as an interesting alternative to intravenous sedatives especially in the context of drug shortage.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42076545","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 : we compared the efficacy of transversus abdominis plane (TAP) block versus local infiltration on acute and chronic pain after a first laparoscopic surgical treatment of bilateral inguinal hernia performed in a day hospital. Methods : In this randomized, prospective, double-blind study, we studied 52 patients scheduled for lapa-roscopic bilateral hernia repair. The patients were randomly allocated to receive local infiltration (group 1) or a TAP block (group 2). The surgeon locally injected the patients in group 1 with a solution of 20 mL of 0.5 levo- bupivacaine. An ultrasound-guided injection of 40 mL 0.25 levobupivacaine was administered to the patients in group 2 by the anesthesiologist. The pain score was assessed using a numeric rating scale at the arrival in the recovery room, one hour after surgery and 6 hours (H+6) after arrival at the recovery room. Subsequently, the pain was assessed 24 hours (H+24), 3 weeks (D21) and 3 months (M3) after surgery. Results : We observed significant differences in terms of pain at H+6 and at H+24 in favor of the TAP block group. However, there was no significant difference between both groups in postoperative pain after 3 weeks (D21) or after 3 months (M3). Conclusions : In our study, we observed a significant difference in terms of pain in favor of TAP block versus local infiltration, during the first 24 hours after a first laparoscopic treatment of inguinal hernia. We did not find any significant difference on chronic pain.
背景：我们比较了在日间医院首次腹腔镜手术治疗双侧腹股沟疝后，腹横肌平面（TAP）阻滞与局部浸润对急性和慢性疼痛的疗效。方法：在这项随机、前瞻性、双盲研究中，我们研究了52名计划接受腹腔镜双侧疝修补术的患者。患者被随机分配接受局部浸润（第1组）或TAP阻断（第2组）。外科医生为第1组患者局部注射20 mL 0.5左旋布比卡因溶液。麻醉师在超声引导下向第2组患者注射40mL 0.25左旋布比卡因。在到达康复室时、手术后1小时和到达康复室后6小时（H+6）使用数字评定量表评估疼痛评分。随后，在手术后24小时（H+24）、3周（D21）和3个月（M3）评估疼痛。结果：我们观察到在H+6和H+24时疼痛方面的显著差异，有利于TAP阻断组。然而，两组在3周后（D21）或3个月后（M3）的术后疼痛方面没有显著差异。结论：在我们的研究中，我们观察到，在首次腹腔镜治疗腹股沟疝后的前24小时内，TAP阻滞与局部浸润在疼痛方面存在显著差异。我们在慢性疼痛方面没有发现任何显著差异。
{"title":"Ultrasound transversus abdominis plane (TAP) block versus local infiltration analgesia for acute and chronic postoperative pain control after laparoscopic bilateral hernia repair : a single-center randomized controlled trial","authors":"M. Hosni, J. P. Soulios, D. Francart","doi":"10.56126/71.4.2","DOIUrl":"https://doi.org/10.56126/71.4.2","url":null,"abstract":"Background : we compared the efficacy of transversus abdominis plane (TAP) block versus local infiltration on acute and chronic pain after a first laparoscopic surgical treatment of bilateral inguinal hernia performed in a day hospital.\u0000\u0000Methods : In this randomized, prospective, double-blind study, we studied 52 patients scheduled for lapa-roscopic bilateral hernia repair. The patients were randomly allocated to receive local infiltration (group 1) or a TAP block (group 2). The surgeon locally injected the patients in group 1 with a solution of 20 mL of 0.5 levo- bupivacaine. An ultrasound-guided injection of 40 mL 0.25 levobupivacaine was administered to the patients in group 2 by the anesthesiologist. The pain score was assessed using a numeric rating scale at the arrival in the recovery room, one hour after surgery and 6 hours (H+6) after arrival at the recovery room. Subsequently, the pain was assessed 24 hours (H+24), 3 weeks (D21) and 3 months (M3) after surgery.\u0000\u0000Results : We observed significant differences in terms of pain at H+6 and at H+24 in favor of the TAP block group. However, there was no significant difference between both groups in postoperative pain after 3 weeks (D21) or after 3 months (M3).\u0000\u0000Conclusions : In our study, we observed a significant difference in terms of pain in favor of TAP block versus local infiltration, during the first 24 hours after a first laparoscopic treatment of inguinal hernia. We did not find any significant difference on chronic pain.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46694685","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}
P. Verelst, M. Verstraeten, N. Tulkens, T. Maertens
Objective : In this observational study, we aimed at measuring preoperative anxiety and preferences for anesthesia in patients undergoing knee arthroscopic surgery. Background : Little is known about preoperative anxieties, expectations and preferences of patients undergoing surgery, for which both spinal or general anesthesia can be provided. Literature shows that spinal anesthesia is associated with lower postoperative co- morbidity and mortality rates as compared to general anesthesia (1-2). Anxiety itself is an important factor influencing patients’ outcome (3). Methods : Every patients >18 years old undergoing an ambulatory arthroscopy of the knee in the surgical day care center of the AZ Nikolaas (in Sint-Niklaas and Beveren), was asked preoperatively to fill in a questionnaire. The questionnaire focused both on the patients’ knowledge about and preference of anesthesia, as well as their preoperative anxieties and worries. Patients were asked to score preoperative anxiety on a 5-point anxiety scale for any of 9 aspects/complications of the anesthetic (placement of the IV cannula, spinal puncture, death, awareness, pain, postoperative nausea and vomiting, cognitive impairment, infection, blood loss). During the study period, from January 11/01/ 2019 to 11/06/2019, a total of 806 patients were asked to fill out the questionnaire. 201 of these patients completed the questionnaire and were consequently enrolled in the study. This work has been approved by the Ethics Committee of the AZ Nikolaas on 11/11/2018 and by the Ethics Committee of the University Hospital in Antwerp (UZA) on 19/11/ 2018. Results : Seventy-five % of patients had a clear preference for their anesthesia technique. Of these, 2/3 opted for general anesthesia. Patients mainly based their preference on a subjective feeling ; a minority had discussed the choice with their surgeon or general practitioner. Rarely, patients indicated the wish to talk to the anesthesiologist about their choice. Fear for a spinal puncture occurred in 40% of patients (median anxiety score 3/5, range 1-5) and was therefore the most prominent anxiety in this patient population. Conclusions : Patients’ greater preference for general over spinal anesthesia was clearly based rather on a subjective than an objective basis. Forty 40% of patients had a substantial fear for spinal puncture. By informing patients about the risks and complications of the different anesthesia techniques, anxiety feelings can probably be alleviated, and a well-judged decision about their anesthesia technique can be made. There is room for improvement in communication and discussion between patients and anesthesiologists about the patients’ choice of anesthesia technique.
{"title":"Preoperative assessment of expectations, anxiety and preferences for anesthesia in patients undergoing ambulatory knee arthroscopic surgery","authors":"P. Verelst, M. Verstraeten, N. Tulkens, T. Maertens","doi":"10.56126/71.4.3","DOIUrl":"https://doi.org/10.56126/71.4.3","url":null,"abstract":"Objective : In this observational study, we aimed at measuring preoperative anxiety and preferences for anesthesia in patients undergoing knee arthroscopic surgery.\u0000\u0000Background : Little is known about preoperative anxieties, expectations and preferences of patients undergoing surgery, for which both spinal or general anesthesia can be provided. Literature shows that spinal anesthesia is associated with lower postoperative co- morbidity and mortality rates as compared to general anesthesia (1-2). Anxiety itself is an important factor influencing patients’ outcome (3).\u0000\u0000Methods : Every patients >18 years old undergoing an ambulatory arthroscopy of the knee in the surgical day care center of the AZ Nikolaas (in Sint-Niklaas and Beveren), was asked preoperatively to fill in a questionnaire. The questionnaire focused both on the patients’ knowledge about and preference of anesthesia, as well as their preoperative anxieties and worries. Patients were asked to score preoperative anxiety on a 5-point anxiety scale for any of 9 aspects/complications of the anesthetic (placement of the IV cannula, spinal puncture, death, awareness, pain, postoperative nausea and vomiting, cognitive impairment, infection, blood loss). During the study period, from January 11/01/ 2019 to 11/06/2019, a total of 806 patients were asked to fill out the questionnaire. 201 of these patients completed the questionnaire and were consequently enrolled in the study. This work has been approved by the Ethics Committee of the AZ Nikolaas on 11/11/2018 and by the Ethics Committee of the University Hospital in Antwerp (UZA) on 19/11/ 2018.\u0000\u0000Results : Seventy-five % of patients had a clear preference for their anesthesia technique. Of these, 2/3 opted for general anesthesia. Patients mainly based their preference on a subjective feeling ; a minority had discussed the choice with their surgeon or general practitioner. Rarely, patients indicated the wish to talk to the anesthesiologist about their choice. Fear for a spinal puncture occurred in 40% of patients (median anxiety score 3/5, range 1-5) and was therefore the most prominent anxiety in this patient population.\u0000\u0000Conclusions : Patients’ greater preference for general over spinal anesthesia was clearly based rather on a subjective than an objective basis. Forty 40% of patients had a substantial fear for spinal puncture. By informing patients about the risks and complications of the different anesthesia techniques, anxiety feelings can probably be alleviated, and a well-judged decision about their anesthesia technique can be made. There is room for improvement in communication and discussion between patients and anesthesiologists about the patients’ choice of anesthesia technique.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48814095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Van de Velde, I. Barvais, M. Coppens, P. Flamée, J. Jastrowicz, J. Mulier, B. Robu, D. Van Beersel, V. Van Reeth
Guideline produced by the Society for Anesthesia and Resuscitation of Belgium Working Group on Procedural Sedation (SARB-WG-PS).
比利时麻醉和复苏学会手术镇静工作组（SARB-WG-PS）制定的指南。
{"title":"Procedural sedation in Belgium : guideline for safe patient care","authors":"M. Van de Velde, I. Barvais, M. Coppens, P. Flamée, J. Jastrowicz, J. Mulier, B. Robu, D. Van Beersel, V. Van Reeth","doi":"10.56126/71.4.1","DOIUrl":"https://doi.org/10.56126/71.4.1","url":null,"abstract":"Guideline produced by the Society for Anesthesia and Resuscitation of Belgium Working Group on Procedural Sedation (SARB-WG-PS).","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47202054","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. Plaetinck, J. Heerman, S. Van de Velde, S. Allaert, A. Kalmar
We report the case of anticholinergic poisoning in a patient suffering from an overdose of bupropion. The patient presented with bilateral mydriasis, involuntary movements and signs of agitation. Bupropion is commonly used as antidepressant and smoking cessation aid. It inhibits neuronal reuptake of dopamine and norepinephrine and also antagonizes acetylcholine at the level of the nicotinic receptor sites. So far bupropion overdose resulting in symptoms mimicking an anticholinergic syndrome has rarely been reported in literature. In this case, one milligram of intravenous physostigmine, an acetylcholinesterase inhibitor, rapidly resolved patient agitation and mydriasis. This case indicates that physostigmine might be used as an antidote to quickly reverse the central and peripheral anticholinergic symptoms in patients with an overdose of bupropion. Erratum This article is the corrected version of the article published in issue 2020/3, pages 137-140. Typos and order of authors have now been corrected. With apologies to the authors.
{"title":"Anticholinergic symptoms in a patient with a bupropion overdose successfully managed with physostigmine: a case report","authors":"I. Plaetinck, J. Heerman, S. Van de Velde, S. Allaert, A. Kalmar","doi":"10.56126/72.1.7","DOIUrl":"https://doi.org/10.56126/72.1.7","url":null,"abstract":"We report the case of anticholinergic poisoning in a patient suffering from an overdose of bupropion. The patient presented with bilateral mydriasis, involuntary movements and signs of agitation. Bupropion is commonly used as antidepressant and smoking cessation aid. It inhibits neuronal reuptake of dopamine and norepinephrine and also antagonizes acetylcholine at the level of the nicotinic receptor sites. So far bupropion overdose resulting in symptoms mimicking an anticholinergic syndrome has rarely been reported in literature.\u0000\u0000In this case, one milligram of intravenous physostigmine, an acetylcholinesterase inhibitor, rapidly resolved patient agitation and mydriasis. This case indicates that physostigmine might be used as an antidote to quickly reverse the central and peripheral anticholinergic symptoms in patients with an overdose of bupropion.\u0000Erratum\u0000\u0000This article is the corrected version of the article published in issue 2020/3, pages 137-140. Typos and order of authors have now been corrected. With apologies to the authors.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45114835","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}
Robinow Syndrome is characterized by the presence of mesomelic limb shortening, midfacial hypoplasia, hemivertebrae and genital hypoplasia. Multi- organ involvement including cardiac, renal, vertebral dysfunctions have been described.We here report successful anaesthetic management of 1year old boy posted for ophthalmic procedure.
{"title":"Robinow Syndrome : an anesthetic challenge and review of literature","authors":"V. Depal, N. Patel, A. Singh, A. Kumar","doi":"10.56126/71.3.7","DOIUrl":"https://doi.org/10.56126/71.3.7","url":null,"abstract":"Robinow Syndrome is characterized by the presence of mesomelic limb shortening, midfacial hypoplasia, hemivertebrae and genital hypoplasia. Multi- organ involvement including cardiac, renal, vertebral dysfunctions have been described.We here report successful anaesthetic management of 1year old boy posted for ophthalmic procedure.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48863784","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 : To test the reliability of the spot check Masimo Rad-67 (Masimo Corp., Irvine, CA, USA) as part of a preoperative anemia screening, hemoglobin measurements were compared to those of the HemoCue® Hb 201+ System (HemoCue AB, Ängelholm, Sweden) and the standard laboratory measurement. Methods : During preoperative evaluation of patients scheduled for elective orthopedic surgery hemoglobin concentration was simultaneously determined by standard laboratory analysis (HbLab), the HemoCue® Hb 201+ System (HbHemocue) and by Pulse Co-Oximetry using the Masimo Rad-67 (SpHb) with the rainbow® DCI®-mini Sensor (Masimo Corp., Irvine, CA, USA). Linear correlation, agreement (Bland-Altman analysis), sensitivity/specificity and positive/negative prediction values (PPV/NPV) for anemic hemoglobin values were determined. P-values less than 0.05 were considered statistically significant. Results : 303 patients were analyzed. Twenty-one patients (12 male and 9 female) had mild or moderate anemia, detected by HbLab. In 20 patients, the HbHemocue, and in 34 patients, the SpHb detected anemia. Linear correlation and mean bias (limits of agreement, LOA) for HbHemocue and HbLab were r = 0.969 and -1.08 (+6.44/-8.60) g/L, and for SpHb and HbLab r = 0.61 and +1.76 (+26.92/-23.4) g/L. Sensitivity/specificity of the HbHemocue to detect anemia in all, male and female patients were 85.0/99.3%, 75.0/100/% and 88.9/98.9/% with a PPV/NPV of 89.5/98.9%, 100/98.0% and 80.0/99.3%, respectively. Sensitivity/specificity of SpHb to detect anemia for all, male and female patients were 71.4%, 93.3%, 75.0/95.2/% and 66.7/91.1%, with a PPV/NPV for all, male and female patients of 44.1/97.8%, 56.3/97.9% and 33.3/97.7%, respectively. Conclusions : HbHemocue and HbLab show a strong linear correlation and a good agreement, while linear correlation of SpHb and HbLab is moderate and agreement poor. For both devices, anemia detection is moderate, but the positive prediction value for anemia is much better with the HbHemocue. Both devices reliably detected non-anemic patients. Glossary : CO = carbon monoxide ; PPV = positive predicted value ; NPV = negative predicted value ; HbLab = hemoglobin determined by the laboratory ; HbHemocue = hemoglobin determined by the HemoCue device ; SpHb = hemoglobin determined by the Masimo-RAD67 device ; LOA = limits of agreement ; LOS = length of stay ; POC = point of care ; SpO2 = arterial hemoglobin ; PR = pulse rate ; PI = perfusion index ; PVI = plethysmography variability index ; SpCO = carboxyhemoglobin ; SpMet = methemoglobin ; LED = Light Emitting Diodes ; HiCN = hemiglobincyanide ; SLS = Sodium Lauryl Sulphate ; BMI = body mass index ; BT = body temperature ; WHO = World Health Organization ; IQR = interquartile range ; MAP = mean arterial pressure ; HF = heart frequency ; SD = standard deviation Key point Summary : – Question : Is Hb measurement of the Masimo Rad-67 and of the HemoCue reliable? – Findings : Non-anemic patients are reliab
{"title":"Reliability of a spot check non-invasive hemoglobin monitoring (SpHb) of the Masimo RAD-67™ and the HemoCue® for anemia screening","authors":"W. Baulig, U. Eichenberger, O. Theusinger","doi":"10.56126/71.3.4","DOIUrl":"https://doi.org/10.56126/71.3.4","url":null,"abstract":"Background : To test the reliability of the spot check Masimo Rad-67 (Masimo Corp., Irvine, CA, USA) as part of a preoperative anemia screening, hemoglobin measurements were compared to those of the HemoCue® Hb 201+ System (HemoCue AB, Ängelholm, Sweden) and the standard laboratory measurement.\u0000\u0000Methods : During preoperative evaluation of patients scheduled for elective orthopedic surgery hemoglobin concentration was simultaneously determined by standard laboratory analysis (HbLab), the HemoCue® Hb 201+ System (HbHemocue) and by Pulse Co-Oximetry using the Masimo Rad-67 (SpHb) with the rainbow® DCI®-mini Sensor (Masimo Corp., Irvine, CA, USA). Linear correlation, agreement (Bland-Altman analysis), sensitivity/specificity and positive/negative prediction values (PPV/NPV) for anemic hemoglobin values were determined. P-values less than 0.05 were considered statistically significant.\u0000\u0000Results : 303 patients were analyzed. Twenty-one patients (12 male and 9 female) had mild or moderate anemia, detected by HbLab. In 20 patients, the HbHemocue, and in 34 patients, the SpHb detected anemia. Linear correlation and mean bias (limits of agreement, LOA) for HbHemocue and HbLab were r = 0.969 and -1.08 (+6.44/-8.60) g/L, and for SpHb and HbLab r = 0.61 and +1.76 (+26.92/-23.4) g/L. Sensitivity/specificity of the HbHemocue to detect anemia in all, male and female patients were 85.0/99.3%, 75.0/100/% and 88.9/98.9/% with a PPV/NPV of 89.5/98.9%, 100/98.0% and 80.0/99.3%, respectively. Sensitivity/specificity of SpHb to detect anemia for all, male and female patients were 71.4%, 93.3%, 75.0/95.2/% and 66.7/91.1%, with a PPV/NPV for all, male and female patients of 44.1/97.8%, 56.3/97.9% and 33.3/97.7%, respectively.\u0000\u0000Conclusions : HbHemocue and HbLab show a strong linear correlation and a good agreement, while linear correlation of SpHb and HbLab is moderate and agreement poor. For both devices, anemia detection is moderate, but the positive prediction value for anemia is much better with the HbHemocue. Both devices reliably detected non-anemic patients.\u0000\u0000Glossary : CO = carbon monoxide ; PPV = positive predicted value ; NPV = negative predicted value ; HbLab = hemoglobin determined by the laboratory ; HbHemocue = hemoglobin determined by the HemoCue device ; SpHb = hemoglobin determined by the Masimo-RAD67 device ; LOA = limits of agreement ; LOS = length of stay ; POC = point of care ; SpO2 = arterial hemoglobin ; PR = pulse rate ; PI = perfusion index ; PVI = plethysmography variability index ; SpCO = carboxyhemoglobin ; SpMet = methemoglobin ; LED = Light Emitting Diodes ; HiCN = hemiglobincyanide ; SLS = Sodium Lauryl Sulphate ; BMI = body mass index ; BT = body temperature ; WHO = World Health Organization ; IQR = interquartile range ; MAP = mean arterial pressure ; HF = heart frequency ; SD = standard deviation\u0000\u0000Key point Summary :\u0000– Question : Is Hb measurement of the Masimo Rad-67 and of the HemoCue reliable?\u0000– Findings : Non-anemic patients are reliab","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47266462","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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