T. Renders, S. Gijsbrechts, K. Bijleveld, F. V. van Loon
Background : After endotracheal intubation, the endotracheal cuff gets inflated to a sufficiently high pressure to prevent air leaking. Placing a patient in Trendelenburg position and establishing a pneumoperitoneum affects the endotracheal cuff pressure. Objectives : Determine the impact of these factors on the endotracheal cuff pressure. Design and setting : This prospective, observational study was conducted in the Catharina Hospital (Eindhoven, the Netherlands). Methods : This study included adult patients undergoing laparoscopic surgery. A routine endotracheal tube was inserted, in which the cuff pressure was continuously monitored. Main outcome measures : The outcome of interest was a change in endotracheal cuff pressure after establishment of a pneumoperitoneum and/ or placing a patient in a Trendelenburg position. Results : 39 patients were included. Cuff pressures in- creased significantly from the moment of pneumo-peritoneum, placing a patient into a Trendelenburg position increased endotracheal cuff pressure and peak pressures even more. The highest endotracheal cuff pressure was 67 cm H2O, the highest registered peak pressure was 35 cm H2O. Conclusion : Both endotracheal cuff pressure and peak pressure increased during laparoscopic surgical procedures with a pneumoperitoneum and the patient placed in Trendelenburg position. Measuring the endo-tracheal cuff pressure only after endotracheal intubation is insufficient and should be repeated during surgery on fixed moments.
{"title":"Establishing changes in endotracheal cuff pressure with continuous monitoring in patients undergoing laparoscopic surgery in Trende- lenburg position","authors":"T. Renders, S. Gijsbrechts, K. Bijleveld, F. V. van Loon","doi":"10.56126/72.2.6","DOIUrl":"https://doi.org/10.56126/72.2.6","url":null,"abstract":"Background : After endotracheal intubation, the endotracheal cuff gets inflated to a sufficiently high pressure to prevent air leaking. Placing a patient in Trendelenburg position and establishing a pneumoperitoneum affects the endotracheal cuff pressure.\u0000\u0000Objectives : Determine the impact of these factors on the endotracheal cuff pressure.\u0000\u0000Design and setting : This prospective, observational study was conducted in the Catharina Hospital (Eindhoven, the Netherlands).\u0000\u0000Methods : This study included adult patients undergoing laparoscopic surgery. A routine endotracheal tube was inserted, in which the cuff pressure was continuously monitored.\u0000\u0000Main outcome measures : The outcome of interest was a change in endotracheal cuff pressure after establishment of a pneumoperitoneum and/ or placing a patient in a Trendelenburg position.\u0000\u0000Results : 39 patients were included. Cuff pressures in- creased significantly from the moment of pneumo-peritoneum, placing a patient into a Trendelenburg position increased endotracheal cuff pressure and peak pressures even more. The highest endotracheal cuff pressure was 67 cm H2O, the highest registered peak pressure was 35 cm H2O.\u0000\u0000Conclusion : Both endotracheal cuff pressure and peak pressure increased during laparoscopic surgical procedures with a pneumoperitoneum and the patient placed in Trendelenburg position. Measuring the endo-tracheal cuff pressure only after endotracheal intubation is insufficient and should be repeated during surgery on fixed moments.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48787776","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 : National surveys are useful to assess the state of regional anaesthesia (RA) practice in a particular country. Given that such information was lacking in Belgium, we conducted a survey to evaluate the Belgian practice of peripheral nerve blocks (PNBs) with a particular focus on its safety aspects. Methods : A survey was sent by email to 1510 Belgian anesthesiologists. No identifying information was collected. Data were collected between September 2019 and October 2019. Results : We collected 324 questionnaires (response rate 21%). Eighty five percent of respondents perform regularly PNB. 99% place a venous access before performing a block, and more than 90% monitor patients with minimum peripheral pulse oximetry. The majority monitor patients for a minimum of 30 minutes after the injection of local anesthetic (LA). Ultrasound-guided technique for RA is used by 89% of respondents. Neurostimulation is totally abandoned by 20% of them. Monitoring of injection pressures is performed by 21% of respondents. More than 50% of respondents use sterile gloves, surgical drapes and a mask. With regards to the solution of LA used, 52% of respondents never mix LAs. An adjuvant is always used by 15% of the respondents while 10% of them never use them. Conclusions : This survey suggests that the practice of PNBs in Belgium is in line with the current international guidelines. This survey can serve as a benchmark for future evaluation and comparison between RA techniques. These observations should be taken into account for the implementation of national guidelines and therefore for the improvement of safety in the practice of PNBs.
{"title":"The practice of regional anesthesia in Belgium – a national survey","authors":"P. Goffin, J. Lecoq, L. Sermeus","doi":"10.56126/72.2.5","DOIUrl":"https://doi.org/10.56126/72.2.5","url":null,"abstract":"Background : National surveys are useful to assess the state of regional anaesthesia (RA) practice in a particular country. Given that such information was lacking in Belgium, we conducted a survey to evaluate the Belgian practice of peripheral nerve blocks (PNBs) with a particular focus on its safety aspects.\u0000\u0000Methods : A survey was sent by email to 1510 Belgian anesthesiologists. No identifying information was collected. Data were collected between September 2019 and October 2019.\u0000\u0000Results : We collected 324 questionnaires (response rate 21%). Eighty five percent of respondents perform regularly PNB. 99% place a venous access before performing a block, and more than 90% monitor patients with minimum peripheral pulse oximetry.\u0000The majority monitor patients for a minimum of 30 minutes after the injection of local anesthetic (LA). Ultrasound-guided technique for RA is used by 89% of respondents. Neurostimulation is totally abandoned by 20% of them. Monitoring of injection pressures is performed by 21% of respondents. More than 50% of respondents use sterile gloves, surgical drapes and a mask. With regards to the solution of LA used, 52% of respondents never mix LAs. An adjuvant is always used by 15% of the respondents while 10% of them never use them.\u0000\u0000Conclusions : This survey suggests that the practice of PNBs in Belgium is in line with the current international guidelines. This survey can serve as a benchmark for future evaluation and comparison between RA techniques. These observations should be taken into account for the implementation of national guidelines and therefore for the improvement of safety in the practice of PNBs.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45879739","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}
K. Nijs, N. Castelein, L. Salimans, I. Callebaut, I. de Pauw, V. Swinnen, M. Van de Velde, Björn Stessel
Study Objective : To assess the knowledge of anesthesia and the role of anesthesiologists and evaluate the prevalence of concerns of certain risks of anesthesia and surgery in Belgian patients. Design : Observational mono-center cross-sectional survey. Setting : Preoperative patients planned for elective surgery in Jessa Hospital, Belgium. Interventions : An observational survey in Dutch. Measurements : Patient demographics and characteristics, perception of the patient of the expertise, role, and responsibility of the anesthesiologist, knowledge of the patient regarding anesthesia, and patients´ fear of specific risks and side effects of anesthesia and surgery. Associations were analyzed with the Pearson correlation coefficient or the Spearman rank’s correlation coefficient. Main Results : In total 361 patients completed the survey. Patient demographics were as follows : 54.8% males, mean age (± SD) 58,84 ± 16,38 years. Most patients (87.3%) recognized anesthesiologists as specially trained medical doctors but more than 50% underestimated their different perioperative responsibilities. Patients underestimated the dura-tion of education of an anesthesiologist in 84.2%. Their role at the intensive care unit (69.3%), the emergency department (71.2%), and the delivery room (71.2%) were relatively well known. Their role at the chronic pain management clinic (44.8%) and the preoperative anesthesia consultation (40.7%) was less well known. Some patients thought that general anesthesia frequently results in brain damage (22.7%). Older age and lower educational level were associated with lower knowledge. In general, 8.3% of all patients were very anxious about anesthesia, 22.7% somewhat, and 69% not at all. Female gender and lower educational level were positively correlated with a higher risk of fear. : Most patients in this single-center Belgian cohort were aware that anesthesiologists are specialized medical doctors. Overall, the patient´s knowledge of the anesthesiologist’s expertise and responsibilities and anesthesia was rather limited.
{"title":"Perception and knowledge of anesthesia and the role of anesthesiologists : a Belgian single-center cross-sectional survey","authors":"K. Nijs, N. Castelein, L. Salimans, I. Callebaut, I. de Pauw, V. Swinnen, M. Van de Velde, Björn Stessel","doi":"10.56126/72.2.4","DOIUrl":"https://doi.org/10.56126/72.2.4","url":null,"abstract":"Study Objective : To assess the knowledge of anesthesia and the role of anesthesiologists and evaluate the prevalence of concerns of certain risks of anesthesia and surgery in Belgian patients.\u0000Design : Observational mono-center cross-sectional survey.\u0000Setting : Preoperative patients planned for elective surgery in Jessa Hospital, Belgium.\u0000\u0000Interventions : An observational survey in Dutch.\u0000\u0000Measurements : Patient demographics and characteristics, perception of the patient of the expertise, role, and responsibility of the anesthesiologist, knowledge of the patient regarding anesthesia, and patients´ fear of specific risks and side effects of anesthesia and surgery. Associations were analyzed with the Pearson correlation coefficient or the Spearman rank’s correlation coefficient.\u0000\u0000Main Results : In total 361 patients completed the survey. Patient demographics were as follows : 54.8% males, mean age (± SD) 58,84 ± 16,38 years. Most patients (87.3%) recognized anesthesiologists as specially trained medical doctors but more than 50% underestimated their different perioperative responsibilities. Patients underestimated the dura-tion of education of an anesthesiologist in 84.2%. Their role at the intensive care unit (69.3%), the emergency department (71.2%), and the delivery room (71.2%) were relatively well known. Their role at the chronic pain management clinic (44.8%) and the preoperative anesthesia consultation (40.7%) was less well known. Some patients thought that general anesthesia frequently results in brain damage (22.7%). Older age and lower educational level were associated with lower knowledge. In general, 8.3% of all patients were very anxious about anesthesia, 22.7% somewhat, and 69% not at all. Female gender and lower educational level were positively correlated with a higher risk of fear. : Most patients in this single-center Belgian cohort were aware that anesthesiologists are specialized medical doctors. Overall, the patient´s knowledge of the anesthesiologist’s expertise and responsibilities and anesthesia was rather limited.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43736196","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. Cavens, J. Baekelandt, P. Van de Putte, P. D. De Mulder
We describe the first case of a vaginal NOTES total hysterectomy under spinal anesthesia in the head- down position without sedation or additive analgesia in a patient with end-stage COPD. This report adds to the growing evidence that neuraxial techniques are a good alternative for general anesthesia in select cases for laparoscopic surgery.
{"title":"Spinal anaesthesia for a NOTES (Natural Orifice Transluminal Endoscopic Surgery) total hysterectomy in a pre-lung transplant patient : a case report","authors":"L. Cavens, J. Baekelandt, P. Van de Putte, P. D. De Mulder","doi":"10.56126/72.1.6","DOIUrl":"https://doi.org/10.56126/72.1.6","url":null,"abstract":"We describe the first case of a vaginal NOTES total hysterectomy under spinal anesthesia in the head- down position without sedation or additive analgesia in a patient with end-stage COPD. This report adds to the growing evidence that neuraxial techniques are a good alternative for general anesthesia in select cases for laparoscopic surgery.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48150013","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}
G. Minguet, T. Franck, E. Cavalier, C. Daniel, D. Serteyn, J. Brichant, J. Joris
Background : During orthopedic surgery, the use of a pneumatic tourniquet results in side effects secondary to ischemia-reperfusion phenomena. We tested the hypothesis that total knee arthroplasty with a tourniquet is associated with increase in plasma concentrations of biomarkers of neutrophil activation and endothelial injury. The second aim was to compare these changes during spinal or general inhalational anesthesia. Methods : 40 adult ASA I-II patients scheduled for total knee arthroplasty with a tourniquet under spinal or sevoflurane anesthesia were included. Venous blood samples were collected before surgery, 1 h, 3 h, and 24 h after tourniquet deflation. To assess neutrophil activation, plasma concentrations of total and active fractions of myeloperoxidase, as well as elastase concentrations and proteolytic activity were measured. Endothelial injury was assessed by measurement of plasma concentrations of syndecan-1, soluble thrombomodulin, soluble E-selectin, and vascular endothelial growth factor. Results were analyzed with a two-way analysis of variance. P< 0.05 was considered statistically significant. Results : Plasma concentrations of active but not total myeloperoxidase and elastase significantly increased following tourniquet deflation. The level of syndecan-1, soluble thrombomodulin, soluble E-selectin, but not vascular endothelial growth factor, significantly decreased postoperatively. These changes of biomarkers were similar during spinal and sevoflurane anesthesia. Conclusions : Total knee arthroplasty with pneumatic tourniquet is associated with systemic release of markers of neutrophil activation which was comparable during spinal or sevoflurane anesthesia. Systemic expression of endothelial injury was not detected in our clinical conditions.
{"title":"A preliminary study to assess neutrophil and endothelial response to knee arthroplasty with the use of a tourniquet : effects of spinal or sevoflurane anesthesia","authors":"G. Minguet, T. Franck, E. Cavalier, C. Daniel, D. Serteyn, J. Brichant, J. Joris","doi":"10.56126/72.1.2","DOIUrl":"https://doi.org/10.56126/72.1.2","url":null,"abstract":"Background : During orthopedic surgery, the use of a pneumatic tourniquet results in side effects secondary to ischemia-reperfusion phenomena. We tested the hypothesis that total knee arthroplasty with a tourniquet is associated with increase in plasma concentrations of biomarkers of neutrophil activation and endothelial injury. The second aim was to compare these changes during spinal or general inhalational anesthesia.\u0000\u0000Methods : 40 adult ASA I-II patients scheduled for total knee arthroplasty with a tourniquet under spinal or sevoflurane anesthesia were included. Venous blood samples were collected before surgery, 1 h, 3 h, and 24 h after tourniquet deflation. To assess neutrophil activation, plasma concentrations of total and active fractions of myeloperoxidase, as well as elastase concentrations and proteolytic activity were measured. Endothelial injury was assessed by measurement of plasma concentrations of syndecan-1, soluble thrombomodulin, soluble E-selectin, and vascular endothelial growth factor. Results were analyzed with a two-way analysis of variance. P< 0.05 was considered statistically significant.\u0000\u0000Results : Plasma concentrations of active but not total myeloperoxidase and elastase significantly increased following tourniquet deflation. The level of syndecan-1, soluble thrombomodulin, soluble E-selectin, but not vascular endothelial growth factor, significantly decreased postoperatively. These changes of biomarkers were similar during spinal and sevoflurane anesthesia.\u0000\u0000Conclusions : Total knee arthroplasty with pneumatic tourniquet is associated with systemic release of markers of neutrophil activation which was comparable during spinal or sevoflurane anesthesia. Systemic expression of endothelial injury was not detected in our clinical conditions.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44672484","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}
H. Jabbour, M. Abou Haidar, K. Jabbour, A. Abi Lutfallah, H. Abou Zeid, I. Ghanem, N. Naccache, E. Ayoub
Background : Pulse pressure variation (PPV) is a predictor of fluid responsiveness in supine patients under mechanical ventilation. Its use has also been validated in the prone position. The aim of this study was to assess changes in PPV induced by prone position in patients undergoing spinal surgery. Methods : Ninety-six patients aged 12 to 75 years, scheduled for elective spinal surgery were included. Patients were excluded if they had clinical signs related to any organ failure, or if they required vasoactive drugs and/or volume expansion during the early stages of anesthesia. Patients received a standardized anesthesia protocol. Fluid expansion was not allowed from induction until 10 minutes after positioning. Hemodynamic measurements recorded before the induction of anesthesia (T0) included : arterial pressure (systolic (SAP) diastolic (DAP) and mean (MAP)) and heart rate (HR). Radial artery was cannulated after intubation and measurements, as well as PPV, were noted in supine position (T1). Patients were then placed in prone position hemodynamics and PPV measurements were repeated (T2). Results : Forty-eight patients completed the study. Anesthesia induction induced a significant decrease in SAP, DAP, and MAP with no effect on HR. Prone position did not induce any significant changes in SAP, MAP, DAP, and HR. A significant difference was found between PPV values in supine (Mean=10.5, SD=4.5) and prone positions (Mean=15.2, SD=7.1) ; t=-4.15 (p<0.001). The mean increase in PPV was 4.7%. Conclusion : Prone position without prior volume expansion induces a significant increase in PPV prior to any modification in arterial blood pressure and heart rate.
{"title":"Effect of prone position without volume expansion on pulse pressure variation in spinal surgery : a prospective observational study","authors":"H. Jabbour, M. Abou Haidar, K. Jabbour, A. Abi Lutfallah, H. Abou Zeid, I. Ghanem, N. Naccache, E. Ayoub","doi":"10.56126/72.1.3","DOIUrl":"https://doi.org/10.56126/72.1.3","url":null,"abstract":"Background : Pulse pressure variation (PPV) is a predictor of fluid responsiveness in supine patients under mechanical ventilation. Its use has also been validated in the prone position. The aim of this study was to assess changes in PPV induced by prone position in patients undergoing spinal surgery.\u0000\u0000Methods : Ninety-six patients aged 12 to 75 years, scheduled for elective spinal surgery were included. Patients were excluded if they had clinical signs related to any organ failure, or if they required vasoactive drugs and/or volume expansion during the early stages of anesthesia. Patients received a standardized anesthesia protocol. Fluid expansion was not allowed from induction until 10 minutes after positioning. Hemodynamic measurements recorded before the induction of anesthesia (T0) included : arterial pressure (systolic (SAP) diastolic (DAP) and mean (MAP)) and heart rate (HR). Radial artery was cannulated after intubation and measurements, as well as PPV, were noted in supine position (T1). Patients were then placed in prone position hemodynamics and PPV measurements were repeated (T2).\u0000\u0000Results : Forty-eight patients completed the study. Anesthesia induction induced a significant decrease in SAP, DAP, and MAP with no effect on HR. Prone position did not induce any significant changes in SAP, MAP, DAP, and HR. A significant difference was found between PPV values in supine (Mean=10.5, SD=4.5) and prone positions (Mean=15.2, SD=7.1) ; t=-4.15 (p<0.001). The mean increase in PPV was 4.7%.\u0000\u0000Conclusion : Prone position without prior volume expansion induces a significant increase in PPV prior to any modification in arterial blood pressure and heart rate.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45835585","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. Wolfskeil, Y. Devriendt, A. Dumoulin, P. Lormans
We present the case of a 65-year-old patient who was admitted to the intensive care unit (ICU) due to Covid-19 respiratory failure. During his hospital stay, he developed a spontaneous pneumomediastinum (SP). To date, there have been few reports of SP associated with Covid-19 and even less is known about the impact of positive pressure ventilation on these patients. Our patient was first treated with high-flow nasal cannula oxygen therapy (HFNC). Because of further respiratory deterioration, he was supported with non-invasive ventilation (NIV). Later, he required intubation and ventilation with invasive positive pressure ventilation. Despite this, a complete spontaneous resolution of the pneumomediastinum was observed 13 days after the initial diagnosis.
{"title":"Spontaneous pneumomediastinum in Covid-19 : a case of complete resolution despite invasive positive pressure ventilation","authors":"M. Wolfskeil, Y. Devriendt, A. Dumoulin, P. Lormans","doi":"10.56126/72.1.5","DOIUrl":"https://doi.org/10.56126/72.1.5","url":null,"abstract":"We present the case of a 65-year-old patient who was admitted to the intensive care unit (ICU) due to Covid-19 respiratory failure. During his hospital stay, he developed a spontaneous pneumomediastinum (SP). To date, there have been few reports of SP associated with Covid-19 and even less is known about the impact of positive pressure ventilation on these patients.\u0000\u0000Our patient was first treated with high-flow nasal cannula oxygen therapy (HFNC). Because of further respiratory deterioration, he was supported with non-invasive ventilation (NIV). Later, he required intubation and ventilation with invasive positive pressure ventilation. Despite this, a complete spontaneous resolution of the pneumomediastinum was observed 13 days after the initial diagnosis.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48811792","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 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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}
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