L. De Schrijver, L. Sermeus, S. Maes, H. Camerlynck, S. Morrison
Background : Virtual reality hypnosis is a combination of visual immersion in a virtual reality environment and clinical hypnosis. It can be used in addition to conventional techniques, for sedation and pain management during wound care. Patients undergoing painful and long-lasting procedures under regional anesthesia could also benefit, from this technique alleviating the need for sedative-hypnotic medication. Case presentation : Two patients with relative contra- indications for general anesthesia underwent lengthy orthopedic surgery of the upper limbs under regional anesthesia with additional virtual reality hypnosis. Written informed consent was obtained from both patients before surgery. A 69-year-old man, with a previous medical history of severe symptomatic aortic valve stenosis (ѳ 0.69cm2, max/mean gradient of 91/58mmHg) sustained a proximal humerus fracture-dislocation and was scheduled to undergo shoulder hemi-arthroplasty. Anesthesia was provided with ultrasound-guided continuous interscalene block at the C5-C6 level (11mL levobupivacaine 0.5%) combined with a single-shot superficial cervical plexus block (6mL levobupivacaine 0.5%). The second case was a 56-year-old man suffering from rheumatoid arthritis with severe restrictive lung function due to interstitial lung disease and bilateral bronchiectasis. He received a unilateral elbow prosthesis. Continuous infra-clavicular brachial plexus block, per- formed under ultrasound guidance was provided (20 mL mepivacaine 1.5%). Both patients required prolonged immobilization on the operating table. We used virtual reality hypnosis to induce sedation and improve comfort without using medication. This was provided by headphones and head-mounted goggles, showing computer generated images of underwater scenes (Aqua module, Oncomfort ™). Both surgeries were uneventful during which time cardiorespiratory stability was maintained. Patients were comfortable during and satisfied after surgery. No sedative drugs were given before nor during the procedures. Conclusion : Non-pharmacological sedation can be achieved with virtual reality hypnosis. When com- bined with regional anesthesia, this technique provides satisfactory sedation when pharmacological methods may be hazardous.
{"title":"Regional anesthesia combined with virtual reality hypnosis for extended orthopedic surgery: two case reports","authors":"L. De Schrijver, L. Sermeus, S. Maes, H. Camerlynck, S. Morrison","doi":"10.56126/71.3.8","DOIUrl":"https://doi.org/10.56126/71.3.8","url":null,"abstract":"Background : Virtual reality hypnosis is a combination of visual immersion in a virtual reality environment and clinical hypnosis. It can be used in addition to conventional techniques, for sedation and pain management during wound care. Patients undergoing painful and long-lasting procedures under regional anesthesia could also benefit, from this technique alleviating the need for sedative-hypnotic medication.\u0000\u0000Case presentation : Two patients with relative contra- indications for general anesthesia underwent lengthy orthopedic surgery of the upper limbs under regional anesthesia with additional virtual reality hypnosis. Written informed consent was obtained from both patients before surgery. A 69-year-old man, with a previous medical history of severe symptomatic aortic valve stenosis (ѳ 0.69cm2, max/mean gradient of 91/58mmHg) sustained a proximal humerus fracture-dislocation and was scheduled to undergo shoulder hemi-arthroplasty. Anesthesia was provided with ultrasound-guided continuous interscalene block at the C5-C6 level (11mL levobupivacaine 0.5%) combined with a single-shot superficial cervical plexus block (6mL levobupivacaine 0.5%). The second case was a 56-year-old man suffering from rheumatoid arthritis with severe restrictive lung function due to interstitial lung disease and bilateral bronchiectasis. He received a unilateral elbow prosthesis.\u0000\u0000Continuous infra-clavicular brachial plexus block, per- formed under ultrasound guidance was provided (20 mL mepivacaine 1.5%). Both patients required prolonged immobilization on the operating table. We used virtual reality hypnosis to induce sedation and improve comfort without using medication. This was provided by headphones and head-mounted goggles, showing computer generated images of underwater scenes (Aqua module, Oncomfort ™). Both surgeries were uneventful during which time cardiorespiratory stability was maintained. Patients were comfortable during and satisfied after surgery. No sedative drugs were given before nor during the procedures.\u0000\u0000Conclusion : Non-pharmacological sedation can be achieved with virtual reality hypnosis. When com- bined with regional anesthesia, this technique provides satisfactory sedation when pharmacological methods may be hazardous.","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":"41605004","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. Chawla, A. Harrocks, P. Casey, E. McLellan, V. Eley
Background : Anaphylaxis is a life-threatening emergency that requires prompt recognition and institution of life-saving therapy. Perioperative Anaphylaxis Management Guidelines have been developed by the Australian and New Zealand College of Anaesthetists and Australian and New Zealand Anaesthetic Allergy Group and anesthetic societies worldwide to facilitate diagnosis and management of this rare, but severe complication. Objectives : To perform a cross-sectional survey of the anesthetists’ experience of perioperative anaphylaxis at a single centre and its effect on their practice. Design : Survey questionnaire constructed in Survey Monkey® and sent via e-mail link to all anesthetists. This questionnaire included qualitative and quantitative questions. Setting : Royal Brisbane and Women’s Hospital, a tertiary referral hospital in Queensland. Methods : Anesthetic specialists and provisional fellows at The Royal Brisbane and Women’s Hospital were surveyed using an online platform regarding their experiences of managing anaphylaxis, referral for testing, formal incident reporting and knowledge of existing departmental protocol. We also asked if their experience of anaphylaxis modified their clinical practice. Results : Forty-five out of 102 (44%) of the specialists and provisional fellows surveyed responded. Of these, 17 (38%) had been involved as primary anesthetist and 20 (44.5%) indirectly in at least one suspected case of perioperative anaphylaxis in the past 12-months. Most anesthetists were aware of the resources available in this crisis and appropriate referral for testing had occurred. There was poor local and national reporting of anaphylaxis as a critical incident. Conclusion : A large percentage of the anesthetists surveyed had seen a case of perioperative anaphylaxis in the past year. Managing this life-threatening event has led to practice change for many anesthetists. There is a requirement for further education around incident reporting.
{"title":"A survey of anesthetists’ experience and perspectives of perioperative anaphylaxis at an Australian tertiary hospital","authors":"G. Chawla, A. Harrocks, P. Casey, E. McLellan, V. Eley","doi":"10.56126/71.3.5","DOIUrl":"https://doi.org/10.56126/71.3.5","url":null,"abstract":"Background : Anaphylaxis is a life-threatening emergency that requires prompt recognition and institution of life-saving therapy. Perioperative Anaphylaxis Management Guidelines have been developed by the Australian and New Zealand College of Anaesthetists and Australian and New Zealand Anaesthetic Allergy Group and anesthetic societies worldwide to facilitate diagnosis and management of this rare, but severe complication.\u0000\u0000Objectives : To perform a cross-sectional survey of the anesthetists’ experience of perioperative anaphylaxis at a single centre and its effect on their practice.\u0000\u0000Design : Survey questionnaire constructed in Survey Monkey® and sent via e-mail link to all anesthetists. This questionnaire included qualitative and quantitative questions.\u0000\u0000Setting : Royal Brisbane and Women’s Hospital, a tertiary referral hospital in Queensland.\u0000\u0000Methods : Anesthetic specialists and provisional fellows at The Royal Brisbane and Women’s Hospital were surveyed using an online platform regarding their experiences of managing anaphylaxis, referral for testing, formal incident reporting and knowledge of existing departmental protocol. We also asked if their experience of anaphylaxis modified their clinical practice.\u0000\u0000Results : Forty-five out of 102 (44%) of the specialists and provisional fellows surveyed responded. Of these, 17 (38%) had been involved as primary anesthetist and 20 (44.5%) indirectly in at least one suspected case of perioperative anaphylaxis in the past 12-months. Most anesthetists were aware of the resources available in this crisis and appropriate referral for testing had occurred. There was poor local and national reporting of anaphylaxis as a critical incident.\u0000\u0000Conclusion : A large percentage of the anesthetists surveyed had seen a case of perioperative anaphylaxis in the past year. Managing this life-threatening event has led to practice change for many anesthetists. There is a requirement for further education around incident reporting.","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":"44391430","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}
E., SEEt, C., Saw Jiayu, M. K., LEong, M. C., KuMar
Last September 14, 2020, Professor Pol Hans (Figure) passed away after a long disease. We, the authors of this letter, had the privilege of professionally running alongside him for several years, and want here to underline his tremendous contribution to the anesthesia and intensive care specialty, in Belgium and outside Belgium. Professor Hans was not only an excellent clinician, always attentive to the needs and safety of patients, an excellent scientist, but also a rare teacher for youngers, and a real mentor for a lot of us. In this short synopsis, we would like to retrace his career, his accomplishments, and depict the extraordinary colleague and friend he was. This is the least we can do to honor his memory. We will honestly do this with our own perception of the character, and might therefore miss some elements of his personality. We apologize in advance for any undesirable omission. Pol Hans was born in 1949. He graduated as a Medical Doctor at the University of Liege in 1975, and was immediately selected by Professor Marcel Hanquet to start a residency in anesthesiology and resuscitation. He obtained his specialist degree in 1979, and rapidly became one of the most faithful and brilliant collaborator of the Department of Anesthesia and Intensive Care Medicine of the Liege University Hospital, first exerting his clinical activity in the ‘Baviere’ Hospital, thereafter moving to the ‘Citadelle’ Regional Hospital until his retirement in 2011. He also practiced anesthesiology at the ‘André Renard’ Clinic, where he was the Head of the Anesthesia and Intensive Care Medicine Department. From the beginning, his main clinical focus of interest was the perioperative and anesthetic management of neurosurgical patients. He was among the pioneers in this domain, and he contributed a lot to its development in Belgium and abroad. His reputation was based on prolific clinical and basic research, which led to a PhD in 1983 and a total of more than 180 papers in national and international peer-reviewed journals, as well as 19 book chapters. His reputation was also sustained by his involvement in scientific societies such as the European Society of Anesthesiology, the ‘Association de Neuroanesthésie-Réanimation de Langue Française’, and the Society for Neuroscience in Anesthesia and Critical Care, and on innumerable invited conferences all over the (Acta Anaesth. Belg., 2020, 71, 105-106)
{"title":"Feasibility of novel smartphone app-based pulse oximetry system compared with proprietary level 4 home sleep testing device for obstructive sleep apnea detection","authors":"E., SEEt, C., Saw Jiayu, M. K., LEong, M. C., KuMar","doi":"10.56126/71.3.2","DOIUrl":"https://doi.org/10.56126/71.3.2","url":null,"abstract":"Last September 14, 2020, Professor Pol Hans (Figure) passed away after a long disease. We, the authors of this letter, had the privilege of professionally running alongside him for several years, and want here to underline his tremendous contribution to the anesthesia and intensive care specialty, in Belgium and outside Belgium. Professor Hans was not only an excellent clinician, always attentive to the needs and safety of patients, an excellent scientist, but also a rare teacher for youngers, and a real mentor for a lot of us. In this short synopsis, we would like to retrace his career, his accomplishments, and depict the extraordinary colleague and friend he was. This is the least we can do to honor his memory. We will honestly do this with our own perception of the character, and might therefore miss some elements of his personality. We apologize in advance for any undesirable omission. Pol Hans was born in 1949. He graduated as a Medical Doctor at the University of Liege in 1975, and was immediately selected by Professor Marcel Hanquet to start a residency in anesthesiology and resuscitation. He obtained his specialist degree in 1979, and rapidly became one of the most faithful and brilliant collaborator of the Department of Anesthesia and Intensive Care Medicine of the Liege University Hospital, first exerting his clinical activity in the ‘Baviere’ Hospital, thereafter moving to the ‘Citadelle’ Regional Hospital until his retirement in 2011. He also practiced anesthesiology at the ‘André Renard’ Clinic, where he was the Head of the Anesthesia and Intensive Care Medicine Department. From the beginning, his main clinical focus of interest was the perioperative and anesthetic management of neurosurgical patients. He was among the pioneers in this domain, and he contributed a lot to its development in Belgium and abroad. His reputation was based on prolific clinical and basic research, which led to a PhD in 1983 and a total of more than 180 papers in national and international peer-reviewed journals, as well as 19 book chapters. His reputation was also sustained by his involvement in scientific societies such as the European Society of Anesthesiology, the ‘Association de Neuroanesthésie-Réanimation de Langue Française’, and the Society for Neuroscience in Anesthesia and Critical Care, and on innumerable invited conferences all over the (Acta Anaesth. Belg., 2020, 71, 105-106)","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":"47214521","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. Casaer, T. Sebrechts, P. Van Houwe, W. Rattenberry
During the COVID-19 pandemic, multiple guidelines have been issued on hospital safety and protection measures to prevent transmission to healthcare workers and to other patients. The operating room is a high-risk environment where enhanced precautions are required. The guidelines differ and practical implementation between hospitals can also vary, according to interpretation and budget. Staff at risk may question if the local policies are sufficient and correct. This article provides an overview and theoretical background to the additional safety measures required in the operating room during a viral pandemic like the COVID-19 pandemic. This may serve as a touchstone and tool for anesthetists and OR managers.
{"title":"Organizing a safe operating room during a pandemic. What did we learn from COVID-19?","authors":"S. Casaer, T. Sebrechts, P. Van Houwe, W. Rattenberry","doi":"10.56126/71.3.3","DOIUrl":"https://doi.org/10.56126/71.3.3","url":null,"abstract":"During the COVID-19 pandemic, multiple guidelines have been issued on hospital safety and protection measures to prevent transmission to healthcare workers and to other patients. The operating room is a high-risk environment where enhanced precautions are required. The guidelines differ and practical implementation between hospitals can also vary, according to interpretation and budget. Staff at risk may question if the local policies are sufficient and correct. This article provides an overview and theoretical background to the additional safety measures required in the operating room during a viral pandemic like the COVID-19 pandemic. This may serve as a touchstone and tool for anesthetists and OR managers.","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":"42488915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A dedication to neuroanesthesia, research, and mentorship","authors":"V. Bonhomme, C. Franssen, M. Lamy","doi":"10.56126/71.3.1","DOIUrl":"https://doi.org/10.56126/71.3.1","url":null,"abstract":"","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":"49489861","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. Desmet, S. Bindelle, M. Breebaart, H. Camerlynck, S. Casaer, K. Fourneau, P. Gautier, P. Goffin, J. Lecoq, I. Lenders, I. Leunen, D. Van Aken, P. Van Houwe, S. Van Hooreweghe, K. Vermeylen, I. Sermeus
The Peripheral Nerve Block working group of the Belgian Association for Regional Anesthesia has revised and updated the “Clinical guidelines for the practice of peripheral nerve block in the adult” which were published in 2013.
比利时区域麻醉协会的周围神经阻滞工作组修订并更新了2013年发布的“成人周围神经阻滞临床指南”。
{"title":"Guidelines for the safe clinical practice of peripheral nerve blocks in the adult patient","authors":"M. Desmet, S. Bindelle, M. Breebaart, H. Camerlynck, S. Casaer, K. Fourneau, P. Gautier, P. Goffin, J. Lecoq, I. Lenders, I. Leunen, D. Van Aken, P. Van Houwe, S. Van Hooreweghe, K. Vermeylen, I. Sermeus","doi":"10.56126/71.3.9","DOIUrl":"https://doi.org/10.56126/71.3.9","url":null,"abstract":"The Peripheral Nerve Block working group of the Belgian Association for Regional Anesthesia has revised and updated the “Clinical guidelines for the practice of peripheral nerve block in the adult” which were published in 2013.","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":"41578810","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}
Pub Date : 2020-07-30DOI: 10.21203/rs.3.rs-50910/v1
Twan Aalbers, S. Heuvel, E. Bronkhorst, A. V. Esch, G. Scheffer, M. Vaneker
Background: Procedural sedation and analgesia (PSA) is used during colonoscopy to facilitate the procedure and relieve patient’s discomfort. The foremost risk of PSA is respiratory depression. Lidocaine could be a promising additional analgesic in IBD patients to minimise side effects of PSA.Our primary objective was to investigate whether i.v. lidocaine reduces the amount of alfentanil used during PSA in IBD patients. Additionally, we investigated whether lidocaine reduces cardiorespiratory incidents and the amount of propofol required during the procedure.Methods: A randomised, double-blind, placebo controlled study was performed at the endoscopy unit of the Radboud University Medical Centre from November 2016 to December 2018. Seventy-six patients with IBD, ASA 1 or 2, between 18 and 65 years, scheduled for colonoscopy with PSA were included. Patients received lidocaine 1.5 mg kg-1 followed by a continuous infusion of 2 mg kg-1 h-1 (intervention group, n=38) or 0.9% saline in equivalent volumes (control group, n=38) during colonoscopy.Results: There was a reduction in the use of alfentanil (327µg (95%CI=-31-505, p=0.082)), and propofol (39 mg (95%CI=-5-83, p=0.083)) in the lidocaine group compared with the control group. Ten patients (26%) in the control group and 8 patients in the lidocaine group (21%) experienced a period of hypoxia (p=0.788). In both groups, no periods of hypotension were noted.Conclusion: Our investigation has shown a reduction in the use of propofol and alfentanil in patients undergoing colonoscopy with PSA. The differences were not statistically significant. Lidocaine did not reduces the incidence of cardiorespiratory events.Trial registration:EudraCT, 2016-002210-46, registered 19 may 2016,https://www.clinicaltrialsregister.eu/ctr-search/trial/2016-002210-46/resultsISRCTN, ISRCTN47787339, retrospectively registered 6 February 2019, http://www.isrctn.com/ISRCTN47787339
{"title":"Effects of Intravenous Lidocaine on Alfentanil Consumption During Procedural Sedation for Colonoscopy in Patients With Inflammatory Bowel Disease: a Randomized Controlled Trial","authors":"Twan Aalbers, S. Heuvel, E. Bronkhorst, A. V. Esch, G. Scheffer, M. Vaneker","doi":"10.21203/rs.3.rs-50910/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-50910/v1","url":null,"abstract":"\u0000 Background: Procedural sedation and analgesia (PSA) is used during colonoscopy to facilitate the procedure and relieve patient’s discomfort. The foremost risk of PSA is respiratory depression. Lidocaine could be a promising additional analgesic in IBD patients to minimise side effects of PSA.Our primary objective was to investigate whether i.v. lidocaine reduces the amount of alfentanil used during PSA in IBD patients. Additionally, we investigated whether lidocaine reduces cardiorespiratory incidents and the amount of propofol required during the procedure.Methods: A randomised, double-blind, placebo controlled study was performed at the endoscopy unit of the Radboud University Medical Centre from November 2016 to December 2018. Seventy-six patients with IBD, ASA 1 or 2, between 18 and 65 years, scheduled for colonoscopy with PSA were included. Patients received lidocaine 1.5 mg kg-1 followed by a continuous infusion of 2 mg kg-1 h-1 (intervention group, n=38) or 0.9% saline in equivalent volumes (control group, n=38) during colonoscopy.Results: There was a reduction in the use of alfentanil (327µg (95%CI=-31-505, p=0.082)), and propofol (39 mg (95%CI=-5-83, p=0.083)) in the lidocaine group compared with the control group. Ten patients (26%) in the control group and 8 patients in the lidocaine group (21%) experienced a period of hypoxia (p=0.788). In both groups, no periods of hypotension were noted.Conclusion: Our investigation has shown a reduction in the use of propofol and alfentanil in patients undergoing colonoscopy with PSA. The differences were not statistically significant. Lidocaine did not reduces the incidence of cardiorespiratory events.Trial registration:EudraCT, 2016-002210-46, registered 19 may 2016,https://www.clinicaltrialsregister.eu/ctr-search/trial/2016-002210-46/resultsISRCTN, ISRCTN47787339, retrospectively registered 6 February 2019, http://www.isrctn.com/ISRCTN47787339","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44423243","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}
Transanal total mesorectal excision (TaTME), a new approach for rectal cancers, requires transanal carbon dioxide (CO2) high-flow insufflation to create a workplace. Two patients scheduled for TaTME experienced CO2 embolism during the anterior mesorectal dissection in contact with the prostate. CO2 embolism resulted in a sudden drop of end-tidal CO2, preceded by a short increase in one patient, and in oxygen desaturation. Hemodynamic alterations were minor. We report these two cases and discuss the pathophysiology of CO2 embolism and risk factors that promote CO2 embolism during TaTME to warn anesthetists of this serious complication, often unexpected and misdiagnosed.
{"title":"Carbon dioxide embolism during transanal total mesorectal excision (TaTME): two case reports","authors":"O. Lempereur, E. Decker, J. Joris","doi":"10.56126/71.2.8","DOIUrl":"https://doi.org/10.56126/71.2.8","url":null,"abstract":"Transanal total mesorectal excision (TaTME), a new approach for rectal cancers, requires transanal carbon dioxide (CO2) high-flow insufflation to create a workplace. Two patients scheduled for TaTME experienced CO2 embolism during the anterior mesorectal dissection in contact with the prostate. CO2 embolism resulted in a sudden drop of end-tidal CO2, preceded by a short increase in one patient, and in oxygen desaturation. Hemodynamic alterations were minor. We report these two cases and discuss the pathophysiology of CO2 embolism and risk factors that promote CO2 embolism during TaTME to warn anesthetists of this serious complication, often unexpected and misdiagnosed.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42164406","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. Kapoor, T. Salwan, S. Garg, Anisha Puri, V. Gupta
Background: Inappropriate endotracheal tube placement depth may be associated with complications. Objective: To determine whether the accurate alignment of the indicator ring on the endotracheal tube at the level of the vocal cords, results in its appropriate placement. Design: Prospective observational study. Patients: 98 adult patients scheduled for general anesthesia with orotracheal intubation. Interventions: The indicator band mark on the endotracheal tube was accurately placed at the vocal cords level under video-laryngoscope view. The tube length at the right upper incisor and the distance between its tip and the carina was measured using fibreoptic bronchoscope. Data to validate methods to predict insertion depth was collected and evaluated. Main Outcome: To determine the distance between the tip of the endotracheal tube and the carina. Results: The endotracheal tube tip depth was inap- propriate in 46.94% cases and was <3 cm above the carina in 41.64% cases. This difference in this distance was similar (p = 0.246) in the two genders. A correlation was noted between topographic length and insertion depth in females only (r2 = 0.201 and p = 0.001). The mean tracheal length was 12.66 + 1.35 cm in males and 12.04 + 1.26 cm in females. Conclusion: We found a high incidence of endo- tracheal tube tip malposition despite the accurate placement of the indicator band at the vocal cords level. We suggest that international endotracheal tube design standards be defined and endotracheal tube manufacturers modify the standard intratracheal length.
{"title":"An observational study to determine whether alignment of endotracheal tube indicator line with the vocal cords results in appropriate depth of intubation","authors":"M. Kapoor, T. Salwan, S. Garg, Anisha Puri, V. Gupta","doi":"10.56126/71.2.5","DOIUrl":"https://doi.org/10.56126/71.2.5","url":null,"abstract":"Background: Inappropriate endotracheal tube placement depth may be associated with complications.\u0000\u0000Objective: To determine whether the accurate alignment of the indicator ring on the endotracheal tube at the level of the vocal cords, results in its appropriate placement.\u0000\u0000Design: Prospective observational study.\u0000\u0000Patients: 98 adult patients scheduled for general anesthesia with orotracheal intubation.\u0000\u0000Interventions: The indicator band mark on the endotracheal tube was accurately placed at the vocal cords level under video-laryngoscope view. The tube length at the right upper incisor and the distance between its tip and the carina was measured using fibreoptic bronchoscope. Data to validate methods to predict insertion depth was collected and evaluated.\u0000\u0000Main Outcome: To determine the distance between the tip of the endotracheal tube and the carina.\u0000\u0000Results: The endotracheal tube tip depth was inap- propriate in 46.94% cases and was <3 cm above the carina in 41.64% cases. This difference in this distance was similar (p = 0.246) in the two genders. A correlation was noted between topographic length and insertion depth in females only (r2 = 0.201 and p = 0.001). The mean tracheal length was 12.66 + 1.35 cm in males and 12.04 + 1.26 cm in females.\u0000\u0000Conclusion: We found a high incidence of endo- tracheal tube tip malposition despite the accurate placement of the indicator band at the vocal cords level. We suggest that international endotracheal tube design standards be defined and endotracheal tube manufacturers modify the standard intratracheal length.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43252761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Foubert, S. Devroe, L. Foubert, M. Van de Velde, S. Rex
Background: Exposure to general anesthesia (GA) in early life is known to be neurotoxic to animals. Objectives: To evaluate the risk of GA inducing long-term neurodevelopmental deficits in human children. Design: Systematic review. Methods: We included observational and randomized studies that compared the long-term neurodevelopment of postnatal children exposed to GA to the long-term neurodevelopment of children not exposed to GA. We searched MEDLINE, Embase and Web of Science for relevant studies published in the year 2000 or later. We screened all the identified studies on predetermined inclusion and exclusion criteria. A risk of bias assessment was made for each included study. We identified 9 neurodevelopmental domains for which a sub-analysis was made: intelligence; memory; learning; language/speech; motor function; visuospatial skills; development/emotions/behavior; ADHD/attention; autistic disorder. Results: We included 26 studies involving 605.391 participants. Based on AHRQ-standards 11 studies were of poor quality, 7 studies were of fair quality and 8 studies were of good quality. The major causes of potential bias were selection and comparability bias. On 2 neurodevelopmental domains (visuospatial skills and autistic disorder), the available evidence showed no association with exposure to GA. On 7 other neurodevelopmental domains, the available evidence showed mixed results. The 4 studies that used a randomized or sibling-controlled design showed no association between GA and neurodevelopmental deficits in their primary endpoints. Limitations: The absence of a meta-analysis and funnel plot. Conclusions: Based on observational studies, we found an association between GA in childhood and neuro-developmental deficits in later life. Randomized and sibling-matched observational studies failed to show the same association and therefore no evidence of a causal relationship exists at present. Since GA seems to be a marker, but not a cause of worse neurodevelopment, we argue against delaying or avoiding interventional or diagnostic procedures requiring GA in childhood based on the argument of GA-induced neurotoxicity.
背景：众所周知，早期全身麻醉对动物具有神经毒性。目的：评估GA诱导人类儿童长期神经发育缺陷的风险。设计：系统审查。方法：我们纳入了观察性和随机研究，比较了暴露于GA的出生后儿童的长期神经发育与未暴露于GA儿童的长期神经元发育。我们在MEDLINE、Embase和Web of Science上搜索了2000年或更晚发表的相关研究。我们根据预先确定的纳入和排除标准筛选了所有已确定的研究。对每项纳入的研究进行偏倚风险评估。我们确定了9个神经发育领域，并对其进行了子分析：智力；记忆力学习语言/言语；运动功能；视觉空间技能；发展/情绪/行为；ADHD/注意力；自闭症。结果：我们纳入了26项研究，涉及605.391名参与者。根据AHRQ标准，11项研究质量较差，7项研究质量尚可，8项研究质量良好。潜在偏差的主要原因是选择和可比性偏差。在2个神经发育领域（视觉空间技能和自闭症），现有证据显示与GA暴露无关。在其他7个神经发育方面，现有证据表明结果喜忧参半。使用随机或兄弟姐妹对照设计的4项研究显示，GA与主要终点的神经发育缺陷之间没有关联。局限性：缺乏荟萃分析和漏斗图。结论：基于观察性研究，我们发现儿童期GA与晚年神经发育缺陷之间存在关联。随机和兄弟姐妹匹配的观察性研究未能显示出相同的关联，因此目前没有证据表明存在因果关系。由于GA似乎是一种标志物，但不是神经发育恶化的原因，我们反对基于GA诱导的神经毒性的论点，推迟或避免儿童期需要GA的介入或诊断程序。
{"title":"Anesthetic neurotoxicity in the pediatric population: a systematic review of the clinical evidence","authors":"R. Foubert, S. Devroe, L. Foubert, M. Van de Velde, S. Rex","doi":"10.56126/71.2.2","DOIUrl":"https://doi.org/10.56126/71.2.2","url":null,"abstract":"Background: Exposure to general anesthesia (GA) in early life is known to be neurotoxic to animals.\u0000\u0000Objectives: To evaluate the risk of GA inducing long-term neurodevelopmental deficits in human children.\u0000\u0000Design: Systematic review.\u0000\u0000Methods: We included observational and randomized studies that compared the long-term neurodevelopment of postnatal children exposed to GA to the long-term neurodevelopment of children not exposed to GA. We searched MEDLINE, Embase and Web of Science for relevant studies published in the year 2000 or later. We screened all the identified studies on predetermined inclusion and exclusion criteria. A risk of bias assessment was made for each included study. We identified 9 neurodevelopmental domains for which a sub-analysis was made: intelligence; memory; learning; language/speech; motor function; visuospatial skills; development/emotions/behavior; ADHD/attention; autistic disorder.\u0000\u0000Results: We included 26 studies involving 605.391 participants. Based on AHRQ-standards 11 studies were of poor quality, 7 studies were of fair quality and 8 studies were of good quality. The major causes of potential bias were selection and comparability bias. On 2 neurodevelopmental domains (visuospatial skills and autistic disorder), the available evidence showed no association with exposure to GA. On 7 other neurodevelopmental domains, the available evidence showed mixed results. The 4 studies that used a randomized or sibling-controlled design showed no association between GA and neurodevelopmental deficits in their primary endpoints.\u0000\u0000Limitations: The absence of a meta-analysis and funnel plot.\u0000\u0000Conclusions: Based on observational studies, we found an association between GA in childhood and neuro-developmental deficits in later life. Randomized and sibling-matched observational studies failed to show the same association and therefore no evidence of a causal relationship exists at present. Since GA seems to be a marker, but not a cause of worse neurodevelopment, we argue against delaying or avoiding interventional or diagnostic procedures requiring GA in childhood based on the argument of GA-induced neurotoxicity.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49085286","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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