Acta anaesthesiologica Belgica最新文献

{"title":"Evaluation of risk prediction model for perioperative respiratory adverse events in pediatric anesthesia","authors":"A D’Haene, A Bauters, B Heyse, P Wyffels","doi":"10.56126/74.2.08","DOIUrl":"https://doi.org/10.56126/74.2.08","url":null,"abstract":"Background: Perioperative respiratory adverse events are among the most common critical incidents in pediatric anesthesia. Three risk prediction models have been developed to predict occurrence of such adverse events in children. However, these tools were only internally validated, limiting generalization. The Perioperative Respiratory Adverse Events in Pediatric Ambulatory Anesthesia risk prediction tool developed by Subramanyam et al. consists of five predictors: age ≤ 3 years, ASA physical status II and III, morbid obesity, preexisting pulmonary disorder, and surgery. Aims and Methods: We aimed to evaluate the suitability of Subramanyam’s model in predicting the occurrence of perioperative respiratory adverse events in a more general tertiary care pediatric population, including anesthesia for both outpatient and inpatient procedures. Therefore we validated this scoring system in a tertiary care cohort of 204 children included in the APRICOT study at our hospital through retrospective analysis of this data. Secondarily, we aimed to study the incidence of perioperative respiratory adverse events in our hospital. Results: Overall incidence of perioperative respiratory adverse events in our sample was 19,6%. Applying Subramanyam’s prediction model to our cohort, we found no patients categorized as low risk, 76 patients as intermediate risk and 128 patients as high risk. Discriminatory ability of the risk scoring system was modest, with AUC of the simplified model 0,65 (95% CI 0,57-0,74) and AUC of the original logistic regression model 0,66 (95% CI 0,57-0,75). Calibration of the simplified model was rather poor, with Brier score 0,49. The original logistic regression model calibrated better, with Brier score 0,18. A subgroup analysis considering solely ambulant patients in Ghent-APRICOT yielded comparable results. Conclusions: We conclude that the overall performance of Subramanyam’s risk prediction tool in our cohort was moderate. Modest discrimination and calibration suggest that the risk score may not reliably predict perioperative respiratory adverse events in individual patients in our tertiary care pediatric population. Therefore the clinical relevance of the implementation of this scoring system in our tertiary hospital would be negligible, which leaves us with the lack of good scoring systems to predict perioperative respiratory adverse events in our population. In addition, we found the incidence of these adverse events in our hospital to be markedly higher as compared to the sample of Subramanyam.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135142620","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":"Impact of spinal needle size and design on post-dural puncture headache: A narrative review of literature","authors":"J Van der Auwera, K Paemeleire, M Coppens","doi":"10.56126/74.2.14","DOIUrl":"https://doi.org/10.56126/74.2.14","url":null,"abstract":"Background: Post-dural puncture headache (PDPH) is a well-known iatrogenic complication of lumbar puncture. The main modifiable risk factors of PDPH appear to be needle size and design, which have been extensively modified in an effort to lower the incidence of PDPH. Currently, there is no consensus on the ideal needle tip for lumbar puncture. Therefore, we have conducted this narrative review of literature to provide a more definite answer regarding the impact of spinal needle size and design on PDPH. Methods: Relevant literature was obtained by searching the scientific literature using PubMed, EMBASE, ISI Web of Knowledge, and Google Scholar for from 1990 to July 2022. Results: Both size and design have been extensively researched in numerous randomized controlled trials. A total of seven systematic reviews published since 2016 were reviewed: Five combined with meta-analyses of which two also with a meta-regression analysis, one combined with a network meta-analysis, and one Cochrane review. Discussion and Conclusion: The evidence presented in this review consistently shows that the atraumatic design is less likely to cause PDPH than the traumatic design. There is no simple linear correlation between smaller needle size and lower incidence of PDPH in either needle type. In lumbar puncture for spinal anesthesia we advise the 26G atraumatic spinal needle as the preferred choice, as it is the least likely to cause PDPH and the most likely to enable successful insertion. If unavailable, the 27-gauge atraumatic needle is the next best choice.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135142410","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":"Hemodynamic maintenance with norepinephrine in caesarean section under spinal anesthesia and its fetal outcome: a systematic review","authors":"S De Deckere, V Saldien, H Coppejans","doi":"10.56126/74.2.12","DOIUrl":"https://doi.org/10.56126/74.2.12","url":null,"abstract":"Background: Postspinal hypotension is a frequent maternal complication in caesarean delivery under neuraxial anesthesia. Anesthesiologists have been using different vasopressors to maintain hemodynamics. Recent studies suggested beneficial effects of norepinephrine on maternal blood pressure and cardiac output, but little evidence exist on the neonatal outcome. Objectives: This systematic review summarises recent evidence on neonatal outcome, such as umbilical arterial pH and base excess, after administration of norepinephrine during caesarean section. Methods: A literature search on PubMed from 2010 to 2022 was performed and every article was reviewed on neonatal outcome, as primary endpoint and on maternal hemodynamics, as secondary endpoint. A total of 15 randomised controlled trials were included. Results: Studies using a prophylactic infusion of norepinephrine show normal fetal blood gases. No evidence of fetal stress (pH < 7,20, base excess < -6) was assessed in the studies. Norepinephrine succeed in maintaining maternal hemodynamics. It is responsible for less bradycardia than phenylephrine and less tachycardia than ephedrine. Conclusion: Our study suggests that norepinephrine, preferably as prophylactic infusion, is a safe vasopressor to prevent postspinal hypotension in caesarean section. No signs of fetal acidosis could be demonstrated in the recent studies.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135142407","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":"When to replace a CO2 absorber?","authors":"D. Verbeke, J. Jouwena, A. D. de Wolf, J. Hendrickx","doi":"10.56126/74.1.06","DOIUrl":"https://doi.org/10.56126/74.1.06","url":null,"abstract":"","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42120376","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":"Lactate and hyperlactatemia revisited: an overview","authors":"M. V. Van Loo, X. Iturriagagoitia, J. van Limmen, M. Vandenheuvel, S. De Hert","doi":"10.56126/74.1.07","DOIUrl":"https://doi.org/10.56126/74.1.07","url":null,"abstract":"In critically ill patients, elevated lactate levels are often used as a marker of illness severity. There is a vast body of literature correlating lactate with an overall worse outcome, however, it is important to remember that correlation does not necessarily imply causality. Furthermore, it is not yet clear whether giving a therapeutic implication to elevated lactate levels will improve patient outcome. Moreover, more recent literature suggests possible protective qualities of the lactate molecule against further injury. In this narrative review, we address these issues by comparing the contemporary literature to the classic view of lactate as a metabolic waste product and marker of shock severity. Firstly, the metabolism of lactate will be described. Then, the causes of elevated lactate levels are reviewed and finally, the prognostic implications of elevated lactate and the evidence surrounding the use of lactate as a guide for therapeutic interventions will be discussed. The acid-base abnormalities resulting from lactate acidosis will not be reviewed in this article.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44898303","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":"Intraoperative opioids: Reduce but not refuse!","authors":"S. Ordies, S. Rex","doi":"10.56126/74.1.02","DOIUrl":"https://doi.org/10.56126/74.1.02","url":null,"abstract":"","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49616721","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":"Standardized training in perioperative Point-of-Care Ultrasound (PoCUS): what are we waiting for?","authors":"M. Momeni, V. Bonhomme, P. Wouters","doi":"10.56126/74.1.01","DOIUrl":"https://doi.org/10.56126/74.1.01","url":null,"abstract":"","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42975845","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":"Expert recommendations on education, training and certification in perioperative Point-of-Care Ultrasound in Belgium (BePOCUS)","authors":"P. Van de Putte, L. Vernieuwe, S. Bouchez, J. Deen, G. Schols, B. Calle, M. Van de Velde, S. Rex","doi":"10.56126/74.1.03","DOIUrl":"https://doi.org/10.56126/74.1.03","url":null,"abstract":"Point-of care ultrasound (PoCUS) is a diagnostic paradigm, instrumental in the evolving anaesthesiologist’s role towards a perioperative physician. The purpose of this article is to propose expert suggestions for a national standard towards official certification in perioperative PoCUS. Previously published recommendations in this journal constituted a first move towards a structured PoCUS pathway for Belgian anaesthesia residents1. This article defines in detail a pathway towards obtaining competency in airway ultrasound, lung ultrasound, gastric ultrasound, hemodynamic volume assessment, basic transthoracic and transesophageal echocardiography. An updated overview of the international literature on the education of perioperative PoCUS serves as a scientific backbone.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43783582","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":"Low Flow Anesthesia – Mission Impossible?","authors":"J. Hendrickx, J. Jouwena, S. D. De Hert, A. D. de Wolf","doi":"10.56126/74.1.05","DOIUrl":"https://doi.org/10.56126/74.1.05","url":null,"abstract":"Because low flow anesthesia reduces waste of environmentally unfriendly inhaled anesthetics, it is coming in the spotlights – again. Despite a detailed theoretical description, considerable teaching efforts of this simple technique have not succeeded in consistently lowering fresh gas flows (FGF) during manual control1. Worse, even though technology has solved the hurdles of manual delivery and the technology is widely available, we fail to maximally implement it. The delivery of inhaled anesthetics with high FGF prior to securing the airway remains common practice. We fail to consistently adjust MAC to age and poorly titrate opioids to reduce the fraction of the MAC we administer. We fail to incorporate hysteresis which is reflected in the use of excessively high FGF and vaporizer settings during wash-in and in the failure to maintain low FGF prior to emergence (“coasting”). By failing to fully appreciate the quantitative effects of the delivery if inhaled anesthetics we miss the opportunity to reduce waste to the absolute minimum. Belief and myth are strong when the environmental impact of inhaled anesthetics is considered. We need better, detailed life cycle analyses with low flow data before making claims pro/con inhaled/TIVA. We tend to lose sight of perspective, and have to continue to weigh the impact of drug selection on patient care.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49262444","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":"Malignant Hyperthermia in Belgium: 35 years of practice-led research","authors":"L. Heytens, S. Temurziev","doi":"10.56126/74.1.04","DOIUrl":"https://doi.org/10.56126/74.1.04","url":null,"abstract":"As of 1986 a laboratory for the diagnosis of Malignant Hyperthermia (MH) was established at the University of Antwerp which since then served as the national reference laboratory for this rare anesthetic complication. Our unit is an accredited lab within the network of the European Malignant Hyperthermia Group and thus has had the chance to attain a solid practical expertise in this disorder, as well as to collaborate in several multicentre studies on MH.\u0000\u0000The present review summarizes what collaborative international research has taught us about MH over the last 3,5 decades, and covers evolving insights in such topics as pathophysiology, clinical presentation, treatment, anesthesia for patients with an increased risk of developing MH, molecular genetics, diagnostic work-up and relationship to other myopathies.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42156490","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}