Acta anaesthesiologica Belgica最新文献

{"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":" ","pages":""},"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":" ","pages":""},"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":" ","pages":""},"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}

{"title":"Chronic abdominal pain after bariatric surgery: a narrative review","authors":"R. Vogelaerts, L. Van Pachtenbeke, M. Raudsepp, B. Morlion","doi":"10.56126/73.4.26","DOIUrl":"https://doi.org/10.56126/73.4.26","url":null,"abstract":"Objective: This paper reviews the prevalence, etiology, risk factors, diagnosis and prevention of chronic abdominal pain after bariatric surgery.\u0000\u0000Introduction: Chronic pain is a very common and complex problem that has serious consequences on individuals and society. It frequently presents as a result of a disease or an injury. Obesity and obesity-related comorbidities are a major health problem and are dramatically increasing year after year. Dieting and physical exercise show disappointing results in the treatment of obesity. Therefore, bariatric surgery is increasingly widely offered as a weight reducing strategy. In our pain clinic we see a lot of patients who suffer from chronic abdominal pain after bariatric surgery. This review aims to explore the link between chronic abdominal pain and bariatric surgery in this specific type of patients.\u0000\u0000Method: The review is based on searches in PubMed, Embase and Cochrane databases. Keywords are used in different combinations. We did a cross-reference of the articles included.\u0000\u0000Results: Chronic abdominal pain after bariatric surgery is very common. Around 30% of the bariatric patients experience persistent abdominal pain. An explanation for the abdominal pain is found in 2/3 of these patients.\u0000There is a wide variety of causes including behavioral and nutritional disorders, functional motility disorders, biliary disorders, marginal ulceration and internal hernia. Another, frequently overlooked, cause is abdominal wall pain. Unexplained abdominal pain after bariatric surgery is present in 1/3 of the patients with persistent abdominal pain. More studies are needed on the risk factors and prevention of unexplained abdominal pain in bariatric patients.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43754341","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":"Towards optimized red blood cells ordering prior to cardiac surgery: a single center retrospective study","authors":"A. Dincq, L. Thiltges, I. Michaux, M. Gourdin, G. Kalscheuer, L. Melly, M. Gillet, M. Bareille, S. Lessire, M. Hardy","doi":"10.56126/73.4.24","DOIUrl":"https://doi.org/10.56126/73.4.24","url":null,"abstract":"Background: Cardiac surgery is associated with a high rate of intraoperative transfusion, requiring pre- ordering or ordering of packed red blood cell (PRBC) before surgery. Our institutional strategy is based on a systematic type and screen (T/S) ordering of 3 PRBCs at the blood bank then stored in a dedicated refrigerator in the operating room for each patient scheduled for cardiac surgery. However, these PRBC units are not always transfused and are therefore at risk of destruction if temperature fluctuations are detected during transport and storage processes. In addition, these orders represent a burden for the blood bank. Therefore, it is relevant to move towards a more tailored PRBC order before cardiac surgery and challenge the systematic ordering protocol.\u0000\u0000Methods: The Transfusion Understanding Scoring Tool (TRUST) and the Transfusion Risk and Clinical Knowledge (TRACK) Score are designed to stratify blood transfusion needs in cardiac surgery. We retrospectively performed both scores for each patient scheduled for cardiac surgery. Then, we compared their performance to predict PRBC transfusion and determined the optimal threshold to optimize the preoperative PRBC order reflecting the needs of our population managed with our local standards.\u0000\u0000Results: Receiver operating characteristic (ROC) curves for prediction of PRBC transfusion using the two scores were computed for the whole cohort (n=1249). Both scores performed well (areas under ROC curves: 0.81 and 0.82 (95% CI) using the TRACK Score and the TRUST, respectively). A TRUST < 3 identified a subgroup of patients (53.6%) at low risk of transfusion. The availability of 1 T/S PRBC in the OR would cover the needs of the majority (92.5%) of this group.\u0000\u0000Conclusions: In our institution, the use of the TRUST preoperatively could offer a more tailored T/S PRBC order for the intraoperative period, especially in the low-risk transfusion group.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70729994","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":"Gender and graduating results in the Anesthesiology and Intensive Care Abomey-Calavi (Cotonou, Benin) program","authors":"B. Ki, E. Zoumènou, M. Chobli, B. le Polain de Waroux, A. Robert, P. Baele","doi":"10.56126/73.4.25","DOIUrl":"https://doi.org/10.56126/73.4.25","url":null,"abstract":"Background: For unknown reasons female participation in anesthesiology is very low in Sub-Saharan Africa (SSA), especially in West Africa, and few women reach top academic or clinical positions.\u0000\u0000Objective: Women reduced professional perspectives.\u0000\u0000Design: Male and female residents’ performances were compared when they presented for their first try the graduating exams of the specialty.\u0000\u0000Settings: The Cotonou anesthesiology and intensive care training center, the second largest in French-speaking SSA, where 146 anesthesiologists from 14 African countries graduated since its creation in 1996.\u0000\u0000Method: All results at their final exams (consisting in 3 written questions and 2 clinical evaluations) were retrieved for the 125 men and 21 women who graduated. Scores obtained by women and males were compared using Student’s t tests. Their total of points was used to divide graduates into deciles. The proportion of women was counted in each decile.\u0000\u0000Results: Women performed better at both anesthesia and intensive care clinical evaluations taken separately and together (total 68.2% vs. 64.2% p=0.004) and were even with men for the three written exams (anesthesia, intensive care and basic sciences - total 66.2 % vs. 66.1% p=0.99). When clinical and written scores are added in each sector, women scored better than males for anesthesiology (69.2% vs. 65.2% p=0.01) and were even for intensive care (65.0% vs. 64.1% p=0.51). Globally women and men results were similar (67% vs. 65%, p=0.1) The proportion of women in each decile increased from the lowest to the best deciles, but the absolute low number of women gives this trend borderline significance (slope +1,56 % women per decile, p=0.046)**.\u0000\u0000Conclusion: Women performance at end-specialty exams is unlikely to explain their subsequent underrepresentation at the academic level in anesthesia and intensive care in SSA**.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48209794","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":"Effect of combined use of cerebral oximetry and electroencephalogram monitoring on the incidence of perioperative neurocognitive disorders in adult cardiac and non-cardiac surgery: A systematic review of randomized and non-randomized trials","authors":"Q. Souberbielle, A. Jacobs Sariyar, M. Momeni","doi":"10.56126/73.4.30","DOIUrl":"https://doi.org/10.56126/73.4.30","url":null,"abstract":"Background: There is insufficient evidence to recommend using either intraoperative cerebral oximetry or (processed) electroencephalogram (EEG) alone for preventing perioperative neurocognitive disorders (PNDs).\u0000\u0000Objective: To evaluate the effectiveness of combined use of cerebral oximetry and electroencephalogram-guided anesthesia on the incidence of PNDs in adult patients undergoing cardiac and non-cardiac interventions.\u0000\u0000Methods: A PICOS - based systematic review of English articles using Pubmed and Embase (from inception to August 2022) was performed. There were no exclusion criteria regarding the type of the study. Abstract proceedings and new study protocols or ongoing studies were not included. Review articles were analyzed in search of eligible references. All possible terms that were illustrative of PNDs were used.\u0000\u0000Results: Among the 63 full manuscripts that were analyzed in detail, 15 met the inclusion criteria. We found 2 retrospective, 8 prospective observational and 5 randomized controlled trials of which 1 did not evaluate the use of neuromonitoring in the randomization process. The definition and the methods used to diagnose PNDs were very heterogeneous. Only 8 studies used an algorithm to avoid/treat cerebral oxygen desaturation and/or to treat EEG abnormalities. Overall, there was a tendency towards less PNDs in studies where such an algorithm was used.\u0000\u0000Conclusions: Our results suggest that integrating information obtained from cerebral oximetry and an EEG monitor may reduce the incidence of PNDs whenever an adapted algorithm is used to improve brain function.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46702893","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":"Chronic pain after surgery and trauma: current situation and future directions","authors":"P. Lavand'homme","doi":"10.56126/73.4.27","DOIUrl":"https://doi.org/10.56126/73.4.27","url":null,"abstract":"Chronic post-surgical pain (CPSP) stands as a major health issue. The unchanged incidence over the last two decades underlines both the failure of predictive models developed until now and the lack of efficacy of common “preventive” strategies (pharmacotherapy and regional analgesic techniques) applied in current clinical practice. The recognition of CPSP as a disease and the release of a common definition of the condition is an important progress in the field. CPSP predictive scores exist but none has presently demonstrated an impact on patient care. New clinical directions based on the resolution of postoperative pain, a complex and highly dynamic process supported by individual pain trajectories, argue for predictive models and preventive strategies extended to the subacute pain period i.e. after hospital discharge.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41656585","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":"Iron deficiency in cardiac surgical patients","authors":"L. Hof, O. Old, A. Steinbicker, P. Meybohm, S. Choorapoikayil, K. Zacharowski","doi":"10.56126/73.4.28","DOIUrl":"https://doi.org/10.56126/73.4.28","url":null,"abstract":"Iron is an essential element and involved in a variety of metabolic processes including oxygen transport, cellular energy production, energy metabolism of heart muscles, brain function, cell growth and cell differentiation. Preoperative anaemia is an independent risk factor for poor outcome. Recently, iron deficiency was considered only in the context of anaemia. However, negative consequences of iron deficiency in the absence of anaemia have been described for patients undergoing cardiac surgery. To date, the benefit of intravenous iron supplementation in these patients has been controversially debated. In this review, we discuss the latest progress in studies of intravenous iron supplementation in iron deficient cardiac surgical patients.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44604010","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":"Laryngoscopy mediated stress response induces opposite effects on cerebral and paraspinal oxygen saturation","authors":"C. Vanpeteghem, S. D. De Hert, A. Moerman","doi":"10.56126/73.4.29","DOIUrl":"https://doi.org/10.56126/73.4.29","url":null,"abstract":"Background: Intraoperative sympathetic stimulation induces a cascade of metabolic and hormonal changes. It increases perfusion of vital organs, but also causes vasoconstriction of blood vessels supplying less vital organs, potentially leading to organ injury. To date, it is unknown how an endogenous stress reaction affects the spinal cord blood supply. Near-infrared spectroscopy (NIRS) can be applied paravertebrally to monitor the oxygenation of the collateral network, which contributes to the spinal cord blood supply. It has already been demonstrated that regional cerebral oxygen saturation (rScO2) increases following sympathetic stimulation.\u0000\u0000Objectives: We hypothesized that laryngoscopy would cause an increase in cerebral and paraspinal regional tissue saturations (rScO2 and rSpsO2, respectively).\u0000\u0000Design: Retrospective analysis of a previous conducted randomized trial.\u0000\u0000Setting: Laryngoscopy in the operating room.\u0000\u0000Methods: Data of 28 patients, scheduled for arterial dilation of the lower limb, were retrospectively analyzed. Before induction of anesthesia, standard monitoring, BIS and 8 NIRS sensors were applied (two on the forehead, six bilaterally on the back at T3-T4, T9-T10 and L1-L2). Sympathetic stimulation was induced by laryngoscopy.\u0000\u0000Main outcome measures: Changes in rStO2 following sympathetic stimulation induced by laryngoscopy.\u0000\u0000Results: Following laryngoscopy, rScO2 significantly increased and rSpsO2 significantly decreased at T9-T10 and L1-L2. The relative changes (regional tissue oxygen saturation (rStO2) after intubation-rStO2 before intubation)/ rStO2 before intubation), at cerebral level, T9-T10 and L1-L2 were 9%, -5% and -3%, respectively (p < 0.01). rSpsO2 at T3-T4 did not change significantly. Changes (Δ) in mean arterial pressure following laryngoscopy were weakly correlated with ΔrScO2 and moderately correlated with ΔrSpsO2 at T9-T10 and L1-L2.\u0000\u0000Conclusions: Intraoperative sympathetic stimulation may decrease the oxygen supply to the spinal cord.\u0000\u0000Trial registration: The trial was registered at ClinicalTrials.gov (NCT 03767296).","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46763167","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}