Acta anaesthesiologica Belgica最新文献

{"title":"Is the Erector Spinae Plane block useful for anti-nociception and analgesia in lumbar spine surgery? A narrative review of the literature and opinion paper","authors":"G. Tran, N. Vyncke, J. Montupil, V. Bonhomme, A. Defresne","doi":"10.56126/73.2.13","DOIUrl":"https://doi.org/10.56126/73.2.13","url":null,"abstract":"We aimed at determining whether the Erector Spinae Plane (ESP) block is useful for providing anti-nociception and analgesia to patients beneficiating from lumbar spine surgery. Using the keywords “Erector Spinae Plane block” and “lumbar” or “spinal surgery” in Pubmed, the Cochrane Library Database, and Google Scholar (end of search in March 2021), we identified 19 relevant papers involving 534 patients. Injection levels, and type, dilution, or volume of local anesthetic agent solution differed between studies. The main studied outcomes were postoperative pain control, and opioid consumption. Only one study compared the ESP block with another loco- regional technique. All published papers conclude that ESP block reduces postoperative pain scores and rescue medication use. As a corollary, ESP block appears promising in this indication for several reasons. First, it is easy to perform and does not have the same adverse effects or complications as neuraxial techniques. Second, even if the best site of injection as not been determined yet, skin puncture can be performed at distance from the surgical site, hence reducing the risk of surgical site infection by the loco-regional technique, and allowing its use as a rescue analgesic technique after surgery. Last, the incidence of ESP block complications seems low even if the number of studied patients is not wide enough to ascertain this fact for sure. Several unresolved questions are still pending. None of the published studies were randomized controlled trials with a group receiving a sham block, length of follow-up was limited to 48 hours, chronic pain was an exclusion criteria, and the pain scores were evaluated at rest. We conclude that the ESP block appears to be a safe and promising technique to be used as part of a multimodal analgesia protocol in lumbar spine surgery. Several studies are needed to precise its superiority and safety as compared to other techniques, its intraoperative opioid sparing effect, and its influence on longer term outcomes such as the development of chronic pain.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46766127","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":"Breakthrough pain during cesarean section under neuraxial anesthesia: a two-center prospective audit","authors":"E. Roofthooft, N. Lippens, S. Rex, S. Devroe, A. Moerman, N. Filetici, M. Van de Velde","doi":"10.56126/73.1.04","DOIUrl":"https://doi.org/10.56126/73.1.04","url":null,"abstract":"Worldwide, most Cesarean sections (CS) are performed under neuraxial anesthesia. However, neuraxial anesthesia can fail and intraoperative breakthrough pain can occur. The aim of the present investigation was to evaluate the incidence of breakthrough pain in consecutive CS and to describe the potential risk factors for breakthrough pain. In a two center, prospective audit all CS performed under neuraxial anesthesia were included and the occurrence of breakthrough pain as well as all possible risk factors of breakthrough pain were recorded as well as the alternative anesthetic strategy. A total of 393 patients were enrolled in the study over 6 months, 206 in UZ Leuven and 187 in ZNA Middelheim, 295 elective CS and 98 secondary CS. Of all 393 participants, 65 experienced breakthrough pain during the CS (16.5%). Twoo significant risk factors for breakthrough pain during CS were observed: the duration of surgery (p <0.001) and the epidural drug used (p=0.0032). Breakthrough pain during a CS is extremely uncomfortable for the mother. In this observational study, the incidence of breakthrough pain during CS was 16.5%.\u0000\u0000Duration of surgery and epidural drug used were both significant risk factors of breakthrough pain during CS in this audit. A pro-active policy is required in order to prevent breakthrough pain or discomfort during CS. Early identification of problematic epidural catheters for labor analgesia, adequate level of anesthetic block before surgery, and administration of a prophylactic epidural top-up if duration of surgery is prolonged as opposed to the choice of local anesthetic used, could be essential in the prevention. Further high-quality studies are needed to evaluate the many potential risk factors associated with breakthrough pain during CS.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41440957","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":"The well-being of physicians during the COVID-pandemic in a Belgian tertiary hospital","authors":"C. Korthoudt, N. Kegels, A. Domen, G. Moorkens, V. Saldien","doi":"10.56126/73.1.06","DOIUrl":"https://doi.org/10.56126/73.1.06","url":null,"abstract":"Background: COVID-19 has become the largest medical challenge worldwide, affecting the physical and mental well-being of physicians. The aim of this study was to explore the well-being of physicians during the second wave of the COVID-19 outbreak in a Belgian tertiary hospital, with special attention to anaesthesiologists. They were confronted with overcrowded intensive care units, were mentally challenged during several months by an overwhelming workload.\u0000\u0000Methods: All physicians of the Antwerp University Hospital (UZA) were invited to participate through an online anonymous questionnaire to objectively evaluate their well-being during the second wave of the COVID-19 outbreak in Belgium. Mental well-being was evaluated by the validated Warwick-Edinburgh Mental Well-being Scale (WEMWBS) summing 14 equally weighted questions (scoring range 1 to 5) about mental well-being. Demographic data such as age, gender, function, COVID exposure was collected.\u0000\u0000Results: Ninety physicians, 42 residents and 48 staff members, completed the questionnaire with an average WEMWBS of 50.6±8.0. Participating residents were deployed more on COVID-19 departments compared to participating staff members (p=0.02) and reported a higher workload (p=0.001). Residents scored significantly lower on the WEMBWS compared to staff members (48.1±8.2 vs. 52.8±7.3, p=0.01). Also, 15 female anaesthesiologists scored significantly lower in the WEMWBS compared to their 12 male colleagues (p=0.03).\u0000\u0000Conclusion: During the second wave of the COVID-19 outbreak in Belgium, residents reported a significantly higher workload due to COVID-19 and reported a significantly lower well-being compared to staff members.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45896893","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 dexmedetomidine on emergence delirium and recovery parameters with sevoflurane and desflurane anaesthesia in children : a double randomized study","authors":"R. Pandey, Jayaram A. Ankur Sharma, V. Darlong, R. Sinha, J. Punj, Sudershan Khokhar, A. Chowdhury, P. Singh","doi":"10.56126/73.1.05","DOIUrl":"https://doi.org/10.56126/73.1.05","url":null,"abstract":"Background: Emergence delirium in pediatric patients is a significant cause of increased anxiety among parents. The incidence of emergence delirium in children varies mainly according to the anesthetic agents used.\u0000\u0000Methods: In this prospective, double-blind, randomized trial, 152 children of age group 1-6 years were randomized into two groups after induction of anesthesia: Group S received Sevoflurane, and Group D received Desflurane. Children in the S group were further randomized into subgroup S- Dex (receiving dexmedetomidine 0.3 mcg/kg in 5 ml saline) and subgroup S-Saline (receiving saline 5 ml). Similarly, Group D was also randomized into two subgroups; D-Dex and D-Saline. We compared perioperative hemodynamic variables, postoperative emergence delirium, recovery profile, pain scoring, the requirement of rescue analgesics, and time to discharge.\u0000\u0000Results: At 5, 15, and 30 minutes, the incidence of emergence delirium was significantly higher in S-Saline and D-Saline groups than S-Dex and D-Dex groups. Both PAED and FLACC scores were significantly higher in the S-Saline group than the S-Dex group and the D-Saline group compared to the D-Dex group (P<0.05). Significantly more patients required analgesia in the S-Saline group than in the S-Dex group (P<0.05). No significant difference for analgesia was present between D-Saline and D-Dex groups. (p = 0.153). Discharge time was significantly longer in S-Dex and D-Dex groups as compared to S-Saline and D-saline groups.\u0000\u0000Conclusions: Dexmedetomidine effectively reduced the incidence of emergence delirium and postoperative pain in pediatric patients undergoing surgery using Sevoflurane and Desflurane anesthesia.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43162492","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":"High frequency percussive ventilation: An asset to existing ventilation modi in intraoperative care?","authors":"L. Rijckaert, A. Moerman, M. Vandenheuvel","doi":"10.56126/73.1.03","DOIUrl":"https://doi.org/10.56126/73.1.03","url":null,"abstract":"High frequency percussive ventilation (HFPV) is a ventilation mode that combines positive pressure ventilation with some advantages of high frequency ventilation. During HFPV, a pulsatile flow is generated with high frequency and low volumes. HFPV has been used in the intensive care unit (ICU) for several decades, in case of insufficient conventional positive pressure ventilation. However, literature on its use in intraoperative care is scarce. We hypothesize that HFPV might be a better alternative to existing ventilation modi during selected operative procedures or in patients with severely compromised pulmonary and/or cardiac function. In this paper, we explain the HFPV system, we zoom in on the physiological effects of HFPV, and we describe its potential role in the intraoperative setting. Results of existing studies show that, compared to other conventional ventilation modes, HFPV improves oxygenation and ventilation without jeopardizing hemodynamics. However, because of the low quality evidence regarding physiological effects and clinical effectiveness, and due to the complicated design and set-up of the HFPV ventilator, the use of HFPV in intraoperative care is currently very limited. We conclude that HFPV could potentially be an interesting ventilation mode for procedures requiring minimal respiratory motion or low airway pressures, however larger (comparative) study trials are required to evaluate its usability in the operating room in patients with compromised pulmonary and/or cardiac function.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45072836","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":"Anesthesia specialty training in Belgium anno 2022 – time for revamping","authors":"A. Moerman, W. Degrève, S. De Hert","doi":"10.56126/73.1.01","DOIUrl":"https://doi.org/10.56126/73.1.01","url":null,"abstract":"","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43314957","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 comparison of midazolam, dexmedetomidine 2µg/kg and dexmedetomidine 4µg/kg as oral premedication in children, a randomized double-blinded clinical triall","authors":"D. Lalin, S. Singh, V. Thakur","doi":"10.56126/73.1.07","DOIUrl":"https://doi.org/10.56126/73.1.07","url":null,"abstract":"Background: The objective of this study was to analyze an oral administration of midazolam with two different doses of dexmedetomidine for premedication in paediatric patients.\u0000\u0000Methods: A prospective, randomized, double blind study. Three hundred patients, aged 1-7 years, undergoing elective surgery under general anesthesia were recruited for the study. Patients were randomized into three groups to receive oral midazolam 0.5mg/kg (group M), oral dexmedetomidine 2 µg/kg (group D2) and oral dexmedetomidine 4 µg/kg (group D4) for premedication. An observer blinded to the patient group allocation assessed level of sedation at 30 minutes after giving the premedication, ease of parental separation was assessed while shifting the patients to the operating room, mask acceptance during induction and postoperative agitation scores in post anesthesia care unit.\u0000\u0000Results: The sedation score of group D4 was significantly higher than group D2 and group M [ group D4- 4 (4,3), group D2- 2(2,2) and group M -2(3,2), H statistics = 80.4718, p < 0.00001]. The parental separation score, mask acceptance score and postoperative was also significantly better for group D4 compared to the other two group.\u0000\u0000Conclusion: These results suggest that oral dexmedetomidine 4 µg/kg is more effective than oral midazolam 0.5mg/kg and oral dexmedetomidine 2 µg/kg for premedication in children.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44384374","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":"Management of Acute Respiratory Distress Syndrome in COVID-19 Patients","authors":"J. Segers, A. Hadzic, S. van Boxstael, I. Van Herreweghe, O. De Fré","doi":"10.56126/73.1.02","DOIUrl":"https://doi.org/10.56126/73.1.02","url":null,"abstract":"Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by an acute, diffuse inflammation leading to pulmonary edema and hypoxemia. The pathophysiology of the lung failure in COVID- 19 ARDS is a combination of the viral infection and the immune response of the host. ARDS due to COVID-19 appears to be similar to the non-COVID-19 ARDS, with exception of hypercoagulability. The mortality due to ARDS remains high and the treatment focuses on supportive measures, such as lung-protective ventilation strategy with small tidal volumes, low driving pressures and PEEP-titration, early consideration of prone positioning and a restrictive fluid management. Oxygen should be titrated, and permissive hypercapnia might be necessary to achieve lung-protective ventilation. The use of extracorporeal membrane oxygenation (ECMO) in COVID-19 ARDS is restricted as a rescue therapy in patients who remain hypoxemic. ECMO should be reserved to experienced ECMO centers. Prophylactic anticoagulant therapy is indicated to reduce the formation of thrombi in the microcirculation of organs, especially in the pulmonary microvasculature. Steroids may reduce the host’s immune response and improve mortality in patients requiring oxygen supplementation or invasive ventilation.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":"37 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41246165","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":"Ultrasound measurement of the optic nerve sheath diameter in traumatic brain injury: a narrative review","authors":"M. Natile, O. Simonet, F. Vallot, M. de Kock","doi":"10.56126/72.4.1","DOIUrl":"https://doi.org/10.56126/72.4.1","url":null,"abstract":"Background : Raised intracranial pressure (ICP) needs to be investigated in various situations, especially in traumatic brain injury (TBI). Ultra-sonographic (US) measurement of the optic nerve sheath diameter (ONSD) is a promising noninvasive tool for assessing elevated ICP.\u0000\u0000Objectives : This narrative review aimed to explain the history of and indications forUS measurement of ONSD. We focused on the detection of elevated ICP after TBI and discussed the possible improvements in detection methods.\u0000\u0000Conclusions : US measurement of ONSD in TBI cases provides a qualitative but no quantitative assessment of ICP. Current studies usually calculate their own optimum cutoff value for detecting raised ICP based on the balance between sensitivity and specificity of the method when compared with invasive methods. There is no universally accepted threshold. We did not find any paper focusing on the prognosis of patients benefiting from it when compared with usual care. Another limitation is the lack of standardization. US measurement of ONSD cannot be used as the sole technique to detect elevated ICP and monitor its evolution, but it can be a useful tool in a multimodal protocol and it might help to determine the prognosis of patients in various situations.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45631952","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":"Surgical adrenalectomy during rescue Extracorporeal Life Support for pheochromocytoma induced cardiogenic shock: a case report","authors":"I. Gruyters, Björn Stessel, A. Yilmaz, K. Vekemans, S. Heye, P. Timmermans, J. Vandenbrande","doi":"10.56126/72.4.4","DOIUrl":"https://doi.org/10.56126/72.4.4","url":null,"abstract":"Introduction : Pheochromocytoma, a rare catecholamine-producing tumor, has been described to provoke stress-induced Takotsubo-like cardiomyopathy and even severe refractory cardiogenic shock. In this case report, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was used for hemodynamic stabilization and was continued during the resection of a large neuroendocrine tumor.\u0000\u0000Description : A 69-year old male, recently diagnosed with a pheochromocytoma, was referred to our center because of severe cardiogenic shock after induction of anesthesia for resection of the mass. Despite adequate alpha-and beta-adrenergic blockade for one month, he developed malignant hypertension with subsequently hemodynamic collapse. After successful cardiopulmonary resusci-tation he developed pulmonary oedema with severe hypoxemia and persistent hemodynamic lability. On arrival in our hospital, echocardiography revealed significant left ventricular impairment. Decision was made to commence him on VA-ECMO for a refractory cardiogenic shock with severe pulmonary oedema. Because of persistent blood pressure swings despite VA-ECMO and beta-adrenergic blockade, we decided to remove the tumor on mechanical circulatory support by an open surgical approach the next day. After clamping of the adrenal circulation, the patient experienced profound hypotension requiring high doses of epinephrine and a methylene blue infusion. Surgical resection was successful but complicated by a postoperative bleeding for which the patient underwent an emergent endovascular embolization of an adrenal artery. Over the next days, there was progressive cardiac recovery and the patient was weaned off VA-ECMO on the fourth postoperative day. The patient was discharged from the intensive care 27 days after admission and left the hospital on day 30.\u0000\u0000Discussion: VA-ECMO seems to be a feasible last resort therapy in refractory cardiogenic shock induced by pheochromocytoma crisis as suggested by a high survival rate in literature. Despite its support benefit during this type of shock, surgical removal of the tumor is rarely done with mechanical circulatory support and heparinization.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42025845","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}