Acta anaesthesiologica Belgica最新文献

{"title":"Case Report : Severe Hypernatremia following treatment for Hyperosmolar Hyperglycaemic State : A pragmatic approach used to manage hypernatremia","authors":"O.M. Shah, A. Ziarkowski","doi":"10.56126/71.4.5","DOIUrl":"https://doi.org/10.56126/71.4.5","url":null,"abstract":"The Hyperosmolar Hyperglycaemia State (HHS) is an endocrine emergency with a mortality rate between 10 and 50%. The mainstay for the treatment of this condition is vigorous IV fluid replacement with close monitoring of blood glucose, serum osmolality, and electrolytes. However, after initial resuscitation, patients can develop hypernatremia and raised serum osmolality, which have deleterious consequences. While hypernatremia in HHS can be treated with infusions of 0.45% saline or 5% dextrose, alternate measures such as intravenous (IV) hypotonic fluid infusion [e.g. 0.18% sodium chloride (NaCl) containing 4% dextrose and 0.15% potassium chloride (KCl)], or free water administration through a nasogastric (NG) tube can be used. We report the case of a 70-year-old man, who was initially admitted to a medical high care ward (MHC) with HHS, and was transferred to the ICU 72 hours later with an altered level of consciousness and severe hypernatremia. His treatment consisted in an IV hypotonic 0.18% NaCl infusion containing 4% dextrose and 0.15% KCl. He also received free water through a NG tube at a rate that was calculated to correct natremia at an average rate of 0.55 meq L-1 hr-1 over 72 hours. A multipronged approach was instituted to manage this patient, including, in addition to natremia correction, blood glucose control with insulin, appropriate IV antibiotics to treat infected foot ulcers, adequate analgesic medications, low-molecular-weight- heparin (LMWH) for thromboprophylaxis, proton- pump inhibitors, and continuation of patient’s ongoing antidepressant drugs at the time of his Glasgow Coma Score improvement. This case report demonstrates the feasibility and success of IV hypotonic fluid (0.18% NaCl - 4% dextrose - 0.15% KCl), alongside NG free water for correcting sodium levels with lower fluid volumes than would have been otherwise required if corrected with 0.45% saline. This treatment seems to be a reasonable choice for correcting sodium levels and osmolality in HHS patients who present with hypernatremia after an initial resuscitation, insofar as it avoids fluid overload and provides dextrose as an energy substrate, in addition to potassium ions. However, while correcting natremia with hypotonic fluid, other aspects of management should not be ignored.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42475486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of sedation with sevoflurane inhalation via AnaConDa for Covid-19 patients under venovenous extracorporeal membrane oxygenation","authors":"P. Paccaud, M. Dechamps, L. Jacquet","doi":"10.56126/71.4.4","DOIUrl":"https://doi.org/10.56126/71.4.4","url":null,"abstract":"Critical care centers around the world have faced a shortage of intravenous sedatives caused by the coronavirus pandemic. Many patients infected with SARS-CoV-2 virus develop severe Acute Respiratory Distress syndrome (ARDS) for which some of them are supported by extra corporeal membrane oxygenation. Under these circumstances, the pharmacokinetics of the sedatives is modified. We observed that many of our COVID-19 infected patients receiving Extracorporeal Membrane Oxygenator (ECMO) require high doses of intravenous drugs. Continuous sedation with halogenated gases in the intensive care unit has shown many benefits on systemic inflammation and offers the possibility of a rapid recovery of consciousness. In this article we describe 3 cases that show the feasibility of sedation with sevoflurane via AnaConDa (Sedana Medical AB, Danderyd, Sweden) for Covid-19 patients under ECMO. Halogenated drugs could be considered as an interesting alternative to intravenous sedatives especially in the context of drug shortage.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42076545","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 transversus abdominis plane (TAP) block versus local infiltration analgesia for acute and chronic postoperative pain control after laparoscopic bilateral hernia repair : a single-center randomized controlled trial","authors":"M. Hosni, J. P. Soulios, D. Francart","doi":"10.56126/71.4.2","DOIUrl":"https://doi.org/10.56126/71.4.2","url":null,"abstract":"Background : we compared the efficacy of transversus abdominis plane (TAP) block versus local infiltration on acute and chronic pain after a first laparoscopic surgical treatment of bilateral inguinal hernia performed in a day hospital.\u0000\u0000Methods : In this randomized, prospective, double-blind study, we studied 52 patients scheduled for lapa-roscopic bilateral hernia repair. The patients were randomly allocated to receive local infiltration (group 1) or a TAP block (group 2). The surgeon locally injected the patients in group 1 with a solution of 20 mL of 0.5 levo- bupivacaine. An ultrasound-guided injection of 40 mL 0.25 levobupivacaine was administered to the patients in group 2 by the anesthesiologist. The pain score was assessed using a numeric rating scale at the arrival in the recovery room, one hour after surgery and 6 hours (H+6) after arrival at the recovery room. Subsequently, the pain was assessed 24 hours (H+24), 3 weeks (D21) and 3 months (M3) after surgery.\u0000\u0000Results : We observed significant differences in terms of pain at H+6 and at H+24 in favor of the TAP block group. However, there was no significant difference between both groups in postoperative pain after 3 weeks (D21) or after 3 months (M3).\u0000\u0000Conclusions : In our study, we observed a significant difference in terms of pain in favor of TAP block versus local infiltration, during the first 24 hours after a first laparoscopic treatment of inguinal hernia. We did not find any significant difference on chronic pain.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46694685","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":"Anticholinergic symptoms in a patient with a bupropion overdose successfully managed with physostigmine: a case report","authors":"I. Plaetinck, J. Heerman, S. Van de Velde, S. Allaert, A. Kalmar","doi":"10.56126/72.1.7","DOIUrl":"https://doi.org/10.56126/72.1.7","url":null,"abstract":"We report the case of anticholinergic poisoning in a patient suffering from an overdose of bupropion. The patient presented with bilateral mydriasis, involuntary movements and signs of agitation. Bupropion is commonly used as antidepressant and smoking cessation aid. It inhibits neuronal reuptake of dopamine and norepinephrine and also antagonizes acetylcholine at the level of the nicotinic receptor sites. So far bupropion overdose resulting in symptoms mimicking an anticholinergic syndrome has rarely been reported in literature.\u0000\u0000In this case, one milligram of intravenous physostigmine, an acetylcholinesterase inhibitor, rapidly resolved patient agitation and mydriasis. This case indicates that physostigmine might be used as an antidote to quickly reverse the central and peripheral anticholinergic symptoms in patients with an overdose of bupropion.\u0000Erratum\u0000\u0000This article is the corrected version of the article published in issue 2020/3, pages 137-140. Typos and order of authors have now been corrected. With apologies to the authors.","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":"45114835","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":"Robinow Syndrome : an anesthetic challenge and review of literature","authors":"V. Depal, N. Patel, A. Singh, A. Kumar","doi":"10.56126/71.3.7","DOIUrl":"https://doi.org/10.56126/71.3.7","url":null,"abstract":"Robinow Syndrome is characterized by the presence of mesomelic limb shortening, midfacial hypoplasia, hemivertebrae and genital hypoplasia. Multi- organ involvement including cardiac, renal, vertebral dysfunctions have been described.We here report successful anaesthetic management of 1year old boy posted for ophthalmic procedure.","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":"48863784","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":"Reliability of a spot check non-invasive hemoglobin monitoring (SpHb) of the Masimo RAD-67™ and the HemoCue® for anemia screening","authors":"W. Baulig, U. Eichenberger, O. Theusinger","doi":"10.56126/71.3.4","DOIUrl":"https://doi.org/10.56126/71.3.4","url":null,"abstract":"Background : To test the reliability of the spot check Masimo Rad-67 (Masimo Corp., Irvine, CA, USA) as part of a preoperative anemia screening, hemoglobin measurements were compared to those of the HemoCue® Hb 201+ System (HemoCue AB, Ängelholm, Sweden) and the standard laboratory measurement.\u0000\u0000Methods : During preoperative evaluation of patients scheduled for elective orthopedic surgery hemoglobin concentration was simultaneously determined by standard laboratory analysis (HbLab), the HemoCue® Hb 201+ System (HbHemocue) and by Pulse Co-Oximetry using the Masimo Rad-67 (SpHb) with the rainbow® DCI®-mini Sensor (Masimo Corp., Irvine, CA, USA). Linear correlation, agreement (Bland-Altman analysis), sensitivity/specificity and positive/negative prediction values (PPV/NPV) for anemic hemoglobin values were determined. P-values less than 0.05 were considered statistically significant.\u0000\u0000Results : 303 patients were analyzed. Twenty-one patients (12 male and 9 female) had mild or moderate anemia, detected by HbLab. In 20 patients, the HbHemocue, and in 34 patients, the SpHb detected anemia. Linear correlation and mean bias (limits of agreement, LOA) for HbHemocue and HbLab were r = 0.969 and -1.08 (+6.44/-8.60) g/L, and for SpHb and HbLab r = 0.61 and +1.76 (+26.92/-23.4) g/L. Sensitivity/specificity of the HbHemocue to detect anemia in all, male and female patients were 85.0/99.3%, 75.0/100/% and 88.9/98.9/% with a PPV/NPV of 89.5/98.9%, 100/98.0% and 80.0/99.3%, respectively. Sensitivity/specificity of SpHb to detect anemia for all, male and female patients were 71.4%, 93.3%, 75.0/95.2/% and 66.7/91.1%, with a PPV/NPV for all, male and female patients of 44.1/97.8%, 56.3/97.9% and 33.3/97.7%, respectively.\u0000\u0000Conclusions : HbHemocue and HbLab show a strong linear correlation and a good agreement, while linear correlation of SpHb and HbLab is moderate and agreement poor. For both devices, anemia detection is moderate, but the positive prediction value for anemia is much better with the HbHemocue. Both devices reliably detected non-anemic patients.\u0000\u0000Glossary : CO = carbon monoxide ; PPV = positive predicted value ; NPV = negative predicted value ; HbLab = hemoglobin determined by the laboratory ; HbHemocue = hemoglobin determined by the HemoCue device ; SpHb = hemoglobin determined by the Masimo-RAD67 device ; LOA = limits of agreement ; LOS = length of stay ; POC = point of care ; SpO2 = arterial hemoglobin ; PR = pulse rate ; PI = perfusion index ; PVI = plethysmography variability index ; SpCO = carboxyhemoglobin ; SpMet = methemoglobin ; LED = Light Emitting Diodes ; HiCN = hemiglobincyanide ; SLS = Sodium Lauryl Sulphate ; BMI = body mass index ; BT = body temperature ; WHO = World Health Organization ; IQR = interquartile range ; MAP = mean arterial pressure ; HF = heart frequency ; SD = standard deviation\u0000\u0000Key point Summary :\u0000– Question : Is Hb measurement of the Masimo Rad-67 and of the HemoCue reliable?\u0000– Findings : Non-anemic patients are reliab","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":"47266462","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":"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}

{"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}

{"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}