Nederlands tijdschrift voor geneeskunde
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Awareness with recall is defined as 'both conscious experience and memory of events during surgery'. Perceptions of sound, pain or paralysis and assimilation of these in the memory can lead to post-traumatic stress disorder. Prospective studies report an incidence of 0.1-1%. ⋯ No additional benefit has been shown for the use of bispectral index (BIS) monitoring compared with measuring the expired concentration of an inhaled anaesthetic agent. High-risk patients undergoing total intravenous anaesthesia may benefit from BIS for monitoring depth of anaesthesia. Further scientific investigation of the neurological processes involved in awareness with recall is required in order to develop novel monitoring techniques.
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Ned Tijdschr Geneeskd · Jan 2015
Review Case Reports[The elderly patient with multiple rib fractures].
Rib fractures resulting from blunt thoracic trauma occur frequently in the elderly. Even though these are usually due to a low impact trauma mechanism (e.g. a fall from standing height), rib fractures are associated with significant morbidity and mortality in the elderly patient. ⋯ More specifically, age-specific indications and contra-indications for intravenous or epidural analgesia and operative rib fixation are discussed. In addition, we show that a multidisciplinary approach, involving a trauma surgeon, anaesthetist, intensive care physician and physiotherapist, is paramount for the prevention of potentially lethal complications.
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Homeless people have substantial health disadvantages as compared to the general population, and excessive losses in life expectancy. High proportions of psychiatric disorders, substance abuse and intellectual disability have been reported. This makes palliative care for this population extremely complex. ⋯ Involvement of a palliative care consultation team and transfer to a homeless shelter, to which homeless people with life-threatening diseases could be admitted, gave both the patient and his family relief. This case illustrates that palliative care in homeless patients may be extremely complex due to the specific physical and psychosocial features involved. Such care should be offered proactively and on a multidisciplinary basis.
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The clinical condition "winged scapula" (scapula alata) is frequently not recognized as such. The accompanying symptoms are often attributed to more frequently occurring shoulder disorders, which can lead to unnecessary surgical procedures. ⋯ Shoulder symptoms due to scapula alata can be caused be a penetrating wound leading to nerve injury. The treatment of patients with a scapula alata calls for a multidisciplinary approach.
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Ned Tijdschr Geneeskd · Jan 2015
Historical Article[The first Dutch debate on anaesthesia in obstetrics].
After the publication of the Dutch medical guideline on pharmacological analgesia during childbirth in 2008, the question of whether pharmacological pain relief should be permissible during labour was hotly debated. This discussion has been going on since the second half of the 19th century when the introduction of ether and chloroform was extensively studied and described in Great Britain. ⋯ Study of historical journals and textbooks, originating in the Netherlands and elsewhere, and of historical medical literature on anaesthesia and obstetrics shows that the Dutch protagonists adopted more nuanced ideas on this issue than many of their foreign colleagues. This description of the first Dutch debate on anaesthesia in obstetrics shows that in fact the issues and arguments are timeless.