Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2003
ReviewShould we reconsider triggers for red blood cell transfusion?
Very few randomized controlled trials on the benefits of red blood cell (RBC) transfusions in humans have been published. Consequently, most clinical practice guidelines remain based on expert opinion, animal studies and the limited human trials available. In the absence of definitive outcome studies, numerous theoretical arguments have been put forward either to support or to condone the classic transfusion threshold of 10 g/dL. ⋯ All RBC transfusions must be tailored to the patient's needs, at the moment the need arises. In conclusion most published recommendations are appropriate but their conclusions are limited, as they are commensurate with existing knowledge. Reliable monitors to guide transfusion therapy and well conducted trials to determine optimal transfusion strategies are required.
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Acta Anaesthesiol Belg · Jan 2003
Intradermal skin testing in the investigation of suspected anaphylactic reactions during anaesthesia--a retrospective survey.
An anaphylactic reaction is a rare, but severe anaesthetic complication. In this retrospective survey we report on patients with a severe suspected anaphylactic reaction during anaesthesia and the investigation with intradermal skin testing of these suspected anaphylactic reactions. In the patients with an anaphylactic reaction to neuromuscular blocking drugs, the subsequent anaesthetic history was examined. ⋯ In 47 patients skin testing was performed and 43 of these patients had positive skin tests: neuromuscular blockings drugs and succinylcholine more specifically, were the most frequently incriminated drugs. After the anaphylactic reaction 19 patients had surgery on 26 occasions with the use of a skin-test-negative neuromuscular blocking drug; no problems occurred. Skin testing proved to be a reliable tool to investigate suspected anaphylactic reactions during anaesthesia and to guide the future use of neuromuscular blocking drugs.
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Acta Anaesthesiol Belg · Jan 2003
Direction and side used to determine the extent of sensory block after subarachnoid anesthesia do not influence the level of the block.
Methods of sensory testing in neuraxial anesthesia may supposedly account for different results in reporting the extent of the block. To determine whether the caudad to cephalad versus the cephalad to caudad direction as well as the side of testing, left versus right, may affect the assessment of sensory block after subarachnoid anesthesia, two groups of patients undergoing transurethral surgery were studied. One group, 44 patients were tested for the influence of direction of block determination and another group 50 patients for the influence of side. ⋯ In 44 patients, the level of sensory block determined 20, 25 and 30 minutes after the subarachnoid anesthesia in a cephalad to caudad direction was found at the T11 dermatome at each time point and did not differ when compared to the levels determined following the caudad to cephalad direction. In the second study in a different group of 50 patients, the level of sensory block 20, 25 and 30 minutes after the subarachnoid injection was found at the T11 dermatome on the right side at each time point and did not differ from the level determined on the left side. We conclude that the level of sensory block after subarachnoid anesthesia with lidocaine is independent of the direction of testing and the side the assessment is performed using the pressure palpator.
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Acta Anaesthesiol Belg · Jan 2003
Case ReportsAmphetamine abuse in pregnancy: anesthetic implications.
The prevalence of recreational substance abuse amongst young adults (including women in child-bearing age) has markedly increased over the past two decades and it remains one of the major problems facing our society today--worldwide. Amphetamine is one of the most common substances abused in pregnancy and one of the most potent sympathomimetic amines with respect to stimulatory effects on the central nervous system. The following case report illustrates the problems that may arise during anesthesia in the parturient with recent amphetamine intake.