Acta anaesthesiologica Belgica
-
Acta Anaesthesiol Belg · Jan 2008
Randomized Controlled Trial Comparative StudySpinal anesthesia: comparison of plain ropivacaine, bupivacaine and levobupivacaine for lower abdominal surgery.
This study was performed to compare the anesthetic efficacy and safety of three local anesthetic agents: racemic bupivacaine and its two isomers: ropivacaine and levobupivacaine, in patients undergoing lower abdominal surgery. One hundred-twenty patients, ASA I-III, were randomized to receive an intrathecal injection of one of three local anesthetic solutions. Group A (n = 40) received 3 ml of isobaric bupivacaine 5 mg/ml (15 mg). ⋯ The onset of motor block was significantly faster in the bupivacaine group compared with that in the ropivacaine group and almost the same of that in the levobupivacaine group (P < 0.05). Ropivacaine presented a shorter duration of both motor and sensory block than bupivacaine and levobupivacaine (P < 0.05). Bupivacaine required more often the use of a vasoactive drug (ephedrine) compared to both ropivacaine and levobupivacaine and of a sympathomimetic drug (atropine) compared to the ropivacaine group.
-
Acta Anaesthesiol Belg · Jan 2008
Randomized Controlled TrialPrevention of postoperative hypotension following spinal anesthesia for TURP: a double-blind randomized controlled trial comparing ephedrine with placebo.
Spinal hypotension (SH) is a common side effect of spinal anesthesia and may also occur after the surgical procedure. In this double-blinded, placebo-controlled, randomised clinical trial fifty patients undergoing transurethral prostatectomy under spinal anesthesia received 10 mg of ephedrine IV before being transferred from the operating table into their bed after the procedure, whereas fifty controls received saline IV. The number of per- and postoperative hypotensive episodes and vasopressor use, time delay between the administration of the study medication and the first hypotensive episode, level of spinal blockade at the start of surgery, pre- and postoperative hemoglobine and sodium concentration, cardiovascular co-morbidity and chronic medication were registered. ⋯ There was no statistically significant relation between age, level of spinal blockade, cardiovascular co-morbidity or biochemical parameters and the risk of developing per- or postoperative hypotension, except for a correlation between preoperative alpha-receptor blocking drugs and peroperative hypotension (p < 0.05). Postoperative hypotension (recorded incidence 31%) was almost as common as peroperative hypotension (recorded incidence 37%) and occurred as late as 190 minutes after the end of surgery. Ephedrine IV at the end of surgery reduced the number of postoperative hypotensive episodes per patient but did not reduce the overall incidence of postoperative SH.
-
Acta Anaesthesiol Belg · Jan 2008
Randomized Controlled Trial Comparative StudyMethylprednisolone vs. dexamethasone in the prevention of postoperative nausea and vomiting: a prospective, randomised, double-blind, placebo-controlled trial.
Dexamethasone and methylprednisolone have been proven effective in the prevention of nausea after chemotherapy. Dexamethasone has been proven effective in the prophylaxis of late PONV. Literature about methylprednisolone in PONV prophylaxis is rare. ⋯ There was a beneficial clinical effect of dexamethasone in this population, although not significant. A possible explanation lies in the fact that monotherapy is mostly insufficient in a population at risk like ours. This study confirms that steroids are mostly effective in the prevention of late PONV, less effective in early PONV.
-
Acta Anaesthesiol Belg · Jan 2008
ReviewDoppler echocardiography as a modern tool to diagnose and monitor non-cardiac surgical patients: does it improve outcome?
Echocardiography and Doppler provide intraoperative and immediate insight when a haemodynamic deterioration occurs. Both morphological and haemodynamic features can be diagnosed instantly. Furthermore, this tool is used as a functional haemodynamic monitoring device offering on line information on systolic function, preload and afterload. No clear data exist on improvement of outcome in noncardiac surgery, but analogy to cardiac patients suggest strongly outcome can be advanced with echo-Doppler.
-
Acta Anaesthesiol Belg · Jan 2008
ReviewThe propofol infusion 'syndrome' in intensive care unit: from pathophysiology to prophylaxis and treatment.
Propofol is a short-acting intravenous anesthetic agent widely used for sedation in anesthesia and intensive care. However, during the last 15 years there have been quite a lot of publications reporting unexplained deaths among pediatric and adult critically ill patients. These cases shared common symptoms and signs unrelated with initial admission diagnosis and were under long-term propofol infusion at high doses. ⋯ It seems that during states of increased metabolic demand, the reduced energy production related to an inhibitory propofol action at the level of mitochondrial oxidative phosphorylation and lipid metabolism may lead to the manifestation of the syndrome. Furthermore, cases of early toxicity due to failure in cellular energy production with development of lactic acidosis have been also described during anesthesia. For the above reasons, recommendations for the limitation of propofol use have been devised by various institutions, whereas physicians need to be cautious when using prolonged propofol sedation and alert for early signs of toxicity.