Acta anaesthesiologica Belgica
-
Acta Anaesthesiol Belg · Jan 2009
Randomized Controlled TrialThe impact of fluid restriction policy in reducing the use of red blood cells in cardiac surgery.
Hemodilution contributes significantly to transfusion requirements in patients undergoing CABG under CPB. We hypothesised that restriction of parenteral fluids in comparison to a liberal fluid administration policy leads to less use of packed red cells in CABG operations supported by cell salvage. After consent and approval, 130 patients operated under equal conditions were assigned prospectively and randomly either for a restrictive protocol for intravenous fluid administration (group A, 65 pts) or not (group B, 65 pts). ⋯ Hours of mechanical ventilation in ICU were ranging from 5 to 29 (mean = 10.0, median = 9) for A and from 5 to 42 (mean = 14.8, median = 10) for B. Length of stay in ICU in nights for group A was ranging from 1 to 10 (mean = 2.7, median = 2) and for group B was ranging from 1 to 6 (mean = 3.5, median = 2). In conclusion, reduction of transfusions in CABG operations is feasible when a restrictive protocol for intravenous fluids is applied.
-
Acta Anaesthesiol Belg · Jan 2009
Review Comparative StudyComparison of contemporary EEG derived depth of anesthesia monitors with a 5 step validation process.
During the last decennium, a growing number of depth of anesthesia monitors, extracting information from the spontaneous electroencephalogram (EEG) have been developed and commercialized. The growing interest in depth of anesthesia monitoring resulted in an intensified technological progress. ⋯ In this review, the authors present a strategy to compare monitors of the hypnotic component of anesthesia, based on the available literature and their own experience with validation studies. They also discuss the level of validation of the most commonly used EEG derived depth of anesthesia monitors.
-
Acta Anaesthesiol Belg · Jan 2009
Review Case ReportsAnesthetic management of epidermolysis bullosa: a review and report of two cases.
Dystrophic epidermolysis bullosa is a rare genetically mechanobullous disorder, characterized by an excessive susceptibility of the skin and mucosa to separate from the underlying tissues after mechanical trauma. Avoiding mechanical stimulation of the skin and mucous membranes is essential in the anesthetic management. ⋯ We report the successful applications of intraoperative indirect electrocardiogram monitoring without electrodes and bilateral axillary and midhumeral nerve block using levobupivacaine in combination with lidocaine in patients who had previously undergone repeated general anesthesia. We conclude that regional anesthesia should be preferred in patients with dystrophic epidermolysis bullosa, especially those who had previously undergone repeated general anesthetic procedures.
-
Acta Anaesthesiol Belg · Jan 2009
ReviewClinical implications of epidural fat in the spinal canal. A scanning electron microscopic study.
This review of articles summarizes recent developments in relation to fat located in the epidural space and also in dural sleeves of spinal nerve roots in order to improve our understanding of the clinical effects of the epidural blockade. ⋯ The epidural space contains abundant epidural fat that distributes along the spinal canal in a predictable pattern. Fat cells are also abundant in the dura that forms the sleeves around spinal nerve roots but they are not embedded within the laminas that form the dura mater of the dural sac. Drugs stored in fat, inside dural sleeves, could have a greater impact on nerve roots than drugs stored in epidural fat, given that the concentration of fat is proportionally higher inside nerve root sleeves than in the epidural space, and that the distance between nerves and fat is shorter. Similarly, changes in fat content and distribution caused by different pathologies may alter the absorption and distribution of drugs injected in the epidural space.
-
Acta Anaesthesiol Belg · Jan 2009
Comparative Study Clinical TrialDesflurane consumption with the Zeus during automated closed circuit versus low flow anesthesia.
During automated closed-circuit anesthesia (CCA), the Zeus (Dräger, Lübeck, Germany) uses a high initial fresh gas flow (FGF) to rapidly attain the desired agent and carrier gas concentrations, resulting in a desflurane consumption well above patient uptake. Because both FGF and carrier gas composition can affect consumption, we determined the Zeus' agent consumption with automated CCA and with automated low flow anesthesia (LFA) (= maintenance FGF of 0.7 L min(-1)) with 3 different carrier gases. ⋯ After 50 min, desflurane consumption with automated CCA is lower than with automated LFA. However, initial agent consumption is complex, and N2O in particular may increase initial desflurane consumption (though ultimately resulting in lower desflurane usage because of its MAC sparing effect) because initial FGF is increased to rapidly reach the target concentrations. Differences in desflurane consumption only become apparent after FGF has stabilized to the target FGF.