Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2009
Pulmonary gas exchange is well preserved during robot assisted surgery in steep Trendelenburg position.
During robot assisted hysterectomies and prostatectomies, surgical exposure demands the application of a CO2 pneumoperitoneum with a very steep Trendelenburg position (40 degrees). The extent to which oxygenation and ventilation might be compromised intra-operatively remains poorly documented. ⋯ The lung has a remarkable yet incompletely understood capacity to withstand the effects of a CO2 pneumoperitoneum and steep Trendelenburg position during general anesthesia. While individual responses vary and should be monitored, effects on dead-space ventilation and venous admixture are small and should not be an obstacle to provide optimal surgical exposure during robot assisted prostatectomy or hysterectomy.
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Acta Anaesthesiol Belg · Jan 2009
Case ReportsTwo cases of isolated unilateral paralysis of hypoglossal nerve after uncomplicated orotracheal intubation.
We report two cases of postoperative unilateral hypoglossal nerve palsy following uncomplicated orotracheal intubation for plastic surgery. Both patients underwent a long procedure and were installed in a non physiological position. ⋯ Furthermore, other etiologies of neurological injury like a difficult airway or anatomical anomalies were not present. The aim of these two case reports is to sensitize the anesthetists to hypoglossal nerve palsy and to highlight a potential clinical problem of positioning during plastic surgery.
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Acta Anaesthesiol Belg · Jan 2009
Patient-controlled intravenous analgesia as an alternative to epidural analgesia during labor: questioning the use of the short-acting opioid remifentanil. Survey in the French part of Belgium (Wallonia and Brussels).
Childbirth ranks among the most intense experiences of acute pain. Neuraxial analgesia (i.e. epidural or combined spinal-epidural technique) is the most effective way to relieve that pain but it is contraindicated or impossible to perform for some parturients. We designed a survey of the current use of analgesic alternatives to epidural analgesia (EA) for labor pain, specifically the use of opioid patient-controlled intravenous analgesia (PCIA), in the French part of Belgium (Wallonia and Brussels). ⋯ Other opioids (piritramide, morphine, fentanyl) and ketamine were also administered by PCIA. Forty-five percents of the centers reported never using opioid PCIA by either lack of knowledge (7%), fear of maternal or fetal side effects (48%) and unability to provide a correct supervision of the parturient during PCIA use (48%), opposition from the pediatricians or obstetricians (17%) or because they considered the technique as ineffective to relieve labor pain (17%). In conclusion, the survey demonstrated that, when EA is contraindicated, systemic opioid administered by PCIA is used in almost half of the centers (47%) and that remifentanil is the first choice, particularly when a live birth is expected.