Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2012
Review Meta AnalysisInadvertent epidural injection of drugs for intravenous use. A review.
The frequency of inadvertent injection of drugs in the epidural space is probably underestimated and underreported, but it can cause serious morbidity and possibly mortality. ⋯ Most drugs do not lead to sequelae other than pain during injection or transient neurological complaints. Other drugs may have more deleterious consequences, such as paraplegia. Both the dose of the inadvertent injected drug and the time frame play an important role in the patient's outcome. "Syringe swap", "ampoule error", and epidural/intravenous line confusion due to inaccurate or absent colour coding of epidural catheters were the main sources of error. Preventive strategies, including non Luer-lock epidural injection ports, might increase safety.
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Acta Anaesthesiol Belg · Jan 2012
Randomized Controlled TrialA randomized, double-blind, controlled trial on non-opioid analgesics and opioid consumption for postoperative pain relief after laparoscopic cholecystectomy.
Following laparoscopic cholecystectomy, an effective post-operative pain control is necessary, at least during the first 24 hours. We present a randomized, double-blind trial on the effect of the combined use of intravenous parecoxib, and metamizol or paracetamol on piritramide consumption using a patient-controlled analgesia (PCA) pump in patients recovering from laparoscopic cholecystectomy. ⋯ The efficacy of tested additive medications on piritramide consumption and pain relief is weak and there is no clear-cut difference between the non-opioid drugs used.
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Acta Anaesthesiol Belg · Jan 2012
ReviewSupraclavicular brachial plexus blocks: review and current practice.
This article reviews the possible revival of the supraclavicular brachial plexus blockade due to the use of ultrasound guidance. The brachial plexus is a complex network of nerves, extending from the neck to the axilla, which supplies motor and sensory fibers to the upper extremity. Understanding the complexities of the formation and structure of the brachial plexus remains a cornerstone for effective regional anaesthesia. ⋯ However, because of the proximity of the pleura, most anaesthesiologists have been reluctant to perform this supraclavicular approach. The introduction of ultrasound guidance techniques not only reduces the possible risk of pneumothorax but also allows a faster onset time of the block with a reduction of the local anaesthetic dose. This makes the supraclavicular approach a valuable alternative to the axillary, interscalene and infraclavicular approach for upper limb surgery.
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Acta Anaesthesiol Belg · Jan 2012
ReviewOpioids and protection against ischemia-reperfusion injury: from experimental data to potential clinical applications.
Ischemic preconditioning, first demonstrated in animal myocardium, is an intrinsic and ubiquitous mechanism of marked protection against ischemia. Accumulating evidences have established that endogenous opioid peptides and their receptors play an important role in this adaptive phenomenon in the heart and other major organs. ⋯ Recent human studies now raise the possibility to exploit this opioid-induced protection in clinical cardiac ischemia. These remarkable anti-ischemic properties of opioids and their emerging potential for organ protection in perioperative medicine will be reviewed at the light of pertinent results from basic and clinical researches.
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Acta Anaesthesiol Belg · Jan 2012
Case ReportsRefractory hypercapnia: a simplified technique for extracorporeal CO2 removal (ECCO2R) in the presence of therapeutic limitations.
Refractory hypercapnia with severe acidosis appeared in a 67-year-old man who presented with lung fibrosis and a left pneumothorax as delayed complications of bleomycin chemotherapy for advanced grade lymphoma. Due to failure of noninvasive ventilation using a high-flow nasal cannula oxygen system, the patient was mechanically ventilated with two ventilators at different settings, after intubation with a double-lumen tube. ⋯ To remove some amount of carbon dioxide, we used a simplified method based on a veno-venous hemofiltration circuit coupled to a paediatric oxygenator and an air/oxygen blender. The efficacy on carbon dioxide removal was modest, with a percentage of CO2 total extraction ranging from 10.5 to 20.4%, but the system was immediately available, well tolerated and not very expensive.