Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2013
Case ReportsRuptured uterine artery pseudoaneurysm: an overlooked cause of late postpartum haemorrhage.
We report an exceptional case of secondary postpartum hemorrhage (PPH) twenty days after cesarean delivery, resulting from a ruptured uterine artery pseudoaneurysm (UAP). The diagnosis was initially confounded by a septic shock necessitating inotropic support in the intensive care unit. Intense vaginal bleeding occurred eleven days after uterine curettage. ⋯ Pitfalls in UAP diagnostic are highlighted (delayed presentation, possibility of spontaneous hemostasis, and lack of typical findings on colour Doppler sonography in hypotensive patients). These pitfalls may further be confounded by a concomitant sepsis. Angiography and selective uterine artery embolization is the treatment of choice.
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Acta Anaesthesiol Belg · Jan 2013
Randomized Controlled Trial Comparative StudyComparison of tube-taping versus a tube-holding device for securing endotracheal tubes in adults undergoing surgery in prone position.
Endotracheal tube displacement is one of the leading causes for airway related complications. Endotracheal tube displacement is much more common in the prone position than in the supine position. ⋯ Both methods of fixation of the endotracheal tube are clinically useful in the prone position but the Thomas tube holder is more effective than adhesive tape in preventing displacement of endotracheal tube.
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The aim of this literature review was to compare the duration of the recovery effects of sugammadex. We therefore systematically searched Medline for relevant reports that investigated the recovery time to a train-of-four (TOF) ratio of 0.9 after sugammadex administration. Thirty-three reports were retrieved. ⋯ Additionally, variability in the onset of sugammadex effect was observed in healthier patients (up to 22.3 minutes). This review confirms the known rapid reversal by the recommended doses of sugammadex. However, due to possibility of an increased recovery time, any patient who receives sugammadex to reverse neuromuscular block should have his or her TOF checked prior to extubation.
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Acta Anaesthesiol Belg · Jan 2013
ReviewUnplanned cesarean section in parturients with an epidural catheter in-situ: how to obtain surgical anesthesia?
Epidural analgesia is frequently used for labor. Several authors advocate its use when parturient women are at increased risk for emergency Cesarean delivery. Hereby, the time needed to achieve adequate surgical anesthesia may be shortened and general anesthesia may be avoided. ⋯ Little consensus can be found in literature about the nature of local anesthetic solution to be used to provide rapid onset and high quality anesthesia for the entire duration of surgery. Women, whose epidural analgesia extension fails either receive a new neuraxial blockade, or receive general anesthesia. We reviewed the medical literature to better define the best methods and choice of products at providing a rapid and adequate surgical anesthesia in parturient women with an epidural catheter in-situ.
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Acta Anaesthesiol Belg · Jan 2013
ReviewIs there a rationale for an anesthesiologist's role against cancer recurrence?
Growth of tumors can accelerate during the peri-operative period. Accordingly, early relapse of cancer occurs in some patients during the first two postoperative years. ⋯ Understanding the role of inflammation and its consequences (i.e., immune response, growth factors, dissemination of tumor cells) could lead to define a role of anesthesiologists in reducing cancer recurrence following surgery. We argue for peri-operative pharmacological interventions to reduce cancer relapse, with a focus on non-steroidal anti-inflammatory drugs.