Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2015
Editorial Review Comparative StudyRegional versus general anesthesia for spine surgery. A comprehensive review.
The use of regional anesthesia techniques for intra-operative anesthesia remains very controversial for patients scheduled to undergo spinal interventions. Spine surgery is still mostly performed under general anesthesia. This has to be explained by the patient's position required during surgery, the extent and duration of some procedures, the preference of the surgeon and/or anesthesiologist and a trend which becomes more and more prominent to abandon central nerve blocks in general. ⋯ The present overview will focus on the feasibility of different regional techniques to be used intra-operatively. These techniques may also be of interest or even intended for prolonged postoperative analgesia and benefit even after a single bolus injection, continuous or intermittent administration. Although all techniques described offered favorable success rates, future research is mandatory to determine their superiority over general intra-operative anesthesia and conventional pain therapy.
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Acta Anaesthesiol Belg · Jan 2015
ReviewClinical evidence for dorsal root ganglion stimulation in the treatment of chronic neuropathic pain. A review.
Treating chronic neuropathic pain remains a challenge, despite the existing therapies. Recent years have seen the emergence of promising new technologies, such as the neurostimulation of the dorsal root ganglion (DRG). ⋯ To improve the level of proof, larger randomized controlled trials are needed. These should include well-described populations, a sufficiently long follow-up and a detailed description of concurrent treatments (pharmacologic and patient integration in a multidisciplinary approach).
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Acta Anaesthesiol Belg · Jan 2015
ReviewAnesthesia and neurotoxicity in the developing brain: A non-systematic review.
In recent years, increasing experimental evidence has suggested an association between exposure to anesthesia in early life and subsequent poor neurodevelopmental outcome. Retrospective and follow-up studies have also suggested anesthesia-related neurotoxicity in the developing human brain. The present non-systematic review summarizes the available evidence, depicts the current knowledge on the potentially harmful effects of anesthesia and will discuss whether this knowledge urges us to implement changes in clinical practice.
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Acta Anaesthesiol Belg · Jan 2014
Review Case ReportsApproach to one lung ventilation during the surgical resection of an intrathoracic ganglioneuroblastoma in a three-year-old child: a case report and review of the literature.
One lung ventilation (OLV) in children is a challenge and requires creative solutions. A case of OLV with bronchial placement of a fiberscope inspection-guided vascular embolectomy catheter in a three-year-old girl, scheduled for the resection of an intrathoracic tumor through thoracotomy is described. ⋯ Knowing all existing strategies in that domain is important to provide optimal perioperative care. In this paper, several methods of OLV in children will be discussed, such as selective endobronchial intubation, types of bronchial blockers, Univent tube, pediatric double lumen tubes, as well as the Marraro double lumen tube.
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Non-depolarizing neuromuscular blocking agents (NMBAs) produce neuromuscular blockade by competing with acetylcholine at the neuromuscular junction, whereas depolarizing NMBAs open receptor channels in a manner similar to that of acetylcholine. Problems with NMBAs include malignant hyperthermia caused by succinylcholine, anaphylaxis with the highest incidence for succinylcholine and rocuronium, and residual neuromuscular blockade. To reverse these blocks, anticholinesterases can act indirectly by increasing the amount of acetylcholine in the neuromuscular junction; sugammadex is the only selective relaxant binding agent (SRBA) in clinical use. ⋯ Moreover, it is uncertain whether the full removal of the competing antagonists (by SRBAs) at the neuromuscular junction impacts the efficiency of acetylcholine transmission. In a recent pilot study in healthy volunteers, we demonstrated increased electromyographic diaphragm activity after sugammadex, compared to neostigmine. Further research is needed to elucidate the role of NMBAs and their reversal agents in the central control of breathing, respiratory muscle activity, and respiratory outcomes.