Acta anaesthesiologica Belgica
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Perioperative aspiration into the lungs is an infrequent but potentially serious cause of anesthesia-related morbidity and mortality. It is still a leading cause of death from pulmonary complications. Aspiration occurs in approximately three per 10.000 anesthetic procedures with higher incidences in special patient populations and emergency situations. ⋯ This article reviews incidence, morbidity and mortality of perioperative aspiration as well as risk factors and preventive measures. Among preventive measures the use of drugs designed to increase gastric pH, recent developments in supraglottic airway devices and application of rapid sequence induction with cricoid pressure are discussed. Also, international fasting guidelines and clinical management following aspiration are provided.
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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.
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Acta Anaesthesiol Belg · Jan 2013
ReviewA review of the interest of sugammadex for deep neuromuscular blockade management in Belgium.
Oro-tracheal intubation and selected surgical conditions are facilitated by a deep neuromuscular block (NMB), but patient's security can be jeopardized by its residual effects at the time of tracheal extubation. Although neostigmine remains the reference reversal agent in many situations, the limitations of its efficacy must be well understood (ceiling effect, delay of action, side effects). It is best administered after re-emergence of the 3rd or 4th train-of-four (TOF) response. ⋯ In Belgium, the use of sugammadex and its reimbursement depend on specific conditions. The excellent clinical tolerance of sugammadex benefits to patients at risk of developing complications related to residual NMB or to the undesirable effects of neostigmine. In all cases, neuromuscular transmission monitoring is the key to adequate NMB management.
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Acta Anaesthesiol Belg · Jan 2013
ReviewShould the "in situ" simulation become the new way in Belgium? Experience of an academic hospital.
The place of simulation in medical education, particularly in anesthesia, appears to be more and more evident. However, the history of simulation in Belgium showed that the associated costs remain a barrier. The use of 'in situ' simulation, defined as the practice of simulation in the usual workplace, could solve the problem of providing access to this educational tool. ⋯ This allows developing skills related to teamwork and communication. Despite those numerous advantages, several difficulties persist. The associated logistic and organizational constraints can be cumbersome.