Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2015
Case ReportsIntermediate cervical plexus block for cervical esophagus diverticulectomy.
We report the case of a 97 year old woman suffering from a voluminous diverticle of the cervical esophagus with important comorbidities and a very poor quality of life. A diverticulectomy under general anesthesia implied a high level of risk. Regional anesthesia was chosen, i.e. an intermediate cervical plexus block, with mild sedation allowing to maintain contact with the patient. The procedure was carried out without complications and the patient's and surgical staff satisfaction were optimal.
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Acta Anaesthesiol Belg · Jan 2015
Case ReportsLeft mainstem bronchus rupture due to a left-sided double lumen tube.
Double lumen tubes (DLT) are a cornerstone in thoracic anaesthesia to achieve onelung ventilation. Due to the shape and size of these devices, airway injuries might occur. ⋯ In the past, treatment of tracheobronchial ruptures was performed surgically, nowadays conservative treatment can be considered (3, 4). Here, we report a case of tracheobronchial rupture during oesophageal surgery.
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Acta Anaesthesiol Belg · Jan 2014
Case ReportsSwift recovery of severe hypoxemic pneumonia upon morbid obesity.
A morbidly obese (body mass index = 55.5) female patient presented with severe hypoxemic community acquired pneumonia [PaO2/FiO2 (P/F) = 57] with primarily right basal atelectasis, but without bilateral opacities in the upper lobes on the chest X-ray. Major O2 desaturations led the nurses to object to moving the patient to the prone position: muscle relaxation combined to prone position was impossible. Therefore, stringent 60 degrees reverse Trendelenburg legs down position was constantly maintained during mechanical ventilation through the endotracheal tube, using low pressure support (pressure support = 5-10 cmH2O) and high positive end-expiratory pressure (PEEP). ⋯ A P/F improvement from 57 to 200 over three days allowed removing the tracheal tube. The patient was discharged 13 days after admission. In this paper, the use of high PEEP in the context of morbid obesity, and low pressure support are discussed.
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Acta Anaesthesiol Belg · Jan 2014
No clinically relevant advantage of intrathecal morphine in total hip arthroplasty?
Adding morphine to intrathecal bupivacaine provides sound analgesia, but is associated with side effects. The purpose of this study is to investigate if the contribution of intrathecal morphine to postoperative analgesia for total hip replacement outweighs its side effects in a modern multimodal setting. From November 2012 till January 2013 patients undergoing total hip arthroplasty (THA) under spinal anesthesia received either plain bupivacaine (group B) or bupivacaine + 0.1 mg morphine (group M). ⋯ Overall morphine consumption and pain scores were low, although they were slightly but significantly lower in group M. Intrathecal morphine was associated with significantly more pruritus. In this study, PCA morphine consumption and pain scores were low in THA with multimodal pain treatment, and the added analgesic value of intrathecal morphine did not outweigh the increased incidence of pruritus.