Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2014
ReviewHydroxyethyl starches in the perioperative period. A review on the efficacy and safety of starch solutions.
Several randomized controlled trials have raised alarming concerns about the safety of hydroxyethyl starches (HES) for the hemodynamic stabilization of critically ill patients. It has been repeatedly demonstrated that the use of HES in patients treated in an intensive care unit was associated with an increased occurrence of serious adverse events, including a higher incidence of renal injury or failure, a higher need for renal replacement therapy (RRT), and (in one study) increased mortality. HES solutions are also widely used in the perioperative period, although high-level evidence on both the efficacy and safety of HES in patients undergoing surgery is sparse. ⋯ Food and Drug Administration also communicated a serious warning with respect to the use of HES (2). The present (non-systematic) review summarizes the evidence upon which these remarkable recommendations are based. Moreover, current guidelines on the use of HES are quoted.
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Rigid bronchoscopy under general anesthesia enables performing diagnostic and/or therapeutic procedures in the tracheobronchial tree. This technique is characterized by specific technical problems, insofar as the anesthesiologist and the operators share the same space, namely the airway. Several potential complications (hemorrhage inside the airway, threat to ventilation ...) may arise. ⋯ General anesthesia is usually total intravenous anesthesia, using short acting agents. Ventilation can be spontaneous, but more often insured using high-frequency jet ventilation. The hospital infrastructure and staff must have the expertise to perform this particular procedure, in order to limit the complication rate.
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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
Ultrasound guided femoral nerve block and lateral femoral cutaneous nerve block for postoperative pain control after primary hip arthroplasty: a retrospective study.
The purpose of this study was to evaluate the use of an ultrasound guided femoral nerve (FN) block together with an ultrasound guided lateral femoral cutaneous nerve (LFCN) block in addition to a patient controlled intravenous analgesia (PCIA) pump with piritramide as a strategy for postoperative pain-management after primary hip arthroplasty. ⋯ This retrospective study indicates that a FN block in combination with a LFCN block as supplementary postoperative analgesia after primary hip arthroplasty, can reduce the piritramide consumption. Furthermore, patients receiving the peripheral nerve block report lower pain scores at rest and during movement compared with the patients who did not receive a peripheral block. However, as this is a retrospective study, conclusions have to be drawn cautiously.
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Acta Anaesthesiol Belg · Jan 2014
Retention of CPR skills and the effect of instructor expertise one year following reciprocal learning.
Although Basic Life Support (BLS) and Cardiopulmonary Resuscitation (CPR) education is mandatory in secondary schools in Flanders, many schools do not programme this content because they lack teachers with expertise in this matter. This study aimed at investigating CPR skill performance and skill decay following reciprocal learning with task cards taught by an expert versus a non-expert teacher. Teacher expertise was asserted by European Resuscitation Council (ERC) certification. ⋯ No clinically relevant skill decay was detected. Instructors with no certification and expertise in BLS can achieve equal learning outcomes as certified instructors when applying reciprocal learning with task cards. The model seems resistant for skill decay since no clinical deterioration of skill was found after 12 months.