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
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.
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Acta Anaesthesiol Belg · Jan 2014
Case ReportsExtracorporeal cardiopulmonary resuscitation for refractory ventricular fibrillation. A rescue bridge to reperfusion.
Accumulating evidence suggests benefit of extracorporeal cardiopulmonary resuscitation (E-CPR) in patients with refractory cardiac arrest by using venoarterial extracorporeal membrane oxygenation. Appropriate patient selection for E-CPR is cumbersome and still debated. We describe a 56-year-old male who developed refractory ventricular fibrillation upon arrival at the emergency department and was successfully treated by urgent E-CPR. Patient selection, complications and the need to adapt the chain of survival are discussed.
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Acta Anaesthesiol Belg · Jan 2014
A comparison of the effects of lidocaine or magnesium sulfate on hemodynamic response and QT dispersion related with intubation in patients with hypertension.
The aim of this study was to investigate the effect of magnesium administered before induction on the hemodynamic response and QT dispersion (QTd) related with intubation in hypertensive patients and to compare it with lidocaine. ⋯ QTd is not increased during tracheal intubation in hypertensive patients so there is no need for magnesium sulfate for these patients. But as QTd has been shown to increase during tracheal intubation for coronary artery disease patients, magnesium sulfate might be useful for those patients although future studies are required to confirm this statement.