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
Case ReportsRuptured uterine artery pseudoaneurysm: an overlooked cause of late postpartum haemorrhage.
We report an exceptional case of secondary postpartum hemorrhage (PPH) twenty days after cesarean delivery, resulting from a ruptured uterine artery pseudoaneurysm (UAP). The diagnosis was initially confounded by a septic shock necessitating inotropic support in the intensive care unit. Intense vaginal bleeding occurred eleven days after uterine curettage. ⋯ Pitfalls in UAP diagnostic are highlighted (delayed presentation, possibility of spontaneous hemostasis, and lack of typical findings on colour Doppler sonography in hypotensive patients). These pitfalls may further be confounded by a concomitant sepsis. Angiography and selective uterine artery embolization is the treatment of choice.
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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.