Acta anaesthesiologica Belgica
-
Acta Anaesthesiol Belg · Jan 2015
Editorial Review Comparative StudyRegional versus general anesthesia for spine surgery. A comprehensive review.
The use of regional anesthesia techniques for intra-operative anesthesia remains very controversial for patients scheduled to undergo spinal interventions. Spine surgery is still mostly performed under general anesthesia. This has to be explained by the patient's position required during surgery, the extent and duration of some procedures, the preference of the surgeon and/or anesthesiologist and a trend which becomes more and more prominent to abandon central nerve blocks in general. ⋯ The present overview will focus on the feasibility of different regional techniques to be used intra-operatively. These techniques may also be of interest or even intended for prolonged postoperative analgesia and benefit even after a single bolus injection, continuous or intermittent administration. Although all techniques described offered favorable success rates, future research is mandatory to determine their superiority over general intra-operative anesthesia and conventional pain therapy.
-
Acta Anaesthesiol Belg · Jan 2015
ReviewClinical evidence for dorsal root ganglion stimulation in the treatment of chronic neuropathic pain. A review.
Treating chronic neuropathic pain remains a challenge, despite the existing therapies. Recent years have seen the emergence of promising new technologies, such as the neurostimulation of the dorsal root ganglion (DRG). ⋯ To improve the level of proof, larger randomized controlled trials are needed. These should include well-described populations, a sufficiently long follow-up and a detailed description of concurrent treatments (pharmacologic and patient integration in a multidisciplinary approach).
-
Acta Anaesthesiol Belg · Jan 2015
ReviewAnesthesia and neurotoxicity in the developing brain: A non-systematic review.
In recent years, increasing experimental evidence has suggested an association between exposure to anesthesia in early life and subsequent poor neurodevelopmental outcome. Retrospective and follow-up studies have also suggested anesthesia-related neurotoxicity in the developing human brain. The present non-systematic review summarizes the available evidence, depicts the current knowledge on the potentially harmful effects of anesthesia and will discuss whether this knowledge urges us to implement changes in clinical practice.
-
Preeclampsia was formerly defined as a multisystemic disorder characterized by new onset of hypertension (i.e. systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg) and proteinuria (> 300 mg/24 h) arising after 20 weeks of gestation in a previously normotensive woman. Recently, the American College of Obstetricians and Gynecologists has stated that proteinuria is no longer required for the diagnosis of preeclampsia. This complication of pregnancy remains a leading cause of maternal morbidity and mortality. ⋯ Airway edema and tracheal intubation-induced elevation in blood pressure are important issues of general anesthesia in those patients. The major adverse outcomes associated with preeclampsia are related to maternal central nervous system hemorrhage, hepatic rupture, and renal failure. Preeclampsia is also a risk factor for developing cardiovascular disease later in life, and therefore mandates long-term follow-up.
-
Non-depolarizing neuromuscular blocking agents (NMBAs) produce neuromuscular blockade by competing with acetylcholine at the neuromuscular junction, whereas depolarizing NMBAs open receptor channels in a manner similar to that of acetylcholine. Problems with NMBAs include malignant hyperthermia caused by succinylcholine, anaphylaxis with the highest incidence for succinylcholine and rocuronium, and residual neuromuscular blockade. To reverse these blocks, anticholinesterases can act indirectly by increasing the amount of acetylcholine in the neuromuscular junction; sugammadex is the only selective relaxant binding agent (SRBA) in clinical use. ⋯ Moreover, it is uncertain whether the full removal of the competing antagonists (by SRBAs) at the neuromuscular junction impacts the efficiency of acetylcholine transmission. In a recent pilot study in healthy volunteers, we demonstrated increased electromyographic diaphragm activity after sugammadex, compared to neostigmine. Further research is needed to elucidate the role of NMBAs and their reversal agents in the central control of breathing, respiratory muscle activity, and respiratory outcomes.