Nederlands tijdschrift voor geneeskunde
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Effective intra-operative anaesthesia and peri-operative analgesia are important aspects of patient care in orthopaedic surgery. The interscalene regional anaesthetic block technique, performed with the patient lying in a lateral decubitus position, is new for arthroscopic shoulder surgery conducted in the Netherlands. The combination of the interscalene block (without general anaesthesia) and the lateral decubitus position results in better peri-operative conditions for the patient. Better analgesia, increased patient satisfaction and fewer complications in comparison to general anaesthesia have been reported for these types of surgery.
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A 50-year-old man came to the emergency department because of vomiting, nausea and abdominal pain. It appeared his complaints were caused by a phytobezoar.
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Ned Tijdschr Geneeskd · Jan 2011
Case Reports[When the end is near: an ICU patient who died at home].
We describe the process of transferring a 64-year-old male from a Dutch intensive care unit to his home so that he could die there. He was a respirator-dependent cardiac surgical patient; his intensive care treatment had been withdrawn. ⋯ We discuss the natural cause of death and subsequent administrative steps. Based on the positive reactions of the patient and his family, we propose to incorporate this process into Dutch intensive care practice guidelines.
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Ned Tijdschr Geneeskd · Jan 2011
[Palliative sedation largely in accordance with Dutch national guideline].
To evaluate the practice of continuous palliative sedation after the introduction of a national guideline. ⋯ Continuous sedation practice in the Netherlands largely reflects the recommendations of the national guideline. Issues needing further attention are the pressure felt by physicians to start continuous sedation, as well as the possible life-shortening effect of continuous sedation as perceived by some of the physicians.
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Ned Tijdschr Geneeskd · Jan 2011
Case Reports[Imminent respiratory insufficiency in children resulting from Guillain-Barré syndrome].
Early recognition of Guillain-Barré syndrome (GBS) is crucial to anticipate and adequately respond to possible respiratory insufficiency. Young children with GBS frequently have non-specific complaints and are more difficult to examine, which may cause a significant delay in diagnosing GBS. ⋯ Young children with GBS often present with pain and refusal to walk, or with difficulty swallowing, and are often initially misdiagnosed with e.g. tonsillitis or coxitis. These nonspecific symptoms can be a first sign of a progressive polyradiculoneuropathy and should prompt a full neurological examination and timely referral to a paediatric neurological centre with Intensive Care facilities.