Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2000
Comparative Study Clinical Trial Controlled Clinical TrialHaemodynamic comparison of propofol-fentanyl anaesthesia with midazolam-fentanyl anaesthesia in CABG patients without preoperative heart failure.
This study was designed to compare prebypass haemodynamics under total intravenous anaesthesia (TIVA) using midazolam-fentanyl (group M) and propofol-fentanyl (group P) combinations. Sixteen adult patients undergoing CABG were studied with patients in group M and P (n = 8 each) given intravenous midazolam 0.1 mg.kg-1.h-1 and propofol 4 mg.kg-1.h-1 with fentanyl 25 micrograms.kg-1 until sternotomy, respectively. Following induction of anaesthesia, cardiac index and heart rate decreased significantly (30% and 20% in both groups, p < 0.05) these variables returned to baseline on completion of sternotomy. ⋯ Only the change in LVSWI reached statistical significance (p < 0.05). This reduction may have exert a caridioprotectant action by decreasing myocardial oxygen consumption. We conclude that both TIVA techniques represent an acceptable anaesthetic regimen for use in cardiac anaesthesia.
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Acta Anaesthesiol Belg · Jan 2000
Randomized Controlled Trial Clinical TrialEpidural PCA with bupivacaine 0.125%, sufentanil 0.75 microgram and epinephrine 1/800.000 for labor analgesia: is a background infusion beneficial?
Eighty term parturients requesting epidural analgesia for labor pain treatment were randomly assigned to receive bupivacaine 0.125%, sufentanil 0.75 microgram/ml and epinephrine 1/800.000 by PCA modality with or without a basal rate of 3 ml/hr. A loading of 10 ml using the same mixture was administered while the PCA-demand dose consisted of 3 ml (lock out time 12 minutes). ⋯ We conclude that for shortlasting labors, a low dose epidural PCA regimen results in a dose-sparing effect when compared to PCEA combined with a background infuson. For longer-lasting labors no differences between the two modalities could be observed.
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Acta Anaesthesiol Belg · Jan 2000
ReviewDay surgery, including the preoperative assessment of the patient: a UK experience by a Belgian anaesthetist.
In some European countries like Belgium, a lot of hospitals are today dealing with two extremely real issues: adult day surgery and the preoperative anaesthesia consultation. Although efforts are made, there is often still a search for a clear-cut identity on these subjects. As in the rest of Europe, Belgian political, financial and medical driving forces are strongly favouring the shift of surgical procedures towards more day care practice. ⋯ The nursing director, as well as the medical director of the day unit will have to use their power in order to avoid abuse of ambulatory beds for other purposes. As the perioperative specialist, the anaesthetist is ideally suited for the pre-, per-, and postoperative management of the ambulatory patient. Moreover, concerning the preoperative assessment clinic, UK anaesthetists have organized a valuable and interesting alternative to the expensive and time/manpower consuming system used in the USA.
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Acta Anaesthesiol Belg · Jan 2000
Clinical TrialEffects of mild hypothermic cardiopulmonary bypass on EEG bispectral index.
We studied the effect of mild hypothermic cardiopulmonary bypass (30 degrees C) on the EEG Bispectral Index in 10 patients undergoing elective CABG. BIS was recorded at 11 event-related time points during the procedure. ⋯ BIS was neither affected by surgical stimulation nor by CPB and mild hypothermia. We conclude that we did not find any reason to preclude the use of BIS to assess the hypnotic effects of anaesthetics during normothermic or mild hypothermic CPB.
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Acta Anaesthesiol Belg · Jan 2000
Case ReportsSuxamethonium-induced rhabdomyolysis in a healthy middle-aged man.
A 43-year-old man developed rhabdomyolysis after uvulo- palatopharyngoplasty. After induction with thiopentone and suxamethonium the anesthesia was maintained with halothane. The patient responded to treatment and made an uneventful recovery. ⋯ Our patient did not have mutations in the four MH-associated genes tested, but the total amount of different mutations is by now about twenty. Therefore, despite these negative tests rhabdomyolysis may be a sign of subclinical malignant hyperthermia which cannot be ruled out by our investigations. This rare case of rhabdomyolysis in a healthy man suggests careful monitoring of the patient when-ever suxamethonium is used.