Acta anaesthesiologica Belgica
-
Spinal anesthesia is a very old and popular anesthetic technique, with a high success rate and a good safety profile. In order to further improve and understand safety issues as well as the clinical use of spinal anesthesia, new local anesthetics and analgesic additives are being investigated for different applications. As practice of medicine focuses increasingly on outpatient care, spinal anesthetics should provide short-acting and adequate anesthesia without compromising early ambulation and discharge from the day surgery unit. A review of the current literature suggests that ropivacaine could have potential in this area.
-
Anaphylactic and anaphylactoid reactions during anaesthesia are rare, but potentially life-threatening allergic events. The worst manifestations are cardiovascular collapse, bronchospasm and laryngeal oedema. Anaphylactic and anaphylactoid reactions are clinically indistinguishable. ⋯ The incidence of cross-reactivity between neuromuscular blocking drugs is high. Further investigation of a suspected anaphylactic reaction is mandatory to find the responsible drug and to make future anaesthesia safe. Diagnosis is made with intraoperative tests (serum histamine and mast cell tryptase) and postoperative tests (skin tests and RASTs for specific IgE antibodies).
-
Acta Anaesthesiol Belg · Jan 2004
ReviewAmbulation with combined spinal-epidural labor analgesia: the technique.
The combined spinal-epidural labor analgesia technique (CSEA) has attained wide spread popularity in obstetric anesthesia worldwide. The onset of analgesia is rapid and reliable, and maternal satisfaction is high. ⋯ This approach with the application of low-dose local anesthetic and/or opioid can provide a very selective sensory block with minimal motor blockade, allowing parturients to ambulate. This article will attempt to assess the validity of some strongly held opinions of whether CSEA offers any advantages for ambulatory labor analgesia as well as highlight some selected technical aspects and controversies of the CSEA specifically applicable to ambulatory labor analgesia.
-
Acta Anaesthesiol Belg · Jan 2004
ReviewPostoperative residual curarisation: complication or malpractice?
Neuromuscular blocking drugs are often used in anaesthesia; in some types of surgery, their continuous infusion is indicated to limit the otherwise high incidence of movement. A large amount of postoperative residual curarisation is found after a single bolus, but more especially when continuous infusions are used in healthy patients and even more so in those with organ dysfunction or undergoing special types of surgery. Therefore, one should always optimise the dose requirements over time using neuromuscular transmission monitoring. ⋯ At present, then, the only objective and reliable guide to facilitating the decision for selective antagonisation is the neuromuscular transmission monitor. Recent data and editorials warning about postoperative residual curarisation after boluses and infusions of neuromuscular blocking drugs have made residual curarisation one of the most feared complications in anaesthesia. There may be a consequent issue of malpractice if neuromuscular transmission monitoring is not used and/or pharmacological antagonisation is not performed.