Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2005
Randomized Controlled Trial Comparative Study Clinical TrialA randomized trial comparing low-dose combined spinal-epidural anesthesia and conventional epidural anesthesia for cesarean section in severe preeclampsia.
A prospective, randomized study was designed to compare the maternal and neonatal effects of conventional epidural anesthesia and combined spinal epidural anesthesia (CSE) for Cesarean section in severe preeclamptic patients. Additionally, two strategies in the prophylactic management of hypotension in severe preeclamptic patients were evaluated: fluid preloading or prophylactic ephedrine. ⋯ Our results confirm that combined spinal and epidural anesthesia (CSE) is a safe alternative to conventional epidural anesthesia in severe preeclamptic women and that the prophylactic use of ephedrine is effective and safe to prevent and treat spinal hypotension after combined spinal and epidural anesthesia for Cesarean section in severe preeclamptic women.
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Acta Anaesthesiol Belg · Jan 2005
Randomized Controlled Trial Comparative Study Clinical TrialLaryngeal mask airway insertion with remifentanil.
We conducted a study to find out the best conditions for LMA insertion with two different doses of remifentanil added to propofol and propofol administered alone. ⋯ Propofol given 2.5 mg kg(-1) alone is not a good agent for LMA insertion. Remifentanil used in both doses combined with propofol provides good and excellent conditions for insertion of LMA with minimal hemodynamic disturbances.
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Acta Anaesthesiol Belg · Jan 2005
Randomized Controlled TrialConventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache.
Post dural puncture headache (PDPH) represents a complication of anesthesia (with an increased incidence in obstetric patients) or as the consequence of a diagnostic lumbar puncture. The aim of the present study was to evaluate the efficacy of the epidural blood-patch (EBP) versus the conventional medical treatment of post-anesthetic headaches also including the PDPH following a diagnostic puncture, a category of patients rarely referred to the anesthesia consultation in our hospital because it was believed that they might have equal benefit from conventional measures due to the smaller size of needles used. We studied in a prospective, randomized, double-blinded manner 32 obstetric and non-obstetric patients with PDPH having the onset of the symptoms 24 hours before the inclusion in the study. ⋯ The difference recorded after 24 hours remained statistically significant (p < 0.0001): the VAS scores were 0.7 +/- 0,16 and 7.8 +/- 1.2 respectively. The epidural blood patch represents the first choice treatment of PDPH no matter the etiology, being significantly superior to the conventional treatment which did not affect pain scores. In severe PDPH there is no reason to delay the EBP more than 24 hours after the diagnosis as all except two patients of the conventional treatment group required blood patching following the study period.
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Acta Anaesthesiol Belg · Jan 2005
Randomized Controlled Trial Comparative Study Clinical TrialPreliminary results of prolonged target controlled infusion of sufentanil adjusted to an effort pain score after cardiac surgery.
Repeated boluses of i.v. morphine are often used for analgesia after cardiac surgery, but this procedure frequently provides inadequate pain relief. Target controlled infusion (TCI) of opioid drugs has been proposed as an alternative. The objective of this study was to evaluate the effects of prolonged sufentanil TCI adjusted to an effort pain score on the postoperative course after cardiac surgery. ⋯ Nine of 10 patients in the TCI group but only 4 of 10 patients in the bolus group gave a VNS below 5 during the stimuli. IS performance was better preserved in the TCI than in the Bolus group (53 +/- 5% versus 35 +/- 5% of preoperative values, p < 0.05). These observations indicate that after cardiac surgery, postoperative pain management with prolonged TCI of sufentanil adapted to a pain score during deep inspiration can achieve better analgesia during routine bedside procedures and higher pulmonary volumes than on-demand boluses of morphine.
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Acta Anaesthesiol Belg · Jan 2005
Randomized Controlled Trial Clinical TrialEffects of nitrous oxide on spectral entropy of the EEG during surgery under balanced anaesthesia with sufentanil and sevoflurane.
Spectral entropy of the electroencephalogram (EEG) has been proposed to monitor anaesthetic depth. We investigated the effect of nitrous oxide on response (RE) and state entropy (SE) of the EEG during lumbar disc surgery under anaesthesia with sufentanil and sevoflurane. ⋯ Addition of nitrous oxide during balanced anaesthesia with sufentanil and sevoflurane provokes a decrease in response and state entropy of the EEG during lumbar disc surgery.