Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2006
Multicenter Study Clinical TrialEmergency reversal of oral anticoagulation through PPSB-SD: the fastest procedure in Belgium.
To corroborate results obtained in The Netherlands with PPSB-SD, showing a safe acute reversal of anticoagulation within 15 minutes of administration. ⋯ PPSB-SD can safely be used for the rapid reversal of anticoagulation as needed in emergency situations.
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In this review paper, the authors analyse advantages, pitfalls and economical considerations related to depth of anaesthesia monitoring. They first describe the most widely distributed monitors in Europe, and the physiological basis of each index. ⋯ Knowledge of patients and practitioners, as well as beliefs and expectations regarding depth of anaesthesia monitoring are discussed. Finally, the authors give their own opinion regarding the use of depth of anaesthesia monitoring, according to clinical benefit and economical considerations.
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Acta Anaesthesiol Belg · Jan 2006
Randomized Controlled Trial Comparative StudyCost minimisation and cost effectiveness in anaesthesia for total hip replacement surgery, in Belgium? A study comparing three general anaesthesia techniques.
The aim of the prospective randomised study is to compare the cost effectiveness of three general anaesthesia techniques for total hip replacement surgery and the cost minimisation by use of anaesthetics. For induction propofol was used in the three techniques. For maintenance, we used desflurane, or sevoflurane, or propofol. ⋯ Cost of inhaled or i.v. anaesthetics was 0.55% to 1.0% of the total cost. There was a discrepancy between the measured consumption of inhaled anaesthetics and the consumption (and cost) on the invoice. Cost minimisation based on anaesthetic medication is ridiculously by small considering the total cost of the procedure.
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Potent opioids are excellent painkillers but their use is hampered by side-effects such as nausea, vomiting, bowel dysfunction, urinary retention, pruritus, sedation and respiratory depression. Co-analgesics are often combined with opioids to reduce the prevalence of these unwanted effects while maintaining or even improve the quality of analgesia. ⋯ In contrast, intravenous lidocaine and corticosteroids not only produce an opioid-sparing but also a significant reduction in the occurrence of postoperative ileus and nausea and vomiting. It remains unclear whether the perioperative use gabapentin, ketamine and corticosteroids has an effect on the development of postsurgical chronic pain states.
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Acta Anaesthesiol Belg · Jan 2006
Randomized Controlled Trial Comparative StudyThe use of intraoperative epidural or spinal analgesia modulates postoperative hyperalgesia and reduces residual pain after major abdominal surgery.
The use of intraoperative multimodal analgesia has clearly improved postoperative pain control, mortality and morbidity after major surgical procedures. However, very few clinical trials have studied the longterm impact of intraoperative epidural or spinal analgesia on chronic postsurgical pain (CPSP) development. Even less studies have evaluated the modulatory effect of intraoperative neuraxial analgesia on objective changes (i.e. mechanical hyperalgesia) reflecting central sensitization. ⋯ An effective intraoperative neuraxial block of nociceptive inputs from the wound using multimodal analgesia--specifically when involving spinal analgesics and antihyperalgesic drugs--contributes to prevent central sensitization and hence reduces CPSP after major abdominal procedures.