Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2007
Review Case ReportsKnotting of an epidural catheter: a rare complication.
Knotting of an epidural catheter leading to entrapment is a rare complication of epidural catheterization. A lumbar epidural catheter inserted in a 28-year-old woman for caesarean section anesthesia and postoperative analgesia proved difficult to remove. ⋯ Leaving catheters of less than 4 cm in length in the epidural space may help to avoid this complication. It is important the patient be informed of the techniques involved in the extraction of the resistant catheter because patient's cooperation is important for the nonsurgical removal of an entrapped epidural catheter.
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Acta Anaesthesiol Belg · Jan 2007
Coronary artery bypass surgery in patients with impaired left ventricular function. Predictors of hospital outcome.
This prospective study evaluates the surgical outcome of 75 consecutive patients with impaired left ventricular function, including an analysis of predictors of the short-term outcome following coronary artery bypass grafting (CABG). Seventy-five patients (mean age 64 +/- 13 years) with coronary artery disease and impaired left ventricular function (left ventricular ejection fraction [EF] < or = 40%) who underwent a coronary artery bypass surgery were prospectively studied. Echocardiography and thallium-201 myocardial scintigraphy were preoperatively performed to measure the left ventricular function and to assess myocardial viability. ⋯ Patients with marked left ventricular dysfunction can safely undergo CABG with a low mortality and morbidity. The presence of extensive reversible defects on preoperative thallium-201 scintigraphy is a strong predictor of postoperative recovery of myocardial function. A poor outcome of surgery can be expected in the presence of pathological Q waves on the preoperative ECG or when the left ventricular endsystolic volume index exceeds 100 ml/m2.
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Acta Anaesthesiol Belg · Jan 2007
Randomized Controlled TrialLocal application of halothane, isoflurane or sevoflurane increases the response to an electrical stimulus in humans.
Volatile anesthetics may interfere with pain perception. This study investigates the effect of halothane, isoflurane and sevoflurane when applied locally, to the response of an electrical stimulus. ⋯ Low liquid volumes of volatile anesthetics, when applied locally to the skin enhanced the response to an electrical stimulus but higher volumes had no effect.
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Perioperative fluid therapy remains the subject of active controversy. Indeed, clinical trials investigating the effects of fluid administration on outcome in surgical patients report controversial results. Critical review of these trials reveals that current standard fluid therapy is not at all evidence-based. ⋯ The debate "Wet or Dry" is not a real one. Fluids should be administered in the perioperative period through a goal-directed approach taking into account patients characteristics and surgical-related events, and not through a "recipe book" approach. The type of fluid to be administered should depend on the specific space that needs to be restored (intracellular, extracellular or intravascular) and on the pharmacokinetic properties of the different solutions.
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Acta Anaesthesiol Belg · Jan 2007
Randomized Controlled TrialThe effects of propofol or sevoflurane on free radical production after tourniquet induced ischaemia-reperfusion injury during knee arthroplasty.
We studied the effects of anesthesia with propofol or sevoflurane on the production of free oxygen radicals during total knee arthroplasty performed with the use of an ischemic tourniquet by measuring the levels of malondialdehyde (MDA). ⋯ Propofol may have anti-oxidant properties in orthopaedic surgery requiring tourniquet application, but sevoflurane needs further study.