Acta anaesthesiologica Belgica
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The practice of regional anaesthesia will be probably forever changed by the introduction of ultrasonography into everyday clinical practice. The ability to now visualise directly the spread of local anaesthetic solution and its relationship with the nerve allows for immediate adjustments to needle position and/or local anaesthetic volume and spread resulting theoratically in improved block performance through faster onset, reduced local anaesthetic volumes and higher success rates. However, whether US guided blocks will ever replace neurostimulation techniques is debatable especially when regional anaesthesia is performed by specialists in the field.
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Acta Anaesthesiol Belg · Jan 2008
ReviewNeonatal clinical pharmacology: recent observations of relevance for anaesthesiologists.
Neonatal drug dosing needs to be based on the physiological characteristics of the newborn, the pharmacokinetic parameters of the drug and has to take maturational aspects of drug disposition into account. We would like to provide the reader with some recently published compound-specific observations (paracetamol, ibuprofen, tramadol, propofol) in neonates of relevance for anaesthesiologists. Age-specific dosing regimes of intravenous paracetamol have been evaluated and were well tolerated, independent of the postnatal age. ⋯ Tramadol seems to be a potential useful analgesic for term neonates and infants, but has limited indications in (extreme) preterm neonates. Finally, propofol clearance depends on post-menstrual and postnatal age. There is a risk for accumulation in preterms and in the first two weeks of postnatal life.
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Acta Anaesthesiol Belg · Jan 2008
Randomized Controlled Trial Comparative StudyMethylprednisolone vs. dexamethasone in the prevention of postoperative nausea and vomiting: a prospective, randomised, double-blind, placebo-controlled trial.
Dexamethasone and methylprednisolone have been proven effective in the prevention of nausea after chemotherapy. Dexamethasone has been proven effective in the prophylaxis of late PONV. Literature about methylprednisolone in PONV prophylaxis is rare. ⋯ There was a beneficial clinical effect of dexamethasone in this population, although not significant. A possible explanation lies in the fact that monotherapy is mostly insufficient in a population at risk like ours. This study confirms that steroids are mostly effective in the prevention of late PONV, less effective in early PONV.
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Acta Anaesthesiol Belg · Jan 2008
Randomized Controlled TrialPrevention of postoperative hypotension following spinal anesthesia for TURP: a double-blind randomized controlled trial comparing ephedrine with placebo.
Spinal hypotension (SH) is a common side effect of spinal anesthesia and may also occur after the surgical procedure. In this double-blinded, placebo-controlled, randomised clinical trial fifty patients undergoing transurethral prostatectomy under spinal anesthesia received 10 mg of ephedrine IV before being transferred from the operating table into their bed after the procedure, whereas fifty controls received saline IV. The number of per- and postoperative hypotensive episodes and vasopressor use, time delay between the administration of the study medication and the first hypotensive episode, level of spinal blockade at the start of surgery, pre- and postoperative hemoglobine and sodium concentration, cardiovascular co-morbidity and chronic medication were registered. ⋯ There was no statistically significant relation between age, level of spinal blockade, cardiovascular co-morbidity or biochemical parameters and the risk of developing per- or postoperative hypotension, except for a correlation between preoperative alpha-receptor blocking drugs and peroperative hypotension (p < 0.05). Postoperative hypotension (recorded incidence 31%) was almost as common as peroperative hypotension (recorded incidence 37%) and occurred as late as 190 minutes after the end of surgery. Ephedrine IV at the end of surgery reduced the number of postoperative hypotensive episodes per patient but did not reduce the overall incidence of postoperative SH.
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Acta Anaesthesiol Belg · Jan 2008
Randomized Controlled Trial Comparative StudyComparison of midazolam sedation with or without fentanyl in cataract surgery.
We compared the effect of midazolam sedation with or without fentanyl on the hemodynamic parameters, sedation, and pain and satisfaction profile in cataract surgery. Two hundred and ten patients were randomly allocated to receive either midazolam 1 mg i.v. (Group M, n = 101) alone or with fentanyl 25 microg (Group MF, n = 100) before retrobulbar injection. Hemodynamic parameters, observer's assessment of alertness/sedation (OAA/S) scores, pain during block and surgery, satisfaction of patient and surgeons were assessed. ⋯ The majority of patients in both groups experienced mild pain during retrobulbar injection but no pain during surgery. There was a significant decrease in OAA/S scores in both groups (p = 0.001) and this decline was more significant in Group MF (p = 0.038). We suggest that midazolam alone may produce optimal block conditions for the patient and it is satisfactory during the procedure while the addition of fentanyl has not improved the effect on the examined parameters.