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
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.
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Acta Anaesthesiol Belg · Jan 2008
ReviewUltrasound-guided vascular access in adults and children: beyond the internal jugular vein puncture.
Based on our clinical experience and a review of the current literature, this paper describes a large variety of ultrasound-guided vascular puncture techniques used in adults and children far beyond the well described puncture of the internal jugular vein. This includes low or posterior approaches of the internal jugular vein, puncture of the subclavian vein and its variant in children, infraclavicular access to the axillary vein and also more peripheral punctures of the basilic, brachial and cephalic veins. Arterial line placement in the radial, humeral, axillary or femoral are also described as well as the aid of ultrasonography for peripheral insertion of central catheters (PICC Lines). Additional information on ultrasonographic assessment of potentially related complications, like pneumothorax or hemopericardium, will complete this review.
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Acta Anaesthesiol Belg · Jan 2008
ReviewDoppler echocardiography as a modern tool to diagnose and monitor non-cardiac surgical patients: does it improve outcome?
Echocardiography and Doppler provide intraoperative and immediate insight when a haemodynamic deterioration occurs. Both morphological and haemodynamic features can be diagnosed instantly. Furthermore, this tool is used as a functional haemodynamic monitoring device offering on line information on systolic function, preload and afterload. No clear data exist on improvement of outcome in noncardiac surgery, but analogy to cardiac patients suggest strongly outcome can be advanced with echo-Doppler.
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Acta Anaesthesiol Belg · Jan 2008
Comparative StudyAcute postoperative pain predicts chronic pain and long-term analgesic requirements after breast surgery for cancer.
Postoperative pain and analgesic requirements may be associated with chronic pain. The aim of the study was to investigate this association. We studied 98 patients who had cancer breast surgery and served as controls in four previous studies, receiving placebo. ⋯ These patients had experienced pain of higher intensity the first 9 postoperative hours (VAS-rest p = 0.022, VAS-movement p = 0.009) as well as during the six postoperative days (VAS-rest p = 0.013, VAS-movement p = 0.001). Higher intensities of acute postoperative pain are associated with chronic pain development. Higher analgesic needs and higher acute postoperatively pain intensity are associated with long-term analgesic consumption.