Acta anaesthesiologica Belgica
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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
Randomized Controlled Trial Comparative StudyLearning Basic Life Support (BLS) with task cards: comparison of four reciprocal learning settings.
Research emphasises the need for instructional methods and tools which can improve BLS performance or reduce instructional time. ⋯ This study demonstrated that implementing role switching and role definition in a reciprocal learning setting with task cards fosters BLS skill retention.
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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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General anesthetics interact with targets at the cellular and molecular levels. They have the potential to induce changes in the body and the brain. Usually, these interactions are thought to be short lasting. ⋯ This is particularly evident in the period of synaptogenesis during which alcohol can induce excessive cerebral apoptosis (histopathologic changes) in juvenile animal models. Even if the vast majority of our patients seems to completely restore homeostasis after general anesthesia, we don't know if the changes induced at the brain level in animal models exist in human. This article intends to supply biological, pharmacological and experimental basis for a possible long term effect of general anesthetics on the human developing brain.
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Acta Anaesthesiol Belg · Jan 2008
Comparative StudyPulmonary morbidity following esophagectomy is decreased after introduction of a multimodal anesthetic regimen.
Respiratory morbidity is the most frequent complication after esophagectomy, which can occur in 50% of the patients treated for esophageal cancer. We tested the hypothesis whether an anesthetic regimen, emphasizing intraoperative fluid restriction and early extubation could, positively influence postoperative morbidity, without affecting the gastric tube reconstruction. We introduced an anesthetic regimen, based on early extubation and a controlled intraoperative fluid management (net fluid balance < 4 L) in combination with the use of norepinephrine to maintain mean arterial blood pressure > 65 mmHg. ⋯ Applying the NR resulted in significantly less fluid administration (balance of 3.5 +/- 0.2 L NR vs. 5.1 +/- 0.2 L SR, p < 0.05) resulting in fewer patients developing pneumonia (26% in the NR group vs. 42% in the SR group, p < 0.05). Similar per operative blood loss and urine output and occurrence of leakage or ischemia of the gastric tube anastomosis occurred in both groups. Respiratory morbidity is significantly reduced with the introduction of a new anesthetic regimen directed at intraoperative fluid restriction and early extubation, without increasing anastomotic leakage of the gastric tube reconstruction.