Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2009
Randomized Controlled TrialEffects of oral preoperative carbohydrate on early postoperative outcome after thyroidectomy.
Preoperative carbohydrate (CHO) reduces perioperative insulin resistance and improves preoperative patient comfort. We tested the hypotheses that preoperative CHO reduces the risk of postoperative nausea and vomiting (PONV) and improves early postoperative patient comfort. ⋯ Oral carbohydrate before thyroidectomy improves pre- and postoperative patient comfort, as well as postoperative analgesia, but has no effect on the PONV.
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Acta Anaesthesiol Belg · Jan 2009
ReviewThe peri-operative use of intra-articular local anesthetics: a review.
Acute and chronic pain are of major concern after orthopedic surgery. The increasing trend toward day case surgery induced the development of different techniques in postoperative pain control. ⋯ Recent attention has been drawn to the possible toxicity on chondrocytes of local anesthetics. The aim of this manuscript is to evaluate and compare through literature review the existing evidence on the clinical use and possible adverse effects of intra-articular injection of local anesthetics peri-operatively.
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Acta Anaesthesiol Belg · Jan 2009
Review Case ReportsAnesthetic management of epidermolysis bullosa: a review and report of two cases.
Dystrophic epidermolysis bullosa is a rare genetically mechanobullous disorder, characterized by an excessive susceptibility of the skin and mucosa to separate from the underlying tissues after mechanical trauma. Avoiding mechanical stimulation of the skin and mucous membranes is essential in the anesthetic management. ⋯ We report the successful applications of intraoperative indirect electrocardiogram monitoring without electrodes and bilateral axillary and midhumeral nerve block using levobupivacaine in combination with lidocaine in patients who had previously undergone repeated general anesthesia. We conclude that regional anesthesia should be preferred in patients with dystrophic epidermolysis bullosa, especially those who had previously undergone repeated general anesthetic procedures.
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Acta Anaesthesiol Belg · Jan 2009
Randomized Controlled TrialLocal anaesthetic use for the iliac crest-donor site: pharmacokinetic and pharmacodynamic evaluations.
During orthopaedic surgery of the limb, we performed a prospective, double blind controlled study on three parallel groups in 30 patients to evaluate the pharmacokinetic and pharmacodynamic effect of infiltration of the iliac crest bone graft harvest site with 20 ml of bupivacaine (100 mg), ropivacaine (150 mg) or saline as control group (n = 10 in each group). Then, in a sheep model of iliac crest infiltration, we compared the pharmacokinetics of single administration of plain bupivacaine (100 mg) and bupivacaine (500 mg)-loaded microspheres. In the clinical control group, pain from the iliac crest was worse than pain from the primary surgical site. ⋯ However, this effect lasts only 12 hours without reducing the morphine consumption due to an increase of pain from the primary surgical site. The local anaesthetic infiltration produced a significant peak of plasma level, which could be dangerous if another infiltration or regional anaesthetic technique was associated with it. Experimentally, as a drug delivery system, the use of local anaesthetic-loaded microspheres could be an interesting alternative.
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Acta Anaesthesiol Belg · Jan 2009
ReviewClinical implications of epidural fat in the spinal canal. A scanning electron microscopic study.
This review of articles summarizes recent developments in relation to fat located in the epidural space and also in dural sleeves of spinal nerve roots in order to improve our understanding of the clinical effects of the epidural blockade. ⋯ The epidural space contains abundant epidural fat that distributes along the spinal canal in a predictable pattern. Fat cells are also abundant in the dura that forms the sleeves around spinal nerve roots but they are not embedded within the laminas that form the dura mater of the dural sac. Drugs stored in fat, inside dural sleeves, could have a greater impact on nerve roots than drugs stored in epidural fat, given that the concentration of fat is proportionally higher inside nerve root sleeves than in the epidural space, and that the distance between nerves and fat is shorter. Similarly, changes in fat content and distribution caused by different pathologies may alter the absorption and distribution of drugs injected in the epidural space.