Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2009
Randomized Controlled TrialThe impact of fluid restriction policy in reducing the use of red blood cells in cardiac surgery.
Hemodilution contributes significantly to transfusion requirements in patients undergoing CABG under CPB. We hypothesised that restriction of parenteral fluids in comparison to a liberal fluid administration policy leads to less use of packed red cells in CABG operations supported by cell salvage. After consent and approval, 130 patients operated under equal conditions were assigned prospectively and randomly either for a restrictive protocol for intravenous fluid administration (group A, 65 pts) or not (group B, 65 pts). ⋯ Hours of mechanical ventilation in ICU were ranging from 5 to 29 (mean = 10.0, median = 9) for A and from 5 to 42 (mean = 14.8, median = 10) for B. Length of stay in ICU in nights for group A was ranging from 1 to 10 (mean = 2.7, median = 2) and for group B was ranging from 1 to 6 (mean = 3.5, median = 2). In conclusion, reduction of transfusions in CABG operations is feasible when a restrictive protocol for intravenous fluids is applied.
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Acta Anaesthesiol Belg · Jan 2009
Randomized Controlled TrialThe effect of self-assessment in reciprocal learning with task cards on the quality of CPR.
This study investigated the effect of self-assessment with and without motor activity on the quality of CPR in reciprocal learning with task cards. Gender differences in learning outcomes were analysed as well. Eighty-six university students (39 women and 47 men) were randomised in pairs into three groups: cognitive self-assessment, cognitive-motor self-assessment, and a control. ⋯ Self-assessment with motor activity did not differ significantly from merely cognitive self-assessment. At retention, males ventilated significantly less volume than females. Within the limitations of this study, it can be concluded that implementing self-assessment in reciprocal learning with task cards does not lead to better CPR performance in the present target group.
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Acta Anaesthesiol Belg · Jan 2009
Comparative Study Clinical TrialDesflurane consumption with the Zeus during automated closed circuit versus low flow anesthesia.
During automated closed-circuit anesthesia (CCA), the Zeus (Dräger, Lübeck, Germany) uses a high initial fresh gas flow (FGF) to rapidly attain the desired agent and carrier gas concentrations, resulting in a desflurane consumption well above patient uptake. Because both FGF and carrier gas composition can affect consumption, we determined the Zeus' agent consumption with automated CCA and with automated low flow anesthesia (LFA) (= maintenance FGF of 0.7 L min(-1)) with 3 different carrier gases. ⋯ After 50 min, desflurane consumption with automated CCA is lower than with automated LFA. However, initial agent consumption is complex, and N2O in particular may increase initial desflurane consumption (though ultimately resulting in lower desflurane usage because of its MAC sparing effect) because initial FGF is increased to rapidly reach the target concentrations. Differences in desflurane consumption only become apparent after FGF has stabilized to the target FGF.
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Acta Anaesthesiol Belg · Jan 2009
Case ReportsHemodynamic stability ensured by a low dose, low volume, unilateral hypobaric spinal block: modification of a technique.
We report the case of an 89-year-old female with a history of arterial hypertension, intermittent rapid atrial fibrillation and severe aortic valve stenosis, suffering from femoral neck fracture. Hyperbaric unilateral spinal anesthesia is a known technique to obtain stable hemodynamics combined with the possibility of continuous neurologic evaluation and preservation of cognitive functions. Because a hyperbaric unilateral technique can be very painful in case of traumatic hip fracture, a low dose, low volume, unilateral hypobaric spinal block may be an adequate alternative. ⋯ During surgery the patient was kept in the lateral recumbent position. Hemodynamics remained stable throughout the entire procedure without any need for vasoconstrictors. The impact of aortic valve stenosis combined with atrial fibrillation on anesthetic management and our considerations to opt for a unilateral hypobaric spinal anesthesia are discussed.
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Acta Anaesthesiol Belg · Jan 2009
Pulmonary gas exchange is well preserved during robot assisted surgery in steep Trendelenburg position.
During robot assisted hysterectomies and prostatectomies, surgical exposure demands the application of a CO2 pneumoperitoneum with a very steep Trendelenburg position (40 degrees). The extent to which oxygenation and ventilation might be compromised intra-operatively remains poorly documented. ⋯ The lung has a remarkable yet incompletely understood capacity to withstand the effects of a CO2 pneumoperitoneum and steep Trendelenburg position during general anesthesia. While individual responses vary and should be monitored, effects on dead-space ventilation and venous admixture are small and should not be an obstacle to provide optimal surgical exposure during robot assisted prostatectomy or hysterectomy.