Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2010
Case ReportsPatient-controlled intravenous analgesia using remifentanil in two parturients with twin pregnancies: case report.
We report the use of Patient-Controlled Intravenous Analgesia (PCIA) with remifentanil in two parturients with twin pregnancies in whom epidural analgesia was contraindicated. ⋯ In the case of twin pregnancy, we recommend remifentanil PCIA only if epidural analgesia is contraindicated (and not as a routine) because of the high risk of obstetrical maneuvers or potential cesarean delivery for the second twin, and the lack of efficacy of remifentanil, at the dose used in this report.
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Rosai-Dorfman Disease (RDD) may be challenging for anesthesiologist in view of its multisystem involvement, specially the airway. We present a patient with RDD scheduled for bilateral rhinotomy and bilateral neck dissection for nasal obstruction and gross bilateral lymphadenopathy. Care should be taken in airway management because of the distortion of airway anatomy by the soft tissue mass with possible intracheal extension of mass. Central venous catheterization should be guided by ultrasonography.
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Acta Anaesthesiol Belg · Jan 2010
Abnormal sensations evoked over the chest and persistent peri-incisional chest pain after cardiac surgery.
Risk factors for developing Persistent peri-incisional Chest Pain (PCP) after sternotomy are multiple. We examined whether hypoesthesia, hyperalgesia or dysesthesia, evoked in the postoperative period might be associated with PCP after sternotomy. One hundred patients undergoing a sternotomy were evaluated on day 5. ⋯ There was no significant difference in the incidence of dysesthesia. On day 5, hyperalgesia was correlated with a risk to develop PCP at 6 months. Among sensory abnormalities, the presence of hyperalgesia is associated with PCP at 6 months postoperatively.
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Acta Anaesthesiol Belg · Jan 2010
Case ReportsCombined spinal epidural anesthesia with epidural volume extension technique for hysterectomy in patient with unpalliated cyanotic heart disease--a case-report.
Adults with unrepaired cyanotic heart disease scheduled for a non-cardiac surgery present serious concerns for the anesthesiologists. Both general and regional anesthetic techniques have been safely reported in Eisenmenger's syndrome and adults with Tetralogy of Fallot (TOF) for non-cardiac surgery. The safety of low-dose sequential combined spinal epidural (CSE) technique in high-risk cardiac cases has recently been emphasized in obstetric anesthetic practice but to our knowledge, this technique has not been reported for hysterectomy in cyanotic heart disease patients in anesthetic literature. We report the successful management of hysterectomy in a patient with ventricular septal defect and pulmonary atresia (VSD-PA) using CSE anesthesia with epidural volume extension (EVE) technique.
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Acta Anaesthesiol Belg · Jan 2010
Pleth variability index combined with passive leg raising-induced pulse pressure variation to detect hypovolemia in spontaneously breathing patients.
The combination of Pleth Variability Index (PVI) and passive leg raising (PLR)-induced pulse pressure variation may help to diagnose hypovolemia in spontaneously breathing patients. In 44 subjects, PVI and Pulse Pressure (PP) variation after PLR were measured before and after induced hypovolemia (blood gift or hemodialysis session). ⋯ In spontaneous ventilation, PVI value is greater after induced hypovolemia, whereas PP variation does not change significantly. The combination of PVI and PLR does not improve the accuracy of the detection of induced hypovolemia.