Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2011
Randomized Controlled TrialLow-dose intravenous ketamine and clonidine for poor postoperative opioid responsiveness: a double blind randomized study.
In the immediate postoperative period, some patients present with pain that responds poorly to intravenous opioids. In a double-blind randomized study, we tested the hypothesis that administering small doses of intravenous ketamine (0.125 mg/kg) combined with clonidine (0.5 microg/kg) would enhance the speed of onset and the quality of an opioid analgesic regimen in patients who initially responded poorly to opioids. We enrolled 68 patients in the study, all physical status I to III according to the American Society of Anesthesiologists classification. ⋯ The primary endpoint of the study was to reduce by 20 minutes the time necessary to achieve an NRS < 4. There was no statistically significant difference between the two groups regarding the time required for patients to achieve an NRS < 4. It was concluded that in the immediate postoperative period, the acute administration of small combined doses of intravenous ketamine (0.125 mg/kg) and clonidine (0.5 mirog/kg) does not reduce the onset of an opioid-based analgesia in patients with an initial poor response to intravenous opioids.
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Acta Anaesthesiol Belg · Jan 2011
Randomized Controlled TrialDexamethasone in preventing post-dural puncture headache: a randomized, double-blind, placebo-controlled trial.
Spinal anesthesia is major complication is Post-Dural Puncture Headache (PDPH) which is an intense and debilitating event. We decided to assess if intravenous administration of dexamethasone can decrease the incidence and/or intensity of this kind of headache. For this purpose 178 patients, who were supposed to undergo lower extremity orthopedic surgery, were enrolled in the study. ⋯ There was no statistically significant difference between DMX and PCB groups regarding the incidence of PDPH. However, the intensity of headache differed between the two groups being less severe if IV dexamethasone had been given prophylactically. Dexamethasone can be used to decrease the severity of PDPH in patients who receive spinal anesthesia.
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Acta Anaesthesiol Belg · Jan 2011
Case ReportsTorsade de pointes during sevoflurane anesthesia and fluconazole infusion in a patient with long QT syndrome. A case report.
We present the occurrence of 'torsade de pointes' induced by the combination of peroperative fluconazole administration and sevoflurane anesthesia in a patient with 'long QT syndrome' (LQTS) scheduled for resection of a sacral abscess. Eight minutes following uneventful induction of anesthesia 'torsade de pointes' occurred, terminated by a counter shock. At this time the end-tidal concentration of sevoflurane was 2%. ⋯ The syndrome in this particular patient was unmasked by sevoflurane. Concomitant administration of fluconazole might have further predisposed the patient to the development of 'torsade des pointes'. Although LQTS is relatively rare, it is important for the anesthesiologist to be familiar with the disease because of the associated morbidity and mortality and the potential for anesthesia to induce malignant arrhythmias in asymptomatic carriers.
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We conducted a one-year prospective study involving a prehospital Emergency Medical Service in the Netherlands to investigate the incidence of failed or difficult prehospital endotracheal intubation. During the study period the paramedics were asked to fill in a registration questionnaire after every endotracheal intubation. Of the 26,271 patient contacts, 256 endotracheal intubations were performed by paramedics in one year. ⋯ The median time between arrival on the scene and a positive capnograph was 7 min.38 s in the case of a Cormack and Lehane grade I laryngoscopy and 14 min.58 s in the case of a Cormack and Lehane grade 4 laryngoscopy. The incidence of endotracheal intubations performed by Dutch paramedics in one year was low, but endotracheal intubation was successful in 95.2%, which is comparable with findings in international literature. Early capnography should be used consistently in prehospital airway management.
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Acta Anaesthesiol Belg · Jan 2011
Three-dimensional magnetic resonance image of structures enclosed in the spinal canal relevant to anesthetists and estimation of the lumbosacral CSF volume.
Three-dimensional (3D) image-reconstruction of structures inside the spinal canal certainly produces relevant data of interest in regional anesthesia. Nowadays, all hospital MRI equipment is designed mainly for clinical diagnostic purposes. In order to overcome the limitations we have produced more accurate images of structures contained inside the spinal canal using different software, validating our quantitative results with those obtained with standard hospital MRI equipment. ⋯ A high variability was detected among cases, without correlation with either weight, height or body mass index. Aspects concerning the partial volume effect are also discussed. Quick semi-automatic hospital 3D reconstructions give results close to detailed neuroanatomical 3D reconstruction and could be used in the future for individual quantification of lumbosacral CSF volumes and other structures for anesthetic purposes.