Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2011
Case ReportsUnexpected entropy response to saline spraying at the end of posterior fossa surgery: a few cases report.
The Spectral Entropy proposed to monitor the depth of anesthesia includes the State Entropy (SE) computed from the EEG (0.8-32 Hz frequency band), and the Response Entropy (RE) computed from EEG and facial muscles activity (0.5-47 Hz frequency band). We report an unexpected Entropy response to saline spraying at the end of posterior fossa surgery. Six patients undergoing scheduled functional surgery of the posterior fossa were included in this report. ⋯ We conclude that Entropy can increase during posterior fossa surgery in non-paralyzed patients. This response probably reflects an increase in facial muscle activity rather than a change in depth of anesthesia, as far as it can be attenuated by a small dose of rocuronium. While this hypothesis requires further investigation, these observations suggest that saline spraying may confound interpretation of Entropy during posterior fossa surgery.
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Acta Anaesthesiol Belg · Jan 2011
Randomized Controlled TrialDifferent preloading protocols with constant ephedrine infusion in the prevention of hypotension for elective cesarean section under spinal anesthesia.
Ninety ASA I or II parturients were randomly allocated to three groups: group 10RL, 15RL and 20RL to receive 10, 15 and 20 mL/kg of Ringer's lactate (RL) respectively within 15 minutes (min) before the spinal block. Spinal anesthesia was performed with hyperbaric bupivacaine 12 mg, morphine 100 microg and fentanyl 10 microg. The operating table was tilted to the left and an IV infusion of ephedrine of 3 mg/min was immediately started and continued until umbilical cord clamping in all groups. ⋯ The total amount of ephedrine was 49.9 +/- 13.5, 46.4 +/- 13.4 and 38.4 +/- 8.5 mg in group 10RL, 15RL and 20RL, respectively (p <0.05). The incidence of nausea and vomiting in group 20RL was significantly less than in group 10RL (p = 0.02). It was concluded that preloading with 20 mL/kg of RL prior to spinal anesthesia followed by constant ephedrine infusion 3 mg/min after spinal block reduced the incidence of hypotension and of nausea and vomiting and decreased the total amount of ephedrine.
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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.
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Acta Anaesthesiol Belg · Jan 2011
Case ReportsAnesthesia for laparoscopic surgery in a patient with myotonic dystrophy (Steinert's disease): beneficial use of sugammadex, but incorrect use of pethidine: a case report.
Patients with Myotonic Dystrophy show an unpredictable response to several anesthetic drugs including opioids, neuromuscular blocking agents and especially reversal agents like neostigmine. We describe the case of a 40 year old patient with myotonic dystrophy who underwent laparoscopic cholecystectomy and ovarian cyst removal under general anesthesia. The authors suggest the use of the new reversal agent suggamadex, for reversing neuromuscular blockade caused by rocuronium, in patients suffering from neuromuscular disease and especially from Myotonic Dystrophy, because it rapidly and completely reverses any residual neuromuscular blockade, but also underline the increased susceptibility of these patients to opioids.