Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2012
Randomized Controlled Trial Comparative StudyA comparison of the efficacy of levobupivacaine 0.125%, ropivacaine 0.125% and ropivacaine 0.2%, all combined with sufentanil 0.5 microg/mL, in patient-controlled epidural analgesia after hysterectomy under combined epidural and general anesthesia.
We compared the relative potencies of ropivacaine and levobupivacaine in combination with sufentanil 0.5 microg/ml in postoperative epidural analgesia after abdominal hysterectomy. ⋯ In the context of this study there was no clinical difference in potency between epidural ropivacaine and levobupivacaine in a concentration of 0.125% combined with sufentanil 0.5 mg/mL because local anesthetic consumption was primarily driven by sufentanil. Increasing the concentration of ropivacaine to 0.2% did not result in better analgesia or reduction in sufentanil consumption.
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Acta Anaesthesiol Belg · Jan 2012
Review Meta AnalysisInadvertent epidural injection of drugs for intravenous use. A review.
The frequency of inadvertent injection of drugs in the epidural space is probably underestimated and underreported, but it can cause serious morbidity and possibly mortality. ⋯ Most drugs do not lead to sequelae other than pain during injection or transient neurological complaints. Other drugs may have more deleterious consequences, such as paraplegia. Both the dose of the inadvertent injected drug and the time frame play an important role in the patient's outcome. "Syringe swap", "ampoule error", and epidural/intravenous line confusion due to inaccurate or absent colour coding of epidural catheters were the main sources of error. Preventive strategies, including non Luer-lock epidural injection ports, might increase safety.
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Acta Anaesthesiol Belg · Jan 2012
ReviewSupraclavicular brachial plexus blocks: review and current practice.
This article reviews the possible revival of the supraclavicular brachial plexus blockade due to the use of ultrasound guidance. The brachial plexus is a complex network of nerves, extending from the neck to the axilla, which supplies motor and sensory fibers to the upper extremity. Understanding the complexities of the formation and structure of the brachial plexus remains a cornerstone for effective regional anaesthesia. ⋯ However, because of the proximity of the pleura, most anaesthesiologists have been reluctant to perform this supraclavicular approach. The introduction of ultrasound guidance techniques not only reduces the possible risk of pneumothorax but also allows a faster onset time of the block with a reduction of the local anaesthetic dose. This makes the supraclavicular approach a valuable alternative to the axillary, interscalene and infraclavicular approach for upper limb surgery.
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Acta Anaesthesiol Belg · Jan 2012
Case ReportsAwake Airtraq intubation in an immobile neck--a case report.
A 78 year old patient, whose neck was fixed with polyaxial lateral mass screws and rod was planned for an incisional hernia repair under general anaesthesia. Securing the airway in such an immobile neck is a challenge to the anesthesiologist. Although awake fibreoptic intubation is considered as the gold standard for such challenging patients, we successfully used the Airtraq optical laryngoscope for performing an awake intubation in this case. This example paves the way for the management of similar cases in the future.
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Cesarean section patients have compelling reasons to achieve optimal postoperative pain relief, because they are expected to recover expeditiously and to care for their newborns within a few hours following surgery. Consequently, it is necessary that pain relief is safe and effective, that it does not interfere with the mother's ability to care for her infant, and that it results in no adverse neonatal effects in breast-feeding women. ⋯ The aim of this manuscript is to evaluate and compare through literature review commonly used opioid- and non-opioid-based methods, when incorporated into a multimodal approach to post-caesarean pain management. Areas of promising research are also discussed.