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
Predictors of cardiac responsiveness to fluid therapy after cardiac surgery.
Central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) are insensitive preload markers and sometimes misleading. The introduction of the pulse contour method for monitoring of continuous cardiac output enabled the real-time quantification of stroke volume variation (SVV). Studies evaluating the accuracy of this parameter as a measure of preload responsiveness are still limited and conflicting results have been published in cardiac surgical patients. The aim of this study was to reevaluate the predictive value of SVV regarding cardiac responsiveness to fluid therapy and to compare it with the standard preload variables in a clinical setting in the ICU after cardiac surgery. ⋯ SVV as measured with the LiDCO system is a better functional marker of cardiac responsiveness to fluid therapy than the static parameters CVP and PCWP.