Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2008
ReviewThe propofol infusion 'syndrome' in intensive care unit: from pathophysiology to prophylaxis and treatment.
Propofol is a short-acting intravenous anesthetic agent widely used for sedation in anesthesia and intensive care. However, during the last 15 years there have been quite a lot of publications reporting unexplained deaths among pediatric and adult critically ill patients. These cases shared common symptoms and signs unrelated with initial admission diagnosis and were under long-term propofol infusion at high doses. ⋯ It seems that during states of increased metabolic demand, the reduced energy production related to an inhibitory propofol action at the level of mitochondrial oxidative phosphorylation and lipid metabolism may lead to the manifestation of the syndrome. Furthermore, cases of early toxicity due to failure in cellular energy production with development of lactic acidosis have been also described during anesthesia. For the above reasons, recommendations for the limitation of propofol use have been devised by various institutions, whereas physicians need to be cautious when using prolonged propofol sedation and alert for early signs of toxicity.
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Acta Anaesthesiol Belg · Jan 2008
ReviewNeonatal clinical pharmacology: recent observations of relevance for anaesthesiologists.
Neonatal drug dosing needs to be based on the physiological characteristics of the newborn, the pharmacokinetic parameters of the drug and has to take maturational aspects of drug disposition into account. We would like to provide the reader with some recently published compound-specific observations (paracetamol, ibuprofen, tramadol, propofol) in neonates of relevance for anaesthesiologists. Age-specific dosing regimes of intravenous paracetamol have been evaluated and were well tolerated, independent of the postnatal age. ⋯ Tramadol seems to be a potential useful analgesic for term neonates and infants, but has limited indications in (extreme) preterm neonates. Finally, propofol clearance depends on post-menstrual and postnatal age. There is a risk for accumulation in preterms and in the first two weeks of postnatal life.
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For many years, office based anesthesia (OBA), has been considerably increasing in the US. This type of practice is starting to develop in Belgium. On the other side of the atlantic, legislation concerning this practice is becoming more and more precise, whereas the same isn't true in our country. ⋯ OBA practice is developping insidiously here, and we should therefore ask ourselves serious questions regarding the legal repercussions that it could have. To conclude, we can say that if for a couple of years, the US have started to legislate and propose guidelines, as well as creating special accreditation organizations to inspect and advise the offices, the same is not the case in Belgium. The OBA phenomenon arrived much later here and is really at its very beginnings, but it seems however important to anticipate and clearly regulate this practice in our country.
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More and more anesthesia machines are foreseen with spirometry monitoring. Nevertheless, the use of such equipment needs some interpretation skills for the displayed curves and numerical values otherwise it remains just a disturbing gadget rather than a powerful tool. This review explains in his first part the basic principles of interpretation of the spirometric data, and in the second part gives concrete examples of clinical situations.