Acta anaesthesiologica Belgica
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General anesthetics interact with targets at the cellular and molecular levels. They have the potential to induce changes in the body and the brain. Usually, these interactions are thought to be short lasting. ⋯ This is particularly evident in the period of synaptogenesis during which alcohol can induce excessive cerebral apoptosis (histopathologic changes) in juvenile animal models. Even if the vast majority of our patients seems to completely restore homeostasis after general anesthesia, we don't know if the changes induced at the brain level in animal models exist in human. This article intends to supply biological, pharmacological and experimental basis for a possible long term effect of general anesthetics on the human developing brain.
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Acta Anaesthesiol Belg · Jan 2008
Comparative StudyPulmonary morbidity following esophagectomy is decreased after introduction of a multimodal anesthetic regimen.
Respiratory morbidity is the most frequent complication after esophagectomy, which can occur in 50% of the patients treated for esophageal cancer. We tested the hypothesis whether an anesthetic regimen, emphasizing intraoperative fluid restriction and early extubation could, positively influence postoperative morbidity, without affecting the gastric tube reconstruction. We introduced an anesthetic regimen, based on early extubation and a controlled intraoperative fluid management (net fluid balance < 4 L) in combination with the use of norepinephrine to maintain mean arterial blood pressure > 65 mmHg. ⋯ Applying the NR resulted in significantly less fluid administration (balance of 3.5 +/- 0.2 L NR vs. 5.1 +/- 0.2 L SR, p < 0.05) resulting in fewer patients developing pneumonia (26% in the NR group vs. 42% in the SR group, p < 0.05). Similar per operative blood loss and urine output and occurrence of leakage or ischemia of the gastric tube anastomosis occurred in both groups. Respiratory morbidity is significantly reduced with the introduction of a new anesthetic regimen directed at intraoperative fluid restriction and early extubation, without increasing anastomotic leakage of the gastric tube reconstruction.
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Acta Anaesthesiol Belg · Jan 2008
Case ReportsProSeal laryngeal mask airway for cardiac surgery after airway rescue.
We present the case of the successful use of a ProSeal laryngeal mask airway in a severe obese 41-year-old women with a difficult airway, scheduled to undergo cardiac surgery (off-pump coronary artery bypass). Two intubation attempts failed and face mask ventilation became impossible with rapidly falling peripheral oxygen saturation. ⋯ Surgery was uneventful and the ProSeal was removed on the ICU three hours later. This case reports illustrates the successful use of a guided insertion of the ProSeal laryngeal mask for airway rescue in cardiac surgery.