Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2007
The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging (MRI).
Anesthesiologists are reluctant to consider higher levels for spinal anesthesia, largely due to direct threats to the spinal cord. The goal of this study is to investigate, with magnetic resonance imaging (MRI), the distances between the relevant structures of the spinal canal (spinal cord, thecal tissue, etc.) to determine modal anatomical positions for neuraxial anesthesia. ⋯ The spinal cord tends to follow the straightest line through the imposed geometry of the spine. Considering the necessary angle of entry of the needle at mid-thoracic levels, there is relatively (more than at upper thoracic and lumbar levels) substantial separation of cord and surrounding thecal tissue. Anesthesiologists perform spinal blockades up to the L2-L3 interspace, but avoid higher levels for fear of neurological damage. The information that there is substantially more space in the dorsal subarachnoid space at thoracic level, might lead to potential applications in regional anesthesia. In contrast, the cauda equina sits more dorsally in the lumbar region.
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Acta Anaesthesiol Belg · Jan 2007
Molecular genetic detection of susceptibility to malignant hyperthermia in Belgian families.
Malignant hyperthermia is an autosomal dominant myopathy triggered by volatile anesthetics or succinylcholine in susceptible persons. While in vitro contracture testing (IVCT) is the gold standard to establish malignant hyperthermia (MH) susceptibility, genetic analysis is increasingly used to diagnose this condition. This work aimed to determine the frequency and distribution of ryanodine receptor (RYR1) mutations in the Belgian MH-population as investigated by IVCT in our centre, as well as the discordance rates between the 2 techniques. ⋯ Discordance between IVCT and mutation analysis was observed in only 6 out of 96 individuals from 4 different families. No mutation-positive/ IVCT-negative diagnosis was found. Genetic evaluation of RYR1-mutations can secure a diagnosis and aid in genetic counselling of individual family members but only in those families in which significant clinical information is present, as well as phenotyping by IVCT has been realized.
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The incidence of postoperative residual curarisation after a neuromuscular blocking drug infusion is important. The greater risk for postoperative residual curarisation than with a single bolus can only be tackled by neuromuscular transmission monitoring, and selectively antagonising the block. Such monitoring is seldom used in cardiac surgery. ⋯ Moreover, by only administering a single neuromuscular blocking drug bolus at induction, postoperative residual curarisation can be avoided, becoming more and more important in fast tracking. Finally, in patients undergoing cardiac surgery, cost-effective combinations of drugs and techniques need to be used that provide adequate anaesthesia and analgesia, as well as appropriate muscle relaxation, while offering ideal operative conditions with minimal risk of myocardial ischaemia and residual curarisation. Therefore the continuous administration of neuromuscular blocking drugs, during cardiac surgery, seems unnecessary.