Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2006
Randomized Controlled Trial Comparative StudyLow-dose combined spinal-epidural anesthesia for cesarean delivery: a comparison of three plain local anesthetics.
The new local anesthetics have been poorly studied for intrathecal use during Cesarean section surely in low doses and in combination with an opioid substance. The purpose of the present study was to compare bupivacaine and the newer local anesthetics in equipotent doses. During the induction of combined spinal-epidural anesthesia, 91 elective Cesarean section patients were randomly assigned to receive a spinal injection of either 10 mg ropivacaine or 6.6 mg bupivacaine or levobupivacaine both combined with sufentanil 3.3 microg. ⋯ Hemodynamic values were comparable between the three groups although a trend towards better systolic blood pressures and a lower incidence of severe hypotension were noticed in favor of levobupivacaine. Apgar scores and umbilical pH values did not differ. When performing a low-dose combined spinal-epidural technique for Cesarean section, the present study confirms that the new local anesthetics can be used successfully, induce less motor block but that ropivacaine requires at least a 50% larger dose than bupivacaine or levobupivacaine.
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Acta Anaesthesiol Belg · Jan 2006
Case ReportsUnilateral pulmonary edema caused by paravalvular leakage recognized by bedside transesophageal echocardiography.
We describe a case of acute unilateral left pulmonary edema occuring in an old man one year after mitral valve replacement. Transesophageal echocardiography identified a paravalvular leakage with severe mitral regurgitant jet directed to both left pulmonary veins. A prompt surgical closure of the leakage by pericardial patch was decided with rapid clinical and radiological improvement.
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Acta Anaesthesiol Belg · Jan 2006
Case ReportsNon-programmed clamping of superior vena cava. The anesthesiologist's Achilles' heel.
This case presentation focuses on the hemodynamic alterations due to acute clamping of superior vena cava (SVC) during a right pneumonectomy for lung cancer and on the alternatives for drug administration. In a 71-yr-old female patient without clinical manifestations of SVC syndrome, this large vein was clamped for 22 minutes for patch placement after sudden and unpredictable hemorrhage. ⋯ Postoperatively, no neurologic deficit was noted. This case demonstrates the difficulties for managing patients without superior vena cava syndrome in which acute, non-programmed intra-operative SVC clamping is performed, as this is followed by systemic and brain hemodynamic deteriorations that may lead to bad outcome.
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The use of locoregional anaesthesia in obstetrics in Flanders was assessed by a postal questionnaire sent to the directors of the anaesthesia departments of the 72 hospitals with an obstetric unit. 59 (82%) answers were returned. In the group of parturients who had a vaginal delivery a neuraxial technique was requested by 65% of the patients and consisted of epidural analgesia in 84%, and combined spinal epidural analgesia in 16%. ⋯ For caesarean section general anaesthesia was used in only 5% of the deliveries, whereas spinal, single or as a part of a CSE technique, was preferred in 80%; the epidural technique was applied in 15%. There is no clear preference in technique for postoperative analgesia after caesarean delivery as both parenteral and epidural analgesia are used in 50% of the cases.