Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2014
ReviewHydroxyethyl starches in the perioperative period. A review on the efficacy and safety of starch solutions.
Several randomized controlled trials have raised alarming concerns about the safety of hydroxyethyl starches (HES) for the hemodynamic stabilization of critically ill patients. It has been repeatedly demonstrated that the use of HES in patients treated in an intensive care unit was associated with an increased occurrence of serious adverse events, including a higher incidence of renal injury or failure, a higher need for renal replacement therapy (RRT), and (in one study) increased mortality. HES solutions are also widely used in the perioperative period, although high-level evidence on both the efficacy and safety of HES in patients undergoing surgery is sparse. ⋯ Food and Drug Administration also communicated a serious warning with respect to the use of HES (2). The present (non-systematic) review summarizes the evidence upon which these remarkable recommendations are based. Moreover, current guidelines on the use of HES are quoted.
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Acta Anaesthesiol Belg · Jan 2014
Case ReportsSwift recovery of severe hypoxemic pneumonia upon morbid obesity.
A morbidly obese (body mass index = 55.5) female patient presented with severe hypoxemic community acquired pneumonia [PaO2/FiO2 (P/F) = 57] with primarily right basal atelectasis, but without bilateral opacities in the upper lobes on the chest X-ray. Major O2 desaturations led the nurses to object to moving the patient to the prone position: muscle relaxation combined to prone position was impossible. Therefore, stringent 60 degrees reverse Trendelenburg legs down position was constantly maintained during mechanical ventilation through the endotracheal tube, using low pressure support (pressure support = 5-10 cmH2O) and high positive end-expiratory pressure (PEEP). ⋯ A P/F improvement from 57 to 200 over three days allowed removing the tracheal tube. The patient was discharged 13 days after admission. In this paper, the use of high PEEP in the context of morbid obesity, and low pressure support are discussed.
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Acta Anaesthesiol Belg · Jan 2014
No clinically relevant advantage of intrathecal morphine in total hip arthroplasty?
Adding morphine to intrathecal bupivacaine provides sound analgesia, but is associated with side effects. The purpose of this study is to investigate if the contribution of intrathecal morphine to postoperative analgesia for total hip replacement outweighs its side effects in a modern multimodal setting. From November 2012 till January 2013 patients undergoing total hip arthroplasty (THA) under spinal anesthesia received either plain bupivacaine (group B) or bupivacaine + 0.1 mg morphine (group M). ⋯ Overall morphine consumption and pain scores were low, although they were slightly but significantly lower in group M. Intrathecal morphine was associated with significantly more pruritus. In this study, PCA morphine consumption and pain scores were low in THA with multimodal pain treatment, and the added analgesic value of intrathecal morphine did not outweigh the increased incidence of pruritus.
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Acta Anaesthesiol Belg · Jan 2014
Case ReportsExtracorporeal cardiopulmonary resuscitation for refractory ventricular fibrillation. A rescue bridge to reperfusion.
Accumulating evidence suggests benefit of extracorporeal cardiopulmonary resuscitation (E-CPR) in patients with refractory cardiac arrest by using venoarterial extracorporeal membrane oxygenation. Appropriate patient selection for E-CPR is cumbersome and still debated. We describe a 56-year-old male who developed refractory ventricular fibrillation upon arrival at the emergency department and was successfully treated by urgent E-CPR. Patient selection, complications and the need to adapt the chain of survival are discussed.
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Acta Anaesthesiol Belg · Jan 2014
Ultrasound guided femoral nerve block and lateral femoral cutaneous nerve block for postoperative pain control after primary hip arthroplasty: a retrospective study.
The purpose of this study was to evaluate the use of an ultrasound guided femoral nerve (FN) block together with an ultrasound guided lateral femoral cutaneous nerve (LFCN) block in addition to a patient controlled intravenous analgesia (PCIA) pump with piritramide as a strategy for postoperative pain-management after primary hip arthroplasty. ⋯ This retrospective study indicates that a FN block in combination with a LFCN block as supplementary postoperative analgesia after primary hip arthroplasty, can reduce the piritramide consumption. Furthermore, patients receiving the peripheral nerve block report lower pain scores at rest and during movement compared with the patients who did not receive a peripheral block. However, as this is a retrospective study, conclusions have to be drawn cautiously.