Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1998
ReviewJugular bulb oximetry: review on a cerebral monitoring technique.
Jugular bulb oximetry is the first available continuous monitoring method estimating the adequacy of cerebral perfusion. Despite its major technical as well as methodological shortcomings the information on the oxygen supply to demand balance of the brain seems most valuable. ⋯ Jugular bulb oximetry could also guide specific intracranial antihypertensive treatment, as it may reveal the pathophysiological mechanisms behind intracranial hypertension with regard to the status of cerebral perfusion (cerebral hyperemia or cerebral hypoperfusion). These insights might increase the efficacy of all treatments available for intracranial hypertension.
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Peritoneal insufflation with CO2 has been associated with profound cardiorespiratory disturbances, which may modify cerebral blood flow (CBF), particularly in hypertensive patients in whom CBF autoregulation is altered. We report a case of bilateral mydriasis during laparoscopic gastrectomy in a patient with chronic hypertension followed by a coma lasting several hours and we shortly discuss the possible mechanisms involved.
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Acta Anaesthesiol Belg · Jan 1998
Comparative StudyEffects of target-controlled anesthesia with propofol and sufentanil on the hemodynamic response to Mayfield head holder application.
The effects of target-controlled anesthesia with propofol and sufentanil on the hemodynamic response to Mayfield head holder (MH) application were evaluated in 18 ASA I and II patients undergoing scheduled intracranial surgery. Premedication consisted of hydroxyzine, alprazolam and atropine given orally 1 h before surgery. Anesthesia was provided with propofol and sufentanil using a target-controlled infusion device; constant calculated plasma concentrations of 4 micrograms ml-1 propofol and 0.5 ng ml-1 sufentanil were maintained throughout the study. ⋯ Systolic, diastolic, mean arterial pressure, and heart rate increased significantly during and after MH application when compared with MH-1 values, but remained constantly lower than control. Hemodynamic parameters measured 1 min before MH application were significantly lower than control. The results of the study indicate that target-controlled anesthesia maintained with constant calculated plasma concentrations of 4 micrograms ml-1 propofol and 0.5 ng ml-1 sufentanil prevents the increase in arterial pressure and heart rate beyond control values following MH application but may induce some degree of arterial hypotension in the absence of nociceptive stimulation.
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Acta Anaesthesiol Belg · Jan 1998
Current anesthesia manpower in Belgium in relation to anesthesia work locations.
Two inquiries were conducted in 1995 and 1996 involving all anesthesiology departments in Belgium. The response rate was 57%. ⋯ When considering also anesthesia in remote locations outside the operating theater, and the availability of fully trained physicians and trainees (efficiency estimated as 75% of a fully trained specialist), the ratio decreases to between 0.48 and 1.25, the highest ratios being found in larger hospitals (> 650 beds). When physicians currently in anesthesiology training will have graduated the mean availability of anesthesiologists per anesthesia work station will be 0.87 in Belgium, vs 0.52 in 1996.