Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1993
Case ReportsThe vicarious liability of a surgeon for a negligent anesthesiologist.
In June 1992, the issue of whether a surgeon could be held liable for the negligence of an anesthesiologist was examined by the tribunal of Leuven (1). Liability was asserted not only against the negligent anesthesiologist, but also against the surgeon. The judgement is most interesting and raises many controversial points of law. ⋯ Second, the liability (criminal and civil) of a team member for his own fault if he observes a negligent colleague and does not take the appropriate measures. Third, the liability in Belgian tort law of the surgeon for the negligent anesthesiologist. Fourth, the liability in Belgian contract law of the surgeon for the anesthesiologist.
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Pulmonary edema may develop in healthy patients after anesthesia. Even in adult patients it is important to ascertain the depth of anesthesia before extubation. Too early extubation can result in laryngospasm, followed by increased inspiratory effort and significant rises in pulmonary capillary pressure, which may create fluid movements in the lung resulting in pulmonary edema.
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Acta Anaesthesiol Belg · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia for major abdominal surgery with continuous thoracic epidural infusion of bupivacaine with sufentanil, versus bupivacaine with morphine. A randomized double blind study.
Forty-six patients undergoing major abdominal surgery were given postoperative epidural analgesia for four days with bupivacaine-sufentanil or bupivacaine-morphine. Both groups received a bolus of 8 ml bupivacaine 0.5% followed after 30 minutes by an infusion of 20 ml/h bupivacaine 0.1%. The sufentanil group (group A: 21 patients) received a loading dose of 50 micrograms sufentanil and a continuous infusion of 5 micrograms/h sufentanil. ⋯ There was also a high incidence of hypotension after the loading dose of bupivacaine 0.5%. Although we noticed a large incidence of pruritus, no patient needed naloxone reversal. In view of these side effects we recommend a lower loading dose of both bupivacaine and sufentanil.
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Acta Anaesthesiol Belg · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialEpidural bupivacaine versus epidural sufentanil anesthesia: hemodynamic differences during induction of anesthesia and abdominal dissection in aortic surgery.
The present study was designed to compare the hemodynamic changes of epidural bupivacaine (EB) with epidural sufentanil (ES), supplemented by general anesthesia, in patients scheduled for abdominal aorto-iliac surgery. Twenty-eight ASA Grade 2 patients randomly received bupivacaine 0.5%, 1-1.5 mg kg-1 (n = 14) or sufentanil 150 micrograms (n = 14) epidurally at T12-L1, combined with light general anesthesia. Hemodynamics were measured before (T1) and after (T2) injection of EB or ES, after induction of general anesthesia (T3), and during the aortic dissection period (T4). ⋯ The induction of general anesthesia caused a significant fall in heart rate (HR) and cardiac index (CI) in the ES group. Abdominal dissection restored systemic pressure and cardiac index in the ES group. It was concluded that both ES and EB provided adequate analgesia and hemodynamics during tracheal intubation and abdominal dissection for aorto-iliac surgery.