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Vandepitte C, Latmore M, O’Murchu E, Hadzic A, Van de Velde M, Nijs S. Combined interscalene-superficial cervical plexus blocks for surgical repair of a clavicular fracture in a 15-week pregnant woman. Int J Obstet Anesth 2014; 23:194-5. [DOI: 10.1016/j.ijoa.2013.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/03/2013] [Accepted: 10/07/2013] [Indexed: 11/15/2022]
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Peeters Y, Van de Velde M, Neyrinck AP, Vermeylen K. Approach to one lung ventilation during the surgical resection of an intrathoracic ganglioneuroblastoma in a three-year-old child: a case report and review of the literature. ACTA ANAESTHESIOLOGICA BELGICA 2014; 65:45-49. [PMID: 24988827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
One lung ventilation (OLV) in children is a challenge and requires creative solutions. A case of OLV with bronchial placement of a fiberscope inspection-guided vascular embolectomy catheter in a three-year-old girl, scheduled for the resection of an intrathoracic tumor through thoracotomy is described. The availability of a broad range of vascular catheters as well as of fiberscope inspection material was decisive in managing the airway intra-operatively. Over the last 20 years, the need for OLV in children has increased, and various methods for performing it have been reported. Knowing all existing strategies in that domain is important to provide optimal perioperative care. In this paper, several methods of OLV in children will be discussed, such as selective endobronchial intubation, types of bronchial blockers, Univent tube, pediatric double lumen tubes, as well as the Marraro double lumen tube.
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Heesen M, Van de Velde M, Klöhr S, Lehberger J, Rossaint R, Straube S. Meta-analysis of the success of block following combined spinal-epidural vs epidural analgesia during labour. Anaesthesia 2013; 69:64-71. [DOI: 10.1111/anae.12456] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2013] [Indexed: 01/01/2023]
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Desmet M, Braems H, Reynvoet M, Plasschaert S, Van Cauwelaert J, Pottel H, Carlier S, Missant C, Van de Velde M. I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized, placebo-controlled study. Br J Anaesth 2013; 111:445-52. [PMID: 23587875 DOI: 10.1093/bja/aet109] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Interscalene brachial plexus block (ISB) provides excellent, but time-limited analgesia. Dexamethasone added to local anaesthetics prolongs the duration of a single-shot ISB. However, systemic glucocorticoids also improve postoperative analgesia. The hypothesis was tested that perineural and i.v. dexamethasone would have an equivalent effect on prolonging analgesic duration of an ISB. METHODS We performed a prospective, double blind, randomized, placebo-controlled study. Patients presenting for arthroscopic shoulder surgery with an ISB were randomized into three groups: ropivacaine 0.5% (R); ropivacaine 0.5% and dexamethasone 10 mg (RD); and ropivacaine 0.5% with i.v. dexamethasone 10 mg (RDiv). The primary outcome was the duration of analgesia, defined as the time between performance of the block and the first analgesic request. Standard hypothesis tests (t-test, Mann-Whitney U-test) were used to compare treatment groups. The primary outcome was analysed by Kaplan-Meier survival analysis with a log-rank test and Cox's proportional hazards regression. RESULTS One hundred and fifty patients were included after obtaining ethical committee approval and patient informed consent. The median time of a sensory block was equivalent for perineural and i.v. dexamethasone: 1405 min (IQR 1015-1710) and 1275 min (IQR 1095-2035) for RD and RDiv, respectively. There was a significant difference between the ropivacaine group: 757 min (IQR 635-910) and the dexamethasone groups (P<0.0001). CONCLUSIONS I.V. dexamethasone is equivalent to perineural dexamethasone in prolonging the analgesic duration of a single-shot ISB with ropivacaine. As dexamethasone is not licensed for perineural use, clinicians should consider i.v. administration of dexamethasone to achieve an increased duration of ISB.
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Depuydt E, Van de Velde M. Unplanned cesarean section in parturients with an epidural catheter in-situ: how to obtain surgical anesthesia? ACTA ANAESTHESIOLOGICA BELGICA 2013; 64:61-74. [PMID: 24191527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Epidural analgesia is frequently used for labor. Several authors advocate its use when parturient women are at increased risk for emergency Cesarean delivery. Hereby, the time needed to achieve adequate surgical anesthesia may be shortened and general anesthesia may be avoided. Starting from epidural labor analgesia, the most predominant anesthetic technique for unplanned Cesarean surgery is to top-up the existing epidural catheter. Little consensus can be found in literature about the nature of local anesthetic solution to be used to provide rapid onset and high quality anesthesia for the entire duration of surgery. Women, whose epidural analgesia extension fails either receive a new neuraxial blockade, or receive general anesthesia. We reviewed the medical literature to better define the best methods and choice of products at providing a rapid and adequate surgical anesthesia in parturient women with an epidural catheter in-situ.
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Mennes I, Van de Velde M, Missant C. Sickle cell anaemia and the consequences on the anaesthetic management of cardiac surgery. ACTA ANAESTHESIOLOGICA BELGICA 2012; 63:81-89. [PMID: 23136809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A review of the available literature on genetics and pathophysiology of Sickle Cell Anaemia was performed with special emphasis on the intraoperative management during cardiac surgery. Hypoxia, acidosis and hypothermia have been identified as independent sickling provoking factors. Although no official guidelines on transfusion for Sickle Cell patients have been published, useful directives on preoperative transfusion could be derived from available data. Additionally, we bundled and reviewed the published expertise in the management of cardiopulmonary bypass and the necessity of hypothermia during cardiac surgery in Sickle Cell patients. Our conclusion is that the available data in case reports and case series on cardiac surgery in case of Sickle Cell Anaemia suggest a necessary preoperative or on bypass blood transfusion to guarantee an uncomplicated course of cardiopulmonary bypass and hypothermia.
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Verstraete S, Van de Velde M. Post-cesarean section analgesia. ACTA ANAESTHESIOLOGICA BELGICA 2012; 63:147-167. [PMID: 23610853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Cesarean section patients have compelling reasons to achieve optimal postoperative pain relief, because they are expected to recover expeditiously and to care for their newborns within a few hours following surgery. Consequently, it is necessary that pain relief is safe and effective, that it does not interfere with the mother's ability to care for her infant, and that it results in no adverse neonatal effects in breast-feeding women. However, although research in this field is increasing, there is no 'gold standard' for post-caesarean pain management. Most methods rely on opioids, supplemented with non-opioid analgesics, nerve blocks or other adjunctive techniques. The aim of this manuscript is to evaluate and compare through literature review commonly used opioid- and non-opioid-based methods, when incorporated into a multimodal approach to post-caesarean pain management. Areas of promising research are also discussed.
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Vermeylen K, Engelen S, Sermeus L, Soetens F, Van de Velde M. Supraclavicular brachial plexus blocks: review and current practice. ACTA ANAESTHESIOLOGICA BELGICA 2012; 63:15-21. [PMID: 22783706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article reviews the possible revival of the supraclavicular brachial plexus blockade due to the use of ultrasound guidance. The brachial plexus is a complex network of nerves, extending from the neck to the axilla, which supplies motor and sensory fibers to the upper extremity. Understanding the complexities of the formation and structure of the brachial plexus remains a cornerstone for effective regional anaesthesia. On the level of the supraclavicular fossa, the plexus is most compactly arranged. The supraclavicular approach of the brachial plexus has a high success rate including blockade of the ulnar and musculocutaneous nerve, which can be missed respectively with the interscalene and axillary approach. However, because of the proximity of the pleura, most anaesthesiologists have been reluctant to perform this supraclavicular approach. The introduction of ultrasound guidance techniques not only reduces the possible risk of pneumothorax but also allows a faster onset time of the block with a reduction of the local anaesthetic dose. This makes the supraclavicular approach a valuable alternative to the axillary, interscalene and infraclavicular approach for upper limb surgery.
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Adama van Scheltema PN, Pasman SA, Wolterbeek R, Deprest JA, Oepkes D, De Buck F, Van de Velde M, Vandenbussche FPHA. Fetal stress hormone changes during intrauterine transfusions. Prenat Diagn 2011; 31:555-9. [DOI: 10.1002/pd.2745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/14/2011] [Accepted: 02/23/2011] [Indexed: 11/11/2022]
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Vermeylen K, Berghmans J, Van de Velde M, De Leeuw T, Himpe D. Ultrasound as guidance for a combined bilateral supraclavicular and caudal block, in order to reduce the total anaesthetic dose in a two year old child after a pneumococcal sepsis. ACTA ANAESTHESIOLOGICA BELGICA 2011; 62:151-155. [PMID: 22145257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present a case of the combination of a bilateral supraclavicular block and a caudal block in a two year old boy who needed amputations of four extremities after a pneumococcal sepsis. With the use of ultrasound guidance, reduction of local anaesthetic dose could be obtained in order not to reach the toxic dose of the local anaesthetic. Amputations of four extremities is not common practice. A good postoperative pain management is more than a challenge.
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Van de Velde M. Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection. ACTA ACUST UNITED AC 2010; 56:546-61. [PMID: 20112546 DOI: 10.1016/s0034-9356(09)70457-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the present review we outline the state-of-the-art of neuraxial analgesia. As neuraxial analgesia remains the gold standar of analgesia during labor, we review the most recent literature on this topic. The neuraxial analgesia techniques, types of administration, drugs, adjuvants, and adverse effects are investigated from the references. Most authors would agree that central neuraxial analgesia is the best form to manage labor pain. When neuraxial analgesia is administered to the parturient in labor, different management choices must be made by the anesthetist: how will we initiate analgesia, how will analgesia be maintained, which local anesthetic will we use for neuraxial analgesia and which adjuvant drugs will we combine? The present manuscript tries to review the literature to answer these questions.
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Louage S, Van de Velde M. Cell salvage in obstetric anesthesia. ACTA ANAESTHESIOLOGICA BELGICA 2010; 61:13-24. [PMID: 20593639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Hemorrhage is a leading cause of maternal morbidity and mortality. The increasing shortage of blood and blood products, and growing anxiety about the use of donor blood, is leading to investigation and use of several blood conservation techniques. There is an increasing interest in the use of cell salvage. The safety of cell salvage in obstetrics has been questioned, therefore the experience in this field is limited. The aim of this article is to review the medical literature about the prevalence of obstetric hemorrhage, the principles of cell salvage and its safety profile in the obstetric setting.
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Van de Velde M, Berends N, Kumar A, Devroe S, Devlieger R, Vandermeersch E, De Buck F. Effects of epidural clonidine and neostigmine following intrathecal labour analgesia: a randomised, double-blind, placebo-controlled trial. Int J Obstet Anesth 2009; 18:207-14. [DOI: 10.1016/j.ijoa.2009.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Revised: 01/05/2009] [Accepted: 01/07/2009] [Indexed: 01/29/2023]
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Van de Velde M. Combined spinal epidural analgesia for labor and delivery: balanced view based on experience and literature. ACTA ANAESTHESIOLOGICA BELGICA 2009; 60:109-122. [PMID: 19594093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Van de Velde M. Emergency Caesarean delivery: is supplementary maternal oxygen necessary? Br J Anaesth 2009; 102:1-2. [DOI: 10.1093/bja/aen329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Van de Velde M. Short- and longterm outcome after bariatric surgery: a critical appraisal by an anesthesiologist. ACTA ANAESTHESIOLOGICA BELGICA 2009; 60:159-163. [PMID: 19961111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Van de Velde M. Remifentanil patient-controlled analgesia should be routinely available for use in labour. Int J Obstet Anesth 2008; 17:339-42. [DOI: 10.1016/j.ijoa.2008.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2008] [Indexed: 10/21/2022]
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Van de Velde M, Schepers R, Berends N, Vandermeersch E, De Buck F. Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department. Int J Obstet Anesth 2008; 17:329-35. [PMID: 18691871 DOI: 10.1016/j.ijoa.2007.04.009] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 04/01/2007] [Indexed: 01/22/2023]
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Van de Velde M, Rettig H, Wulf H, Argyra E, Borghi B, Klaastad Ø, Rettig H, Van de Velde M, Wulf H. Introduction. Reg Anesth Pain Med 2008. [DOI: 10.1136/rapm-00115550-200809001-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Van de Velde M, Rettig H, Wulf H, Argyra E, Borghi B, Klaastad Ø, Rettig H, Van de Velde M, Wulf H. Introduction. Reg Anesth Pain Med 2008. [DOI: 10.1097/00115550-200809001-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Van de Velde M. Recombinant factor VIIa should be used in massive obstetric haemorrhage. Int J Obstet Anesth 2007; 16:357-9. [PMID: 17702565 DOI: 10.1016/j.ijoa.2007.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Indexed: 11/18/2022]
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Abstract
Although anaesthesia for Caesarean section is predominantly performed using regional techniques of anaesthesia, general anaesthesia will remain essential for subgroups of obstetric patients, especially those who are at high risk of complications. In the present review, recent reports that addressed issues regarding general and regional anaesthesia in Caesarean section will be discussed.
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Buyse I, Stockman W, Columb M, Vandermeersch E, Van de Velde M. Effect of sufentanil on minimum local analgesic concentrations of epidural bupivacaine, ropivacaine and levobupivacaine in nullipara in early labour. Int J Obstet Anesth 2007; 16:22-8. [PMID: 17125998 DOI: 10.1016/j.ijoa.2006.07.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim was to assess the effect of epidural sufentanil on relative analgesic potencies of epidural bupivacaine, ropivacaine and levobupivacaine by determining the minimum local analgesic concentrations during labour. METHODS In a randomised, double-blind study, 171 parturients were allocated to one of six groups receiving a 10-mL bolus of bupivacaine, ropivacaine or levobupivacaine alone or with sufentanil 0.75 microg/mL. The concentration of local anaesthetic was determined by the response of the previous parturient using up-down sequential allocation starting at a concentration of 0.13% wt/vol with a testing interval of 0.01%. Effective analgesia was defined as a visual analogue pain score < or = 15/100 mm within 30 min and lasting for 30 min. Median effective concentrations were estimated and two-sided P < 0.05 was significant. RESULTS Local anaesthetic concentration, use of sufentanil and local anaesthetic drug were independent significant predictors of effective and ineffective analgesia. Bupivacaine was significantly more potent than levobupivacaine and ropivacaine. The relative potency ratios without sufentanil of 0.77:0.83:1.00 were reduced to 0.36:0.38:1.00 by the addition of sufentanil. The major factor influencing local anaesthetic requirements was the addition of sufentanil, which reduced overall requirements by a factor of 4.2 (95% CI 3.6-4.8); this effect was proportionately more enhanced for bupivacaine. CONCLUSIONS Local anaesthetic requirements for bupivacaine, levobupivacaine and ropivacaine follow an analgesic potency hierarchy. Any potency differences are small when compared to the effect of sufentanil, which resulted in a four-fold reduction in local anaesthetic requirements. Sufentanil may also enhance the potency differences between bupivacaine and the two S-enantiomer agents.
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Allegaert K, Van de Velde M, Debeer A, Casteels I, Devlieger H. Cryotherapy versus laser photocoagulation for threshold retinopathy of prematurity: impact on early postoperative clinical recovery. BULLETIN DE LA SOCIETE BELGE D'OPHTALMOLOGIE 2006:7-10. [PMID: 16903506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In a retrospective study in preterms treated with either cryotherapy (n= 16, 2000-2001) or laser photocoagulation (n= 19, 2002-2005) for threshold retinopathy, a significant decrease in duration of postoperative ventilation, in postoperative administration of analgesics and in time until regain of full enteral feeding was documented in infants who received laser photocoagulation. We therefore conclude that - compared to cryotherapy - laser treatment for threshold retinopathy is associated with a faster clinical postoperative recovery.
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Van de Velde M. Identification of the epidural space: stop using the loss of resistance to air technique! ACTA ANAESTHESIOLOGICA BELGICA 2006; 57:51-4. [PMID: 16617758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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