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Abramovich I, Crisan I, Sobreira Fernandes D, De Hert S, Lukic A, Norte G, Matias B, Majić M, Berger-Estilita J. Anaesthesia training designs across Europe: A survey-based study from the trainees committee of the European Society of Anaesthesiology and Intensive Care. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00074-X. [PMID: 38636795 DOI: 10.1016/j.redare.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/13/2023] [Indexed: 04/20/2024]
Abstract
BACKGROUND Anaesthesiology training programs in Europe vary in duration, content, and requirements for completion. This survey-based study conducted by the Trainees Committee of the European Society of Anaesthesiology and Intensive Care explores current anaesthesia training designs across Europe. METHODS Between May and July 2018, we sent a 41-item online questionnaire to all National Trainee Representatives, members of the National Anaesthesiologists Societies Committee, and Council Representatives of the European Society of Anaesthesiology and Intensive Care (ESAIC) of all member countries. We cross-validated inconsistent data with different country representatives. RESULTS Forty-three anaesthesiologists from all 39 associated ESAIC countries completed the questionnaire. Results showed considerable variability in teaching formats, frequency of teaching sessions during training, and differences in assessments made during and at the end of training. The reported duration of training was 60 months in 59% (n = 23) of participating countries, ranging from 24 months in Russia and Ukraine to 84 months in the UK. CONCLUSION This study shows the significant differences in anaesthesiology training formats across Europe, and highlights the importance of developing standardised training programs to ensure a consistent level of training and to improve patient safety. This study provides valuable insights into European anaesthesia training, and underlines the need for further research and collaboration to improve requirements.
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Affiliation(s)
- I Abramovich
- Charité - Universitätsmedizin Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany.
| | - I Crisan
- Universitätsspital Zürich, Department of Emergency Medicine, Zürich, Switzerland
| | - D Sobreira Fernandes
- Centro Hospitalario de Póvoa de Varzim y Vila de Conde, Póvoa de Varzim, Portugal
| | - S De Hert
- Department of Anaesthsiology and Peri-operative Medicine, Ghent University, Ghent, Belgium
| | - A Lukic
- Department of Anaesthesiology, Reanimateology and Intensive Care, General Hospital Varaždin, Varaždin, Croatia
| | - G Norte
- Department of Anaesthesiology, Centro Hospitalar Trás-os-Montes y Alto Douro, Vila Real, Portugal
| | - B Matias
- Department of Anaesthesiology, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - M Majić
- Department of Anaesthesiology and ICU, University Hospital Centre Zagreb, Zagreb, Croatia
| | - J Berger-Estilita
- Institute for Medical Education, University of Bern, Bern, Switzerland; Institute of Anaesthsiology and Intensive Care, Salemspital, Hirslanden Medical Group, Bern, Switzerland; CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, Porto, Portugal
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Rodrigus IE, Amsel BJ, Conraads V, Hert SD, Moulijn AC. Emergency Ventricular Assist Device: Better Survival Rates In Non-Post Cardiotomy-Related Cardiogenic Shock. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- I. E. Rodrigus
- Departments of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
| | - B. J. Amsel
- Departments of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
| | - V. Conraads
- Departments of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - S. De Hert
- Departments of Anaesthesia, Antwerp University Hospital, Edegem, Belgium
| | - A. C. Moulijn
- Departments of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
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Coppens M, Anssens S, Parashchanka A, Roelens K, Deschepper E, De Hert S, Wouters PF. Determination of the median effective dose (ED50) of spinal chloroprocaine in labour analgesia. Anaesthesia 2017; 72:598-602. [DOI: 10.1111/anae.13808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2016] [Indexed: 12/01/2022]
Affiliation(s)
- M. Coppens
- Department of Anaesthesiology and Peri-operative Medicine; Ghent University Hospital; Ghent Belgium
| | - S. Anssens
- Department of Anaesthesiology and Peri-operative Medicine; Ghent University Hospital; Ghent Belgium
| | - A. Parashchanka
- Department of Anaesthesiology and Peri-operative Medicine; Ghent University Hospital; Ghent Belgium
| | - K. Roelens
- Department of Uro-Gynaecology; Ghent University Hospital; Ghent Belgium
| | - E. Deschepper
- Biostatistics Unit; Department of Public Health; Ghent University Hospital; Ghent Belgium
| | - S. De Hert
- Department of Anaesthesiology and Peri-operative Medicine; Ghent University Hospital; Ghent Belgium
| | - P. F. Wouters
- Department of Anaesthesiology and Peri-operative Medicine; Ghent University Hospital; Ghent Belgium
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Kolh P, De Hert S, De Rango P. The Concept of Risk Assessment and Being Unfit for Surgery. Eur J Vasc Endovasc Surg 2016; 51:857-66. [PMID: 27053098 DOI: 10.1016/j.ejvs.2016.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 02/03/2016] [Indexed: 02/06/2023]
Abstract
The concept of risk assessment and the identification of surgical unfitness for vascular intervention is a particularly controversial issue today as the minimally invasive surgical population has increased not only in volume but also in complexity (comorbidity profile) and age, requiring an improved pre-operative selection and definition of high risk. A practical step by step (three steps, two points for each) approach for surgical risk assessment is suggested in this review. As a general rule, the identification of a "high risk" patient for vascular surgery follows a step by step process where the risk is clearly defined, quantified (when too "high"?), and thereby stratified based on the procedure, the patient, and the hospital, with the aid of predictive risk scores. However, there is no standardized, updated, and objective definition for surgical unfitness today. The major gap in the current literature on the definition of high risk in vascular patients explains the lack of sound validated predictive systems and limited generalizability of risk scores in vascular surgery. In addition, the concept of fitness is an evolving tool and many traditional high risk criteria and definitions are no longer valid. Given the preventive purpose of most vascular procedures performed in elderly asymptomatic patients, the decision to pursue or withhold surgery requires realistic estimates not only regarding individual peri-operative mortality, but also life expectancy, healthcare priorities, and the patient's primary goals, such as prolongation of life versus maintenance of independence or symptom relief. The overall "frailty" and geriatric risk burden, such as cognitive, functional, social, and nutritional status, are variables that should be also included in the analyses for stratification of surgical risk in elderly vascular patients.
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Affiliation(s)
- P Kolh
- Cardiovascular Surgery Department, University Hospital (CHU, ULg) of Liège, Belgium.
| | - S De Hert
- Department of Anesthesiology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - P De Rango
- Unit of Vascular Surgery, Hospital S.M. Misericordia, Perugia, Italy
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Leslie K, McIlroy D, Kasza J, Forbes A, Kurz A, Khan J, Meyhoff CS, Allard R, Landoni G, Jara X, Lurati Buse G, Candiotti K, Lee HS, Gupta R, VanHelder T, Purayil W, De Hert S, Treschan T, Devereaux PJ. Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial†. Br J Anaesth 2015. [PMID: 26209855 DOI: 10.1093/bja/aev255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS 10 010 high-risk noncardiac surgical patients were randomized aspirin or placebo and clonidine or placebo. Neuraxial block was defined as intraoperative spinal anaesthesia, or thoracic or lumbar epidural anaesthesia. Postoperative epidural analgesia was defined as postoperative epidural local anaesthetic and/or opioid administration. We used logistic regression with weighting using estimated propensity scores. RESULTS Neuraxial block was not associated with the primary outcome [7.5% vs 6.5%; odds ratio (OR), 0.89; 95% CI (confidence interval), 0.73-1.08; P=0.24], death (1.0% vs 1.4%; OR, 0.84; 95% CI, 0.53-1.35; P=0.48), myocardial infarction (6.9% vs 5.5%; OR, 0.91; 95% CI, 0.74-1.12; P=0.36) or stroke (0.3% vs 0.4%; OR, 1.05; 95% CI, 0.44-2.49; P=0.91). Neuraxial block was associated with less clinically important hypotension (39% vs 46%; OR, 0.90; 95% CI, 0.81-1.00; P=0.04). Postoperative epidural analgesia was not associated with the primary outcome (11.8% vs 6.2%; OR, 1.48; 95% CI, 0.89-2.48; P=0.13), death (1.3% vs 0.8%; OR, 0.84; 95% CI, 0.35-1.99; P=0.68], myocardial infarction (11.0% vs 5.7%; OR, 1.53; 95% CI, 0.90-2.61; P=0.11], stroke (0.4% vs 0.4%; OR, 0.65; 95% CI, 0.18-2.32; P=0.50] or clinically important hypotension (63% vs 36%; OR, 1.40; 95% CI, 0.95-2.09; P=0.09). CONCLUSIONS Neuraxial block and postoperative epidural analgesia were not associated with adverse cardiovascular outcomes among POISE-2 subjects.
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Affiliation(s)
- K Leslie
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia Anaesthesia, Perioperative and Pain Medicine Unit Department of Pharmacology, University of Melbourne, Melbourne, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - D McIlroy
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia
| | - J Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Kurz
- Department of Outcomes Research, Cleveland Clinic, Cleveland, USA
| | - J Khan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada Departments of Clinical Epidemiology Biostatistics, McMaster University, Hamilton, Canada Department of Anesthesiology, University of Toronto, Toronto, Canada
| | - C S Meyhoff
- Department of Anaesthesiology, Herlev Hospital and University of Copenhagen, Herlev, Denmark
| | - R Allard
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital and Queen's University, Kingston, Canada
| | - G Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - X Jara
- Department of Anesthesiology, Clinica Santa Maria and Universidad de Los Andes, Santiago, Chile
| | - G Lurati Buse
- Department of Anaesthesiology, Juravinski Hospital, Hamilton, Canada
| | - K Candiotti
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miami, USA
| | - H-S Lee
- Department of Anesthesiology, Sultanah Aminah Hospital, Johor Bahru, Malaysia
| | - R Gupta
- Department of Medicine, Fortis Escorts Hospital, Jaipur, India
| | - T VanHelder
- Department of Anesthesia, Hamilton General Hospital, Hamilton, Canada
| | - W Purayil
- Department of Anaesthesia, Westfort Hi-tech Hospital, Thrissur, India
| | - S De Hert
- Department of Anaesthesiology, Ghent University Hospital, Ghent, Belgium
| | - T Treschan
- Department of Anaesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - P J Devereaux
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada Departments of Clinical Epidemiology Biostatistics, McMaster University, Hamilton, Canada Department of Medicine, McMaster University, Hamilton, Canada
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De Hert S, De Baerdemaeker L. Re. 'Benefits of remote ischemic preconditioning in vascular surgery'. Eur J Vasc Endovasc Surg 2014; 48:712-3. [PMID: 25281533 DOI: 10.1016/j.ejvs.2014.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/18/2014] [Indexed: 11/18/2022]
Affiliation(s)
- S De Hert
- Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium.
| | - L De Baerdemaeker
- Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium
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Abstract
The cost/benefit ratio of probiotics in the ambulatory treatment of acute infectious gastro-enteritis with or without a synbiotic food supplement (containing fructo-oligosaccharides and probiotic strains of Streptoccoccus thermophilus, Lactobacillus rhamnosus, Lactobacillus acidophilus, Bifidobacterium lactis and Bifidobacterium infantis) has been studied. 111 children (median age 37 and 43 months for the synbiotic and placebo group, respectively) with acute infectious gastroenteritis were included in a randomised, prospective placebo-controlled trial performed in primary health care. All children were treated with an oral rehydration solution and with the synbiotic food supplement (n=57) or placebo (n=54). Physicians were allowed to prescribe additional medication according to what they considered as 'necessary'. Cost of add-on medication and total healthcare cost were calculated. Median duration of diarrhoea was 1 day shorter (95% confidence interval -0.6 to -1.9 days) in the symbiotic than in the placebo group (P<0.005). Significantly more concomitant medication (antibiotics, antipyretics, antiemetics) was prescribed in the placebo group (39 prescriptions in 28 patients) compared to the synbiotic group (12 prescriptions in 7 patients) (P<0.001). The difference was most striking for antiemetics: 28 vs. 5 prescriptions. The cost of add-on medication in the placebo group was evaluated at € 4.04/patient (median 4.97 (interquartile (IQ) 25-75: 0-4.97)) vs. € 1.13 /patient in the synbiotic arm (P<0.001). If the cost of the synbiotic is considered, median cost raised to € 7.15/patient (IQ 25-75: 7.15-7.15) (P<0.001). The extra consultations needed to prescribe the concomitant medication resulted in a higher health care cost in the placebo group (€ 14.41 vs. € 10.74/patient, P<0.001). Synbiotic food supplementation resulted in a 24 h earlier normalisation of stool consistency. Although use of the synbiotic supplementation increased cost, add-on medication and extra consultations were reduced, resulting in a reduction of health care cost of 25%.
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Affiliation(s)
- Y Vandenplas
- Department of Pediatrics, Universitair KinderZiekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
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Hermans V, De Pooter F, De Groote F, De Hert S, Van der Linden P. Effect of dexamethasone on nausea, vomiting, and pain in paediatric tonsillectomy. Br J Anaesth 2012; 109:427-31. [PMID: 22879656 DOI: 10.1093/bja/aes249] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The efficacy of dexamethasone (DEX) to reduce morbidity after paediatric tonsillectomy remains controversial. We evaluated the effect of 0.15 and 0.5 mg kg(-1) DEX on the incidence of postoperative nausea and vomiting (PONV) and on pain intensity after paediatric tonsillectomy. METHODS A total of 147 children aged 2-8 yr undergoing elective tonsillectomy were included in this prospective randomized double-blind study. At the induction of anaesthesia, subjects received 0.15 mg kg(-1) (DEX 0.15), 0.5 mg kg(-1) (DEX 0.5) DEX, or an equivalent volume of saline solution (placebo). Anaesthetic and surgical techniques were standardized. The incidence of PONV and the need for anti-emetic drugs and additional analgesia (tramadol and/or morphine) were recorded. Postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale, the visual analogue scale, and the postoperative pain measure for parents. RESULTS The incidence of early PONV (primary outcome variable) was lower in both DEX groups (DEX 0.15: 21%; DEX 0.5: 22%; placebo: 49%; P=0.001). The incidence of severe pain was reduced in the DEX groups on the second postoperative day (DEX 0.15: 20%; DEX 0.5: 5%; placebo: 47%; P<0.001). The study was not powered to assess a difference between the two DEX dose groups. CONCLUSIONS A single i.v. injection of DEX at the induction of anaesthesia was effective in reducing the incidence of early and late PONV and the level of pain on the second postoperative day. A 0.15 mg kg(-1) DEX dose appeared to be as effective as a 0.5 mg kg(-1) dose to reduce the incidence of PONV.
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Affiliation(s)
- V Hermans
- Department of Anesthesiology, Centre-hospitalo-universitaire Brugmann, Free University of Brussels, 4 Place Van Gehuchten, B-1020 Brussels, Belgium.
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Faraoni D, Willems A, Melot C, De Hert S, Van der Linden P. Efficacy of tranexamic acid in paediatric cardiac surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2012; 42:781-6. [DOI: 10.1093/ejcts/ezs127] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Authors/Task Force Members, Poldermans D, Bax JJ, Boersma E, De Hert S, Eeckhout E, Fowkes G, Gorenek B, Hennerici MG, Iung B, Kelm M, Kjeldsen KP, Kristensen SD, Lopez-Sendon J, Pelosi P, Philippe F, Pierard L, Ponikowski P, Schmid JP, Sellevold OF, Sicari R, Van den Berghe G, Vermassen F, Hoeks SE, Vanhorebeek I, Vahanian A, Auricchio A, Bax JJ, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, De Caterina R, Agewall S, Al Attar N, Andreotti F, Anker SD, Baron-Esquivias G, Berkenboom G, Chapoutot L, Cifkova R, Faggiano P, Gibbs S, Hansen HS, Iserin L, Israel CW, Kornowski R, Eizagaechevarria NM, Pepi M, Piepoli M, Priebe HJ, Scherer M, Stepinska J, Taggart D, Tubaro M. Corrigendum to: 'Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA)' [Eur Heart J 2009;30:2769-2812]. Eur Heart J 2010. [DOI: 10.1093/eurheartj/ehp593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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De Hert S, Vlasselaers D, Barbé R, Ory JP, Dekegel D, Donnadonni R, Demeere JL, Mulier J, Wouters P. A comparison of volatile and non volatile agents for cardioprotection during on-pump coronary surgery. Anaesthesia 2009; 64:953-60. [DOI: 10.1111/j.1365-2044.2009.06008.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Anaesthetists are confronted on a daily basis with patients with coronary artery disease, myocardial ischaemia, or both during the perioperative period. Therefore, prevention and ultimately adequate therapy of perioperative myocardial ischaemia and its consequences are the major challenges in current anaesthetic practice. This review will focus on the translation of the laboratory evidence of anaesthetic-induced cardioprotection into daily clinical practice.
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Affiliation(s)
- J Frässdorf
- Departement of Anesthesiology, AMC-University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
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Abstract
Diastolic heart failure is an underestimated pathology with a high risk of acute decompensation during the perioperative period. This article reviews the epidemiology, risk factors, pathophysiology, and treatment of diastolic heart failure. Although frequently underestimated, diastolic heart failure is a common pathology. Diastolic heart failure involves heart failure with preserved left ventricular (LV) function, and LV diastolic dysfunction may account for acute heart failure occurring in critical care situations. Hypertensive crisis, sepsis, and myocardial ischaemia are frequently associated with acute diastolic heart failure. Symptomatic treatment focuses on the reduction in pulmonary congestion and the improvement in LV filling. Specific treatment is actually lacking, but encouraging data are emerging concerning the use of renin-angiotensin-aldosterone axis blockers, nitric oxide donors, or, very recently, new agents specifically targeting actin-myosin cross-bridges.
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Affiliation(s)
- R Pirracchio
- Department of Anaesthesiology, Lariboisière University Hospital, Paris, France
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Tazeroualti N, De Groote F, De Hert S, De Villé A, Dierick A, Van der Linden P. Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. A prospective, randomized, controlled trial †. Br J Anaesth 2007; 98:667-71. [PMID: 17416907 DOI: 10.1093/bja/aem071] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This randomized, double-blind study tested the hypothesis that, in comparison with midazolam, premedication with oral clonidine reduces the incidence of emergence agitation in preschool children anaesthetized with sevoflurane. METHODS Sixty-eight ASA I-II children undergoing circumcision were randomized into three groups to receive different oral premedication given 30 min before anaesthesia: midazolam 0.5 mg kg-1, clonidine 2 microg kg-1, and clonidine 4 microg kg-1. Sevoflurane anaesthesia was administered via a facemask (O2/N2O: 40/60). Analgesia was with penile block (bupivacaine 0.5% 0.3 ml kg-1) and rectal paracetamol (30 mg kg-1). During the first postoperative hour, children were evaluated using a modified 'objective pain scale'. RESULTS Only the 4 microg kg-1 dose of clonidine was associated with a significant reduction in emergence agitation. Fewer children in the clonidine 4 microg kg-1 group displayed agitation (25%) than in the midazolam group (60%) (P=0.025). Incidence of hypotension and bradycardia, time to first micturition and first drink did not differ among groups. CONCLUSIONS In comparison with midazolam, clonidine 4 microg kg-1 reduced sevoflurane-induced emergence agitation without increasing postoperative side-effects.
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Affiliation(s)
- N Tazeroualti
- Department of Anaesthesia, CHU-Brugmann-HUDERF, 4, Place Van Gehuchten, B-1020 Brussels, and University Hospital Antwerp, Edegem, Belgium
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Robert D, Cromheecke S, Rodrigus I, De Hert S. Crit Care 2005; 9:P70. [DOI: 10.1186/cc3133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Herregods L, Barvais L, Brichant JF, Camu F, De Hert S, De Kock M, Dubois P, Ewalenko P, Lamy M, Mortier E, Vandermeersch E, Vermeyen K, Wouters P. Position of SARB in regard to premedication. Acta Anaesthesiol Belg 2005; 56:389-94. [PMID: 16416955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Vets P, ten Broecke P, Adriaensen H, Van Schil P, De Hert S. Cerebral oximetry in patients undergoing carotid endarterectomy: preliminary results. Acta Anaesthesiol Belg 2004; 55:215-20. [PMID: 15515298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Carotid endarterectomy (CEA) is an appropriate treatment for carotid occlusive disease. The risk of stroke during CEA ranges from 1.1% to 7.5%. Shunting is usually advised when severe ischemia during cross-clamping of the internal carotid artery is suspected. Routine use of an intraluminal shunt may increase the perioperative stroke rate. Popular and well documented methods of neurologic monitoring for ischemia during general anesthesia are electroencephalography (EEG) and transcranial Doppler ultrasonography (TCD) of the middle cerebral artery. The purpose of this prospective study was to compare cerebral oximetry using near infrared spectrophotometry (NIRS) with EEG and TCD. Preliminary data on 14 patients scheduled for elective carotid endarterectomy were included and a literature search was performed to correlate the findings. No postoperative neurologic events occurred. During carotid clamping there was a significant decrease in regional oxygen saturation (rSO2) but there was only a weak correlation with the decrease in mean Doppler flow (R = 0.74; P = 0.02) and no correlation with EEG changes (R = 0.49; P = 0.18). A useful rSO2 cut-off value predictive for cerebral ischemia could not be defined.
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Affiliation(s)
- Ph Vets
- Department of Anesthesiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
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De Hert S, Foubert L, Poelaert J, Verborgh C, Vlasselaers D, Wouters P. Beta-adrenergic blocking drugs in the perioperative period. Acta Anaesthesiol Belg 2003; 54:127-39. [PMID: 12872429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
During the last years increasing evidence has indicated that patients at risk for coronary artery disease may benefit from beta-adrenergic blocking therapy in the perioperative setting. It has been demonstrated that even a relatively brief treatment with beta-adrenergic blocking drugs decreases the incidence of perioperative myocardial ischemia. Even more important is the observation that this reduction in perioperative ischemic events ultimately results in a decrease in long term cardiac morbidity and mortality. Despite overwhelming evidence on the beneficial effects of beta-adrenergic blocking in patients with coronary artery disease, many clinicians still feel some reluctance to use this type of drugs in the perioperative period. We organized a meeting to search for the major objectives that keep anesthetists from implementing prophylactic beta blocking therapy in their daily clinical practice. In this brief review we summarize the results of this meeting and discuss the current knowledge on this subject.
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Affiliation(s)
- S De Hert
- Department of Anesthesiology, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium.
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Himpe D, Neels H, De Hert S, Van Cauwelaert P. Adding lactate to the prime solution during hypothermic cardiopulmonary bypass: a quantitative acid-base analysis. Br J Anaesth 2003; 90:440-5. [PMID: 12644414 DOI: 10.1093/bja/aeg084] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The effect of adding lactate to the cardiopulmonary bypass (CPB) prime was investigated using Stewart's quantitative acid-base approach. According to this quantitative model, serum pH and bicarbonate are determined by three independent factors: the partial pressure of carbon dioxide (PCO(2)), the total concentration of weak acids (e.g. albumin), and the strong ion difference. The apparent strong ion difference is calculated as the sum of sodium, potassium, magnesium and calcium minus chloride concentrations. The pH decreases with a smaller strong ion difference and vice versa. METHODS Twenty patients scheduled for coronary surgery were studied prospectively. All patients were treated identically, except for the prime, which either contained lactate or was lactate free. Just before bypass and before coming off bypass, haemoglobin, glucose, plasma osmolality and colloid osmotic pressure were determined; albumin, lactate, sodium, potassium, ionized calcium, magnesium, phosphate, arterial pH, PCO(2), bicarbonate, and base excess were measured for use in Stewart's analysis. RESULTS Metabolic acidosis had resolved by the end of bypass with the lactated prime. Although the strong ion gap (apparent minus effective strong ion difference) increased significantly in both groups, its composition differed significantly between the groups. The Stewart technique detected polyanionic gelatin as a weak acid component contributing to the unidentified anion fraction. Colloid osmotic pressure was maintained in both groups. CONCLUSION Exogenous lactate attenuates acidosis related to CPB. The oncotic and weak acid deficits produced by hypoalbuminaemia may be compensated for temporarily during CPB by polyanionic synthetic colloids such as succinylated gelatin.
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Affiliation(s)
- D Himpe
- Department of Anaesthesia and Intensive Care, Middelheim General Hospital, Antwerp, Belgium.
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Van der Linden P, De Hert S, Daper A, Trenchant A, Jacobs D, De Boelpaepe C, Kimbimbi P, Defrance P, Simoens G. A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery. Can J Anaesth 2001; 48:894-901. [PMID: 11606348 DOI: 10.1007/bf03017357] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Individual and institutional practices remain an independent predictor factor for allogeneic blood transfusion. Application of a standardized multidisciplinary transfusion strategy should reduce the use of allogeneic blood transfusion in major surgical patients. METHODS This prospective non randomized observational study evaluated the effects of a standardized multidisciplinary transfusion strategy on allogeneic blood products exposure in patients undergoing non-emergent cardiac surgery. The developed strategy involved a standardized blood conservation program and a multidisciplinary allogeneic blood transfusion policy based mainly on clinical judgement, not only on a specific hemoglobin concentration. Data obtained in a first group including patients operated from September 1997 to August 1998 (Group pre: n=321), when the transfusion strategy was progressively developed, were compared to those obtained in a second group, including patients operated from September 1998 to August 1999 (Group post: n=315) when the transfusion strategy was applied uniformly. RESULTS Patient populations and surgical procedures were similar. Patients in Group post underwent acute normovolemic hemodilution more frequently, had a higher core temperature at arrival in the intensive care unit and presented lower postoperative blood losses at day one. Three hundred forty units of packed red blood cells were transfused in 33% of the patients in Group pre whereas 161 units were transfused in 18% of the patients in Group post (P <0.001). Pre- and postoperative hemoglobin concentrations, mortality and morbidity were not different among groups. CONCLUSION Development of a standardized multidisciplinary transfusion strategy markedly reduced the exposure of cardiac surgery patients to allogeneic blood.
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Affiliation(s)
- P Van der Linden
- Department of Cardiac Anaesthesia, CHU Charleroi, Jumet, Belgium
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22
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Rodrigus IE, Amsel BJ, Conraads V, De Hert S, Moulijn AC. Emergency ventricular assist device: better survival rates in non-post cardiotomy-related cardiogenic shock. Acta Chir Belg 2001; 101:226-31. [PMID: 11758106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE The Abiomed BVS 5000 ventricular assist device (VAD) has been approved in Belgium for emergency cardiac support in patients with postcardiotomy failure with the aim of native heart function recovery. Other indications have emerged from world wide experience, but the indication and usefulness of emergency implantation of assist devices is often debated. METHODS To decide which patients benefit most from emergency ventricular assist device implantation, we retrospectively reviewed our results of mechanical circulatory support with Abiomed in 20 patients over a 4-year period. Fifteen patients with mean age 58 +/- 6 years experienced postcardiotomy failure and underwent biventricular assist device (BVAD) implantation (group A), after elective (n = 9) or after emergency coronary artery bypass grafting (CABG) (n = 6). Five patients (group B), with mean age 35 +/- 19 years, had an implantation for other underlying conditions: hypertrophic cardiomyopathy (n = 3), myocarditis (n = 1) and primary cardiac allograft failure (n = 1). RESULTS Of these two groups, eight and two patients respectively needed cardiopulmonary resuscitation before VAD implantation. The mean duration of support in both groups was 5.8 (range 12 h-13 days) and 4.4 days (range 2 h-9 days) respectively. Six and two patients could be weaned from the device and nine and one patients respectively, died on the device. Two patients in group B underwent successful heart transplantation and four patients in group A died after weaning. Two patients in the postcardiotomy group and four patients in group B survived (13% and 80%) with an overall survival and discharge rate of 30%. CONCLUSION Although sample sizes are small, better survival rates with emergency Abiomed BVS 5000 implantation were obtained in the non postcardiotomy group (group B). For patients in the postcardiotomy group, outcome was negatively influenced by cardiac arrest and resuscitation before urgent CABG. Since death is the only alternative for these patients in cardiogenic shock and organ recovery cannot be predicted, we continue to consider emergency VAD implantation in this patient population.
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Affiliation(s)
- I E Rodrigus
- Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium.
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Van der Linden P, De Hert S, Bélisle S, De Groote F, Mathieu N, d'Eugenio S, Julien V, Huynh C, Mélot C. Comparative effects of red blood cell transfusion and increasing blood flow on tissue oxygenation in oxygen supply-dependent conditions. Am J Respir Crit Care Med 2001; 163:1605-8. [PMID: 11401881 DOI: 10.1164/ajrccm.163.7.2001003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Red blood cell (RBC) transfusion is usually administered to improve oxygen delivery (DO(2)) in order to sustain tissue oxygen demand. However, this practice is not supported by firm clinical or experimental data. Using a randomized two-period crossover design, this study compared the efficacy of "fresh" RBC transfusion and increased blood flow to restore tissue oxygenation in oxygen supply-dependent conditions. In 12 ketamine-anesthetized mongrel dogs submitted to nonpulsatile normothermic cardiopulmonary bypass, DO(2) was reduced by a progressive decrease in pump flow. DO(2) dependency was defined as an O(2) uptake (V O(2)) decrease by more than 15% from baseline value. Then, intervention consisted of a 40% increase in DO(2) obtained either by transfusion of "fresh" dog's RBC (stored < 3 d) or by increase in pump flow. Animals received both interventions sequentially in a random order, while O(2) saturation was maintained constant. In O(2) supply-dependent conditions, rising pump flow from 1.6 +/- 0.4 to 2.7 +/- 0.7 L/ min increased DO(2) from 5.4 +/- 1.1 to 9.0 +/- 1.3 ml/kg/min (p < 0.01) and V O(2) from 3.5 +/- 0.4 to 4.1 +/- 0.5 ml/kg/min (p = 0.02). "Fresh" RBC transfusion, which increased the hemoglobin concentration from 6.4 +/- 0.9 to 11.1 +/- 1.3 g/dl, increased DO(2) from 5.4 +/- 1.2 to 9.0 +/- 1.4 ml/kg/min (p < 0.01) and V O(2) from 3.6 +/- 0.4 to 4.1 +/- 0.5 ml/kg/min (p = 0.02). There was no difference in V O(2) resulting from both interventions. In oxygen supply-dependent conditions, "fresh" RBC transfusion and increased blood flow are equally effective in restoring tissue oxygenation.
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Affiliation(s)
- P Van der Linden
- Department of Experimental Anesthesia, Erasme University Hospital, Brussels, Belgium.
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Vercauteren M, Lauwers E, Meert T, De Hert S, Adriaensen H. Comparison of epidural sufentanil plus clonidine with sufentanil alone for postoperative pain relief. Anaesthesia 1990; 45:531-4. [PMID: 2143638 DOI: 10.1111/j.1365-2044.1990.tb14824.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Sufentanil 25 micrograms plus clonidine 1 microgram/kg administered epidurally was compared with epidural sufentanil 50 micrograms alone in a double-blind fashion for pain relief in 40 patients after abdominal surgery. The duration of complete pain relief was significantly longer in those who received the mixture. Oxygen saturation was reduced 10 and 20 minutes after sufentanil alone, but remained stable after sufentanil and clonidine. There were significant decreases in arterial blood pressure in the latter group that were maximum between 20 and 120 minutes after administration.
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De Maeseneer M, De Hert S, Van Schil P, Vanmaele R, Schoofs E. Deep venous thrombosis of the upper extremity: case reports and review of the literature. Acta Chir Belg 1989; 89:253-61. [PMID: 2683533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The development of a thrombosis of the axillary-subclavian vein has long been an uncommon clinical entity. The more routinely use of central venous lines in modern patient management, however, has increased its incidence. Three cases of deep venous thrombosis of the upper extremity are reported. The different possible etiologic factors, the diagnostic tools, complications and different treatments--both conservative and non-conservative--are reviewed and discussed.
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Affiliation(s)
- M De Maeseneer
- Department of Surgery, Universitair Ziekenhuis Antwerpen
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Abstract
To determine the diagnostic value of R wave amplitude changes occurring during exercise testing after myocardial infarction, exercise ECG's and coronary angiograms were reviewed in 76 postinfarction patients and in 40 patients with normal coronary arteries. During exercise, an increase in R wave amplitude (mean: + 2.7 +/- 1.3 mm) was observed in the postinfarction patients, significantly different (P less than 0.001) from the decrease (mean: - 2.6 +/- 1.1 mm) observed in the group with normal coronary arteries. Although this change increased with the number of diseased coronary arteries, the difference between 1-vessel and multi- or 3-vessel disease was not significant. Extension of infarct size from one to more akinetic segments on the left ventricular angiogram was associated with a significant (P less than 0.001) increase of the R wave amplitude change during exercise (mean: + 1.6 +/- 1.1 vs 3.3 +/- 1.3 mm). It is concluded that the abnormal increase in R wave amplitude observed during exercise testing after myocardial infarction is more strongly related to infarct size then to the number of diseased coronary arteries. Furthermore exercise induced R wave amplitude changes have no diagnostic value in the prediction of multi- or 3-vessel disease in postinfarction patients.
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