What about guidelines?
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Erythrocyte Transfusion↗
Biomedical subjects
L Herregods
Publications and source records attributed to L Herregods.
Comparative efficacy and safety of remifentanil and fentanyl in 'fast track' coronary artery bypass graft surgery: a randomized, double-blind study.
This multi-centre, parallel group, randomized, double-blind study compared the efficacy and safety of high-dose remifentanil administered by continuous infusion with an intermittent bolus fentanyl regimen, when given in combination with propofol for general anaesthesia in 321 patients undergoing elective coronary artery bypass graft surgery. A significantly lower proportion of the patients who received remifentanil had responses to maximal sternal spread (the primary efficacy endpoint) compared with those who received fentanyl (11% vs 52%; P<0.001). More patients who received remifentanil responded to tracheal intubation compared with those who received fentanyl (24% vs 9%; P<0.001). However, fewer patients who received remifentanil responded to sternal skin incision (11% vs 36%; P<0.001) and sternotomy (14% vs 60%; P <0.001). Median time to extubation was longer in the subjects who received remifentanil than for those who received fentanyl (5.1 vs 4.2 h; P=0.006). There were no statistically significant differences between the two groups in the times for transfer from intensive care unit or hospital discharge but time to extubation was significantly longer in the remifentanil group. Overall, the incidence of adverse events was similar but greater in the remifentanil group with respect to shivering (P<0.049) and hypertension (P<0.001). Significantly more drug-related adverse events were reported in the remifentanil group (P=0.016). There were no drug-related adverse cardiac outcomes and no deaths from cardiac causes before hospital discharge in either treatment group.
Adult↗
Belgian standards for patient safety in anesthesia. The Belgian Anesthesia Patient Safety Steering-Committee.
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Anesthesia↗
Our association on the worldwide web.
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Anesthesiology↗
Interventional neuroradiology--anesthetic management.
Interventional Neuroradiology is a rather young department, that asks for an appropriate anesthesia management. This article highlights mainly the practical approach, with special directions for a thorough premedication, monitoring and patient positioning and extra attention to heparinisation and allergic reactions. Different anesthetic techniques are dealt with, namely conscious sedation and general anesthesia, as well as directives concerning potential complications.
Anesthesia↗
Therapeutic coma or neuroprotection by anaesthetics.
Some surgical patients are at an increased risk for developing cerebral ischaemia. A subset of these patients is believed to benefit from putative cerebroprotective effects of anaesthetic agents. Therefore, in this setting these drugs could have therapeutic modalities, besides their auxiliary functions to make surgery possible. However, both animal and especially human data are very disappointing. Only the barbiturates and isoflurane have an experimental record warranting further research to delineate proper indications for their use as neuroprotective agents in surgical patients.
Anesthetics↗
Effect of nitric oxide predilution on inhaled nitrogen dioxide concentrations.
We examined the possibility that predilution of a concentrated nitric oxide (NO) source with nitrogen, before contact with oxygen, can reduce the inspired nitrogen dioxide (NO2) concentration during administration of nitric oxide. A Manley Blease and a Siemens Servo 900 C ventilator delivered 10, 20, 40, 60 and 80 parts per million (ppm) NO using an NO source of 1000, 400 and 200 ppm. With the Manley Blease system, predilution from 1000 to 200 ppm NO reduced the inhaled NO2 concentration from 0.14 to 0.05 ppm (p < 0.01) at 10 ppm inhaled NO, and from 1.20 to 1.00 ppm (p < 0.01) at 40 ppm inhaled NO. With the Siemens Servo 900 C ventilator, inspiratory NO2 concentrations decreased from 0.21 to 0.11 ppm (p < 0.01) at 10 ppm inhaled NO, and from 1.49 to 1.16 ppm (p < 0.01) at 40 ppm NO. Predilution from 1000 to 400 ppm NO reduced the inspired NO2 concentrations by < 3% using either ventilator when the inspirated NO concentration was 80 ppm. Predilution of NO with nitrogen significantly reduced the inspired NO2 concentrations for nitric oxide concentrations between 10 and 40 ppm, but offered no clinically relevant advantage at higher NO concentrations.
Drug Administration Schedule↗
Influence of anaesthesia on defibrillation threshold.
Internal cardioverter-defibrillator implantation can be performed under local or general anaesthesia. Whether the technique of general anaesthesia influences the defibrillation threshold remains a matter of debate. We therefore compared, in a prospective, randomised clinical study, the effect of intravenous anaesthesia using propofol with inhalational anaesthesia using isoflurane on the defibrillation threshold in 68 patients scheduled for transvenous single-lead internal cardioverter-defibrillator implantation. Defibrillation threshold was measured at implantation and at device testing 1 week and 1 month after implantation. Patients acted as their own controls. Neither the anaesthetic technique nor the duration of anaesthesia was associated with significant changes in the defibrillation threshold. We conclude that in this group of high-risk patients, both types of anaesthesia are acceptable techniques for internal cardioverter-defibrillator implantation and testing.
Anesthesia, General↗
Limited intentional normovolemic hemodilution: ST-segment changes and use of homologous blood products in patients with left main coronary artery stenosis.
OBJECTIVE: To assess and compare the effects of limited intentional normovolemic hemodilution (LINH) on ST-segment changes and to evaluate the need for homologous blood products. DESIGN: Prospective, randomized study. SETTING: University hospital. PARTICIPANTS: Seventy-one patients with left main stenosis scheduled for semi-urgent coronary artery bypass grafting. INTERVENTIONS: Patients in group A (n = 39) underwent LINH during the prebypass period until a hematocrit of 34% was obtained. Simultaneously, succinyl-linked gelatin was infused. In group B (n = 32), no hemodilution was performed. Mean arterial pressure and central venous pressure were kept as constant as possible. During the postbypass period, autologous blood was retransfused. The need for homologous blood products was noted intraoperatively and postoperatively. MEASUREMENTS AND MAIN RESULTS: ST-segment analysis of lead II and chest lead was continuously performed in all patients. An ST-segment change was defined as a decrease from baseline of 1.0 mm (-0.1 mV). The appearance and degree of ST-segment depression were comparable in both groups (group A: 7 patients -0.1 mV, 1 patient -0.2 mV; group B: 5 patients -0.1 mV; 3 patients -0.2 mV). In group A, ST-segment depression occurred during and after the blood exchange. However, the mean duration of the ST-segment depression (group A: 33 +/- 18 minutes; group B: 20 +/- 10 minutes) was comparable between groups. In group A, a mean of 750 mL +/- 245 mL of blood was obtained. Total blood loss was significantly higher in group B (p < 0.052); 25 patients in group A (64%) and 12 patients in group B (38%) did not require homologous blood products (p < 0.03). Intraoperatively, only the need for packed red cells was greater in group B (p < 0.04). Postoperatively, the use of homologous blood products is higher than intraoperatively (p < 0.02). CONCLUSIONS: LINH performed in patients with left main stenosis, scheduled for semi-urgent coronary bypass, is not associated with increases in frequency, degree, or duration of ST-segment changes. This procedure allowed a reduction in the number of patients who received homologous blood products.
Aged↗
Comparison of computer-controlled administration of propofol with two manually controlled infusion techniques.
Ninety women were studied in order to compare dose requirements and quality of anaesthesia between target-controlled infusion and two manually controlled infusion schemes for propofol administration: group I received target-controlled infusion for induction (4 micrograms.ml-1 target blood concentration, increased by 2 micrograms.ml-1 after 3 min of consciousness not lost), groups II and III received an induction bolus of propofol at infusion rates of 1200 or 600 ml.h-1, respectively, until loss of consciousness. Anaesthesia was maintained with propofol target-controlled infusion in group 1 or by constant rate infusion in the other two groups. Computer simulations were used to calculate blood and effect-site propofol concentrations. Mean induction times (SD) were 78 (65)s in group I versus 51 (10)s and 62 (12)s in groups II and III, respectively (p < 0.05 between groups II and III). Mean induction doses were: 1.31 (0.44), 2.74 (0.56) and 1.77 (0.43) mg.kg-1 and mean maintenance doses were 13.4 (3.55), 9.32 (1.72) and 9.97 (1.53) mg.kg-1 h-1 in groups I, II and III, respectively (p < 0.05 between all groups). There was a lower incidence of apnoea in group I than in groups II and III. There were no significant differences between the groups in other objective parameters of anaesthetic quality studied. Computer simulations showed an "overshoot' in propofol blood and effect-site concentration with manual induction and significantly higher maintenance levels with target-controlled infusion.
Adult↗
In vitro evaluation of the effect of profound haemodilution with hydroxyethyl starch 6%, modified fluid gelatin 4% and dextran 40 10% on coagulation profile measured by thromboelastography.
Synthetic colloids have been implicated as a cause of coagulopathy when administered in large quantities. The effect of profound haemodilution (50%) on coagulation profile was measured in vitro by thromboelastography. Blood samples were taken from 11 ASA grade 1 patients prior to induction of anaesthesia for elective surgery. Each sample was simultaneously tested in four different preparations: undiluted blood (control sample); blood diluted with hydroxyethyl starch 6%; blood diluted with modified fluid gelatin 4%; blood diluted with dextran 40 10%. There was a significant decrease in reaction time in the preparations treated with hydroxyethyl starch 6% and modified fluid gelatin 4%, reflecting activation of initial fibrin formation. A significant increase in clot formation time was noted in the hydroxyethyl starch 6%-treated preparations. There was also a significant decrease in clot formation rate and maximum amplitude in the hydroxyethyl starch 6% group. Clot formation time, clot formation rate and maximum amplitude did not change in the modified fluid gelatin 4% group. Profound haemodilution with dextran 40 10% exerted extreme effects on the measured variables, very often resulting in a straight line on the thromboelastography profile.
Blood Coagulation↗
Transoesophageal echocardiographic evaluation of ventricular function during transvenous defibrillator implantation.
BACKGROUND: Intraoperative testing and defibrillation threshold determination may jeopardise patients, scheduled for implantation of a cardioverter-defibrillator (ICD). The purpose of this study was the assessment of the influence of consecutive defibrillation attempts on left ventricular systolic and diastolic function by means of transoesophageal echocardiography (TEE). METHODS: Eighteen patients with malignant ventricular arrhythmias that were resistant to antiarrhythmic drugs were monitored with TEE before, during and after implantation of a cardioverter-defibrillator. Left ventricular fractional area contraction as a measure of ejection fraction was assessed before and after each defibrillation attempt. Transmitral and right upper pulmonary venous flow parameters were evaluated before and after the whole implantation procedure. RESULTS: Adequate data were available in 14 patients during 4 consecutive attempts. No major alterations were observed in heart rate or fractional area contraction, measured at 30 s and 3 min after defibrillation. Overall, the ratio of early-to-late transmitral filling decreased significantly after the implantation procedure (from 0.91 +/- 0.12 to 0.82 +/- 0.14; P < 0.05). Systolic pulmonary venous flow velocity decreased from 0.49 +/- 0.11 to 0.41 +/- 0.10 m/s (P = 0.04); this decrease was observed in both groups. A significant increase of the atrial contraction wave (from 0.25 +/- 0.06 to 0.34 +/- 0.07 m/s; P < 0.03) was seen. Subdividing patients related to their precperative ejection fraction, a significant decrease of the early-to-late transmitral filling of the LV was revealed in patients with ejection fraction less than 35% (group 1). Also, a significantly lower systolic fraction of the pulmonary venous flow after ICD implantation in conjunction with a significantly longer diastolic flow time was shown in this patient group in comparison with patients with a preoperative ejection fraction of more than 35% (group 2). CONCLUSION: Defibrillation threshold testing of the ICD system changes LV inflow characteristics and impedes diastolic function of the left ventricle and may thus precipitate heart failure by this mechanism. No deleterious effects of threshold testing were observed with respect to fractional area contraction nor any deterioration of LV function was found in a clinically significant amount due to consecutive defibrillation attempts.
Aged↗
Removal of endocardial defibrillation leads.
Two patients, each with an endocardial defibrillation lead system (Endotak O62), required lead removal; one because of chronic lead infection and the second because of spurious shocks caused by lead insulation damage. Neither lead could be removed by simple traction. The defective lead was removed by a combination of catheterization techniques including a steerable ablation catheter and traction, both under general anesthesia. The lead with the insulation defect was rapidly removed with a locking stylet, suggesting that endocardial lead defibrillating leads can be removed similarly to pacemaker leads, thus avoid thoracotomy.
Cardiac Catheterization↗
A new transvenous internal cardioverter-defibrillator: implantation technique, complications, and short-term follow-up.
Twenty-four patients with ventricular fibrillation or sustained ventricular tachycardia underwent implantation of a new transvenous defibrillator. All patients had a device implanted without thoracotomy. High placement of a shock lead in the anonymous vein and inversion of the shock-wave polarity allowed avoidance of placement of subcutaneous patches. Implantation time decreased from 138 minutes for the first 12 patients to 82 minutes for the last 12 patients, with 4 and 11 subpectoral pockets, respectively. Three patients required a minor reintervention. No bleeding or infection occurred. One episode of pulmonary edema and one pulmonary embolism were seen in the postoperative course. No postoperative deaths were observed. During a mean follow-up period of 4.12 months, 58% of the 24 patients had symptomatic arrhythmic episodes, with shocks in 50% of the 24. Inappropriate shocks were delivered in three cases (atrial fibrillation and T-wave sensing). One episode was not terminated even with four internal shocks. One patient had ventricular fibrillation because of a sensing problem. By reprogramming of sensitivity, back-up pacing, and adjustment of drug therapy these arrhythmic complications could be prevented. Pectoral implantation of a cardioverter-defibrillator is easy and can be performed by cardiologists experienced in pacemaker implantation. Careful postoperative observation, reprogramming after the first spontaneous event, and prehospital discharge induction of ventricular fibrillation will prevent arrhythmic complications.
Adult↗
Effects of perioperative hemodynamic variations on mitral regurgitation.
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Aged↗
Comparative study of limited intentional normovolaemic haemodilution in patients with left main coronary artery stenosis.
Intentional normovolaemic haemodilution is a blood saving technique which can be performed when major blood loss is expected. Severe coronary artery disease and particularly left main stenosis are considered a contraindication for intentional normovolaemic haemodilution. The effects and complications of limited intentional normovolaemic haemodilution in patients with left main coronary artery stenosis scheduled for coronary artery bypass grafting were evaluated. Patients were randomly allocated to two groups: group A (n = 15) underwent limited intentional normovolaemic haemodilution to a haematocrit of 34%; group B (n = 15), no intentional normovolaemic haemodilution was performed. In both groups succinyl-linked gelatin was used to maintain normovolaemia. Haemodynamic parameters were kept as constant as possible. In group A, a mean (SD) volume of 785 (250) ml of blood was withdrawn [range 500-1200 ml]. ST segment changes occurred on the ECG in three patients in each group. There were no statistically significant differences for frequency, maximum deflection and duration of ST-segment changes. Limited intentional normovolaemic haemodilution can be performed safely in patients with left main coronary artery stenosis. In this study it was not associated with increased frequency, severity or duration of ST-segment changes, or with arrhythmias or haemodynamic instability.
Aged↗
Awareness during anaesthesia for implantable cardioverter defibrillator implantation. Recall of defibrillation shocks.
Implantable cardioverter defibrillator implantation is performed under general anaesthesia. This report describes awareness or recall in two of 33 patients scheduled for implantation. After induction, anaesthesia was maintained using continuous infusions of propofol and atracurium and intermittent boluses of alfentanil. Propofol was given in the same arm as the implantation side. In these two patients propofol flowed out of the bleeding central venous access. To minimise the possibility of awareness, we advise that continuous infusions should be administered intravenously on the contralateral side to the implantation and that neuromuscular blocking agent be given by intermittent bolus injections.
Anesthesia, General↗
Haemodynamic effects of R 80122 immediately after cardiopulmonary bypass; preliminary results.
R 80122 is a new short-acting phosphodiesterase type III inhibitor. In a preliminary investigation, three patients, scheduled for coronary artery bypass surgery, were given R 80122 after weaning from cardiopulmonary bypass. Two patients received 10 micrograms.kg-1.min-1 for 10 min as a loading infusion followed by a 5 micrograms.kg-1.min-1 maintenance dose. One patient received a 20 micrograms.kg-1.min-1 for 10 min loading infusion followed by a 10 micrograms.kg-1.min-1 maintenance infusion. After weaning from cardiopulmonary bypass and during the administration period, no arrhythmias or cardiac ischaemia were detected. The administration of R 80122 improved the haemodynamic profile with an increase in cardiac output, a decrease in systemic vascular resistance and a stable heart rate and mean arterial blood pressure. These preliminary results indicate that R 80122 possesses positive inotropic activity in combination with vasodilating properties.
Aged↗