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Marc Van de Velde

Publications and source records attributed to Marc Van de Velde.

15 recordsLinked to original sources
PubMed2007

Determination of the full dose-response relation of intrathecal bupivacaine, levobupivacaine, and ropivacaine, combined with sufentanil, for labor analgesia.

BACKGROUND: Ropivacaine and levobupivacaine are local anesthetics that produce less motor block and greater sensory-motor separation when compared with equal milligram doses of bupivacaine. Although minimum local analgesic concentration studies suggested that they are less potent than bupivacaine, full dose-response studies have not been performed. The current trial describes the dose-response relation of levobupivacaine, ropivacaine, and bupivacaine, combined with sufentanil, when used for intrathecal labor analgesia. METHODS: Four hundred fifty term parturients in active labor were included in this double-blind, randomized trial. Combined spinal-epidural anesthesia was performed, and ropivacaine, levobupivacaine, or bupivacaine was intrathecally administered in a dose of 1.0, 1.5, 2.0, 2.5, 3.0, or 3.5 mg, always combined with 1.5 microg sufentanil. Patients were considered responders to spinal analgesia if the visual analog scale score for pain was less than 25 mm within 15 min and the visual analog scale score remained less than 25 mm for 45 min. Patient demographics, obstetric data, maternal side effects, and fetal and neonatal well-being were noted. Group-specific dose-response curves were constructed using a probit regression model. RESULTS: The ED95 of bupivacaine was 3.3 mg (95% confidence interval, 2.9-4.1). The ED95s of ropivacaine and levobupivacaine were 4.8 mg (95% confidence interval, 4.0-6.7) and 5.0 mg (95% confidence interval, 4.1-7.0), respectively. Racemic bupivacaine was significantly more potent than ropivacaine (P=0.0027) and levobupivacaine (P=0.0006). Ropivacaine and levobupivacaine were of similar potency (P=0.91). CONCLUSIONS: This full dose-response study suggests that ropivacaine and levobupivacaine are of similar potency, whereas bupivacaine is more potent than both other drugs.

Adolescent↗
PubMed2006

Fetoscopic surgery: encouraged by clinical experience and boosted by instrument innovation.

Today, modern ultrasound equipment and the wide implementation of screening programmes allow the timely diagnosis of many congenital anomalies. For some of these, fetal surgery may be a life-saving option. In Europe, open fetal surgery became poorly accepted because of its invasiveness and the high incidence of postoperative premature labour and rupture of the fetal membranes. In the 1990s, the merger of fetoscopy and advanced video-endoscopic surgery formed the basis for endoscopic fetal surgery. We review the current applications of fetal surgery via both methods of access. The first clinical fetoscopic surgeries were interventions on the umbilical cord and the placenta, often referred to as obstetrical endoscopy. The outcome of a randomized clinical trial demonstrating that fetoscopic laser coagulation of chorionic plate vessels is the most effective treatment for twin-twin transfusion syndrome (TTTS) has revived interest in endoscopic fetal therapy. Operating on the fetus is another more challenging enterprise. Clinical fetal surgery programmes were virtually non-existent in Europe until minimally invasive fetoscopic surgery made such operations clinically possible as well as maternally acceptable. At present, most experience has been gathered with fetal tracheal occlusion as a therapy for severe congenital diaphragmatic hernia. As in other fields, minimally invasive surgery has pushed back boundaries and now allows safe operations to be performed on the fetal patient. Whereas minimal access seems to solve the problem of preterm labour, all procedures remain invasive, and carry a risk to the mother and a substantial risk of preterm prelabour rupture of the membranes (PPROM). The latter problem may prove to be a bottleneck for further developments, although treatment modalities are currently being evaluated.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed2006

Fetal pain perception and pain management.

This paper gives an overview of current science related to the concept of fetal pain. We have answered three important questions: (1) does fetal pain exist? (2) does management of fetal pain benefit the unborn child? and (3) which techniques are available to provide good fetal analgesia?

Analgesia↗
PubMed2006

Combined spinal-epidural anesthesia for cesarean delivery: dose-dependent effects of hyperbaric bupivacaine on maternal hemodynamics.

Hypotension remains an important side effect of spinal anesthesia for cesarean delivery. There is limited evidence that reducing the spinal dose has a favorable effect on maternal hemodynamic stability. We designed the present randomized trial to test the hypothesis that reducing the spinal dose of local anesthetics results in equally effective anesthesia and less maternal hypotension. Fifty term pregnant patients were randomly assigned to two study groups. In the HIGH-group combined spinal-epidural anesthesia was performed using 9.5 mg hyperbaric bupivacaine combined with 2.5 microg sufentanil. In the LOW-group combined spinal-epidural anesthesia was performed using 6.5 mg hyperbaric bupivacaine combined with 2.5 microg sufentanil. Demographic data, obstetrical data, visual analog scale score for pain, number of medical interventions for pain, maternal hemodynamics, and neonatal outcome were recorded. Patients in the HIGH-group experienced more pronounced and longer hypotensive periods as compared with the LOW-group. The mean lowest recorded systolic blood pressure was higher in the LOW-group (102 +/- 16 versus 88 +/- 16 in the HIGH-group; P < 0.05). More patients in the HIGH-group experienced hypotension compared with the LOW-group (68% versus 16%; P < 0.05). In the HIGH-group 15 patients required pharmacological treatment for hypotension compared with 5 in the LOW-group. Duration of effective anesthesia (block to cold sensation above or at T3) was longer in the HIGH-group as compared with the LOW-group (95 +/- 25 versus 68 +/- 18 min, respectively, P < 0.05). We conclude that small-dose spinal anesthesia (6.5 mg hyperbaric bupivacaine combined with sufentanil) better preserves maternal hemodynamic stability with equally effective anesthesia that is of shorter duration.

Adult↗
PubMed2005

Anesthesia for in-vitro fertilization.

PURPOSE OF REVIEW: To review the most recent literature on anesthesia for in-vitro fertilization. RECENT FINDINGS: Very limited new information has become available in the review period. Propofol seems to be an acceptable option for anesthesia/sedation during in-vitro fertilization but more research is necessary to definitively establish its safety. Remifentanil is also an effective alternative. SUMMARY: Presently, propofol and remifentanil seem to be acceptable options for anesthesia for in-vitro fertilization but further research is required.

Journal Article↗
PubMed2005

Neuraxial analgesia and fetal bradycardia.

PURPOSE OF REVIEW: To review the most recent data on labor analgesia and the risk of fetal heart rate changes. RECENT FINDINGS: Fetal heart rate changes are more common with intrathecal opioids, especially when high doses are used. Intrathecal clonidine seems to increase the risk of hypotension and fetal heart rate changes. Intravenous fluid preloading is useful in high-dose labor epidural analgesia, but its use remains controversial with low-dose techniques of epidural analgesia. Despite the potential of neuraxial analgesia to induce fetal bradycardia, neonatal outcome is usually reassuring. SUMMARY: Despite the potential of neuraxial analgesia to cause fetal heart rate problems, neuraxial analgesia is the most effective and safest form of labor analgesia. Specific techniques of labor analgesia, such as high-dose spinal opioids or intrathecal clonidine, must be avoided based on the most recent evidence. Maternal and neonatal outcome is good following regional analgesia.

Journal Article↗
PubMed2005

Remifentanil for fetal immobilization and maternal sedation during fetoscopic surgery: a randomized, double-blind comparison with diazepam.

Obstetric endoscopy procedures are routinely performed at our institution to treat selected complications of monochorionic twin gestation. We perform these procedures under combined spinal epidural anesthesia plus maternal sedation. In the absence of general anesthesia, fetal immobilization is not achieved. We hypothesized that remifentanil would induce adequate maternal sedation and provide fetal immobilization, which is equal or superior to that induced by diazepam. Fifty-four second trimester pregnant women were included in this randomized, double-blind trial. After combined spinal epidural anesthesia, maternal sedation was initiated using either incremental doses of diazepam or a continuous infusion of remifentanil. Maternal sedation, hemodynamics, side effects, and fetal hemodynamics and immobilization were evaluated before, during, and for 60 min after surgery. Remifentanil produced adequate maternal sedation with mild but clinically irrelevant respiratory depression (respiratory rate 13 +/- 4 breaths/min and Pco(2) 38.6 +/- 4 mm Hg at 40 min of surgery), whereas diazepam resulted in a more pronounced maternal sedation but no respiratory depression (respiratory rate 18 +/- 3 breaths/min and Pco(2) 32.7 +/- 3 mm Hg at 40 min of surgery). Compared with diazepam, fetal immobilization with remifentanil occurred faster and was more pronounced, resulting in improved surgical conditions; the number of gross body and limb movements was 12 +/- 4 (diazepam) versus 2 +/- 1 (remifentanil) at 40 min of surgery. Because of this, the mean (range) duration of surgery was significantly shorter in the remifentanil-treated patients, 60 (54-71) min versus 80 (60-90) min in the diazepam group. We conclude that remifentanil produces improved fetal immobilization with good maternal sedation and only minimal effects on maternal respiration.

Adult↗
PubMed2004

Morbidity and mortality related to anaesthesia outside the operating room.

PURPOSE OF REVIEW: The purpose of this review is to provide information related to morbidity and mortality associated with anaesthesia outside the operating room. RECENT FINDINGS: There is an increasing demand for anaesthesia at remote locations. Because of its specific characteristics, resulting from the location and the patient, morbidity and mortality rates of remote location anaesthesia could differ from conventional operating room anaesthesia. However, no studies are currently available. On the basis of morbidity and mortality data from conventional operating room anaesthesia, we reached some important conclusions with regard to the safety of anaesthesia outside the operating room. A well-equipped anaesthesia machine, standard monitoring (electrocardiogram, oxygen saturation and non-invasive blood pressure), trained personnel and adequate planning should be standard for all out of the operating room procedures. When all these are in place, the incidence of morbidity or mortality should be comparable to that of anaesthesia provided in the operating room. SUMMARY: There is certainly a need for studies concerning morbidity and mortality at remote location anaesthesia. Special care for the prevention of hypothermia should be given to those patients undergoing long-lasting diagnostic procedures, e.g. magnetic resonance imaging scans or cardiological investigations.

Journal Article↗
PubMed2003

Fetal assessment: do newer technologies offer better assessment and outcomes?

PURPOSE OF THE REVIEW: The present manuscript reviews recent data on fetal intrapartum surveillance with special attention to new technologies. RECENT FINDINGS: Continuous fetal heart-rate monitoring, fetal blood sampling, intrapartum stimulation tests, fetal pulse oximetry and fetal electrocardiography will be reviewed. SUMMARY: From the available data it appears that to date the analysis of the sinus tachycardia segment of the fetal electrocardiography used in conjunction with continuous fetal heart-rate monitoring is the method of choice.

Journal Article↗
PubMed2003

Interventional neuroradiology.

PURPOSE OF THE REVIEW: The aim of this review is to give a general overview of anesthetic management, technical considerations and specific complications of interventional neuroradiology based on the most recent literature. RECENT FINDINGS: In more and more services anesthetists become an integrated part in the management of patients treated with endovascular neurosurgery. More and more centers opt for general anesthesia using less invasive monitoring than with common neurosurgery. SUMMARY: Interventional neuroradiology is challenging because of the location and the sudden and acutely life-threatening complications that may occur.

Journal Article↗
PubMed2002

Positioning in anesthesiology: toward a better understanding of stretch-induced perioperative neuropathies.

BACKGROUND: Stretch-induced neuropathy of the brachial plexus and median nerve in conventional perioperative care remains a relatively frequent and poorly understood complication. Guidelines for positioning have been formulated, although the protective effect of most recommendations remains unexamined. The similarity between the stipulated potentially dangerous positions and the components of the brachial plexus tension test (BPTT) justified the analysis of the BPTT to quantify the impact of various arm and neck positions on the peripheral nervous system. METHODS: Four variations of the BPTT in three different shoulder positions were performed in 25 asymptomatic male participants. The impact of arm and neck positions on the peripheral nervous system was evaluated by analyzing the maximal available range of motion, pain intensity, and type of elicited symptoms during the BPTT. RESULTS: Cervical contralateral lateral flexion, lateral rotation of the shoulder and fixation of the shoulder girdle in a neutral position in combination with shoulder abduction, and wrist extension all significantly reduced the available range of motion. Elbow extension also challenged the nervous system substantially. A cumulative impact could be observed when different components were simultaneously added, and a neutralizing effect was noted when an adjacent region allowed for unloading of the nervous system. CONCLUSIONS: The experimental findings support the experientially based guidelines for positioning. Especially when simultaneously applied, submaximal joint positions easily load the nervous system, which may substantially compromise vital physiologic processes in and around the nerve. Therefore, even when the positioning of all upper limb joints is carefully considered, complete prevention of perioperative neuropathy seems almost inconceivable.

Adult↗
PubMed2002

Neuraxial opioids for labour analgesia: analgesic efficiency and effect on labour.

Neuraxial opioids have changed the practice of obstetric anaesthesia and analgesia dramatically. Excellent analgesia with minimal side effects started an era of ever increasing numbers of women who opt for the 'painless birth experience'. Several papers have been reported during 2001 that examine analgesic efficacy, maternal side effects, and effect on foetal well-being of epidural and spinal opioids. Foetal bradycardia following intrathecal opioid analgesia, an increasingly popular technique, has attracted particular attention over the past few years. The present review addresses recently reported work that, according to the author, is key to this field.

Journal Article↗
PubMedDate not supplied

Intrathecal clonidine prolongs labour analgesia but worsens fetal outcome: a pilot study.

PURPOSE: Intrathecal clonidine prolongs total duration of spinal bupivacaine analgesia. However, there are contradictory reports about its effect on maternal blood pressure and only limited data are available on fetal and neonatal outcome. In this study, we evaluated the efficacy of spinal clonidine combined with ropivacaine and sufentanil and its effects on maternal and fetal outcome. METHODS: Fifty patients requesting combined spinal epidural analgesia for labour pain relief were randomly assigned to receive intrathecal ropivacaine 3 mg, sufentanil 1.5 microg with or without clonidine 30 microg. Onset time and duration of analgesia, visual analogue scores for pain, blood pressure, ephedrine requirements, heart rate, incidence of nausea, pruritus and motor blockade, umbilical artery pH, fetal heart rate abnormalities and Apgar scores were noted and analyzed. RESULTS: Patients receiving spinal clonidine had significantly longer lasting analgesia compared to patients treated without clonidine (122 +/- 56 min vs 90 +/- 36 min, P < 0.05). Clonidine-treated patients experienced a more pronounced decrease in mean arterial pressure as compared to patients treated without clonidine (25 +/- 10% vs 15 +/- 12%, P < 0.05). The groups also differed in ephedrine requirement (4.91 mg vs 0.75 mg, P < 0.05), number of new onset fetal heart rate abnormalities (28% vs 0%, P < 0.05) and umbilical artery pH (7.219 +/- 0.096 vs 7.289 +/- 0.085, P < 0.05). CONCLUSION: Intrathecal clonidine prolongs spinal analgesia with ropivacaine and sufentanil at the expense of maternal hypotension, worse fetal well being and worse neonatal umbilical artery pH. We do not recommend routine administration of spinal clonidine 30 microg to sufentanil and ropivacaine for labour pain relief.

Adult↗