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Biomedical subjects

E Vandermeersch

Publications and source records attributed to E Vandermeersch.

At least 37 records · Page 2Linked to original sources
PubMed1999

Treatment for postdural puncture headache associated with late postpartum eclampsia.

Postdural puncture headache (PDPH) is the most common complication of accidental or deliberate dural puncture. It also occurs after epidural or spinal analgesia for labor and delivery. Treatment may be conservative with analgesics and/or caffeine. Definitive treatment can be accomplished with an epidural blood patch (EBP). We present a case of postpartum convulsions which were temporally related to a caffeine infusion and an EBP.

Acetaminophen↗
PubMed1999

Prospective, randomized comparison of epidural and combined spinal epidural analgesia during labor.

The analgesic efficacy and incidence of maternal, fetal and neonatal side-effects of combined spinal epidural (CSE) and epidural (EPI) analgesia, using a mixture of bupivacaine 0.125%, epinephrine (1.25 micrograms.ml-1) and sufentanil (0.75 microgram.ml-1) for the relief of labor pain, were randomly and prospectively compared in 110 parturients. A 29 gauge Whitacre tip spinal needle was used to perforate the dura in CSE patients. Compared to EPI, CSE resulted in rapid (326 +/- 22 vs 766 +/- 79 sec, p < 0.05), excellent analgesia, using less bupivacaine (23.5 +/- 2.3 vs 33.9 +/- 2.9 mg, p < 0.05) and sufentanil (12.5 +/- 1.0 vs 16.5 +/- .7 micrograms, p < 0.05). A tendency to improved patient satisfaction in the CSE group was observed. The incidence of maternal or neonatal side effects was similar in both groups. No PDPH was observed. We conclude that CSE analgesia results in excellent pain relief during labor with immediate gratification as compared to epidural analgesia.

Adult↗
PubMed1998

Nonsurgical extraction of intracardiac double-knotted pulmonary artery catheter.

A 75-year-old patient was admitted to the operating room for an emergency laparotomy for leaking abdominal aortic aneurysm. A pulmonary artery catheter (PAC) was inserted through the right internal jugular vein but it was impossible to advance the catheter lip into the pulmonary artery. We tried to withdraw the catheter but this was also impossible. A postoperative chest radiograph revealed a catheter knot in the right atrium. We succeeded in removing the PAC through a 14-French sheath introducer placed in the femoral vein via fluoroscopy.

Aged↗
PubMed1998

Comparative hemodynamic effects of three different parenterally administered lipid emulsions in conscious dogs.

OBJECTIVE: To compare the hemodynamic side effects of three structurally different lipid emulsions. DESIGN: Randomized, controlled, prospective animal study. SETTING: University research laboratory. SUBJECTS: Six chronically instrumented mongrel dogs. INTERVENTIONS: On separate days, all animals were submitted to three different treatments, in a randomized order. After baseline measurements, either a long-chain triglyceride emulsion (treatment 1), a mixed medium-chain triglyceride/long-chain triglyceride emulsion (treatment 2), or an omega3 polyunsaturated fatty acid long-chain triglyceride (PUFA) emulsion (treatment 3) was administered intravenously over 30 mins. MEASUREMENTS AND MAIN RESULTS: Global and regional hemodynamics (sonomicrometry) were recorded for 2 hrs after baseline measurements. Arterial blood gases and plasma concentrations of hemoglobin, triglycerides, total protein, and glucose were recorded for 2 hrs. Long-chain triglycerides did not affect the cardiovascular performance in awake animals. However, medium-chain triglycerides/long-chain triglycerides and omega3 PUFA caused marked increases in systemic vascular resistance (from 1833 +/- 154 to 3277 +/- 163 mm Hg/dynexsec5, p < .05), heart rate (from 89 +/- 6 to 158 +/- 10 beats/min, p < .05), and depressed ventricular performance (wall-thickening fraction [as percentage from baseline] decreased to 53 +/- 9%, p < .05). CONCLUSIONS: Commercially available lipid emulsions can cause profound cardiovascular side effects at high doses, depending on their composition. Whereas long-chain triglyceride emulsions have virtually no effects on hemodynamics in normal dogs, medium-chain triglyceride/long-chain triglyceride, and omega3 PUFA emulsions should be used with caution in critically ill patients with compromised cardiovascular function.

Acidosis↗
PubMed1998

Blood transfusion practice in Belgium. As assessed by a national survey.

In April 1995 the Ministry of Public Health invited all Belgian hospitals to participate to a survey on the use of blood transfusion. The questionnaire presented two parts, the first one devoted to products transfused and the second one to the transfusion organisation in the hospital. 71 hospitals answered: 7 university and 64 general hospitals. All hospitals reported the use of red cells, 31 of them still used whole blood. Surgical departments transfused the greatest absolute amount of units, but the highest intensity (units/bed/year) was observed in intensive care units. 52 hospitals mentioned the use of autologous predeposit. The highest consumption of platelets occurred in medicine but intensive care showed the highest intensity of platelet transfusion. In 41 hospitals platelets were obtained by cytapheresis. The number of plasma units transfused was highly correlated with the quantities of packed red cells and whole blood transfused. Ten hospitals didn't report the use of any blood conservation technique. Returning unused units to the blood bank was allowed in 80% of the hospitals, their return to the transfusion center was permitted in 65% of the hospitals. A transfusion committee existed in only 11 hospitals. Transfusion should be improved by a better education of all physicians and nurses involved with transfusion and by improving standardisation, by better documentation, better reporting and information of all health care workers involved.

Belgium↗
PubMed1996

Long-chain triglycerides improve recovery from myocardial stunning in conscious dogs.

OBJECTIVES: Free fatty acid (FFA) oxidation is depressed in the postischaemic stunned myocardium and recovers in parallel with the normalization of contractile performance. Assuming a causal role for this metabolic disturbance in the pathogenesis of stunning, we questioned whether exogenous administration of high dose triglycerides during reperfusion of postischaemic myocardium, could improve its functional recovery. METHODS: Thirteen dogs were chronically instrumented to measure global and regional haemodynamics and to produce a 10 min episode of regional myocardial ischaemia. In 7 dogs, Intralipid 20% was administered i.v. during the reperfusion phase. Contractile recovery of stunned myocardium was compared with control saline treatments. The series were repeated in another 6 animals, but oxfenicine (CPT I inhibitor) preceeded Intralipid during reperfusion. RESULTS: Contractile recovery of stunned myocardium was faster and more extensive when Intralipid was administered during reperfusion than with saline treatment (wall thickening fraction 86 +/- 6% of preischaemic controls versus 52 +/- 11% at 90 min post-reperfusion; P < 0.05). Oxfenicine pretreatment completely abolished this beneficial effect. CONCLUSIONS: Exogenous administration of triglycerides during reperfusion of postischaemic myocardium improves functional recovery from stunning. This beneficial effect most likely operates through enhanced FFA availability and/or oxidation since it could be abolished by selective inhibition of the carnitine palmitoyl I enzyme.

Animals↗
PubMed1996

The effect of prophylactic clonidine on postoperative shivering. A large prospective double-blind study.

The primary goal of this study was to assess the influence of clonidine administered after induction on postoperative shivering after elective peripheral surgery. The effect of clonidine on intra-operative haemodynamics (blood pressure and heart rate) during the first 30 min after induction and on the postoperative sedation of the patient was also investigated. Two hundred and eighty male ASA 1 and 2 patients, undergoing elective peripheral surgery were randomly administered either placebo or clonidine 2 micrograms.kg-1 intravenously over 10 min after induction of anaesthesia. Clonidine was found to reduce the total incidence (p = 0.024), the severity (p = 0.005) and the duration (p = 0.01) of postoperative shivering. Clonidine did not increase postoperative sedation or diminish overall consciousness. We conclude that administration of clonidine 2 micrograms.kg-1 intravenously after induction of anaesthesia is safe and reduces postoperative shivering in this group of patients.

Adrenergic alpha-Agonists↗
PubMed1995

[A concept for the improvement of postoperative pain management].

Many articles in the literature document the fact that postoperative pain therapy has not improved for decades despite new insights into pain physiology, the availability of powerful analgesics and the development of new techniques. This project was set up to develop practical, effective, safe, and easy to run acute pain therapy. METHODS. Postoperative pain management had to be optimized according to the facilities available today. Therefore, the legal background is presented first. Second, several medical and organizational principles were chosen to serve as a basis for the new organizational structure: Continuously monitoring the patient's pain during the whole stay in hospital, Introduction of a simple verbal 4-point pain score for determination and documentation of pain allowing the nurses to differentiate pain that should be treated or not, A simple sedation score, Use of "balanced analgesia" and "pre-emptive analgesia", Drug administration according to the needs of the patient, Partial transfer of the responsibility for pain treatment to nurses. Plans and algorithms were expanded to allow nurses and anaesthesiologists to reach the previously determined goals. RESULTS. In a small study including 107 patients, it was demonstrated that the quality of pain treatment improved significantly. Furthermore, patients, nurses and physicians are much more content with the new pain treatment regimen. DISCUSSION. The difficulties in realizing such a concept are described. The importance of thorough teaching is underlined in a nurse-based system. However, it is not yet clear whether this pain treatment has resulted in reduced morbidity, reduced mortality and a shortened hospital stay of the patients.

Algorithms↗
PubMed1995

Intubating conditions and neuromuscular effects of mivacurium during propofol-alfentanil anaesthesia.

In three groups of 20 patients, anaesthetized with propofol and alfentanil, tracheal intubation conditions and the onset of neuromuscular blockade after administration of three different doses of mivacurium chloride (0.11, 0.15, and 0.19 mg/kg = 1.5 x ED95, 2 x ED95, and 2.5 x ED95) were assessed. Intubation conditions were found to be clinically acceptable (good or excellent) in 83% of patients. Eighty-two per cent of patients were successfully intubated on the first attempt after 60-90 s. No difference in intubation scores or number of intubation attempts among the three dosage groups were found. We conclude that mivacurium chloride allows smooth intubation in most patients within 60-90 s, even with the lowest dose (0.11 mg/kg), after a propofol-alfentanil induction of anaesthesia. However, because there were a few patients in whom intubating conditions were inadequate at 60-90 s, we are reluctant to advocate the preference of mivacurium chloride over suxamethonium for rapid sequence induction in emergency situations.

Adolescent↗
PubMed1993

Muscle paralysis by rocuronium during halothane, enflurane, isoflurane, and total intravenous anesthesia.

We determined the dose-response relationship, the onset time, the duration, and the recovery time of a rocuronium neuromuscular block under four anesthesia techniques. Patients were equally randomized to four different groups (n = 20) receiving 0.5%-1% halothane, 1.5%-2% enflurane, 1.2%-1.8% isoflurane end-tidal concentration in 34%/66% O2/N2O, or 6.0 mg.kg-1 x h-1 propofol without N2O for anesthesia and alfentanil for analgesia. Strength of thumb adduction in response to single and train-of-four stimulation of the ulnar nerve was quantitated. Rocuronium 0.15, 0.2, 0.25, and 0.3 mg/kg were given intravenously. When maximal depression of twitch tension occurred, supplemental doses up to a total of 0.5 mg/kg were given. If required, additional doses of 0.15 mg/kg were given at 25% recovery of control twitch tension. Standard hemodynamics, end-tidal CO2, and anesthetic gas concentrations were monitored continuously. The mean ED50 (SD) was 0.133 (+/- 0.009) mg/kg for the halothane group, 0.118 (+/- 0.012) mg/kg for the enflurane group, 0.069 (+/- 0.026) mg/kg for the isoflurane group, and 0.167 (+/- 0.007) mg/kg for the total intravenous anesthesia (TIVA) group, respectively. There was a statistically significant difference between the halothane and TIVA, and between the enflurane and TIVA groups (P < 0.05). Rocuronium has a short onset time and an intermediate duration of action. The neuromuscular blocking potency and pharmacodynamic profile are moderately influenced by volatile anesthetics.

Adult↗
PubMed1992

Light anaesthesia with propofol for paediatric MRI.

Anaesthetic techniques and monitoring equipment may interfere with the technical demands of magnetic resonance imaging. The purpose of this study was to evaluate the safety and efficacy of a light anaesthetic technique with intravenous propofol in nonintubated children. In 20 neuropaediatric patients sedation was induced with propofol 1 mg.kg-1, followed by a continuous infusion titrated to produce adequate immobilisation. Oxygen, 4 l.min-1, was administrated by paediatric face mask. Respiratory rate, end-tidal carbon dioxide tension and oxygen saturation were continuously monitored. In 10 patients capillary blood gas tensions were determined 3 and 20 min after the procedure. Data are reported as mean (SD) and the mean (SD) total propofol dose was 5 (2) mg.kg-1.h-1. Oxygen saturation remained constantly higher than 96% in all patients. End-tidal carbon dioxide tension varied between 35 (7) mmHg 3 min after induction, and 41 (6) mmHg 30 min after the start of the procedure. End-tidal to capillary PCO2 difference was 4 (3) mmHg. Within 20 min after the end of the procedure all patients were fit for dismissal to the ward. One imaging sequence out of 49 was repeated because of movement artefacts. In conclusion, intravenous propofol sedation appears to be a safe and reliable technique for paediatric sedation during magnetic resonance imaging.

Anesthesia, Intravenous↗
PubMed1992

[The reuse of 29-gauge spinal needles following combined spinal-epidural anesthesia].

The technique of combined spinal epidural anaesthesia (CSE) combines the versatility of spinal with the variability of epidural anaesthesia. Spinal application of the local anaesthetic achieves a fast response, reliable sensorial and motor block at a low dose with little toxicity. The epidural catheter allows for the duration of surgical anaesthesia to be extended and provides analgesia for the postoperative period. As the incidence of post dural puncture headache (PDPH) is inversely related to the size of the spinal needle, PDPH rarely or never occurs when 29 gauge needles are used. In 1775 parturients receiving spinal anaesthesia for caesarean section, Dittmann et al. [4] reported an incidence of PDPH of 1.37% with 29 gauge needles. The 29 gauge needle produced by Becton-Dickinson is the one now most frequently used for this technique. It is recommended that these needles be reused after resterilization. The objective of this study was to examine how clean 29 gauge spinal needles really are after resterilization. MATERIALS AND METHODS. Fifteen needles (29 gauge; Becton-Dickinson) were routinely used for combined spinal epidural anaesthesia. After identification of the epidural space at the L3-4 spinal segment with the 18 gauge Tuohy needle, the 29 gauge needle was advanced through the Tuohy needle. Immediately after use the needles were cleaned, rinsed with 20 ml distilled water, dried with pressurized air and subsequently resterilized in gas. Preparation of the used needles was in accordance with the manufacturer's recommendations ("wash, rinse, dry, sterilize before initial and each subsequent use") and with generally accepted principles [6]. Two needles were additionally cleaned in an ultrasonic bath for 15 min. The needles were examined using a scanning electron microscope. After this analyses, eight needles were sterilized again and then taken for hygienic examination. They were incubated with trypticase soy broth and checked for bacterial growth. RESULTS. Scanning electron microscopy (ScEM) showed organic impurities on all needles. These impurities were equally distributed among all needles. Even the two cleaned in the ultrasonic bath were not free of organic particles. However, no material defects or damage could be seen. Hygienic evaluation proved sterility as no bacterial growth could be detected. CONCLUSION. Owing to the possibility of medico-legal consequences, which sometimes occur a long time after anaesthesia has been given, we think it is unwise to reuse such needles. We hope that disposable and cheap 29 gauge needles will soon become available.

Anesthesia, Epidural↗
PubMed1992

[Monitoring patients in the anesthesia recovery room. Continuous transcutaneous O2 and CO2 measurements].

To establish whether continuous transcutaneous O2 and CO2 measurement in the recovery room is suitable for non-invasive monitoring of spontaneous respiration in patients newly operated upon, comparative transcutaneous and arterial pO2 and pCO2 investigations were carried out on 35 adults. There was a correlation coefficient of 0.66 between paO2 and tcpO2. The transcutaneous pO2 values measured were 45.3 mm Hg under the arterial values. When the transcutaneous CO2 values were compared with the arterial values, the correlation coefficient was 0.906. The mean transcutaneous pCO2 values measured lay around 0.7 mm Hg above the arterial values. On the basis of this slight deviation in CO2 values, the method appears to be suitable for continuous non-invasive determination of pCO2. The very large deviations in the O2 values indicate that transcutaneous measurement of oxygen partial pressure in this specific examination situation is not sufficiently reliable, which makes questionable the practice of using one piece of equipment for both measurements. In the clinical setting presented, transcutaneous O2 monitoring does not represent an alternative to close clinical observation and pulse oximetry.

Adult↗