[Post-spinal headache].
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Anesthesia, Spinal↗
Biomedical subjects
E Vandermeulen
Publications and source records attributed to E Vandermeulen.
[Para-spinal regional anesthesia and prevention of thromboembolism/anticoagulation. Recommendations of the German Society of Anesthesiology and Intensive Care Medicine, October 1997].
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Anesthesia, Spinal↗
[Risks and complications following peridural anesthesia].
Postoperative neurological sequelae in patients that have received epidural anaesthesia are not necessarily caused by the epidural anaesthetic technique. As a whole, adverse neurological outcomes following epidural anaesthesia may be subdivided into 3 different ethiological categories. A first category involves events that are not at all caused by the epidural, but merely due to the interference of anaesthesia and/or surgery with a preexisting medical condition. A second category includes mishaps such as backache, arachnoiditis, and post-dural puncture headache that are solely due to the epidural anaesthesia. Finally, epidural anaesthesia may be a contributory factor in the development of post-anaesthetic complications attributable to a pre-existing medical condition that are triggered by anaesthesia, surgery or childbirth. These complications include some of the most dramatic sequelae of major neuraxial blockade, such as spinal epidural abscess, spinal infarction, and spinal hematoma. Although extremely rare, the latter complications often result in permanent major neurological deficits. The present manuscript is a review of the most recent, literature addressing post-anaesthetic sequelae, and will discuss their incidence, pathophysiology, clinical course, diagnosis, prevention, and treatment.
Anesthesia, Epidural↗
HLA typing in a large family with multiple cases of different autoimmune diseases.
OBJECTIVE: Because of the concurrence, in members of one family, of different autoimmune disorders [rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriasis (PS), and inflammatory bowel disease (IBD)], we investigated the genotypes of each member and compared the results with current knowledge of genetic inheritance of rheumatic and other autoimmune diseases. METHODS: Sera and peripheral blood lymphocytes of 16 family members were collected for HLA typing and investigation. RESULTS: All patients with RA were DR4 positive ad 4 of 5 showed the maternal A2B51DR4 haplotype. Two of 3 siblings with the genotype HLA-A2/3, B8/35, DR2/3 had SLE. Patients with IBD and psoriasis shared the haplotype HLA-A3, B35 CW4 DR2. CONCLUSION: The results show that the important role of patients, sex and confirm the association between HLA haplotype and RA or SLE. They support the hypothesis that autoimmunity is a mendelian dominant trait, and that secondary genes, including these of the major histocompatibility complex, confer phenotypic specificity.
Arthritis, Rheumatoid↗
[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↗
The effects of the addition of sufentanil to 0.125% bupivacaine on the quality of analgesia during labor and on the incidence of instrumental deliveries.
In a double-blinded, randomized, prospective multi-center study of 695 women, we investigated whether epidural injection of sufentanil added to 0.125% bupivacaine with epinephrine (1:800,000) reduces the total amount of local anesthetic required, resulting in less motor blockade and reduced incidence of instrumental deliveries, and improves the quality of analgesia provided by this low concentration of local anesthetic without jeopardizing the safety of the baby. In addition, other potential benefits of sufentanil (such as decrease in the incidence of shivering) and side effects were examined. It was found that adding incremental doses of 10 micrograms sufentanil up to a maximum of 30 micrograms reduced the incidence of instrumental deliveries from 36 to 24% (P less than 0.01) and significantly improved quality and duration of analgesia without depressing the neurobehavioral status of the baby. No other benefits from adding sufentanil were found. The only side effect that occurred more frequently after sufentanil was pruritus. We conclude that epidural injection of 10-30 micrograms sufentanil added to 0.125% bupivacaine with epinephrine (1:800,000) improved the quality of analgesia during labor and reduced the incidence of instrumental deliveries without jeopardizing the safety of the baby.
Adult↗
Maternal and neonatal effects of adding epidural sufentanil to 0.5% bupivacaine for cesarean delivery.
STUDY OBJECTIVE: To determine the maternal and fetal effects of the addition of epidural sufentanil to 0.5% bupivacaine for cesarean delivery. DESIGN: Randomized, double-blind, prospective study. SETTING: University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium. PATIENTS: Sixty women at term scheduled for elective cesarean section, all of whom had elected epidural anesthesia. INTERVENTIONS: The 60 women were divided into three groups of 20, with each group receiving a different 1 ml study solution: saline (control) or sufentanil 20 micrograms or sufentanil 30 micrograms added to 0.5% bupivacaine and epinephrine (1:200,000). MEASUREMENTS AND MAIN RESULTS: In the mother, the quality of anesthesia, the duration of postoperative analgesia, the volume of anesthetic, and the frequency of side effects were examined. The neonates were evaluated at 5 and 10 minutes after birth by Apgar scores and between 60 and 120 minutes after birth by both the screening test developed by Prechtl and the Neurological and Adaptive Capacity Scoring System. Immediately after delivery, maternal and umbilical vein blood were drawn and assayed for sufentanil levels. Adding sufentanil significantly improved the quality of anesthesia without depressing the neurobehavioral status of the baby. CONCLUSION: The epidural injection of sufentanil added to 0.5% bupivacaine with epinephrine improved the quality of anesthesia during elective cesarean section without jeopardizing the safety of the baby.
Anesthesia, Epidural↗