Similarity in standards and safety of practice within Europe: reality or fantasy?
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Anesthesiology↗
Biomedical subjects
M Vercauteren
Publications and source records attributed to M Vercauteren.
Successful treatment of postherpetic neuralgia with oral ketamine.
OBJECTIVE: To demonstrate the possibilities of the use of oral ketamine in the treatment of postherpetic neuralgia. SETTING: A pain clinic in a university hospital. PATIENT: A patient with postherpetic neuralgia of the ophthalmic nerve. INTERVENTION: Subcutaneous and later oral ketamine after classical treatment had failed. RESULTS: A complete recovery was accomplished without any sign of side effects. CONCLUSIONS: Oral ketamine may provide an alternative in the treatment of postherpetic neuralgia. The possible mechanism of action by its N-methyl-D-aspartate (NMDA) blocking properties is discussed.
Administration, Oral↗
The time course of a sixth nerve paresis following epidural anesthesia.
An isolated sixth nerve palsy is seldom seen following epidural anesthesia. An unintentional puncture through the dura may cause a leak of cerebrospinal fluid resulting in a shift of the cerebral content. This may cause a stretching of the sixth cranial nerve giving an abduction palsy. The palsy is benign and resolves completely within two months. The time course of a case will be described.
Abducens Nerve↗
[Reference values of the height and weight growth and growth rate of Belgian boys and girls 3-18 years of age].
BACKGROUND: Belgian growth standards have until now been based on cross-sectional studies. This paper describes the first Belgian longitudinal growth standards for height and height velocity and recent cross-sectional standards of weight-for-age. POPULATION AND METHODS: The study was conducted between 1955 and 1975, initially on 259 Belgian boys and girls born in Brussels between 1955 and 1958. Only 48 boys and 50 girls were still being checked for height and weight at the end of the study. The distance charts show the classical centile lines; the height standards are provided with growth curves for the typical early average and late-maturing child in the population. The velocity charts show centiles for whole-year increments in height. Individual-type velocity curves are also provided. RESULTS: Comparison between these standards and those for British children shows that the Belgian children (essentially the girls) are taller than the British, probably due to more rapid maturation.
Adolescent↗
Spinal sufentanil in rats: Part I: Epidural versus intrathecal sufentanil and morphine.
Male Wistar rats were injected epidurally or intrathecally with increasing doses of sufentanil or morphine in order to determine differences in potency, onset and duration of analgesia and supra-spinal side-effects. For sufentanil, only small differences in the lowest ED50-values for analgesia and supra-spinal side-effects were observed between the two spinal routes. Given intrathecally, sufentanil had a somewhat faster onset but a shorter duration of action than did epidural sufentanil. However, intrathecal morphine when compared to epidural morphine had a faster onset with a greater potency and a longer duration of action. The stronger opioid activity of intrathecal morphine was also reflected in a reduced safety ratio for the blockade of the cornea reflex. These differences between the two opioids, with regard to their optimal route of spinal administration, are discussed in terms of lipophilicity and optimal clinical use.
Analgesia, Epidural↗
Spinal sufentanil in rats: Part II: Effect of adding bupivacaine to epidural sufentanil.
Male Wistar rats were injected epidurally with various doses of sufentanil, bupivacaine or sufentanil combined with bupivacaine either 40 or 80 micrograms. Addition of 80 micrograms bupivacaine to sufentanil produced a 2.2- to 3-fold decrease of the lowest ED50 for a tail withdrawal reaction latency greater than 6 and greater than or equal to 10 s. The potentiation was already present at low doses. Whereas both 0.16 microgram sufentanil and 80 micrograms bupivacaine were inactive, the combination of the two drugs resulted in a deep analgesia in all animals. Because the addition of low doses of bupivacaine to sufentanil did not increase the ED50's for side-effects, higher specificity ratios were obtained as compared to sufentanil given alone. These results were discussed with regard to the potentiation of the analgesic properties of epidurally administered lipophilic opioids by local anaesthetics.
Analgesia, Epidural↗
Spinal sufentanil in rats: Part III: Effect of diluent volume on epidural sufentanil.
Male Wistar rats were injected epidurally with various doses of sufentanil in 3 different dilution volumes, in order to determine differences in the lowest ED50 values for analgesia and side-effects. The lowest ED50 for both a TWR latency greater than 6 and greater than or equal to 10 s was significantly lower in the 20-microliters group as compared to the 2-microliters group. With an injection of 5 microliters, intermediate values were obtained. With regard to the side-effects, there was a trend towards increased systemic resorption with larger diluent volumes in spite of a better and more selective spinal effect, as evidenced by increasing specificity ratios. In terms of duration of analgesia at fixed doses of sufentanil, different results were obtained. At low doses of sufentanil, a pronounced diluent volume effect was present and the duration of analgesia increased as a function of the volume. At higher doses of sufentanil, however, the volume effect faded away and no differences were observed as a function of the diluent.
Analgesia, Epidural↗
Reconstruction of the upper extremity in tetraplegia: functional assessment, surgical procedures and rehabilitation.
The results of 22 procedures (8 for elbow extension, 14 for hand rehabilitation) on the upper limb in tetraplegia are reported. To evaluate the effect of surgery an objective hand function test is presented. The few complications after surgery must be attributed to the material used.
Activities of Daily Living↗
Transcutaneous electrical stimulation (TCES) for the treatment of adolescent idiopathic scoliosis: preliminary results.
The authors report on the results of a preliminary study on the treatment of progressive idiopathic scoliosis by electrical surface stimulation. The study, involving 30 spinal curvatures, showed stabilization of the median primary curvature (30 degrees) in the course of treatment, the median duration of which was 12 months. Overall, 73.2% of the curvatures treated, responded favorably (stabilization or regression of the curve); however, 26.8% of the curvatures progressed in spite of the transcutaneous electrical stimulation treatment. The only complication noted was contact eczema in 20% of the cases. The authors feel that surface electrical stimulation treatment can be regarded as an acceptable alternative to a brace in the treatment of idiopathic scoliosis, and at this stage it deserves a place in the conservative therapeutic approach to idiopathic scoliosis.
Adolescent↗
Comparison of epidural sufentanil plus clonidine with sufentanil alone for postoperative pain relief.
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.
Adult↗
Age effects and secular trend in a cross-sectional sample: application to four head dimensions in Belgian adults.
If longitudinal studies represent the more direct way to analyze modifications resulting from aging, often for obvious reasons cross-sectional samples can also be used for this purpose. But in this case differences between age groups cannot be identified with the effects of age only; they can also be attributed to the effects of a secular trend. It is the aim of this study to show, using four cephalic dimensions and a cross-sectional sample, the need to take into account the effect of a secular trend when the age effect is studied. In 1985 a study of head and facial measurements of 182 Belgian men, aged 25-54 years, was carried out. A simple comparison between different age groups (F tests) revealed significant differences for head breadth and facial breadths. However, no difference for head length was observed. The amplitude of the secular trend in the Belgian population is already known; thus an easy calculation is proposed to define the effects of the age factor. For head breadth the whole difference seems to be the result of the important decrease of secular trend, whereas the global increase observed for the bizygomatic and bigonial breadths results in part from the decrease resulting from the secular trend and in part from the increase resulting from the age effect.
Adult↗
Giant-cell tumor involving a lumbar vertebra. Long-term follow-up after radiotherapy.
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Adult↗
Traumatic dislocation of the extensor tendons over the fifth metacarpo-phalangeal joint.
An unusual traumatic dislocation of the extensor tendons of the fifth metacarpo-phalangeal joint is reported. The extensor hood and capsule were split longitudinally in the mid-line dorsally and the extensor tendons separated, displacing in opposite directions onto the side of the metacarpal head.
Adult↗
Low dose sufentanil for major intracranial surgery.
The use of intravenous sufentanil in a single dose of 3 to 5 micrograms/kg body weight, was evaluated in 41 patients anesthetised for major intracranial surgery. It was assessed in a technique of balanced anesthesia which allowed controllable alteration in cardiovascular parameters and rapid postoperative recovery and neurological evaluation. It was concluded that the 4 micrograms/kg dose was superior regarding peroperative stability and recovery. The delayed recovery in aneurysm and fossa posterior surgery should be explained by several factors not involving the anesthetic technique.
Adult↗
Safety of labetalol-induced controlled hypotension during middle ear microsurgery.
In order to study the influence of labetalol on the peroperative oxygenation during deliberate hypotension, 50 patients undergoing middle ear microsurgery were randomly divided in two groups of 25 patients; one group receiving labetalol to induce hypotension, the other group receiving placebo in a double blind manner. In the group receiving labetalol the arterial oxygen tension (PaO2) decreased significantly 5 minutes after the intravenous bolus injection. Within 30 minutes the PaO2 returned to the starting level. The arterial carbon dioxide tension (PaCO2) increased within 5 minutes and also returned to the initial level after 30 minutes. These changes were absent in the control group. It is concluded that, although labetalol produces a statistically significant change in PaO2 and PaCO2, this finding has only minor clinical implications and so labetalol remains a safe drug to be used for the induction of deliberate hypotension during middle ear microsurgery.
Adult↗
A comparison of the anaesthetic properties of propofol and methohexitone when used as the sole induction agent for thermocoagulation of the gasserian ganglion.
Methohexitone and propofol were compared when used as the sole induction agent for thermocoagulation of the Gasserian ganglion. Sleeping and apnoea times were not significantly different for both drugs, nor were they for the same drug during repetitive inductions. However, the haemodynamic data showed a better stability when propofol was used. Amnesia may be in favour of propofol. There were no significant differences concerning pre- and post-operative side-effects in both groups.
Aged↗
Respiratory arrest after sufentanil.
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Analgesics↗
Intranasal sufentanil for pre-operative sedation.
Sufentanil, a short-acting and potent narcotic agent, was studied as a premedicant administered by the nasal route. A total dose of 5 micrograms appeared to be too low, while either 10 or 20 micrograms was very effective in producing sedation. Side effects were minor. There appeared to be no differences between nose drops and spray. In a further study, sufentanil nose drops were compared with saline 0.9% in a double-blind fashion. Sedation of rapid onset but of limited duration was observed in the majority of patients who received sufentanil.
Administration, Intranasal↗