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See detailIncreased analgesic requirements associated with induced labour are related to dystocia
Sougné, Christelle; Dewandre, Pierre-Yves ULg; Hans, Pol ULg et al

in Acta Anaesthesiologica Belgica (2008), 59(3), 229

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See detailEffect of propofol and sevoflurane on coughing in smokers and non-smokers awakening from general anaesthesia at the end of a cervical spine surgery.
Hans, Pol ULg; Marechal, Hugues ULg; Bonhomme, Vincent ULg

in British Journal of Anaesthesia (2008), 101(5), 731-7

BACKGROUND: Coughing during emergence from general anaesthesia may be detrimental, particularly after cervical spine surgery. We compared the effect of propofol or sevoflurane anaesthesia on the incidence ... [more ▼]

BACKGROUND: Coughing during emergence from general anaesthesia may be detrimental, particularly after cervical spine surgery. We compared the effect of propofol or sevoflurane anaesthesia on the incidence and severity of coughing during recovery in patients undergoing cervical spine surgery via an anterior approach. As a secondary aim, we also evaluated the influences of smoking and estimated residual anaesthetic agent concentrations on coughing. METHODS: Thirty-four patients were enrolled in a randomized prospective, double-blind study to receive either propofol (PPF) or sevoflurane (SEVO) for maintenance of anaesthesia. The decision to perform tracheal extubation was based on specified criteria, including resumption of spontaneous respiration and consciousness. During emergence from anaesthesia and extubation, coughing was observed and graded at predefined times. RESULTS: The incidence of severe coughing was higher in the SEVO group than in the PPF group (59% and 6%, respectively), and also in smokers than in non-smokers (50% and 17%, respectively). The peak incidence of coughing was at tracheal extubation. The probability of coughing was influenced by the estimated residual concentration of anaesthetic agents at extubation, except for smokers in the SEVO group who were at the highest risk of coughing. CONCLUSIONS: The incidence of coughing after cervical spine surgery when tracheal extubation is performed according to clinical criteria is lower after propofol anaesthesia compared with sevoflurane anaesthesia. Smokers are at increased risk of coughing, independently of the type of anaesthesia maintenance. Higher residual concentrations of anaesthetic agents decrease the probability of coughing, except for smokers anaesthetized with sevoflurane. [less ▲]

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See detailAnesthetic management for neurosurgery in awake patients
Hans, Pol ULg; Bonhomme, Vincent ULg

in Minerva Anestesiologica (2007), 73(10), 507-512

Neurnsurgery without general anesthesia is based on the necessity to avoid any interference between brain electrophysiological recordings and anesthetic agents, and the opportunity to have a patient able ... [more ▼]

Neurnsurgery without general anesthesia is based on the necessity to avoid any interference between brain electrophysiological recordings and anesthetic agents, and the opportunity to have a patient able to follow commands and to cooperate during surgery. It includes not only several minimally invasive procedures, but also craniotornies for epilepsy surgery or the removal of tumors located close to brain eloquent areas. Before surgery, the patient must be carefully evaluated, correctly informed and appropriately prepared. In the operating room, monitoring is important for conducting the anesthetic management, ensuring patient's comfort and safety, and meeting surgical requests. Propofol and remifentanil are frequently used for anesthesia, but sufentanil, local anesthetics and a2-agonists are also of primary interest. Patient's ventilation may be spontaneous, assisted or controlled. Airway management is a key point strongly related to the anesthesia technique and the type of surgery. Airway may be secured with different airway devices and the laryngeal mask appears to progressively replace the enclotracheal tube. Respiratory, hemodynamic, and neurologic complications as well as nausea and vomiting and loss of patient's cooperation may have disastrous consequences and should be prevented rather than cared. [less ▲]

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See detailMuscle relaxation and depth of anaesthesia: where is the missing link?
BONHOMME, Vincent ULg; Hans, Pol ULg

in British Journal of Anaesthesia (2007), 99(4), 456-460

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See detailBispectral Index profile during carotid cross clamping
Bonhomme, Vincent ULg; Desiron, Quentin ULg; Lemineur, Thierry et al

in Journal of Neurosurgical Anesthesiology (2007), 19(1), 49-55

This study aimed at investigating the Bispectral Index (BIS) profile during carotid cross clamping (CXC). The study involved a pilot group of 10 patients undergoing routine carotid endarterectomy with ... [more ▼]

This study aimed at investigating the Bispectral Index (BIS) profile during carotid cross clamping (CXC). The study involved a pilot group of 10 patients undergoing routine carotid endarterectomy with shunt insertion under total intravenous anesthesia, and a study group of 26 additional patients. In all patients, rates of propofol and remifentanil providing a steady-state level of hypnosis (BIS: 40-60) were maintained constant throughout a recording period ranging from 3 minutes before CXC to shunt insertion. BIS was recorded throughout this period and the internal carotid backflow observed at the time of shunt insertion was graded as good, moderate, or poor. In addition, A-Line Autoregressive Index (AAI) and processed electroencephalogram (EEG) parameters were recorded in patients of the study group. All parameters were averaged over I minute before CXC, at CXC, 1, 2, and 3 minutes after CXC, and at shunt insertion. Statistical analysis was performed using X 2, Friedman, and Spearman correlation tests. For technical reasons, reliable AAI, BIS monitor-derived, and other processed EEG data were obtained in 24, 25, and 18 patients of the study group, respectively. During the first 3 minutes after CXC, BIS increased over 60 [68.8 (6.1)] in 47%, decreased below 40 [34.9 (4.4)] in 25%, and remained in the 40 to 60 range in 28% of all recruited patients. A BIS increase was more frequently observed in patients with moderate or poor than in those with good internal carotid backflow (78, 67, and 29%, respectively). It was significantly correlated to an increase in AAI and EEG amplitude, a decrease in EEG suppression ratio, and a shorter time between induction of anesthesia and CXC. A BIS decrease was significantly correlated to an increase in suppression ratio and a longer time between induction and CXC. In conclusion, during CXC under a constant level of intravenous anesthesia, BIS may increase, decrease, or remain unchanged. The paradoxical BIS increase could be related to borderline ischemia, a change in brain anesthetic agent concentration, or a change in the nociceptive-antinociceptive balance associated with a CXC-elicited painful stimulation. Caution should be used when interpreting BIS value during CXC. [less ▲]

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See detailMonitorage de la profondeur de l'anesthésie: pourquoi, comment et a quel prix?
BONHOMME, Vincent ULg; Hans, Pol ULg

in Revue Médicale de Liège (2007), 62 Spec No

The precise titration of anaesthetic agents is necessary to avoid the consequences of a too light depth of anaesthesia such as unexpected intraoperative awareness, as well as a too deep level of ... [more ▼]

The precise titration of anaesthetic agents is necessary to avoid the consequences of a too light depth of anaesthesia such as unexpected intraoperative awareness, as well as a too deep level of anaesthesia, which can be deleterious in terms of postoperative morbidity and mortality. The clinical evaluation of the depth of anaesthesia is poorly sensitive and specific. It does not permit to distinguish between pharmacodynamic components of anaesthesia. Several paraclinical depth of anaesthesia indices are currently available. Most of them are mainly designed to monitor the depth of the hypnotic component of anaesthesia. Their calculation is mostly based on the mathematical analysis of the electroencephalogram. They are efficient at reducing the incidence of unexpected intraoperative awareness, adjusting anaesthetic depth at an individual scale, predicting the time needed for recovery, allowing early extubation of patients, reducing their length of stay in the post anaesthesia care unit, and limiting the number of episodes of peroperative over and under dosage of anaesthetic agents. The knowledge of conditions that may impede the accurate interpretation of those indices is mandatory for an optimal use. Although undoubtedly beneficial for the patients, the use of those monitors is frequently responsible for supplementary' costs, particularly when the procedure is short. [less ▲]

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See detailEffect of an intubation dose of rocuronium on Spectral Entropy and Bispectral Index (TM) responses to laryngoscopy during propofol anaesthesia
Hans, Pol ULg; Giwer, Jérôme ULg; Brichant, Jean-François ULg et al

in British Journal of Anaesthesia (2006), 97(6), 842-847

Background. The spectral entropy of the electroencephalogram has been proposed to monitor the depth of anaesthesia. State Entropy (SE) reflects the level of hypnosis. Response Entropy (RE), computed from ... [more ▼]

Background. The spectral entropy of the electroencephalogram has been proposed to monitor the depth of anaesthesia. State Entropy (SE) reflects the level of hypnosis. Response Entropy (RE), computed from electroencephalogram and facial muscle activity, reflects the response to nociceptive stimulation. We evaluated the effect of rocuronium on Bispectral Index (TM) (BIS) and entropy responses to laryngoscopy. Methods. A total of 25 patients were anaesthetized with propofol using a target-controlled infusion. At steady state, they randomly received 0.6 mg kg(-1) rocuronium (R) or saline (S). After 3 min, a 20 s laryngoscopy was applied. BIS, RE and SE were recorded continuously and averaged over 1 min during baseline, at steady state, 2 min after R or S administration (R/S+2) and 0, 1, 2 and 3 min after laryngoscopy (L0, L1, L2, L3). Results. At R/S+2, the RE-SE gradient was higher in Group S than in Group R. Laryngoscopy provoked an increase in BIS, RE and SE. Comparing R/S+2 and L0 values in Groups R and S, BIS increased from 43 (6) to 49 (8) and 42 (9) to 51 (15), SE increased from 43 (7) to 50 (8) and 41 (10) to 55 (12), and RE increased from 46 (8) to 54 (9) and 47 (12) to 66 (15), respectively. BIS and SE did not differ between groups. At L0, RE and RE-SE were higher in Group S [66 (15) and 11 (4), respectively] than in Group R [54 (9) and 4 (2), respectively]. Conclusions. Rocuronium alters the RE-SE gradient and the RE and RE-SE responses to laryngoscopy. Muscle relaxation may confound interpretation of entropy monitoring. [less ▲]

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See detailWhy We Still Use Intravenous Drugs as the Basic Regimen for Neurosurgical Anaesthesia
Hans, Pol ULg; BONHOMME, Vincent ULg

in Current Opinion in Anaesthesiology (2006), 19(5), 498-503

PURPOSE OF REVIEW: Evolution of neurosurgery mainly trends towards minimally invasive and functional procedures including endoscopies, small-size craniotomies, intraoperative imaging and stereotactic ... [more ▼]

PURPOSE OF REVIEW: Evolution of neurosurgery mainly trends towards minimally invasive and functional procedures including endoscopies, small-size craniotomies, intraoperative imaging and stereotactic interventions. Consequently, new adjustments of anaesthesia should aim at providing brain relaxation, minimal interference with electrophysiological monitoring, rapid recovery, patients' cooperation during surgery and neuroprotection. RECENT FINDINGS: In brain tumour patients undergoing craniotomy, propofol anaesthesia is associated with lower intracranial pressure and cerebral swelling than volatile anaesthesia. Hyperventilation used to improve brain relaxation may decrease jugular venous oxygen saturation below the critical threshold. It decreases the cerebral perfusion pressure in patients receiving sevoflurane, but not in those receiving propofol. The advantage of propofol over volatile agents has also been confirmed regarding interference with somatosensory, auditory and motor evoked potentials. Excellent and predictable recovery conditions as well as minimal postoperative side-effects make propofol particularly suitable in awake craniotomies. Finally, the potential neuroprotective effect of this drug could be mediated by its antioxidant properties which can play a role in apoptosis, ischaemia-reperfusion injury and inflammatory-induced neuronal damage. SUMMARY: Although all the objectives of neurosurgical anaesthesia cannot be met by one single anaesthetic agent or technique, propofol-based intravenous anaesthesia appears as the first choice to challenge the evolution of neurosurgery in the third millennium. [less ▲]

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See detailCorrelation and agreement between bispectral index and state entropy of the electroencephalogram during propofol anaesthesia
BONHOMME, Vincent ULg; Deflandre, Eric ULg; Deflandre, Eric

in British Journal of Anaesthesia (2006), 97(3), 340-346

Background. Bispectral index (BIS) and state entropy (SE) monitor hypnosis. We evaluated the correlation and the agreement between those parameters during propofol anaesthesia and laryngoscopy with and ... [more ▼]

Background. Bispectral index (BIS) and state entropy (SE) monitor hypnosis. We evaluated the correlation and the agreement between those parameters during propofol anaesthesia and laryngoscopy with and without muscle relaxation. Methods. A total of 25 patients were anaesthetized with propofol. At steady state (SS: BIS 40-50), they randomly received rocuronium (R) or saline (S); 3 min thereafter, a 20 s laryngoscopy was performed. Correlation (regression analysis) and agreement (Bland-Altman analysis) were evaluated before induction (baseline), at loss of eyelash reflex (LER), at SS and during the first 3 min after laryngoscopy (L). Results. The correlation coefficient r (95% CI), the mean difference (MD) (95% CI), and the limits of agreement [lower-upper limits of 95% CI of MD (sd 1.96)] between BIS and SE were as follows. Overall recordings: 0.87 (0.83 to 0.90), 2.5 (1.2 to 3.0), and [-19.5 to 24.6]; Baseline: 0.45 (0.06 to 0.72), 7.6 (6.0 to 9.2), and [-2.7 to 17.9]; LER: 0.74 (0.47 to 0.88), 8.3 (3.5 to 13.2), and [-22.6 to 39.3]; SS, all patients: 0.41 (0.14 to 0.63), 2.0 (-0.5 to 4.6), and [-19.0 to 23.3]; SS, Group S: 0.36 (-0.07 to 0.68), 1.9 (-2.5 to 6.3), and [-25.0 to 28.8]; SS, Group R: 0.63 (0.32 to 0.82), 0.2 (-2.0 to 2.3), and [-14.0 to 14.4]; L, all patients: 0.49 (0.32 to 0.63), 0.7 (-1.6 to 3.0), and [-25.6 to 27.1]; L, Group S: 0.41 (0.13 to 0.63), 2.3 (-2.4 to 7.1), and [-36.7 to 41.3]; L, Group R: 0.72 (0.56 to 0.83), -0.6 (-2.2 to 1.0), and [-14.3 to 13.1]. The correlation was good except for SS in Group S. The MD was significantly different from 0 for overall recordings, during baseline and LER, but not for the other conditions. The agreement was poor except for baseline, and SS and L in Group R. Conclusions. BIS and SE are globally well correlated. In contrast, agreement is poor as differences of more than 20 units are frequently observed, except for awake and paralysed patients. [less ▲]

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See detailBlood glucose concentration profile after 10 mg dexamethasone in non-diabetic and type 2 diabetic patients undergoing abdominal surgery
Hans, Pol ULg; Vanthuyne, A.; Dewandre, Pierre-Yves et al

in British Journal of Anaesthesia (2006), 97(2), 164-170

BACKGROUND: Dexamethasone prevents postoperative nausea and vomiting but may increase blood glucose. We compared blood glucose concentrations after dexamethasone in non-diabetic and type 2 diabetic ... [more ▼]

BACKGROUND: Dexamethasone prevents postoperative nausea and vomiting but may increase blood glucose. We compared blood glucose concentrations after dexamethasone in non-diabetic and type 2 diabetic patients undergoing surgery and looked for any association with preoperative glycosylated haemoglobin [HbA (1c)] and BMI. METHODS: Sixty three patients were enrolled: 32 were non-diabetic (Group ND) and 31 type 2 diabetic (Group D) without insulin treatment. Anaesthesia was induced using i.v. anaesthetic agents and maintained with sevoflurane. All patients received 10 mg dexamethasone at induction. Blood glucose concentrations were measured at induction and then every 60 min for 240 min. Data were analysed using anova. Effects of HbA (1c) and BMI were investigated using linear correlation and logistic regression. RESULTS: Blood glucose concentrations increased significantly over time and peaked at 120 min after 10 mg dexamethasone in both groups. The magnitude of increase was comparable between the groups [mean (SD) 29 (19) and 35 (19)% of baseline in Group D and Group ND, respectively]. Maximum concentrations were higher in Group D [8.97 (1.51) mmol litre(-1), range 6.67-12.94 mmol litre(-1)] than in Group ND [7.86 (1.00) mmol litre(-1), range 5.78-10.00 mmol litre(-1)]. There was a significant correlation between the maximum concentrations and BMI (R(2)=0.21) or HbA (1c) (R(2)=0.26). Logistic regression analysis revealed that the higher the BMI, the lower the HbA (1c) threshold associated with an increased probability (>0.5) of observing blood glucose levels higher than 8.33 mmol litre(-1) during 240 min after dexamethasone administration. Similarly, the higher the HbA (1c), the lower the BMI threshold associated with the same probability. CONCLUSIONS: After 10 mg dexamethasone, blood glucose levels increase in non-diabetic and type 2 diabetic patients undergoing abdominal surgery. Poorly controlled diabetes and severe obesity can influence the development of hyperglycaemia. [less ▲]

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See detailOn knots in epidural catheters: a case report and a review of the literature
Brichant, Jean-François ULg; Bonhomme, Vincent ULg; Hans, Pol ULg

in International Journal of Obstetric Anesthesia (2006), 15(2), 159-162

A lumbar epidural catheter placed for labor analgesia proved to be difficult to remove after an uneventful delivery. With the patient in the position of catheter insertion, i.e. seated, firm and steady ... [more ▼]

A lumbar epidural catheter placed for labor analgesia proved to be difficult to remove after an uneventful delivery. With the patient in the position of catheter insertion, i.e. seated, firm and steady traction allowed removal of the catheter and revealed a knot 4 mm from its tip. Passing excessive amount of catheter into the epidural space may have contributed to this complication. Guidelines to prevent and to minimize this complication are suggested. (c) 2005 Elsevier Ltd. All rights reserved. [less ▲]

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See detailCombined use of Bispectral Index (TM) and A-Line (TM) Autoregressive Index (TM) to assess anti-nociceptive component of balanced anaesthesia during lumbar arthrodesis
Bonhomme, Vincent ULg; Llabres, V.; Dewandre, Pierre-Yves et al

in British Journal of Anaesthesia (2006), 96(3), 353-360

BACKGROUND: This study evaluated the A-Line Autoregressive Index (AAI) response to surgical stimulation during lumbar arthrodesis, as an estimate of the anti-nociceptive component of a Bispectral Index ... [more ▼]

BACKGROUND: This study evaluated the A-Line Autoregressive Index (AAI) response to surgical stimulation during lumbar arthrodesis, as an estimate of the anti-nociceptive component of a Bispectral Index (BIS) guided anaesthesia combined with epidural analgesia. METHODS: An epidural catheter was inserted in 23 patients allocated randomly to receive ropivacaine plus clonidine (Group R) or normal saline (Group S) epidurally. General anaesthesia was induced with propofol, cis-atracurium and a remifentanil infusion that was stopped 3 min after tracheal intubation, and maintained using sevoflurane to keep BIS at 50 (range 40-60). Mean arterial pressure, heart rate, end-tidal sevoflurane, BIS and AAI were analysed from 2 min before to 17 min after surgical incision. RESULTS: While BIS was maintained at 50, AAI significantly increased from a 2 min averaged value of 12 (4) to 21 (7) in Group S within the first 5 min after surgical incision, but did not change in Group R. Maximum AAI values reached during the study period were significantly higher in Group S than in Group R [38 (12) and 27 (10), respectively]. Binary logistic regression analysis allowed the calculation of AAI threshold values above which the probability of predominant nociception over anti-nociception was higher than 95%. At 1 MAC sevoflurane concentration, a 2 min averaged AAI of 35 or an AAI peak value of 62 were associated with such a probability. CONCLUSIONS: During a BIS-guided constant level of hypnosis, AAI response to the onset of surgical stimulation significantly differs according to the analgesic regimen. Further studies are needed to refine the estimation of sensitivity and specificity of this variable in assessing the balance between nociception and anti-nociception during general anaesthesia. [less ▲]

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See detailAcute bilateral submandibular swelling following surgery in prone position
Hans, Pol ULg; Demoitie, Jeannick ULg; Collignon, Laurent et al

in European Journal of Anaesthesiology (2006), 23(1), 83-84

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See detailCerebral Monitoring Devices: What We Pay For
BONHOMME, Vincent ULg; Hans, Pol ULg

in Acta Anaesthesiologica Belgica (2006), 57(4), 419-28

view paper, the authors analyse advantages, pitfalls and economical considerations related to depth of anaesthesia monitoring. They first describe the most widely distributed monitors in Europe, and the ... [more ▼]

view paper, the authors analyse advantages, pitfalls and economical considerations related to depth of anaesthesia monitoring. They first describe the most widely distributed monitors in Europe, and the physiological basis of each index. The optimal use of those monitors and their demonstrated clinical benefits are detailed, as well as the circumstances that can lead to erroneous information or interpretation. Knowledge of patients and practitioners, as well as beliefs and expectations regarding depth of anaesthesia monitoring are discussed. Finally, the authors give their own opinion regarding the use of depth of anaesthesia monitoring, according to clinical benefit and economical considerations. [less ▲]

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See detailHead Trauma
Bonhomme, Vincent ULg; Hans, Pol ULg; Brichant, Jean-François ULg

in Acta Anaesthesiologica Belgica (2006), 57(3), 239-47

this review is to provide the reader with the most commonly accepted principles for the management of head trauma patients. The initial clinical evaluation and resuscitation, radiological evaluation ... [more ▼]

this review is to provide the reader with the most commonly accepted principles for the management of head trauma patients. The initial clinical evaluation and resuscitation, radiological evaluation, monitoring, intracranial pressure and cerebral perfusion pressure management, brain protection, associated organ dysfunctions and complications, anaesthetic manage ment and the singularities of paediatric head trauma patients are described, either for the acute phase and the secondary phase of management. [less ▲]

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See detailComparative effects of ketamine on Bispectral Index and spectral entropy of the electroencephalogram under sevoflurane anaesthesia
Hans, Pol ULg; Dewandre, Pierre-Yves; Brichant, Jean-François ULg et al

in British Journal of Anaesthesia (2005), 94(3), 336-340

BACKGROUND: The Bispectral Index (BIS) and spectral entropy of the electroencephalogram can be used to assess the depth of hypnosis. Ketamine is known to increase BIS in anaesthetized patients and may ... [more ▼]

BACKGROUND: The Bispectral Index (BIS) and spectral entropy of the electroencephalogram can be used to assess the depth of hypnosis. Ketamine is known to increase BIS in anaesthetized patients and may confound that index as a guide to steer administration of hypnotics. We compared the effects of ketamine on BIS, response entropy (RE) and state entropy (SE) during surgery under sevoflurane anaesthesia. METHODS: Twenty-two women undergoing gynaecological surgery were enrolled in this double-blind, randomized study. Anaesthesia was induced i.v. and maintained with sevoflurane. Under stable surgical and anaesthetic conditions, patients were assigned to receive either a bolus of ketamine 0.5 mg kg(-1) or the same volume of saline. Blood pressure, heart rate, BIS, RE and SE were measured every 2.5 min from 10 min before (baseline) until 15 min after ketamine or saline administration. The maximum relative increase in BIS, RE and SE compared with baseline was calculated for each patient. Values are mean (sd). RESULTS: Baseline values were BIS 33 (4), RE 31 (5), SE 30 (5) for the ketamine patients and BIS 35 (3), RE 33 (5) and SE 32 (6) for the patients receiving saline. BIS, RE and SE increased significantly from 5 min (BIS) and 2.5 min (RE and SE) after ketamine administration, peaking at 46 (8) (BIS), 52 (12) (RE) and 50 (12) (SE) respectively. The maximum relative increase in RE [42.2 (10.4%)] and SE [41.6 (10.9)%] was higher than that of BIS [29.4 (10.4%)]. Blood pressure, heart rate and RE-SE gradient did not change in either group. CONCLUSIONS: Ketamine administered under sevoflurane anaesthesia causes a significant increase in BIS, RE and SE without modification of the RE-SE gradient. This increase is paradoxical in that it is associated with a deepening level of hypnosis. [less ▲]

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See detailThe Cervical Spine in Trauma: Implications for the Anaesthesiologist
Bonhomme, Vincent ULg; Hartstein, Gary ULg; Hans, Pol ULg

in Acta Anaesthesiologica Belgica (2005), 56(4), 405-11

In this paper, the authors review the most recent literature concerning the management of the cervical spine in trauma patients. They address the main topics of concern for the anaesthesiologist including ... [more ▼]

In this paper, the authors review the most recent literature concerning the management of the cervical spine in trauma patients. They address the main topics of concern for the anaesthesiologist including pre-hospital care, clearance of the cervical spine, neuroprotective therapies, difficult tracheal intubation, and management during general anaesthesia, in the intensive care unit and in paediatric patients. The most widely accepted strategies are provided as well as alternative options. [less ▲]

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See detailEffects of Nitrous Oxide on Spectral Entropy of the Eeg During Surgery under Balanced Anaesthesia with Sufentanil and Sevoflurane
Hans, Pol ULg; Dewandre, Pierre-Yves; Brichant, Jean-François ULg et al

in Acta Anaesthesiologica Belgica (2005), 56(1), 37-43

BACKGROUND: Spectral entropy of the electroencephalogram (EEG) has been proposed to monitor anaesthetic depth. We investigated the effect of nitrous oxide on response (RE) and state entropy (SE) of the ... [more ▼]

BACKGROUND: Spectral entropy of the electroencephalogram (EEG) has been proposed to monitor anaesthetic depth. We investigated the effect of nitrous oxide on response (RE) and state entropy (SE) of the EEG during lumbar disc surgery under anaesthesia with sufentanil and sevoflurane. METHODS: In an open study, anaesthesia was induced with propofol and sufentanil, and maintained with 2% end-tidal sevoflurane concentration in air/oxygen (FiO2 = 0.4) in 25 patients. During surgery, nitrous oxide was randomly administered either at 0 or at 60% end-tidal concentration in 10 (control group) and 15 patients (nitrous oxide group), respectively. RE and SE were recorded at 2.5 min intervals for 10 min before randomization and for 25 min either continuously (control) or after achieving the target nitrous oxide concentration. RESULTS: Two patients who received nitrous oxide were excluded from statistical analysis because of protocol violation. Nitrous oxide provoked a significant decrease in RE and SE from 46.2 +/- 11.1 and 44.3 +/- 11.1 to a lowest value of 27.8 +/- 8.3 and 27.1 +/- 8.9, respectively. The decrease in entropy persisted during the 25 min recording period. CONCLUSIONS: Addition of nitrous oxide during balanced anaesthesia with sufentanil and sevoflurane provokes a decrease in response and state entropy of the EEG during lumbar disc surgery. [less ▲]

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See detailPropofol scavenges reactive oxygen species and inhibits the protein nitration induced by activated polymorphonuclear neutrophils
Thiry, J. C.; Hans, Pol ULg; Deby-Dupont, G. et al

in European Journal of Pharmacology (2004), 499(1-2), 29-33

Activated polymorphonuclear neutrophils may damage tissues through the release of biochemical mediators. Among them, peroxynitrite is responsible for hydroxylation reactions and nitration of proteins, or ... [more ▼]

Activated polymorphonuclear neutrophils may damage tissues through the release of biochemical mediators. Among them, peroxynitrite is responsible for hydroxylation reactions and nitration of proteins, or is metabolised into nitrate. We investigated the effect of propofol on the production of reactive oxygen species, the nitration of proteins and the formation of nitrate by activated human polymorphonuclear neutrophils. Propofol dose-dependently inhibited chemiluminescence, nitration of proteins and nitrate production in a concentration range from 10(-3) to 10(-6) mM. A significant correlation was observed between the logarithm of propofol concentration and the intensity of chemiluminescence (r(2) = 0.90), the nitration of proteins (r(2) = 0.67) and the production of nitrate (r(2) = 0.79). Those results are consistent with the scavenging effect of propofol on peroxynitrite and could confer a protective property to propofol in pathological situations involving polymorphonuclear neutrophils activation. (C) 2004 Elsevier B.V. All rights reserved. [less ▲]

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See detailRecovery from Neuromuscular Block after an Intubation Dose of Cisatracurium and Rocuronium in Lumbar Disc Surgery
Hans, Pol ULg; Welter, Philippe ULg; Dewandre, Pierre-Yves et al

in Acta Anaesthesiologica Belgica (2004), 55(2), 129-33

BACKGROUND AND OBJECTIVE: Residual muscle paralysis remains a concern for anaesthesiologists. This study investigated the recovery from neuromuscular block (NMB) after an intubation dose of cisatracurium ... [more ▼]

BACKGROUND AND OBJECTIVE: Residual muscle paralysis remains a concern for anaesthesiologists. This study investigated the recovery from neuromuscular block (NMB) after an intubation dose of cisatracurium (C) or rocuronium (R) in 32 patients undergoing lumbar disc surgery. METHODS: Anaesthesia was induced with propofol and sufentanil, and maintained with sevoflurane in nitrous oxide/oxygen. Patients were randomised to receive twice the ED95 of either cisatracurium (GC) or rocuronium (GR) before tracheal intubation. After placement in prone position, neuromuscular transmission was monitored at the wrist by accelerometry. NMB was antagonised when the TOF ratio (TOFR) was < 0.75 at muscle closure. The time from muscle relaxant to muscle closure, and to TOFR of 0.25 and of 0.50 were recorded. Data were analysed using Student's t-tests, chi-squared tests and two-way mixed-designed ANOVA's. The prediction probability (Pk) of the times from muscle relaxant to muscle closure, and to TOFR of 0.25 for the necessity to antagonize NMB was calculated in both groups. P < 0.05 was considered statistically significant. RESULTS: NMB was antagonized in 8 (GC) and 6 (GR) patients, respectively. The time from muscle relaxant to muscle closure was shorter in patients whose NMB was antagonized. The Pk of this time was significant in GC (0.85) but not in GR (0.69). In GR contrarily to GC, the times to a TOFR of 0.25 and 0.50 were longer in patients whose NMB was antagonized. The Pk of the time to TOFR of 0.25 was significant in GR (0.95) but not in GC (0.64). CONCLUSIONS: A single dose of cisatracurium or rocuronium may be associated to some degree of NMB at the end of lumbar surgery, depending on the duration of surgery and on the duration of action of the muscle relaxant which is more variable for rocuronium than for cisatracurium. [less ▲]

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