Revelations from the unconscious: studying residual brain function in coma and related states.

in Bulletin et Mémoires de l'Académie Royale de Médecine de Belgique (2008), 163(7-9), 381-8388-90

The purpose of our research is to contribute to a better understanding of the residual brain function of patients who survive an acute brain damage but remain in a coma, vegetative state, minimally ... [more ▼]

The purpose of our research is to contribute to a better understanding of the residual brain function of patients who survive an acute brain damage but remain in a coma, vegetative state, minimally conscious state or locked-in syndrome. The diagnosis, prognosis, therapy and medical management of these patients remain difficult. These studies are also of interest scientifically, as they help to elucidate the neural correlates of human consciousness. We here review our studies on bedside behavioral evaluation scales, electrophysiology and functional neuroimaging in these disorders of consciousness and conclude by discussing methodological and ethical issues and current concepts of the standards for care and quality of life in these challenging conditions. [less ▲]

Hypnose et perception de la douleur

in Revue Médicale de Liège (2008), 63(5-6), 424-8

Improvement in functional neuroimaging allows researchers to disentangle the brain mechanisms involved in the pain modulation encountered during hypnosis. It has been shown that the anterior cingulate and ... [more ▼]

Improvement in functional neuroimaging allows researchers to disentangle the brain mechanisms involved in the pain modulation encountered during hypnosis. It has been shown that the anterior cingulate and prefrontal cortices are important in the modulation of incoming sensory and noxious input. Moreover, clinical studies in certain types of surgery (eg thyroidectomy, mastectomy and plastic surgery) have demonstrated that hypnosis may avoid general anesthesia. [less ▲]

Cerebral subarachnoid blood migration consecutive to a lumbar haematoma after spinal anaesthesia

in Acta Anaesthesiologica Belgica (2008), 59(3), 223

Diagnostic and prognostic use of bispectral index in coma, vegetative state and related disorders

in Brain Injury (2008), 22(12), 926-931

Cerebral subarachnoid blood migration consecutive to a lumbar haematoma after spinal anaesthesia

in Acta Anaesthesiologica Scandinavica (2008), 52

Prise en charge de la douleur en pediatrie apres chirurgie ambulatoire

in Revue Médicale de Liège (2007), 62(11), 679-84

Over the last fifteen years, child's pain has become one of our major concerns. In spite of this evolution, it remains one of the most frequent complications after ambulatory surgery. It is thus essential ... [more ▼]

Over the last fifteen years, child's pain has become one of our major concerns. In spite of this evolution, it remains one of the most frequent complications after ambulatory surgery. It is thus essential to implement all the resources we have at our disposal in order to optimize pain management. This can be obtained by basing our strategy on the concept of multimode analgesia. It is consequently essential that each team can achieve its own quality program; the corollary will be the development of clear recommendations for the parents with a systematic analgesics regulation at home and the possibility to resort to the family doctor or to the ambulatory centre in the event of persistence of pain. [less ▲]

Preconditioning and protection against ischaemia-reperfusion in non-cardiac organs: a place for volatile anaesthetics?

in European Journal of Anaesthesiology (2007), 24(9), 733-745

There is an increasing body of evidence that volatile anaesthetics protect myocardium against ischaemic insult by a mechanism termed 'anaesthetic preconditioning'. Anaesthetic preconditioning and ... [more ▼]

There is an increasing body of evidence that volatile anaesthetics protect myocardium against ischaemic insult by a mechanism termed 'anaesthetic preconditioning'. Anaesthetic preconditioning and ischaemic preconditioning share several common mechanisms of action. Since ischaemic preconditioning has been demonstrated in organs other than the heart, anaesthetic preconditioning might also apply in these organs and have significant clinical applications in surgical procedures carrying a high risk of ischaemia-reperfusion injury. After a brief review on myocardial preconditioning, experimental and clinical data on preconditioning in non-cardiac tissues will be presented. Potential benefits of anaesthetic preconditioning during non-cardiac surgery will be addressed. [less ▲]

Actualites therapeutiques en anesthesie-reanimation: cap sur l'hopital de jour

in Revue Médicale de Liège (2007), 62(5-6, May-Jun), 272-6

The one day clinic possesses its own structure and organisation; patient management is also specific. Preoperative visit and assessment are programmed at least 48 hours before anesthesia. Preoperative ... [more ▼]

The one day clinic possesses its own structure and organisation; patient management is also specific. Preoperative visit and assessment are programmed at least 48 hours before anesthesia. Preoperative examinations and choice of anesthetic technique (sedation associated with local anesthesia or not, general anesthesia, locoregional anesthesia, or hypnosedation) are discussed and determined depending upon medical history, clinical examination, and type of procedure. General recommandations, instructions about fasting, interruption of some therapies, and introduction of new medication(s) are explained orally and also provided in a written document. New anesthetics and analgesics allow quick awakening and recovery of vital functions, and subsequently rapid hospital discharge. Prevention and aggressive treatment of postoperative nausea and vomiting are also a major concern in our anesthesic management of ambulatory patient. [less ▲]

Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy

in Anesthesiology (2007), 106(1), 11-85-6

BACKGROUND: Intravenous infusion of lidocaine decreases postoperative pain and speeds the return of bowel function. The authors therefore tested the hypothesis that perioperative lidocaine infusion ... [more ▼]

BACKGROUND: Intravenous infusion of lidocaine decreases postoperative pain and speeds the return of bowel function. The authors therefore tested the hypothesis that perioperative lidocaine infusion facilitates acute rehabilitation protocol in patients undergoing laparoscopic colectomy. METHODS: Forty patients scheduled to undergo laparoscopic colectomy were randomly allocated to receive intravenous lidocaine (bolus injection of 1.5 mg/kg lidocaine at induction of anesthesia, then a continuous infusion of 2 mg.kg.h intraoperatively and 1.33 mg.kg.h for 24 h postoperatively) or an equal volume of saline. All patients received similar intensive postoperative rehabilitation. Postoperative pain scores, opioid consumption, and fatigue scores were measured. Times to first flatus, defecation, and hospital discharge were recorded. Postoperative endocrine (cortisol and catecholamines) and metabolic (leukocytes, C-reactive protein, and glucose) responses were measured for 48 h. Data (presented as median [25-75% interquartile range], lidocaine vs. saline groups) were analyzed using Mann-Whitney tests. P<0.05 was considered statistically significant. RESULTS: Patient demographics were similar in the two groups. Times to first flatus (17 [11-24] vs. 28 [25-33] h; P<0.001), defecation (28 [24-37] vs. 51 [41-70] h; P=0.001), and hospital discharge (2 [2-3] vs. 3 [3-4] days; P=0.001) were significantly shorter in patients who received lidocaine. Lidocaine significantly reduced opioid consumption (8 [5-18] vs. 22 [14-36] mg; P=0.005) and postoperative pain and fatigue scores. In contrast, endocrine and metabolic responses were similar in the two groups. CONCLUSIONS: Intravenous lidocaine improves postoperative analgesia, fatigue, and bowel function after laparoscopic colectomy. These benefits are associated with a significant reduction in hospital stay. [less ▲]

Effects of perioperative i.v. infusion of low dose ketamine associated with thoracic epidural analgesia for abdominal aortic surgery on postoperative analgesia and early postoperative outcome

in Acta Anaesthesiologica Belgica (2007), 58(3), 219