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See detailCardiac surgery and acute kidney injury.
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; KOCH, Jean-Noël ULg et al

Conference given outside the academic context (2013)

Lecture about Cardiac surgery and acute kidney injury. Presentations of results about a retrospective study performed in the University Hospital of Liège and presentations about the protocol of a ... [more ▼]

Lecture about Cardiac surgery and acute kidney injury. Presentations of results about a retrospective study performed in the University Hospital of Liège and presentations about the protocol of a prospective study on the same topic. [less ▲]

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See detailL'insuffisance rénale aiguë dans le décours d'une chirurgie cardiaque adulte: incidence au Centre Hospitalier Universitaire de Liège
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; Defraigne, Jean-Olivier ULg et al

Scientific conference (2012, November 20)

Cadre théorique En chirurgie cardiaque, l’insuffisance rénale aiguë (IRA) est une complication postopératoire sévère et est associée à une augmentation du taux de mortalité, de morbidité et des durées de ... [more ▼]

Cadre théorique En chirurgie cardiaque, l’insuffisance rénale aiguë (IRA) est une complication postopératoire sévère et est associée à une augmentation du taux de mortalité, de morbidité et des durées de séjour aux soins intensifs (SI). Elle survient dans 5 à 30 % des cas selon le type de définition utilisée (1,2). Objectifs L’objectif de cette étude est de présenter un état des lieux de l’IRA survenant dans le décours d’une chirurgie cardiaque, dans notre Centre. Matériel et Méthodes Cette étude rétrospective inclut des patients pris en charge pour une chirurgie cardiaque entre le 1er avril 2008 et le 31 mars 2009. Les patients sélectionnés sont des opérés de : pontages aorto-coronaires avec CEC (PAC CEC), pontages aorto-coronaires à cœur battant (PAC battant), remplacement valvulaire aortique (RVA), remplacement ou réparation valvulaire mitral (RVM), ou remplacement valvulaire aortique associé à des pontages aorto-coronaires (RVA+PAC). Les insuffisants rénaux chroniques dialysés, en période préopératoire, sont exclus. La classification RIFLE (Risk, Injury, Failure, Loss and End stage kidney disease) permet de stratifier les patients en trois grades de sévérité d’IRA. Cette stratification est basée sur l’élément le plus péjoratif observé durant les 7 premiers jours postopératoires : augmentation du niveau de créatinine sérique ou diminution de la diurèse, ou diminution de la filtration glomérulaire selon les critères définis par Bellomo (3). La fréquence d’IRA est étudiée par type de chirurgie ainsi que son impact sur les durées de séjour aux SI et hospitalier. Les proportions sont comparées par un test du Chi2 et les valeurs médianes par un test U de Mann Whitney. Les résultats sont considérés comme étant significatifs au niveau d’incertitude de 5% (p<0.05). Résultats Quatre cent trente-quatre patients sont inclus : âge médian (interquartiles) 69.0 (60.0-76.0) ans, 30.2% de femmes, 2.76 de cas urgents. Cinquante-huit patients (13.4%) sont opérés par la technique PAC battant, 182 (41.9%) PAC CEC, 104 (24.0%) RVA, 44 (10.1%) RVM et 46 (10.6%) RVA+PAC. Une IRA est diagnostiquée chez 213 (49.1%) patients : 79 (37.1%) « Risk », 108 (50.7%) « Injury » et 26 (12.2%) « Failure ». La distribution d’IRA par type de chirurgie est respectivement égale à 36.2% pour le groupe PAC battant, 44.0% PAC CEC, 49.0% RVA, 52.3 RVM et 82.6% RVA+PAC. La fréquence d’IRA diffère significativement selon le type d’intervention chirurgicale (p<0.0001). Les durées de séjour aux SI sont statistiquement plus longues (p<0.0001) pour le groupe de patients ayant développé une IRA, respectivement : 3(2-4) jours versus 2(2-3) jours. Cependant, il n’y a pas de différence (p=0.65) observée entre les deux groupes (IRA et non IRA) en termes de durées de séjour hospitalier : 13 (10-18) jours versus 12 (10-16) jours. Discussion L’incidence d’IRA est très élevée dans cette population de patients, comparée aux données disponibles dans la littérature. Cela est probablement dû au fait que les trois éléments de la classification RIFLE ont été utilisés sur toute la population de l’étude. Conclusions L’IRA après chirurgie cardiaque associée à la CEC devrait être étudiée, à l’avenir pour développer des mesures préventives pour réduire les IRA. [less ▲]

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See detailCardiac surgery and acute kidney injury: retrospective study
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; Defraigne, Jean-Olivier ULg et al

Conference (2012, October 27)

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units ... [more ▼]

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units (ICU). It occurs in 5% to 30% of patients depending on the definition used [1] [2] [3]. The aim of this study is to present an overview of AKI following cardiac surgery associated or not with cardiopulmonary bypass, in our center. Methods: This retrospective study includes patients treated by cardiac surgery from April 1st, 2008 to March 31th, 2009 in a single center. We selected patients who underwent on-pump coronary artery bypass surgery (CABG), off-pump CABG (OPCAB), aortic valve replacement, mitral valve repair or replacement and aortic valve replacement combined with CABG. Patients undergoing renal replacement therapy preoperatively were excluded. The RIFLE classification (Risk, Injury, Failure, Loss and End stage kidney disease) allowed stratifying the patients into the 3 grades of AKI severity. The stratification was based on the most pejorative element observed within 7 days after surgery: increased serum creatinine level or decreased urine output, or decreased glomerular filtration rate according to criteria of Bellomo [4]. Occurrence of AKI was studied by type of cardiac surgery as its impact on the length of stay in ICU and in the hospital. Proportions were compared by the Chi-square test and median values by the Mann-Whitney U test. Results were considered significant at p < 0.05. Results: Four hundred and thirty-four patients were included: median (IQR) age 69.0(60.0-76.0) year, 30.2% females, 2.76% urgent/emergent cases. Fifty-eight patients (13.4%) underwent OPCAB, 182(41.9%) on-pump CABG, 104(24.0%) aortic valve replacement, 44(10.1%) mitral valve repair or replacement and 46(10.6%) aortic valve replacement combined with CABG. AKI occurred in 213(49.1%) patients: 79(37.1%) “Risk”, 108(50.7%) “Injury” and 26(12,2%) “Failure”. Distribution of AKI by type of surgery was equal to 36.2% among OPCABG, 44.0% on-pump CABG, 49.0% aortic valve replacement, 52.3% mitral valve surgery and 82.6% aortic valve replacement combined with CABG, respectively. AKI occurrences differed significantly according to the type of surgery (p<0.0001). Lengths of stay in ICU were significantly longer (p<0.0001) in AKI group compared with non AKI group: 3(2-4) days versus 2(2-3) days. However, no difference (p = 0.65) was observed between the two (AKI and NON-AKI) groups in hospital length of stay: 13(10-18) days versus 12(10-16) days. Conclusions: The incidence of AKI is very high in this population as compared to the literature. This may be due to the fact that the three elements of the RIFLE classification for all the population studied have been used. This study emphasizes the need for clear definition of AKI in order to compare different studies adequately. AKI after cardiac surgery with cardiopulmonary bypass would be further studied in order to develop more appropriate preventive measures. [less ▲]

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See detailCardiac surgery and acute kidney injury: retrospective study
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; Defraigne, Jean-Olivier ULg et al

Conference (2012, September 29)

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units ... [more ▼]

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units (ICU). It occurs in 5% to 30% of patients depending on the definition used [1] [2] [3]. The aim of this study is to present an overview of AKI following cardiac surgery associated or not with cardiopulmonary bypass. Methods: This retrospective study includes patients treated by cardiac surgery from April 1st, 2008 to March 31th, 2009 in a single center. We selected patients who underwent on-pump coronary artery bypass surgery (CABG), off-pump CABG (OPCAB), aortic valve replacement, mitral valve repair or replacement and aortic valve replacement combined with CABG. Patients undergoing renal replacement therapy preoperatively were excluded. The RIFLE classification (Risk, Injury, Failure, Loss and End stage kidney disease) allowed to stratify the patients into the 3 grades of AKI severity. The stratification was based on the most pejorative element observed within 7 days after surgery: increased serum creatinine level or decreased urine output, or decreased glomerular filtration rate according to criteria of Bellomo [4]. Occurrence of AKI was studied by type of cardiac surgery as its impact on the length of stay in ICU and in the hospital. Proportions were compared by the Chi-square test and median values by the Kruskal-Wallis. Results were considered significant at p < 0.05. Results: Four hundred and thirty four patients were included: median (IQR) age 69.0(60.0-76.0) year, 30.2% females, 2.76% urgent/emergent cases. Fifty-eight patients (13.4%) underwent OPCAB, 182(41.9%) on-pump CABG, 104(24.0%) aortic valve replacement, 44(10.1%) mitral valve repair or replacement and 46(10.6%) aortic valve replacement combined with CABG. AKI occurred in 213(49.1%) patients: 79(37.1%) “Risk”, 108(50.7%) “Injury” and 26(12,2%) “Failure”. Occurrence of AKI after OPCAB was 21(9.86%), CABG 80(37.6%), aortic valve replacement 51(23.9%), mitral valve surgery 23(10.8%) and aortic valve replacement combined with CABG 38(17.8%). AKI occurrences differed significantly between the different groups of surgery (p<0.0001). Lengths of stay in ICU were significantly longer (p<0.0001) in AKI group compared with non AKI group: 3(2-4) days versus 2(2-3) days. No difference (p = 0.65) was observed between the two (AKI and NON-AKI) groups in hospital length of stay: 13(10-18) days versus 12(10-16) days. Conclusions: The incidence of AKI is very high in this population as compared to the literature. This may be due to the fact that the three elements of the RIFLE classification for all the population studied have been used: serum creatinine level, urine output and glomerular filtration rate. This study emphasizes the need for clear definition of AKI in order to compare adequately different studies. AKI after cardiac surgery with cardiopulmonary bypass would be further studied in order to develop more appropriate preventive measures. [less ▲]

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See detailAnesthésie et sécurité des procédures en dehors du bloc opératoire: "l'affaire de tous"
Jastrowicz, Julie ULg; Hallet, Claude ULg; Roediger, Laurence ULg et al

in Revue Médicale de Liège (2011), 66(1), 18-24

Due to important technological improvements, anesthesiological activity outside the operating theatre is increasing. Most of these procedures are performed for gastro- enterology procedures; other ... [more ▼]

Due to important technological improvements, anesthesiological activity outside the operating theatre is increasing. Most of these procedures are performed for gastro- enterology procedures; other procedures include medical ima- ging, electroconvulsive therapy or cardioversion. The practice of anesthesia at alternative sites is associated with logistical dif- ficulties with many constraints. Anesthesia will be requested if the procedure is likely to be unpleasant or painful, if the patient is not cooperative, or if the patient’s hemodynamic condition is unstable. The pre-anesthesia assessment, an adequate monito- ring and an appropriate choice of the anesthetic technique and drugs will be helpful in managing an anesthetic procedure too frequently neglected despite it is associated with risks similar to procedures performed in the operating theatre. [less ▲]

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See detailEffect of celecoxib combined with thoracic epidural analgesia on pain after thoracotomy
Senard, Marc ULg; Deflandre, Eric; Ledoux, Didier ULg et al

in British Journal of Anaesthesia (2010), 105(2), 196-200

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See detailAnesthésie locorégionale et anti-agrégants plaquettaires: le jeu en vaut-il la chandelle?
Senard, Marc ULg; Roediger, Laurence ULg; Hubert, Marie-Bernard ULg et al

in Praticien en Anesthésie Réanimation (Le) (2010), 14

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See detailCerebral subarachnoid blood migration consecutive to a lumbar haematoma after spinal anaesthesia
Goujon-Dubois, Julie; Hans, Grégory ULg; Senard, Marc ULg et al

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

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See detailRemodelage chirurgical du ventricule gauche par endoventriculoplastie: observation clinique
Radermecker, M. A.; Canivet, J. L.; Roediger, Laurence ULg et al

in Revue Médicale de Liège (2006), 61(9), 649-52

A case of dilated ischemic cardiomyopathy, with severely impaired left ventricular systolic function, treated by endoventriculoplasty and CABG, is reported. The authors discuss the modern concepts ... [more ▼]

A case of dilated ischemic cardiomyopathy, with severely impaired left ventricular systolic function, treated by endoventriculoplasty and CABG, is reported. The authors discuss the modern concepts regarding the surgical treatment of large anterior asynergic scars following occlusion of the LAD. Since there are more similarities between akinesia and dyskinesia than previously thought, the endoventriculoplasty of DOR may constitute a new way to surgically remodel the left ventricle in dilated cardiomyopathies with large anterior akinesia. This surgery significantly improves the ventricular function and the overall patients' prognosis at short and mid term follow up. [less ▲]

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See detailThe use of pre-operative intrathecal morphine for analgesia following coronary artery bypass surgery
Roediger, Laurence ULg; Joris, Jean ULg; Senard, Marc ULg et al

in Anaesthesia (2006), 61(9), 838-844

With the emergence of rapid extubation protocols following cardiac surgery, providing adequate analgesia in the early postoperative period is important. This prospective randomised double-blind study ... [more ▼]

With the emergence of rapid extubation protocols following cardiac surgery, providing adequate analgesia in the early postoperative period is important. This prospective randomised double-blind study investigated the benefits of pre-operative intrathecal administration of low dose morphine in patients undergoing coronary artery bypass graft surgery. Postoperative analgesia, pulmonary function, stress response and postoperative recovery profile were assessed. Thirty patients were allocated into two groups, receiving either 500 mug of morphine intrathecally prior to anaesthesia and intravenous patient-controlled analgesia with morphine postoperatively following tracheal extubation, or only postoperative intravenous patient-controlled analgesia. In the intrathecal group, the total consumption of intravenous morphine following surgery was significantly reduced by 40% and patients reported lower pain scores at rest, during the first 24 h following extubation. Peak expiratory flow rate was greater and postoperative catecholamine release was significantly lower. Patients in the control group had a higher incidence of reduced respiratory rate following extubation. [less ▲]

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See detailNew approaches and old controversies to postoperative pain control following cardiac surgery
Roediger, Laurence ULg; Larbuisson, Robert ULg; Lamy, Maurice ULg

in European Journal of Anaesthesiology (2006), 23(7), 539-550

Objective: To evaluate the effect of postoperative pain control in cardiac surgical patients on morbidity, mortality and other outcome measures. Background: New approaches in pain control have been ... [more ▼]

Objective: To evaluate the effect of postoperative pain control in cardiac surgical patients on morbidity, mortality and other outcome measures. Background: New approaches in pain control have been introduced over the past decade. The impact of these interventions, either alone or in combination, on perioperative outcome was evaluated in cardiac surgical patients. Methods: We searched Medline for the period of 1980 to the present using the key terms analgesics, opioid, non-steroidal anti-inflammatory drugs, cardiac surgery, regional analgesia, spinal, epidural, fast-track cardiac anaesthesia, fast-track cardiac surgery, myocardial ischaemia, myocardial infarction, postoperative care, accelerated care programmes, postoperative complications, and we examined and discussed the articles that were identified to be included in this review. Results: Pain management in cardiac surgery is becoming more important with the establishment of minimally invasive direct coronary artery bypass surgery and fast-track management of conventional cardiac surgery patients. Advances have been made in this area and encompass specific techniques, such as central neuraxial blockade or selective nerve blocks, and drugs (opioids, sedative-hypnotics and non-steroidal anti-inflammatory drugs). Ideally, these therapies provide not only patient comfort but also mitigate untoward cardiovascular responses, pulmonary responses, and other inflammatory and secondary sympathetic responses. The introduction of these newer approaches to perioperative care has reduced morbidity, but not mortality, in cardiac surgical patients. Conclusions: Understanding perioperative pathophysiology and implementation of care regimes to reduce the stress of cardiac surgery, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge. Reorganization of the perioperative team (anaesthesiologists, surgeons, nurses and physical therapists) will be essential to achieve successful fast-track cardiac surgical programmes. Developments and improvements of multimodal interventions within the context of 'fast-track' cardiac surgery programmes represents the major challenge for the medical professionals working to achieve a 'pain and risk free' perioperative course. [less ▲]

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See detailEffect of hydroxyethylstarch on renal function in cardiac surgery: A large scale retrospective study
Wiesen, Patricia ULg; Canivet, Jean-Luc ULg; Ledoux, Didier ULg et al

in Acta Anaesthesiologica Belgica (2005), 56(3), 257-263

BACKGROUND: Recent reports indicated negative effects of hydroxyethylstarch (HES) on renal function. The goal of this large scale retrospective study was to detect whether there was an association between ... [more ▼]

BACKGROUND: Recent reports indicated negative effects of hydroxyethylstarch (HES) on renal function. The goal of this large scale retrospective study was to detect whether there was an association between postoperative deterioration of renal function and the use of HES 200 kD, 0.5 DS in the cardiac surgery setting. METHODS: Retrospective analysis of daily collected data in 3124 patients who underwent coronary artery bypass and/or valvular surgery. Three groups were compared according to differences in fluid therapy: --GEL: gelatin was used as priming fluid of extracorporeal circulation (ECC) and for postoperative filling (n = 1276). --MIX: HES was used as priming fluid of ECC an gelatin was used for postoperative filling (n = 1008). --HES: HES was used as priming fluid of ECC and for postoperative filling (n = 840). MAIN RESULTS: There were no significant differences in postoperative serum creatinine concentrations between the 3 groups: GEL: 12,2 +/- 0,5 mg/l; MIX: 12,3 +/- 0.5 mg/l; HES: 12,3 +/- 0.6 mg/l. The need for postoperative extrarenal epuration was not significantly different between the 3 periods: GEL: 2,9%; MIX: 3,1%; HES: 3,8%. CONCLUSION: The use of HES 200 kD, 0.5 DS in cardiac surgery does not seem to be associated with a clinically significant deterioration of postoperative renal function. [less ▲]

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See detailActualites en anesthésie-réanimation en chirurgie cardiaque adulte
Roediger, Laurence ULg; Larbuisson, Robert ULg; Senard, Marc ULg et al

in Revue Médicale de Liège (2004), 59(1), 35-45

Anesthetic techniques and treatment of cardiac surgery patients have considerably evolved over the past twenty years. The demand for cardiac surgical procedures is increasing. This demand coincides with a ... [more ▼]

Anesthetic techniques and treatment of cardiac surgery patients have considerably evolved over the past twenty years. The demand for cardiac surgical procedures is increasing. This demand coincides with a change in the profile of patients presenting for surgery, requiring modification in perioperative management strategies. Several new anesthetics, related drugs, and technologies have become available in recent years that inevitably have made new approaches with patient management possible. In parallel to these new developments, there have appeared real opportunities to apply novel physiologic and pharmacologic concepts that may redefine our clinical practice. Fast-tracking, which emphasizes the major role of anesthetic management in postoperative outcome, is one such line of investigation. Fast-tracking was first introduced in an attempt to decrease the time to tracheal extubation and reduce expensive time in intensive care unit areas. Large doses of opioids have been clearly identified as a factor in delaying weaning from mechanical ventilatory support after cardiac surgery. Thus, early investigations emphasized the importance of limiting the dose of potent opioid analgesics during the intraoperative period to achieve early recovery. Supplementation with hypnotic drugs allows reduction of the opioid dose, enabling earlier extubation without compromising hemodynamic stability. Fast track cardiac anesthesia (FTCA) is becoming an accepted practice for perioperative management of cardiac surgical patients. FTCA is a key component to successful conduction of fast-track cardiac surgery. Also, analgesia management in cardiac surgery is becoming more important with the establishment of minimally invasive direct coronary artery bypass surgery and fast track management of conventional cardiac surgery patients. [less ▲]

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See detailIncreased cerebral functional connectivity underlying the antinociceptive effects of hypnosis
Faymonville, Marie-Elisabeth ULg; Roediger, Laurence ULg; Del Fiore, Guy et al

in Cognitive Brain Research (2003), 17(2), 255-262

The neural mechanisms underlying the antinociceptive effects of hypnosis are not well understood. Using positron emission tomography (PET), we recently showed that the activity in the anterior cingulate ... [more ▼]

The neural mechanisms underlying the antinociceptive effects of hypnosis are not well understood. Using positron emission tomography (PET), we recently showed that the activity in the anterior cingulate cortex (midcingulate area 24a') covaries with the hypnosis-induced reduction of affective and sensory responses to noxious thermal stimulation [Faymonville et al., Anesthesiology 92 (2000) 1257-1267]. In the present study, we assessed changes in cerebral functional connectivity related to the hypnotic state, compared to simple distraction and the resting state. Nineteen highly hypnotizable right-handed volunteers were studied using (H2O)-O-15-PET. The experimental conditions were hot noxious or warm non-noxious stimulation of the right hand during resting state, mental imagery and hypnotic state. Using a psychophysiological interaction analysis, we identified brain areas that would respond to noxious stimulations under the modulatory action of the midcingulate cortex in, and only in, the hypnotic state. Hypnosis, compared to the resting state, reduced pain perception by 50%. Pain perception during rest and mental imagery was not significantly different. Analysis of PET data showed that the hypnotic state, compared to normal alertness (i.e., rest and mental imagery), significantly enhanced the functional modulation between midcingulate cortex and a large neural network encompassing bilateral insula, pregenual anterior cingulate cortex, pre-supplementary motor area, right prefrontal cortex and striatum, thalamus and brainstem. These findings point to a critical role for the midcingulate cortex in the modulation of a large cortical and subcortical network underlying its influence on sensory, affective, Cognitive and behavioral aspects of nociception, in the specific context of hypnosis. (C) 2003 Elsevier B.V. All rights reserved. [less ▲]

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See detailPeripheral vascular surgery: Update on the perioperative non-surgical management for high cardiac risk patients
Stammet, P.; Senard, Marc ULg; Roediger, Laurence ULg et al

in Acta Chirurgica Belgica (2003), 103(3), 248-254

This review of the recent literature regarding perioperative management in peripheral vascular surgery emphasizes some of the important features for the 2003 state-of-the-art on non surgical perioperative ... [more ▼]

This review of the recent literature regarding perioperative management in peripheral vascular surgery emphasizes some of the important features for the 2003 state-of-the-art on non surgical perioperative care for these high cardiac risk patients. The most adapted preoperative cardiac evaluation for each patient is guided by its individual risk factors and clinical history. Perioperative medication should nowadays consist of pre- and postoperative beta-blockers and acetyl salicylic acid, both reducing cardiac morbidity and mortality. Neuraxial locoregional anaesthesia techniques are reasonable alternatives to general anaesthesia because of their potential advantages, by reducing postoperative inflammatory response and reducing procoagulating activity, and increasing peripheral vascular graft patency, but the individual benefit/risk balance has always to be evaluated for patients submitted to aggressive antithrombotic therapy. During the postoperative course, early detection and treatment of postoperative myocardial ischemia or infarction by ST wave changes and/or cardiac enzyme control has to be considered. [less ▲]

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See detailLes morphiniques
Roediger, Laurence ULg; Lamy, Maurice ULg

in Martin, C.; Viviand, X.; Pourriat, J. L. (Eds.) Sédation et analgésie en réanimation (1998)

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See detailHypnosis as adjunct therapy in conscious sedation for plastic surgery
Faymonville, Marie ULg; Fissette, Jean ULg; Mambourg, P.-H. et al

in Regional Anesthesia (1995), 20(2), 145-151

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