Massive transfusion protocol: a local two years' experience.
TONGLET, Martin ; ; et al
in Acta Anaesthesiologica Belgica (2015), 66
Evidence supporting the implementation of a Massive Transfusion Protocol (MTP) and its effect on patients’ outcome is still limited. However, we implemented in June 2013 a local MTP for trauma and ... [more ▼]
Evidence supporting the implementation of a Massive Transfusion Protocol (MTP) and its effect on patients’ outcome is still limited. However, we implemented in June 2013 a local MTP for trauma and nontrauma massively bleeding patients. Twenty months later, we propose here a short presentation of our MTP population and a critical analysis of the actual data supporting MTP implementation. [less ▲]Detailed reference viewed: 5 (1 ULg)
Catastrophic antiphospholipid syndrome : case reports and review of the literature
; LAYIOS, Nathalie ; DAMAS, Pierre
in Acta Anaesthesiologica Belgica (2014), 65Detailed reference viewed: 34 (6 ULg)
Preeclampsia: an update.
LAMBERT, Géraldine ; BRICHANT, Jean-François ; Hartstein, Gary et al
in Acta anaesthesiologica Belgica (2014), 65(4), 137-49
Preeclampsia was formerly defined as a multisystemic disorder characterized by new onset of hypertension (i.e. systolic blood pressure (SBP) >/= 140 mmHg and/or diastolic blood pressure (DBP) >/= 90 mmHg ... [more ▼]
Preeclampsia was formerly defined as a multisystemic disorder characterized by new onset of hypertension (i.e. systolic blood pressure (SBP) >/= 140 mmHg and/or diastolic blood pressure (DBP) >/= 90 mmHg) and proteinuria (> 300 mg/24 h) arising after 20 weeks of gestation in a previously normotensive woman. Recently, the American College of Obstetricians and Gynecologists has stated that proteinuria is no longer required for the diagnosis of preeclampsia. This complication of pregnancy remains a leading cause of maternal morbidity and mortality. Clinical signs appear in the second half of pregnancy, but initial pathogenic mechanisms arise much earlier. The cytotrophoblast fails to remodel spiral arteries, leading to hypoperfusion and ischemia of the placenta. The fetal consequence is growth restriction. On the maternal side, the ischemic placenta releases factors that provoke a generalized maternal endothelial dysfunction. The endothelial dysfunction is in turn responsible for the symptoms and complications of preeclampsia. These include hypertension, proteinuria, renal impairment, thrombocytopenia, epigastric pain, liver dysfunction, hemolysis-elevated liver enzymes-low platelet count (HELLP) syndrome, visual disturbances, headache, and seizures. Despite a better understanding of preeclampsia pathophysiology and maternal hemodynamic alterations during preeclampsia, the only curative treatment remains placenta and fetus delivery. At the time of diagnosis, the initial objective is the assessment of disease severity. Severe hypertension (SBP >/= 160 mm Hg and/or DBP >/= 110 mmHg), thrombocytopenia < 100.000/muL, liver transaminases above twice the normal values, HELLP syndrome, renal failure, persistent epigastric or right upper quadrant pain, visual or neurologic symptoms, and acute pulmonary edema are all severity criteria. Medical treatment depends on the severity of preeclampsia, and relies on antihypertensive medications and magnesium sulfate. Medical treatment does not alter the course of the disease, but aims at preventing the occurrence of intracranial hemorrhages and seizures. The decision of terminating pregnancy and perform delivery is based on gestational age, maternal and fetal conditions, and severity of preeclampsia. Delivery is proposed for patients with preeclampsia without severe features after 37 weeks of gestation and in case of severe preeclampsia after 34 weeks of gestation. Between 24 and 34 weeks of gestation, conservative management of severe preeclampsia may be considered in selected patients. Antenatal corticosteroids should be administered to less than 34 gestation week preeclamptic women to promote fetal lung maturity. Termination of pregnancy should be discussed if severe preeclampsia occurs before 24 weeks of gestation. Maternal end organ dysfunction and non-reassuring tests of fetal well-being are indications for delivery at any gestational age. Neuraxial analgesia and anesthesia are, in the absence of thrombocytopenia, strongly considered as first line anesthetic techniques in preeclamptic patients. Airway edema and tracheal intubation-induced elevation in blood pressure are important issues of general anesthesia in those patients. The major adverse outcomes associated with preeclampsia are related to maternal central nervous system hemorrhage, hepatic rupture, and renal failure. Preeclampsia is also a risk factor for developing cardiovascular disease later in life, and therefore mandates long-term follow-up. [less ▲]Detailed reference viewed: 73 (30 ULg)
Is the "in situ" simulation for teaching anesthesia residents a lower cost, feasible and satisfying alternative to simulation center ? A 24 months prospective observational study in a university hospital.
Lois, Fernande ; ; et al
in Acta Anaesthesiologica Belgica (2014)Detailed reference viewed: 17 (1 ULg)
Quality of the preoperative medication history for the patients scheduled for total hip replacement or total knee replacement at the CHU of Liege (QAMP-STUDY)
STAQUET, Cécile ; ; REMY, Bernadette et al
in Acta Anaesthesiologica Belgica (2014), 65(3), 132Detailed reference viewed: 60 (11 ULg)
Should the "in situ" simulation become the new way in Belgium? Experience of an academic hospital.
; Lois, Fernande ; et al
in Acta Anaesthesiologica Belgica (2013), 64(4), 147-52
The place of simulation in medical education, particularly in anesthesia, appears to be more and more evident. However, the history of simulation in Belgium showed that the associated costs remain a ... [more ▼]
The place of simulation in medical education, particularly in anesthesia, appears to be more and more evident. However, the history of simulation in Belgium showed that the associated costs remain a barrier. The use of 'in situ' simulation, defined as the practice of simulation in the usual workplace, could solve the problem of providing access to this educational tool. Indeed, it allows reducing equipment and manpower costs: the needed equipment comes from the hospital, and supervision and organization are provided by staff members. It also provides access to simulation for a larger number of individuals on site. The environment is more realistic because the participants operate in their usual workplace, with their customary equipment and team. Furthermore, 'in situ' simulation allows participation of the paramedical staff. This allows developing skills related to teamwork and communication. Despite those numerous advantages, several difficulties persist. The associated logistic and organizational constraints can be cumbersome. [less ▲]Detailed reference viewed: 19 (2 ULg)
Intraoperative recruitment does not affect postoperative restrictive pulmonary syndrome and hypoxaemia after laparoscopic gastric by-pass in morbidly obese patients: A randomised controlled study
BINDELLE, Simon ; GOFFIN, Pierre ; HANS, Grégory et al
in Acta Anaesthesiologica Belgica (2013), 64(3), 124
[No abstract available]Detailed reference viewed: 75 (16 ULg)
Editorial. Nursing Aid Specialized in Anesthesia and Resuscitation (NASAR): why should we promote the involvement of anesthesia helping nurses within the current and future Belgian anesthesia field?
; ; BONHOMME, Vincent
in Acta Anaesthesiologica Belgica (2012), 63(1), 1-2Detailed reference viewed: 40 (0 ULg)
Nursing aid specialized in anesthesia and resuscitation (NASAR): why should we promote the involvement of anesthesia helping nurses within the current and future Belgian anesthesia field?
; ; BONHOMME, Vincent
in Acta Anaesthesiologica Belgica (2012), 63(1), 1-2Detailed reference viewed: 53 (6 ULg)
Measuring end expiratory lung volume after cardiac surgery
MICHIELS, Grégoire ; ; LEDOUX, Didier et al
in Acta Anaesthesiologica Belgica (2012), 63(3), 115-120Detailed reference viewed: 25 (3 ULg)
Opioids and protection against ischemia-reperfusion injury: from experimental data to potential clinical applications
MINGUET, Grégory ; Brichant, Jean-François ; JORIS, Jean
in Acta Anaesthesiologica Belgica (2012), 63(1), 23-34Detailed reference viewed: 17 (3 ULg)
Linking sleep and general anesthesia mechanisms: this is no walkover
BONHOMME, Vincent ; BOVEROUX, Pierre ; Vanhaudenhuyse, Audrey et al
in Acta Anaesthesiologica Belgica (2011), 62(3), 161-171Detailed reference viewed: 161 (18 ULg)
Surgical resection of a sphenoid wing meningioma in a patient with Glanzmann thrombasthenia.
WERTZ, Damien ; Boveroux, Pierre ; PETERS, Pierre et al
in Acta anaesthesiologica Belgica (2011), 62(2), 83-6
Glanzmann thrombasthenia (GT) is a rare autosomal recessive disorder characterized by a deficiency or functional defect of platelet glycoprotein (GP) IIb/IIIa. Physiologically, this platelet receptor ... [more ▼]
Glanzmann thrombasthenia (GT) is a rare autosomal recessive disorder characterized by a deficiency or functional defect of platelet glycoprotein (GP) IIb/IIIa. Physiologically, this platelet receptor mediates aggregation of activated platelets by binding the adhesive proteins, fibrinogen, von Willebrand factor (VWF) and fibronectin. This facilitates attachment and aggregation of platelets at sites of vascular injury. We reported the management of a pterional meningioma resection in a patient with Glanzmann thrombasthenia, with recombinant factor VIIa (rFVIIa - NovoSeven) as haemostatic agent. A 48-year-old woman suffering from Glanzmann thrombasthenia was scheduled for spheno-orbital meningioma en plaque surgery. Because of repeated platelet transfusions, this patient developed isoantibodies against missing GPIIbIIIa and alloantibodies against Human Leukocyte Antigen (HLA) leading to refractoriness to platelet transfusions. We observed that Novoseven offered sufficient haemostasis conditions. Therefore, we noticed a deep vein thrombosis. This imposed us to use low weight molecular heparin despite recent surgery. [less ▲]Detailed reference viewed: 55 (14 ULg)
Maintaining the communication and information tool of the Belgian anesthesiology community
in Acta Anaesthesiologica Belgica (2011), 62(4), 173-174Detailed reference viewed: 18 (0 ULg)
Unexpected entropy response to saline spraying at the end of posterior fossa surgery: a few cases report.
; BONHOMME, Vincent ; et al
in Acta anaesthesiologica Belgica (2011), 62(2), 87-90
The Spectral Entropy proposed to monitor the depth of anesthesia includes the State Entropy (SE) computed from the EEG (0.8-32 Hz frequency band), and the Response Entropy (RE) computed from EEG and ... [more ▼]
The Spectral Entropy proposed to monitor the depth of anesthesia includes the State Entropy (SE) computed from the EEG (0.8-32 Hz frequency band), and the Response Entropy (RE) computed from EEG and facial muscles activity (0.5-47 Hz frequency band). We report an unexpected Entropy response to saline spraying at the end of posterior fossa surgery. Six patients undergoing scheduled functional surgery of the posterior fossa were included in this report. They were anesthetized with propofol and remifentanil using TCI and received an intubation dose of rocuronium. At the end of surgery, saline spraying, performed for hemostatic purpose and wreckage elimination, resulted in a sustained increase in RE and SE without hemodynamic modification in four patients, while no change was observed in the two other ones. In one of the responding patients, 0.1 mg kg(-1) rocuronium attenuated the Entropy response. In the two non responders, repetition of spraying or rocuronium administration did not change Entropy value. Recovery from anesthesia was comparable in all patients and none of them complained from awareness. We conclude that Entropy can increase during posterior fossa surgery in non-paralyzed patients. This response probably reflects an increase in facial muscle activity rather than a change in depth of anesthesia, as far as it can be attenuated by a small dose of rocuronium. While this hypothesis requires further investigation, these observations suggest that saline spraying may confound interpretation of Entropy during posterior fossa surgery. [less ▲]Detailed reference viewed: 209 (4 ULg)
Lipomatous hypertrophy of the interatrial septum: the typical echographic aspect is worth being known
ROYER, Ludovic ; HANS, Grégory ; CANIVET, Jean-Luc et al
in Acta Anaesthesiologica Belgica (2011), 62(3), 157-159Detailed reference viewed: 44 (14 ULg)
Sevoflurane facial mask induction in children: using two different techniques end to comparable intubation conditions but different Bispectral Index values
Dabee, Loïc ; Hallet, Claude ; Venneman, Ingrid et al
in Acta Anaesthesiologica Belgica (2010, June 19), 61(2), 94Detailed reference viewed: 46 (0 ULg)
Antiplatelet therapy in the perioperative period.
; ; Van Damme, Hendrik et al
in Acta Anaesthesiologica Belgica (2010), 61
antiplatelet drugs are the cornerstone treatment in the secondary prevention of arterial thrombosis. Until recently, their intake was interrupted in the perioperative period because of fear for bleeding ... [more ▼]
antiplatelet drugs are the cornerstone treatment in the secondary prevention of arterial thrombosis. Until recently, their intake was interrupted in the perioperative period because of fear for bleeding, but new insights have challenged this old habit. in patients at high risk for atherothrombotic events who need to undergo surgery or an invasive procedure, the risk for bleeding complications because of a treatment with low-dose acetylsalicylic acid (lD aSa) needs to be balanced against the risk of atherothrombotic events after treatment discontinuation. for patients at high risk of atherothrombotic complications recent guidelines do no longer advocate to interrupt lD aSa routinely. However, the likelihood of bleeding versus atherothrombotic complications should be considered on a case-by-case basis. when continued perioperatively, the bleeding risk associated with thienopyridines (ticlopidine, clopidogrel and prasugrel) is higher than that of lD aSa. it is recommended to stop their intake 1 week before the surgical intervention, except in patients with (recent) coronary stenting [less ▲]Detailed reference viewed: 16 (1 ULg)
Intracranial subdural hematoma following spinal anesthesia: case report and review of the literature
; ; et al
in Acta Anaesthesiologica Belgica (2010), 61(2), 63-66Detailed reference viewed: 34 (2 ULg)
Effect of the transversus abdominis plane block on pain after laparoscopic inguinal hernia repair
; ; Detry, Olivier et al
in Acta Anaesthesiologica Belgica (2009, September 19), 60(3), 205Detailed reference viewed: 75 (5 ULg)