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See detailWhat is the outcome of intraoperative management? Reply
Hans, Grégory ULg; Sottiaux, Thierry; Joris, Jean ULg

in European Journal of Anaesthesiology (2010), 27

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See detailVentilatory management during routine general anaesthesia
Hans, Grégory ULg; Sottiaux, Thierry; Lamy, Maurice ULg et al

in European Journal of Anaesthesiology (2009), 26(1), 1-8

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See detailAwake craniotomy
Bonhomme, Vincent ULg; Franssen, Colette ULg; Hans, Pol ULg

in European Journal of Anaesthesiology (2009), 26(11), 906-912

Awake craniotomy has become an increasingly frequent procedure. In this paper, the principles of its anaesthetic management are reviewed. The means allowing achievement of anaesthetic objectives are ... [more ▼]

Awake craniotomy has become an increasingly frequent procedure. In this paper, the principles of its anaesthetic management are reviewed. The means allowing achievement of anaesthetic objectives are described, with emphasis on points that determine success of the procedure. A careful and adequate selection and preparation of patients are mandatory, and the intervening team must be a skilled team. Choosing an awake technique or general anaesthesia depends on several factors, including the risk of obstructive apnoea, seizures, nausea and vomiting, patient's ability to cooperate, and localization of lesions. The main challenge of intraoperative anaesthetic management relies on the ability of rapidly adjusting the level of sedation and analgesia according to the sequence of surgical events, while ensuring haemodynamic stability, adequate ventilation, and minimal interference with eventual eletrophysiological recordings. Throughout the procedure, complications must be anticipated and managed according to predefined guidelines. More prospective randomized clinical trials are still needed to improve safety and efficacy of awake craniotomies, as well as to validate this technique in comparison with more conventional anaesthetic management. [less ▲]

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See detailPreconditioning and protection against ischaemia-reperfusion in non-cardiac organs: a place for volatile anaesthetics?
Minguet, Grégory ULg; Joris, Jean ULg; Lamy, Maurice ULg

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 ▲]

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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 detailReporting systems in healthcare from a case-by-case experience to a general framework: an example in anaesthesia
Nyssen, Anne-Sophie ULg; Aunac, Sophie; Faymonville, Marie-Elisabeth ULg et al

in European Journal of Anaesthesiology (2004), 21(10), 757-765

Reporting systems are becoming more widespread in healthcare. Since they may become mandatory under the pressure of insurance companies and administrative organizations, it is important to begin to go ... [more ▼]

Reporting systems are becoming more widespread in healthcare. Since they may become mandatory under the pressure of insurance companies and administrative organizations, it is important to begin to go beyond a case-by-case approach and to move to a system where there is a general reflection on the best conditions of development and setting up of such systems in medicine. In this paper, we review existing reporting systems, break down their components, examine how they are constructed and propose some ideas on how to articulate them in a dynamic process in order to improve the validity of the tool as mediator of safety, quality and well-being at work. [less ▲]

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See detailMonitoring depth of anaesthesia: is it worth the effort?
Bonhomme, Vincent ULg; Hans, Pol ULg

in European Journal of Anaesthesiology (2004), 21(6), 423-8

In this review paper, the authors critically analyse the use of a number of depth of anaesthesia monitors in light of the most recent literature and their own clinical experience. There appears to be ... [more ▼]

In this review paper, the authors critically analyse the use of a number of depth of anaesthesia monitors in light of the most recent literature and their own clinical experience. There appears to be increasing evidence that anaesthesia depth monitors reduce the incidence of unexpected intraoperative awareness and also that they improve the quality of anaesthesia. Proper use of these monitors necessitates background knowledge about the physiology of the loss of consciousness, the type of variable recorded and processed by the monitoring devices, the factors that might interfere with recording and the limits of use. The information provided by anaesthesia depth monitors is detailed and relationships with clinical practice are established to provide the reader with key features for optimal use of those monitors and correct interpretation of data. Practitioners and patient's knowledge and expectations regarding this matter, as well as the cost-benefit relationship are also discussed. [less ▲]

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See detailPotential neuroprotective properties of atracurium and cisatracurium in neurosurgical anaesthesia
Hans, Pol ULg; Bonhomme, Vincent ULg

in European Journal of Anaesthesiology (2004), 21(4), 334-335

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See detailThe rationale for perioperative brain protection
Hans, Pol ULg; Bonhomme, Vincent ULg

in European Journal of Anaesthesiology (2004), 21(1), 1-5

Perioperative brain protection refers to prophylactic measures instituted during the perioperative period to prevent or reduce ischaemic damage and to improve neurological outcome. In that context ... [more ▼]

Perioperative brain protection refers to prophylactic measures instituted during the perioperative period to prevent or reduce ischaemic damage and to improve neurological outcome. In that context, strategies for protecting the brain rely on the control of physiological variables, anaesthesia, administration of non-anaesthetic pharmacological agents and preconditioning. Avoiding hyperthermia, hyperglycaemia and arterial hypotension are passive neuroprotective measures acknowledged in human beings. The protective effect of anaesthesia, compared to the awake state, is demonstrated in animals but remains to be validated in clinical practice. Laboratory studies investigating pharmacological neuroprotection have shown interesting results but most clinical trials have been disappointing except for a few drugs in specific settings. Preconditioning which results in the induction of some resistance to ischaemia appears as a promising strategy. Up to now, the translation of beneficial experimental results into clinical success is considered an entirely permissible hope but remains an unachieved objective. [less ▲]

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See detailMuscle relaxants in neurosurgical anaesthesia: a critical appraisal.
Hans, Pol ULg; Bonhomme, Vincent ULg

in European Journal of Anaesthesiology (2003), 20(8), 600-5

The use of muscle relaxants, considered until recently as common practice in current neurosurgical anaesthesia protocols, becomes increasingly more questionable today. The reasons rely on the evolution of ... [more ▼]

The use of muscle relaxants, considered until recently as common practice in current neurosurgical anaesthesia protocols, becomes increasingly more questionable today. The reasons rely on the evolution of neurosurgery including the advent of new surgical techniques, the evolution of anaesthesia having the benefit of new drugs and devices, and the rationale for using muscle relaxants balanced against their potential side-effects and possible pharmacodynamic alterations in neurosurgical patients. [less ▲]

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See detailManagement of Difficult Intubation
Janssens, Marc ULg; Hartstein, Gary ULg

in European Journal of Anaesthesiology (2001), 18(1), 3-12

Appropriate airway management is an essential part of the anaesthetist's role. Difficult intubation, which can now be quantified using the 'Intubation Difficulty Scale', should be anticipated whenever ... [more ▼]

Appropriate airway management is an essential part of the anaesthetist's role. Difficult intubation, which can now be quantified using the 'Intubation Difficulty Scale', should be anticipated whenever possible. A strategy needs to be developed in order to anticipate problems. The first part of this paper reviews the different factors that contribute to make intubation and/or ventilation difficult. Problems with intubation (or ventilation of the lungs) can be caused by abnormal laryngeal structures (e.g. tumour, stenosis), or by difficulty in seeing the glottis. The clinical history will usually help identify the former problem, while physical examination of the airway is required to reveal either disproportion between the various structures of the airway (e.g. tongue, larynx), and/or difficulties in aligning the oral, pharyngeal, and laryngeal axes. The different techniques used to diagnose these problems are described. The second part of this paper summarizes the algorithms used by the anaesthetist when management of the airway is found difficult. Three situations are considered: (a) anticipated difficult intubation, for which awake fibreoptic intubation would appear to be the technique of choice in the majority of cases, (b) unforeseen difficult intubation in a patient whose lungs can be ventilated; here, various techniques for control of the airway will be briefly described, and (c) both tracheal intubation and lung ventilation are impossible; this is a life-threatening emergency, for which three solutions are proposed. These include use of the laryngeal mask airway, the Combitube, or transtracheal ventilation. These situations will be analysed with the aim of proposing management strategies that always guarantee the safety of the patient. [less ▲]

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See detailOxidative Stress in Clinical Situations--Fact or Fiction?
Pincemail, Joël ULg; Defraigne, Jean-Olivier ULg; Limet, Raymond ULg

in European Journal of Anaesthesiology (1996), 13(3), 219-34

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