53 research outputs found
Blockade of the mental nerve for lower lip surgery as a safe alternative to general anesthesia in two very old patients
No full textFerdinand Frederik Som Ling Tan,1 Sjouke Schiere,1 Auke C Reidinga,2 Fennie Wit,3 Peter HJM Veldman3 1Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands; 2Department of Anesthesiology, de Tjongerschans Hospital, Heerenveen, the Netherlands; 3Department of Surgery, de Tjongerschans Hospital, Heerenveen, the Netherlands Purpose: Regional anesthesia is gaining popularity with anesthesiologists as it offers superb postoperative analgesia. However, as the sole anesthetic technique in high-risk patients in whom general anesthesia is not preferred, some regional anesthetic possibilities may be easily overlooked. By presenting two cases of very old patients with considerable comorbidities, we would like to bring the mental nerve field block under renewed attention as a safe alternative to general anesthesia and to achieve broader application of this simple nerve block. Patients and methods: Two very old male patients (84 and 91 years) both presented with an ulcerative lesion at the lower lip for which surgical removal was scheduled. Because of their considerable comorbidities and increased frailty, bilateral blockade of the mental nerve was considered superior to general anesthesia. As an additional advantage for the 84-year-old patient, who had a pneumonectomy in his medical history, the procedure could be safely performed in a beach-chair position to prevent atelectasis and optimize the ventilation/perfusion ratio of the single lung. The mental nerve blockades were performed intraorally in a blind fashion, after eversion of the lip and identifying the lower canine. A 5 mL syringe with a 23-gauge needle attached was passed into the buccal mucosa until it approximated the mental foramen, where 2 mL of lidocaine 2% with adrenaline 1:100.000 was injected . The other side was anesthetized in a similar fashion. Results: Both patients underwent the surgical procedure uneventfully under a bilateral mental nerve block and were discharged from the hospital on the same day. Conclusion: A mental nerve block is an easy-to-perform regional anesthetic technique for lower lip surgery. This technique might be especially advantageous in the very old, frail patient. Keywords: intraoral, regional anesthesia, percutaneous, ultrasound, mental nerve bloc
Hoofdpijn na een laparotomie: Een chronisch subduraal hematoom na epidurale anesthesie
No full textEen 63-jarige man onderging een proeflaparotomie in verband met een rectumcarcinoom. De operatie werd uitgevoerd onder algehele anesthesie gecombineerd met epidurale anesthesie. Vanaf de operatie had patiënt hoofdpijnklachten; 8 weken daarna werd hij opgenomen in verband met een toename van de hoofdpijn en tevens somnolentie. Bij lichamelijk onderzoek vonden wij een lichte valneiging naar links. Op de CT-scan van de hersenen bleek er sprake te zijn van een subduraal hematoom, dat operatief werd ontlast. Wij vermoedden dat het hematoom veroorzaakt was door een accidentele durapunctie. Wij beschrijven incidentie, oorzaken, symptomen, diagnose en behandeling van deze zeldzame complicatie
Headache after a laparotomy:A chronic subdural hematoma after epidural anesthesia
No full textEen 63-jarige man onderging een proeflaparotomie in verband met een rectumcarcinoom. De operatie werd uitgevoerd onder algehele anesthesie gecombineerd met epidurale anesthesie. Vanaf de operatie had patiënt hoofdpijnklachten; 8 weken daarna werd hij opgenomen in verband met een toename van de hoofdpijn en tevens somnolentie. Bij lichamelijk onderzoek vonden wij een lichte valneiging naar links. Op de CT-scan van de hersenen bleek er sprake te zijn van een subduraal hematoom, dat operatief werd ontlast. Wij vermoedden dat het hematoom veroorzaakt was door een accidentele durapunctie. Wij beschrijven incidentie, oorzaken, symptomen, diagnose en behandeling van deze zeldzame complicatie.A 63-year-old man underwent an exploratory laparotomy because of rectal carcinoma. The operation was performed under general anaesthesia in combination with epidural anaesthesia. Since the operation the patient complained of a headache. Eight weeks after the operation he was hospitalized because of worsening of the headache and also drowsiness. A physical examination showed a slight tendency to incline to the left. A CT scan showed a subdural haematoma, which was relieved with surgery. We suspected that accidental puncture of the dura caused the haematoma. The incidence, causes, symptoms, diagnosis and treatment of this rare complication are discussed.</p
Headache after a laparotomy:A chronic subdural hematoma after epidural anesthesia
No full textEen 63-jarige man onderging een proeflaparotomie in verband met een rectumcarcinoom. De operatie werd uitgevoerd onder algehele anesthesie gecombineerd met epidurale anesthesie. Vanaf de operatie had patiënt hoofdpijnklachten; 8 weken daarna werd hij opgenomen in verband met een toename van de hoofdpijn en tevens somnolentie. Bij lichamelijk onderzoek vonden wij een lichte valneiging naar links. Op de CT-scan van de hersenen bleek er sprake te zijn van een subduraal hematoom, dat operatief werd ontlast. Wij vermoedden dat het hematoom veroorzaakt was door een accidentele durapunctie. Wij beschrijven incidentie, oorzaken, symptomen, diagnose en behandeling van deze zeldzame complicatie.A 63-year-old man underwent an exploratory laparotomy because of rectal carcinoma. The operation was performed under general anaesthesia in combination with epidural anaesthesia. Since the operation the patient complained of a headache. Eight weeks after the operation he was hospitalized because of worsening of the headache and also drowsiness. A physical examination showed a slight tendency to incline to the left. A CT scan showed a subdural haematoma, which was relieved with surgery. We suspected that accidental puncture of the dura caused the haematoma. The incidence, causes, symptoms, diagnosis and treatment of this rare complication are discussed.</p
Headache after a laparotomy:A chronic subdural hematoma after epidural anesthesia
No full textEen 63-jarige man onderging een proeflaparotomie in verband met een rectumcarcinoom. De operatie werd uitgevoerd onder algehele anesthesie gecombineerd met epidurale anesthesie. Vanaf de operatie had patiënt hoofdpijnklachten; 8 weken daarna werd hij opgenomen in verband met een toename van de hoofdpijn en tevens somnolentie. Bij lichamelijk onderzoek vonden wij een lichte valneiging naar links. Op de CT-scan van de hersenen bleek er sprake te zijn van een subduraal hematoom, dat operatief werd ontlast. Wij vermoedden dat het hematoom veroorzaakt was door een accidentele durapunctie. Wij beschrijven incidentie, oorzaken, symptomen, diagnose en behandeling van deze zeldzame complicatie.A 63-year-old man underwent an exploratory laparotomy because of rectal carcinoma. The operation was performed under general anaesthesia in combination with epidural anaesthesia. Since the operation the patient complained of a headache. Eight weeks after the operation he was hospitalized because of worsening of the headache and also drowsiness. A physical examination showed a slight tendency to incline to the left. A CT scan showed a subdural haematoma, which was relieved with surgery. We suspected that accidental puncture of the dura caused the haematoma. The incidence, causes, symptoms, diagnosis and treatment of this rare complication are discussed.</p
Headache following laparotomy; chronic subdural haematoma following epidural anaesthesia
No full textEen 63-jarige man onderging een proeflaparotomie in verband met een rectumcarcinoom. De operatie werd uitgevoerd onder algehele anesthesie gecombineerd met epidurale anesthesie. Vanaf de operatie had patiënt hoofdpijnklachten; 8 weken daarna werd hij opgenomen in verband met een toename van de hoofdpijn en tevens somnolentie. Bij lichamelijk onderzoek vonden wij een lichte valneiging naar links. Op de CT-scan van de hersenen bleek er sprake te zijn van een subduraal hematoom, dat operatief werd ontlast. Wij vermoedden dat het hematoom veroorzaakt was door een accidentele durapunctie. Wij beschrijven incidentie, oorzaken, symptomen, diagnose en behandeling van deze zeldzame complicatie.A 63-year-old man underwent an exploratory laparotomy because of rectal carcinoma. The operation was performed under general anaesthesia in combination with epidural anaesthesia. Since the operation the patient complained of a headache. Eight weeks after the operation he was hospitalized because of worsening of the headache and also drowsiness. A physical examination showed a slight tendency to incline to the left. A CT scan showed a subdural haematoma, which was relieved with surgery. We suspected that accidental puncture of the dura caused the haematoma. The incidence, causes, symptoms, diagnosis and treatment of this rare complication are discussed.</p
Fluid Resuscitation in Septic Patients Improves Systolic but not Diastolic Middle Cerebral Artery Flow Velocity
No full textTo investigate the effects of fluid resuscitation on cerebral hemodynamics in sepsis, the following set of transcranial Doppler (TCD) parameters was used: maximal change in flow velocity (FV) during stroke onset (acc), maximal FV during first (sys1) or second (sys2) phase of systole and mean diastolic FV (dias@560). We aim to evaluate changes in cerebral hemodynamics that result from (i) sepsis and (ii) adequate fluid resuscitation in critically ill septic patients. In the majority of 16 septic patients sys2 was initially absent but reappeared during the period of fluid resuscitation; whereas sys2 absence was never seen in healthy controls. Second, adequate fluid resuscitation resulted in a significant increase of the systolic FV components (acc, sys1, sys2 and systolic blood pressure); whereas the diastolic components (dias@560 and diastolic blood pressure) remained unchanged. Sys2 absence and reappearance in sepsis suggests that TCD could become a non-invasive alternative for hemodynamic monitoring
Blockade of the mental nerve for lower lip surgery as a safe alternative to general anesthesia in two very old patients
No full textPurpose: Regional anesthesia is gaining popularity with anesthesiologists as it offers superb postoperative analgesia. However, as the sole anesthetic technique in high-risk patients in whom general anesthesia is not preferred, some regional anesthetic possibilities may be easily overlooked. By presenting two cases of very old patients with considerable comorbidities, we would like to bring the mental nerve field block under renewed attention as a safe alternative to general anesthesia and to achieve broader application of this simple nerve block. Patients and methods: Two very old male patients(84 and 91 years) both presented with an ulcerative lesion at the lower lip for which surgical removal was scheduled. Because of their considerable comorbidities and increased frailty, bilateral blockade of the mental nerve was considered superior to general anesthesia. As an additional advantage for the 84-year-old patient, who had a pneumonectomy in his medical history, the procedure could be safely performed in a beach-chair position to prevent atelectasis and optimize the ventilation/perfusion ratio of the single lung. The mental nerve blockades were performed intraorally in a blind fashion, after eversion of the lip and identifying the lower canine. A 5 mL syringe with a 23-gauge needle attached was passed into the buccal mucosa until it approximated the mental foramen, where 2 mL of lidocaine 2% with adrenaline 1:100.000 was injected. The other side was anesthetized in a similar fashion. Results: Both patients underwent the surgical procedure uneventfully under a bilateral mental nerve block and were discharged from the hospital on the same day. Conclusion: A mental nerve block is an easy-to-perform regional anesthetic technique for lower lip surgery. This technique might be especially advantageous in the very old, frail patient
Trends in hospital and intensive care admissions in the Netherlands attributable to the very elderly in an ageing population
No full textAbstract Introduction: The Dutch population is ageing and it is unknown how this is affecting trends in the percentage of hospital and intensive care unit (ICU) admissions attributable to patients aged 80 years or older, the very elderly. Methods: We present data on the percentage of the very elderly in the general population and the percentage of hospital admissions attributable to the very elderly. We subsequently performed a longitudinal cross-sectional study on ICU admissions from hospitals participating in the National Intensive Care Evaluation registry for the period 2005 to 2014. We modeled the percentage of adult ICU admissions and treatment days attributable to the very elderly separately for ICU admissions following cardiac surgery and other reasons
Trends in hospital and intensive care admissions in the Netherlands attributable to the very elderly in an ageing population
No full textThe Dutch population is ageing and it is unknown how this is affecting trends in the percentage of hospital and intensive care unit (ICU) admissions attributable to patients aged 80 years or older, the very elderly. We present data on the percentage of the very elderly in the general population and the percentage of hospital admissions attributable to the very elderly. We subsequently performed a longitudinal cross-sectional study on ICU admissions from hospitals participating in the National Intensive Care Evaluation registry for the period 2005 to 2014. We modeled the percentage of adult ICU admissions and treatment days attributable to the very elderly separately for ICU admissions following cardiac surgery and other reasons. The percentage of Dutch adults aged 80 years and older, increased from 4.5 % in 2005 to 5.4 % in 2014 (p-value < 0.0001) and with this ageing of the population, the percentage of hospital admissions attributable to very elderly increased from 9.0 % in 2005 to 10.6 % in 2014 (p-value < 0.0001). The percentage of ICU admissions following cardiac surgery attributable to the very elderly increased from 6.7 % in 2005 to 11.0 % in 2014 in nine hospitals (p-value < 0.0001), while the percentage of treatment days attributable to this group rose from 8.6 % in 2005 to 11.7 % in 2014 (p-value = 0.0157). In contrast, the percentage of very elderly patients admitted to the ICU for other reasons than following cardiac surgery remained stable at 13.8 % between 2005 and 2014 in 33 hospitals (p-value = 0.1315). The number of treatment days attributable to the very elderly rose from 11,810 in 2005 to 15,234 in 2014 (p-value = 0.0002), but the percentage of ICU treatment days attributable to this group remained stable at 12.0 % (p-value = 0.1429). As in many European countries the Dutch population is ageing and the percentage of hospital admissions attributable to the very elderly rose between 2005 and 2014. However, the percentage of ICU admissions and treatment days attributable to very elderly remained stable. The percentage of ICU admissions following cardiac surgery attributable to this group increased between 2005 and 201
- …
