221 research outputs found
The effect of anesthesia on hemodynamics and outcome of patients undergoing thrombectomy after acute ischemic stroke: a retrospective analysis
No full textBackground Anesthesia during thrombectomy remains a matter of debate. We retrospectively investigated the influence of intraprocedural blood pressure and type of anaesthetic agent on 3-month functional outcome and mortality in stroke patients undergoing mechanical thrombectomy under general anesthesia in a single center study.Methods All patients suffering from stroke who presented between January 2019 and July 2021 at Ziekenhuis Oost-Limburg Genk, Belgium and who received thrombectomy were included. Patient's characteristics and outcome data had been collected for benchmarking. Detailed perioperative data were exported from the electronic anesthesia records and clinically validated. Patients were stratified by peri-operative presence of hypotension (MAP = 65 mmHg).Results All 98 patients received mechanical thrombectomy under general anesthesia. Thirty-six percent (n = 35) was hypotensive peri-operatively at any time point. Proportion of sevoflurane use was higher in non-hypotensive patients compared to hypotensive patients (73% (n = 45) vs. 51% (n = 18), p = 0.04). Peri-operative use of vasopressors was higher in the hypotensive group compared to non-hypotensive (88% (n = 30) vs. 63% (n = 39), p = 0.008). Proportion of patients with good functional outcome at 3 months (mRS 0-2) was higher in non-hypotensive patients compared to hypotensive patients 44% (n = 27) vs. 24% (n = 8), p < 0.05. 90-day mortality was lower in non-hypotensive patients compared to hypotensive patients 21% (n = 13) vs. 43% (n = 15), (p = 0.02).Conclusion Patients who are hypotensive at any given time during thrombectomy under general anesthesia may have worse neurological outcome compared to non-hypotensive patients. The best anaesthetic management for mechanical thrombectomy needs to be clarified prospectively in large multicenter studies.We would like to thank all health care workers who helped with this study. Dr. Pieter Jan Van Asbroeck, Dr. Ruben Haesendonck, Dr. Cédric Van Dijck are greatly thanked for their assistance. The Stroke Consortium includes following collaborators who were directly involved in patient care of the study: Stockx Luc, MD3 , Ernon, Ludovic, MD4 ,Van Boxstael, Sam, MD1, Vanelderen, Pascal, MD, PhD1,5
Pre-ICU characteristics in cardiac surgery patients with CPB developing AKI
No full textAims. AKI is common after cardiac surgery involving CPB. Lack of reliable early detection methods for post-op AKI limits timely therapeutic intervention. A number of new biomarkers for AKI await validation in this setting. Analysis of a database was
performed to define baseline patient and biomarker characteristics in patients developing AKI.
Methods. 259 patients were enrolled. Patients with severe pre-existing renal insufficiency were excluded (eGFR<15ml/min). Urine and blood samples were obtained immediately before initiation of CPB. Patients were retrospectively divided into 2 groups,
AKI (n=84) and non-AKI (n=175), based on the AKIN criteria (increase in s-Creat ≥ 0.3 mg/dl or ≥ 50% compared to baseline within 48h or reduction in Urine output <0.5 ml/kg/h for more than 6h). Statistical analysis of all characteristics before arrival on the ICU was performed.
Results. AKI patients (32% of total) were older (70 yrs (SD= 9) vs 67 (11), p=0.043) with higher BMI’s (27.7 (4.8) vs. 26.7 (4.3), p=0.036). As to be expected baseline eGFR (CKD-EPI, in ml/min) was lower in the AKI-group (69.49 (20.30) vs. 76.45 (15.01), p=0.024). Both baseline urinary-NGAL (μg/l)(1211 (2172) vs. 749 (946), p=0.020) and serum-cystatin C (in mg/L)(0.98 (0.39) vs 0.86 (0.36), p=0.0175) were statistically higher in the AKI group and CPB time (in minutes) was significantly longer: 163 (63) vs 121 (51), p<0.0001.
Conclusion. u-NGAL and s-Cystatin most likely reflect pre-existing kidney dysfunction (like eGFR). CPB time is a significant factor for development of AKI, which is amenable to improvement
Pre-ICU characteristics in cardiac surgery patients with CPB developing AKI
No full textAims. AKI is common after cardiac surgery involving CPB. Lack of reliable early detection methods for post-op AKI limits timely therapeutic intervention. A number of new biomarkers for AKI await validation in this setting. Analysis of a database was
performed to define baseline patient and biomarker characteristics in patients developing AKI.
Methods. 259 patients were enrolled. Patients with severe pre-existing renal insufficiency were excluded (eGFR<15ml/min). Urine and blood samples were obtained immediately before initiation of CPB. Patients were retrospectively divided into 2 groups,
AKI (n=84) and non-AKI (n=175), based on the AKIN criteria (increase in s-Creat ≥ 0.3 mg/dl or ≥ 50% compared to baseline within 48h or reduction in Urine output <0.5 ml/kg/h for more than 6h). Statistical analysis of all characteristics before arrival on the ICU was performed.
Results. AKI patients (32% of total) were older (70 yrs (SD= 9) vs 67 (11), p=0.043) with higher BMI’s (27.7 (4.8) vs. 26.7 (4.3), p=0.036). As to be expected baseline eGFR (CKD-EPI, in ml/min) was lower in the AKI-group (69.49 (20.30) vs. 76.45 (15.01), p=0.024). Both baseline urinary-NGAL (μg/l)(1211 (2172) vs. 749 (946), p=0.020) and serum-cystatin C (in mg/L)(0.98 (0.39) vs 0.86 (0.36), p=0.0175) were statistically higher in the AKI group and CPB time (in minutes) was significantly longer: 163 (63) vs 121 (51), p<0.0001.
Conclusion. u-NGAL and s-Cystatin most likely reflect pre-existing kidney dysfunction (like eGFR). CPB time is a significant factor for development of AKI, which is amenable to improvement
Long-Term Outcome in Patients With Spinal Cord Stimulation for Failed Back Surgery Syndrome:A 20-Year Audit of a Single Center
No full textSTUDY DESIGN: This is a retrospective, observational study.INTRODUCTION: Spinal cord stimulation (SCS) has found its application in chronic pain treatment, with failed back surgery syndrome (FBSS) as one of the most important indications. However, to date, little is known about the long-term effectiveness of the treatment. The aim of this study is to analyze retrospectively the long-term outcomes of SCS treatment in a single multidisciplinary pain center on predominant radicular pain, using devices of a single manufacturer.MATERIALS AND METHODS: Patient data on overall patient satisfaction, pain intensity, and adverse events were retrospectively collected in our clinical practice between January 1998 and January 2018, for 191 patients who received a permanent SCS implant. Secondary health measures included the influence of opioid and nicotine use on pain reduction after therapy.RESULTS: The trial-to-implant ratio was 93.6%. At a mean follow-up of 10.6 years, 78.5% of the patients were satisfied with the treatment outcome, with a significant pain reduction of an average three points on a Numeric Rating Scale. Opioid and nicotine usage did not have a significant link with the pain reduction one year after the treatment. Furthermore, devices had an average battery lifespan of 8.4 years. A total of 248 revisions were recorded. A total of 24 patients (11.7%) acquired an infection; 7 of 204 patients had an infection during the trial period, 2 of 191 patients had an infection in the first postoperative year, and 15 of 191 patients had an infection after the first year. The average time to infection, if not in the first year, was 10.1 years.CONCLUSIONS: A successful long-term outcome regarding pain relief in patients with predominant radicular pain due to FBSS is established with SCS therapy.</p
Addition of Liposome Bupivacaine to Bupivacaine HCl Versus Bupivacaine HCl Alone for Interscalene Brachial Plexus Block in Patients Having Major Shoulder Surgery
No full textBACKGROUND AND OBJECTIVES: We examined whether liposome bupivacaine (Exparel) given in the interscalene brachial plexus block lowers pain in the setting of multimodal postoperative pain management for major shoulder surgery. METHODS: Fifty-two adult patients were randomized to receive either 5 mL of 0.25% bupivacaine HCl immediately followed by 10 mL of liposome bupivacaine 133 mg (n = 26) or 15 mL of 0.25% standard bupivacaine alone (n = 26) in interscalene brachial plexus block. The primary outcome (worst pain in the first postoperative week) was assessed by the Modified Brief Pain Inventory short form. Secondary outcomes were overall satisfaction with analgesia (OBAS), functionality of the surgical arm, sleep duration, time to first opioid (tramadol) request and opioid consumption (mEq), sensory-motor block characteristics, and the occurrence of adverse effects. RESULTS: Worst pain was lower in patients given liposome bupivacaine added to standard bupivacaine than in patients given standard bupivacaine alone (generalized estimating equation [GEE] estimated marginal mean values, 3.6 +/- 0.3 vs 5.3 +/- 0.4 points on the Numeric Rating Scale, respectively, although the effect was modest, 1.6 +/- 0.5; 95% confidence interval, 0.8-2.5). Total OBAS scores indicated greater satisfaction (GEE estimated marginal mean values, 1.8 +/- 0.3 vs 3.3 +/- 0.4 on total OBAS, respectively, with modest effect, difference, 1.4 +/- 0.5; 95% confidence interval, 0.5-2.4). There were no differences in any of the other secondary outcomes. CONCLUSIONS: Liposome bupivacaine added to standard bupivacaine may lower pain and enhance patient's satisfaction in the first postoperative week even in the setting of multimodal analgesia for major shoulder surgery.This study was registered with clinicaltrials.gov (NCT02554357) on July 11, 2015, by Principal Investigator Catherine Vandepitte, MD
Radiofrequency Treatment of Facet-related Pain: Evidence and Controversies
No full textPain originating from the lumbar facet joints is estimated to represent about 15% of all low back pain complaints. The diagnostic block is considered to be a valuable tool for confirming facetogenic pain. It was demonstrated that a block of the ramus medialis of the ramus dorsalis is preferred over an intra-articular injection. The outcome of the consequent radiofrequency treatment is not different in patients reporting over 80% pain relief after the diagnostic block than in those who have between 50% and 79% pain relief. There is one well-conducted comparative trial assessing the value of one or two controlled diagnostic blocks to none. The results of the seven randomized trials on the use of radiofrequency treatment of facet joint pain demonstrate that good patient selection is imperative for good clinical outcome. Therefore, we suggest one block of the ramus medialis of the ramus dorsalis before radiofrequency treatment
Diagnostic Medial Branch Blocks before Lumbar Radiofrequency Zygapophysial (Facet) Joint Denervation
No full text
The Effect of Deep Versus Moderate Neuromuscular Block on Surgical Conditions and Postoperative Respiratory Function in Bariatric Laparoscopic Surgery: A Randomized, Double Blind Clinical Trial
No full textItem does not contain fulltextBACKGROUND: In recent literature, it has been suggested that deep neuromuscular block (NMB) improves surgical conditions during laparoscopy; however, the evidence supporting this statement is limited, and this was not investigated in laparoscopic bariatric surgery. Moreover, residual NMB could impair postoperative respiratory function. We tested the hypotheses that deep NMB could improve the quality of surgical conditions for laparoscopic bariatric surgery compared with moderate NMB and investigated whether deep NMB puts patients at risk for postoperative respiratory impairment compared with moderate NMB. METHODS: Sixty patients were evenly randomized over a deep NMB group (rocuronium bolus and infusion maintaining a posttetanic count of 1-2) and a moderate NMB group (rocuronium bolus and top-ups maintaining a train-of-four count of 1-2). Anesthesia was induced and maintained with propofol and remifentanil. The primary outcome measures were the quality of surgical conditions assessed by a single surgeon using a 5-point rating scale (1 = extremely poor, 5 = optimal), the number of intra-abdominal pressure increases >18 cmH2O and the duration of surgery. Secondary outcome measure was the postoperative pulmonary function assessed by peak expiratory flow, forced expiratory volume in 1 second, and forced vital capacity, and by the need for postoperative respiratory support. Data are presented as mean +/- standard deviation with estimated treatment effect (ETE: mean difference [95% confidence interval]) for group comparisons. RESULTS: There was no statistically significant difference in the surgeon's rating regarding the quality of the surgical field between the deep and moderate NMB group (4.2 +/- 1.0 vs 3.9 +/- 1.1; P = .16, respectively; ETE: 0.4 [-0.1, 0.9]). There was no difference in the proportional rating of surgical conditions over the 5-point rating scale between both groups (P = .91). The number of intra-abdominal pressure increases >18 cmH2O and the duration of surgery were not statistically different between the deep and moderate NMB group (0.2 +/- 0.9 vs 0.3 +/- 1.0; P = .69; ETE: -0.1 [-0.5, 0.4] and 61.3 +/- 15.1 minutes vs 70.6 +/- 20.8 minutes; P = .07, ETE: -9.3 [-18.8, 0.1], respectively). All the pulmonary function tests were considerably impaired in both groups when compared with baseline (P < .001). There was no statistically significant difference in the decrease in peak expiratory flow, forced expiratory volume in 1 second, and forced vital capacity (expressed as % change from baseline) between the deep and the moderate NMB group. CONCLUSIONS: Compared with a moderate NMB, there was insufficient evidence to conclude that deep NMB improves surgical conditions during laparoscopic bariatric surgery. Postoperative pulmonary function was substantially decreased after laparoscopic bariatric surgery independently of the NMB regime that was used. The study is limited by a small sample size
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