- 1968 born in Cologne / GermanyAnesthesiology - Intensive Care Medicine - Emergency Medicine MD, PhD, DEAA, EDICErasmu... more1968 born in Cologne / GermanyAnesthesiology - Intensive Care Medicine - Emergency Medicine MD, PhD, DEAA, EDICErasmus University Medical Center, Rotterdam, The NetherlandsVice-Chairman Dept. of Anesthesiology Vice-Head Residency Training ProgramChairman Hospital's Incident CommitteeNeuroanesthesia - Patient Safety - TeachingDutch National ATLS-Board Memberedit
BackgroundAwake craniotomy with electrocortical and subcortical mapping (AC) has become the mainstay of surgical treatment of supratentorial low-grade gliomas in eloquent areas, but not as much for glioblastomas.ObjectiveThis... more
BackgroundAwake craniotomy with electrocortical and subcortical mapping (AC) has become the mainstay of surgical treatment of supratentorial low-grade gliomas in eloquent areas, but not as much for glioblastomas.ObjectiveThis retrospective controlled-matched study aims to determine whether AC increases gross total resections (GTR) and decreases neurological morbidity in glioblastoma patients as compared to resection under general anesthesia (GA, conventional).MethodsThirty-seven patients with glioblastoma undergoing AC were 1:3 controlled-matched with 111 patients undergoing GA for glioblastoma resection. The two groups were matched for age, gender, preoperative Karnofsky Performance Score (KPS), preoperative tumor volume, tumor location, and type of adjuvant treatment. Primary outcomes were extent of resection and the rate of postoperative complications. The secondary outcome was overall postoperative survival.ResultsAfter matching, there were no significant differences in clinical variables between groups. Extent of resection was significantly higher in the AC group: mean extent of resection in the AC group was 94.89% (SD = 10.57) as compared to 70.30% (SD = 28.37) in the GA group (p = 0.0001). Furthermore, the mean rate of late minor postoperative complications in the AC group (0.03; SD = − 0.16) was significantly lower than in the GA group (0.15; SD = 0.39) (p = 0.05). No significant differences between groups were found for the other subgroups of postoperative complications. Moreover, overall postoperative survival did not differ between groups (p = 0.297).ConclusionThese findings suggest that resection of glioblastoma using AC is associated with significantly greater extent of resection and less late minor postoperative complications as compared with craniotomy under GA without the use of surgery adjuncts. However, due to certain limitations inherent to our study design (selection bias) and the absence of the use of surgery adjuncts in the GA group, we advocate for a prospective study to further build upon this evidence and study the use of AC in glioblastoma patients.
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IntroductionSupplemental oxygen is commonly used in trauma patients, although it may lead to hyperoxaemia that has been associated with pulmonary complications and increased mortality. The primary objective of this trial, TRAUMOX2, is to... more
IntroductionSupplemental oxygen is commonly used in trauma patients, although it may lead to hyperoxaemia that has been associated with pulmonary complications and increased mortality. The primary objective of this trial, TRAUMOX2, is to compare a restrictive versus liberal oxygen strategy the first 8 hours following trauma.Methods and analysisTRAUMOX2 is an investigator-initiated, international, parallel-grouped, superiority, outcome assessor-blinded and analyst-blinded, randomised, controlled, clinical trial.Adult patients with suspected major trauma are randomised to eight hours of a restrictive or liberal oxygen strategy. The restrictive group receives the lowest dosage of oxygen (>21%) that ensures an SpO2of 94%. The liberal group receives 12–15 L O2/min or FiO2=0.6–1.0.The primary outcome is a composite of 30-day mortality and/or development of major respiratory complications (pneumonia and/or acute respiratory distress syndrome).With 710 participants in each arm, we will b...
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Delirium is a frequent occurring complication in surgical patients. Nevertheless, a scientific work-up of the clinical relevance of delirium after intracranial surgery is lacking. We conducted a systematic review (CRD42020166656) to... more
Delirium is a frequent occurring complication in surgical patients. Nevertheless, a scientific work-up of the clinical relevance of delirium after intracranial surgery is lacking. We conducted a systematic review (CRD42020166656) to evaluate the current diagnostic work-up, incidence, risk factors and health outcomes of delirium in this population. Five databases (Embase, Medline, Web of Science, PsycINFO, Cochrane Central) were searched from inception through March 31st, 2021. Twenty-four studies (5589 patients) were included for qualitative analysis and twenty-one studies for quantitative analysis (5083 patients). Validated delirium screening tools were used in 70% of the studies, consisting of the Confusion Assessment Method (intensive care unit) (45%), Delirium Observation Screening Scale (5%), Intensive Care Delirium Screening Checklist (10%), Neelon and Champagne Confusion Scale (5%) and Nursing Delirium Screening Scale (5%). Incidence of post-operative delirium after intracran...
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IntroductionDelirium is a neurocognitive disorder characterised by an acute and temporary decline of mental status affecting attention, awareness, cognition, language and visuospatial ability. The underlying pathophysiology is driven by... more
IntroductionDelirium is a neurocognitive disorder characterised by an acute and temporary decline of mental status affecting attention, awareness, cognition, language and visuospatial ability. The underlying pathophysiology is driven by neuroinflammation and cellular oxidative stress.Delirium is a serious complication following neurosurgical procedures with a reported incidence varying between 4% and 44% and has been associated with increased length of hospital stay, increased amount of reoperations, increased costs and mortality.Perioperative music has been reported to reduce preoperative anxiety, postoperative pain and opioid usage, and attenuates stress response caused by surgery. We hypothesize that this beneficial effect of music on a combination of delirium eliciting factors might reduce delirium incidence following neurosurgery and subsequently improve clinical outcomes.MethodsThis protocol concerns a single-centred prospective randomised controlled trial with 6 months follow...
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BACKGROUND Post-operative delirium (POD) is a frequent and severe complication after neurosurgical operations. Good prediction of POD after craniotomy in neuro-oncologic patients is important to install prophylactic measures, increase... more
BACKGROUND Post-operative delirium (POD) is a frequent and severe complication after neurosurgical operations. Good prediction of POD after craniotomy in neuro-oncologic patients is important to install prophylactic measures, increase recognition and apply early treatment. Hence, we compared logistic regression with machine learning to build an accurate predictive model in a large dataset. MATERIAL AND METHODS POD was defined in case of a Delirium Observation Scale (DOS) ≥ 3 or start of antipsychotic treatment for delirium within 10 days after surgery. Adult patients undergoing a craniotomy for a neuro-oncologic disease in the Erasmus Medical Centre in Rotterdam were retrospectively included. The cohort was split into a training (75%), after three-fold cross validation, and test set (25%). Logistic regression and Lasso Elastic-Net Regularized Generalized Linear Models (GLMNet) were trained based on 19 pre- and intra-operative features and risk factors were identified based on the su...
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Nearly 60% of the Dutch population undergoing surgery is over the age of 65. The elderly are at higher risk of developing perioperative complications (e.g. myocardial infarction, pneumonia or delirium), that lead to a prolonged hospital... more
Nearly 60% of the Dutch population undergoing surgery is over the age of 65. The elderly are at higher risk of developing perioperative complications (e.g. myocardial infarction, pneumonia or delirium), that lead to a prolonged hospital stay or death. Preoperative risk stratification calculates the patient's risk by evaluating the presence and extent of frailty, and pathophysiological risk factors, type of surgery and the results of additional testing. The type of anaesthesia, fluid management and pain management strongly influences the outcome of surgery and the way this is experienced by the patient. Recent developments focus on multimodal perioperative care of the older patient to shorten hospital stay, using minimal invasive surgery, postoperative anaesthesiology rounds and early geriatric consultation.
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Background Clinical practice guidelines (CPG) are statements that provide recommendations regarding the approach to different diseases and aim to increase quality while decreasing the risk of complications in health care. Numerous... more
Background Clinical practice guidelines (CPG) are statements that provide recommendations regarding the approach to different diseases and aim to increase quality while decreasing the risk of complications in health care. Numerous guidelines in the field of perioperative care have been published in the previous decade but their methodological quality and transparency are relatively unknown. Objective To critically evaluate the transparency and methodological quality of published CPG in the preoperative assessment and management of adult patients undergoing elective surgery. Design Systematic review and methodological appraisal study. Data sources We searched for eligible CPG published in English or Spanish between January 1, 2010, and June 30, 2022, in Pubmed MEDLINE, TRIP Database, Embase, the Cochrane Library, as well as in representatives’ medical societies of Anaesthesiology and developers of CPG. Eligibility criteria CPG dedicated on preoperative fasting, cardiac assessment for...
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A major change in obstetric anaesthesia practice over the last decades has been the use of phenylephrine instead of ephedrine for anti-hypotensive management after spinal anaesthesia for caesarean section. Phenylephrine has largely... more
A major change in obstetric anaesthesia practice over the last decades has been the use of phenylephrine instead of ephedrine for anti-hypotensive management after spinal anaesthesia for caesarean section. Phenylephrine has largely replaced ephedrine because of its decreased tendency to cause fetal acidosis [1] and a prophylactic phenylephrine infusion has even been suggested to be the preferred technique to prevent a decrease in blood pressure in healthy women [2, 3]. However, in 2015, a study by Ngan Kee et al. [4] suggested noradrenaline to be superior to phenylephrine due to its beta-activity that may avoid the bradycardia often seen with phenylephrine. Since then, the literature has debated whether obstetric anaesthetists should now switch from phenylephrine to noradrenaline [5]. This editorial addresses some of the issues around noradrenaline with special emphasis on the effects on both maternal haemodynamic variables and fetal acid base status. Table 1 summarises the main properties of noradrenaline, phenylephrine and ephedrine. Phenylephrine can cause a reflex bradycardia [1] due to its alpha-activity. Noradrenaline has beta-activity in addition to the alpha activity and, consequently, Ngan Kee et al. [4] hypothesised that noradrenaline would be associated with less bradycardia than phenylephrine. Since then, a body of evidence on the use of noradrenaline during caesarean section has been published and the findings on bradycardia have not been unanimous; there have been studies reporting less bradycardia with noradrenaline [6, 7] and others reporting no difference in the incidence of bradycardia [8, 9]. All of these studies used noradrenaline and phenylephrine in adequate equipotent ratios of phenylephrine : noradrenaline of 1 : 12.5–16. In studies using a 1:20 ratio, this controversy remained, with one study finding less bradycardia [4] while another did not [10]. It is important, however, to point out that most studies showed that treatment of phenylephrine-associated bradycardia was rarely necessary [4, 9, 11]. Even high doses of 100 μg.min phenylephrine infusion do not usually require treatment of bradycardia [11]. Ngan Kee, a pioneer in vasopressor infusions, reported that bradycardia “corrected rapidly after turning off the phenylephrine infusion” [11] and we share this experience in our clinical practice. In addition, we have to say that not only phenylephrine but also noradrenaline can be associated with bradycardia. In a study by Mohta et al. [10], treatment for bradycardia was required in 3 out of 45 patients in the phenylephrine group but also in 1 out of 45 patients in the noradrenaline group, a difference that was not statistically significant. Taken together, we do not think that bradycardia related to phenylephrine is a predominant clinical problem, given the easy titrability of the drug and its short half-life.
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Background Awake craniotomy is used to resect tumor while preserving language. However, differences between patients in post-operative speech/language outcome are observed despite careful intra-operative monitoring. Literature describes... more
Background Awake craniotomy is used to resect tumor while preserving language. However, differences between patients in post-operative speech/language outcome are observed despite careful intra-operative monitoring. Literature describes improved performance in language tasks during cognitive tests in musicians. Moreover increased white matter connectivity properties in the corpus callosum are described in musicians compared to non-musicians. We hypothesize better recovery of language in musical patients after awake glioma surgery, caused by higher connectivity properties from the corpus callosum. Material and Methods Adult patients undergoing resection for glioma with an awake resection procedure at two neurosurgical centers were prospectively included. Patients without standardized language tests at pre- and post-operative level, with a glioblastoma multiforme (WHO grade 4) or undergoing re-resection were excluded. Language was assessed with the Diagnostic Instrument for Mild Aphas...
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Background: Robot-assisted pancreatoduodenectomy (RAPD) is a challenging procedure for the perioperative anesthesiologist, e.g. because of prolonged pneumoperitoneum exposure and reversed-Trendelenburg positioning. Purpose of this... more
Background: Robot-assisted pancreatoduodenectomy (RAPD) is a challenging procedure for the perioperative anesthesiologist, e.g. because of prolonged pneumoperitoneum exposure and reversed-Trendelenburg positioning. Purpose of this retrospective cohort study is to identify differences in perioperative anesthesia-related factors between RAPD and open pancreatoduodenectomy (OPD) and to determine perioperative anesthetic factors associated with major morbidity (Clavien Dindo ≥ III) after RAPD. Methods: All consecutive patient undergoing pancreatoduodenectomy were retrospectively included during a two year inclusion period. Anesthesia charts were studied on fluid management details, rates of vasopressor administration and arterial blood gas results. All factors were compared between both surgical approaches. Within RAPD, factors were subsequently compared between patients with major (Clavien Dindo ≥ III) vs. without major postoperative morbidity and between procedures with high and low i...
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To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and... more
To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. All victims of severe blunt trauma were consecutively included. Patients with a revised trauma score (RTS) of 12 were resuscitated by a "minor trauma" team and patients with an RTS of less than 12 were resuscitated by a "severe trauma" team. Digital video recordings were used to analyse protocol compliance and time management during initial assessment. From 1 May to 1 September 2003, 193 resuscitations were included. The "minor trauma" team assessed 119 patients, with a mean injury severity score (ISS) of 7 (range 1-45). Overall protocol compliance was 42%, ranging from 0% for thoracic percussion to 93% for thoracic auscultation. The median resuscitation time was 45.9 minutes (range 39.7-55.9). The "severe team" assessed 74 patients, with a mean ISS of 22 (range 1-59). Overall protocol compliance was 53%, ranging from 4% for thoracic percussion to 95% for thoracic auscultation. Resuscitation took 34.8 minutes median (range 21.6-44.1). Results showed the current trauma resuscitation to be ATLS-like, with sometimes very low protocol compliance rates. Timing of secondary survey and radiology and thus time efficiency remains a challenge in all trauma patients. To assess the effect of trauma resuscitation protocols on outcome, protocol adherence needs to be improved.
Research Interests: Nursing, Emergency Medicine, Medicine, Prospective studies, Humans, and 15 moreFemale, Resuscitation, Male, Netherlands, Digital Video, Clinical Sciences, Adult, Patient Care Team, Clinical Protocols, Level, Blunt Trauma, Digital Video Recorder, Injury Severity Score, Guideline Adherence, and auscultation
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BACKGROUND Although the standard procedure to treat adult patients with lesions in eloquent brain areas is awake craniotomy with direct electrical stimulation, this procedure is not often used in children because of feasibility concerns.... more
BACKGROUND Although the standard procedure to treat adult patients with lesions in eloquent brain areas is awake craniotomy with direct electrical stimulation, this procedure is not often used in children because of feasibility concerns. Some studies have shown that the procedure is feasible in children. They reported the postoperative language ability, which was not based on standardized language tests for children. To give an objective overview of preoperative assessment of the language ability of a child before and after this procedure, the authors described the perioperative course, including standardized language tests for children and the awake surgery setting, of a 12-year-old child undergoing awake craniotomy with brain mapping for the indication of cavernoma in the left somatosensory cortex close to the motor cortex. OBSERVATIONS The patient performed better on language tests after surgery, showing that his language ability improved. He also cooperated well during the entir...
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Chapter 17 contains 83 questions and answers regarding pharmacology.
ABSTRACTBackgroundClinical practice guidelines (CPG) are statements that provide recommendations regarding the approach to different diseases and aim to increase quality while decrease the risk of complications in health care. Numerous... more
ABSTRACTBackgroundClinical practice guidelines (CPG) are statements that provide recommendations regarding the approach to different diseases and aim to increase quality while decrease the risk of complications in health care. Numerous guidelines in the field of perioperative care have been published in the previous decade but their methodological quality and transparency are relatively unknown.ObjectiveTo critically evaluate the transparency and methodological quality of published CPG in the preoperative assessment and management of adult patients undergoing elective surgery.DesignDescriptive methodological study and quality appraisal.Data sourcesWe searched for eligible CPG published in English or Spanish between January 1, 2010, and June 30, 2022, in MEDLINE, Embase, the Cochrane Library, as well as in representatives’ medical societies of Anaesthesiology and developers of CPG.Eligibility criteriaCPG dedicated on preoperative fasting, cardiac assessment for non-cardiac surgery, a...
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Patient safety is an essential component of quality in health care. After understanding and awareness of the medical act is subject to the occurrence of errors, in recent decades, more attention has been paid to the processes related to... more
Patient safety is an essential component of quality in health care. After understanding and awareness of the medical act is subject to the occurrence of errors, in recent decades, more attention has been paid to the processes related to the culture of patient safety, particularly in sensitive areas as perioperative care. Implementing measures of improvement begins with a self-assessment of "safety climate" which it represents the measurable component of the "safety culture". Analysis can identify strengths and weaknesses that shape the way health care professionals think, act and focus their attention. Different instruments assess the safety climate, each one with strengths and limitations. In this reflection, the basics of perioperative safety and instruments commonly used for analysis are reviewed, while the situation of health care system in Colombia is approached.
This thesis aims to provide a solid framework of the anesthesiological aspects linked to an awake craniotomy procedure for brain tumor resection. To begin with, it should be clarified, that the term ‘anesthesiological’ in case of the... more
This thesis aims to provide a solid framework of the anesthesiological aspects linked to an awake craniotomy procedure for brain tumor resection. To begin with, it should be clarified, that the term ‘anesthesiological’ in case of the awake craniotomy covers the whole non-operative/non-surgical context, including metabolic and psychological aspects, too - and not only sedation and analgesia. In summary, after the publication of this thesis, there remain a lot of unanswered questions and challenges for the patient undergoing and the team performing an awake craniotomy for brain tumor resection. There is no doubt, that all efforts must be taken, to make the procedure for the patient as safe, as effective, and as pleasant as possible. This is most probably warranted by an experienced and dedicated team, with intensive counselling of the patient – which is routine at Erasmus MC.
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BackgroundRobot-assisted pancreatoduodenectomy (RAPD) poses several challenges concerning perioperative anesthetic guidance compared to open pancreatoduodenectomy (OPD), e.g. combined pneumoperiotoneum with reversed-Trendelenburg... more
BackgroundRobot-assisted pancreatoduodenectomy (RAPD) poses several challenges concerning perioperative anesthetic guidance compared to open pancreatoduodenectomy (OPD), e.g. combined pneumoperiotoneum with reversed-Trendelenburg positioning. The primary objective of this observational study is to specify these anesthetic differences of RAPD versus OPD and secondly to identify independent anesthetic factors associated with patient morbidity following RAPD.MethodsAll consecutive patients who underwent either RAPD or OPD between 2017 and 2018 were included for analysis. Patient records were screened for intraoperative vasopressor and fluid administration as well as for results of perioperative arterial blood gas analysis. Variables were compared for the groups RAPD versus OPD, major morbidity following RAPD versus non-major morbidity following RAPD (resp. Clavien-Dindo score ≥ III vs. < III) and high versus low intraoperative blood loss during RAPD. Perioperative factors associated...
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IntroductionChronic post-surgical pain (CPSP) after lung or pleural surgery is a common complication and associated with a decrease in quality of life, long-term use of pain medication and substantial economic costs. An abundant number of... more
IntroductionChronic post-surgical pain (CPSP) after lung or pleural surgery is a common complication and associated with a decrease in quality of life, long-term use of pain medication and substantial economic costs. An abundant number of primary prognostic factor studies are published each year, but findings are often inconsistent, methods heterogeneous and the methodological quality questionable. Systematic reviews and meta-analyses are therefore needed to summarise the evidence.Methods and analysisThe reporting of this protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. We will include retrospective and prospective studies with a follow-up of at least 3 months reporting patient-related factors and surgery-related factors for any adult population. Randomised controlled trials will be included if they report on prognostic factors for CPSP after lung or pleural surgery. We will exclude case series, case reports, l...
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This article illustrates the epidemiological concepts of absolute risk, absolute risk reduction and relative risk through a clinical example. In addition, it emphasizes the usefulness of these concepts in clinical practice, clinical... more
This article illustrates the epidemiological concepts of absolute risk, absolute risk reduction and relative risk through a clinical example. In addition, it emphasizes the usefulness of these concepts in clinical practice, clinical research and health decision-making process.
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OBJECTIVE The primary aim of this study is to review the available tools for prehospital triage in case of mass casualty incidents and secondly, to develop a tool which enables lay person first responders (LPFRs) to perform triage and... more
OBJECTIVE The primary aim of this study is to review the available tools for prehospital triage in case of mass casualty incidents and secondly, to develop a tool which enables lay person first responders (LPFRs) to perform triage and start basic life support in mass casualty incidents. METHODS In July 2019, online databases were consulted. Studies addressing prehospital triage methods for lay people were analyzed. Secondly, a new prehospital triage tool for LPFRs was developed. Therefore, a search for prehospital triage models available in literature was conducted and triage actions were extracted. RESULTS The search resulted in 6188 articles, and after screening, a scoping review of 4 articles was conducted. All articles stated that there is great potential to provide accurate prehospital triage by people with no healthcare experience. Based on these findings, and combined with the pre-existing prehospital triage tools, we developed a, not-yet validated, prehospital triage tool fo...
OBJECTIVE The Hospital Survey on Patient Safety Culture (HSPSC) was designed to assess staff views on patient safety and has been translated and validated into several languages and settings. This study developed a Latin American Spanish... more
OBJECTIVE The Hospital Survey on Patient Safety Culture (HSPSC) was designed to assess staff views on patient safety and has been translated and validated into several languages and settings. This study developed a Latin American Spanish version of the HSPSC for use in perioperative settings and examines its psychometric properties. METHODS After translation and adjustments, a web-based questionnaire was administered to all health care personnel at operating room in a public university-affiliated hospital in Popayán, Colombia. Descriptive statistics, internal reliability, confirmatory and exploratory factor analysis, and intercorrelations among survey composites were calculated. RESULTS Confirmatory factor analysis showed inadequate model fit for the original 12-factor structure of the HSPSC. Rather, a 9-factor, 36-item instrument showed acceptable factor loadings, internal consistency, and psychometric properties. Five factors were formed with minor changes. Adjusted factors emerged, like "staffing and work pressure" and "supervisor/manager expectations and actions promoting patient safety," "organizational learning-continuous improvement," and "hospital management support for safety," as well as "repeated errors and perception of safety." Internal consistency for each remaining composite met or exceeded a Cronbach α value of 0.60. CONCLUSIONS Psychometric analyses provided overall support for 9 of the 12 initial factors of patient safety culture. Our findings suggest that more validation studies need to be conducted before applying safety dimensions from the original HSPSC to perioperative settings only. By providing this initial tool, we hope to stimulate further studies and the patient safety research agenda in this part of the world.
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Background The superiority of either the traditional or Stewart based approach to acid-base balance has focused primarily on analyzing metabolic acidemia, with little attention given to patients with neutral pH. In this study, we evaluate... more
Background The superiority of either the traditional or Stewart based approach to acid-base balance has focused primarily on analyzing metabolic acidemia, with little attention given to patients with neutral pH. In this study, we evaluate metabolic disturbances in patients in the immediate postoperative period focusing on patients with neutral pH, while comparing the Stewart and traditional approach. Methods We conducted a single center retrospective observational cohort study. Over a 17-month period, data on arterial blood gas analysis, electrolytes, and albumin on the morning after surgery were retrieved from patients admitted to the postsurgical high dependency unit (HDU). Albumin-corrected anion gap (AG), apparent (SIDa) and effective strong ion difference (SIDe), and strong ion gap (SIG) were calculated. Results Out of 1207 HDU admissions, 400 cases had a complete set of laboratory-data including albumin of which 281 presented with neutral pH (7.35 ≤ pH ≤ 7.45), 64 with acidemi...
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INTRODUCTION Dural puncture epidural analgesia (DPE) is a modification of conventional epidural analgesia that involves the intentional puncture of the dura with a spinal needle through the needle placed in the epidural space, without a... more
INTRODUCTION Dural puncture epidural analgesia (DPE) is a modification of conventional epidural analgesia that involves the intentional puncture of the dura with a spinal needle through the needle placed in the epidural space, without a medication being injected intrathecally. There have been contradictory findings regarding better analgesia and better block quality. METHODS A systematic literature search was done to identify randomized controlled trials (RCT) comparing DPE with epidural analgesia. The risk of bias was assessed with the Cochrane tool. Risk ratio and 95% confidence intervals were calculated. RESULTS Five RCTs including 581 patients were identified, five reporting on labor analgesia and one on caesarean section. Single studies suggested slightly better analgesia by finding a median time to achieve sufficient analgesia of two minutes less in the DPE group, a higher number of women having a pain score <10/100 at 20 min, a reduction in the number of epidural top-ups and better sacral spread. The studies did not show a difference between DPE and epidural analgesia for catheter replacement or manipulation rates, the incidence of intravascular placement or unilateral block. CONCLUSION There is a lack of clear evidence on either the benefits or therisks of the DPE technique, such that a recommendation for or against its routine use is premature. Two of the three studies showing a beneficial effect of DPE came from the same institution and replication of the findings by other groups is warranted.
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Background In the post-anesthesia care unit in our hospital, selected postoperative patients receive care from anesthesiologists and nursing staff if these patients require intensive hemodynamic monitoring or treatment to stabilize vital... more
Background In the post-anesthesia care unit in our hospital, selected postoperative patients receive care from anesthesiologists and nursing staff if these patients require intensive hemodynamic monitoring or treatment to stabilize vital functions (e.g., vasopressor use and mechanical ventilation support) during a one-night admission. We investigated the agreement between elective preoperative planning for post-anesthesia care unit admission and the postoperative reality, along with the consequences of planning failures. Methods Data from records for 479 consecutive patients from June 1 to November 30, 2014, in a tertiary referral hospital were reviewed and analyzed. All patients admitted to PACU were included, along with patients scheduled to be referred to PACU but ultimately transferred to another ward. The primary outcome was the efficiency of planning PACU admission for elective patients. Secondary outcomes included secondary admissions to PACU or the intensive care unit (ICU) ...
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Objective Sleep disruption occurs frequently in hospitalised patients. Given the potential of music intervention as a non-pharmacological measure to improve sleep quality, we aimed to assess and quantify current literature on the effect... more
Objective Sleep disruption occurs frequently in hospitalised patients. Given the potential of music intervention as a non-pharmacological measure to improve sleep quality, we aimed to assess and quantify current literature on the effect of recorded music interventions on sleep quality and quantity in the adult critical care and surgical populations. Design Systematic review and meta-analysis. Data sources Embase, MEDLINE Ovid, Cochrane Central, Web of Science and Google Scholar. Eligibility criteria for studies Randomised controlled trials assessing the effect of music on sleep quality in critically ill and surgical patients. Methods The electronic databases were systematically searched from 1 January 1981 to 27 January 2020. Data were screened, extracted and appraised by two independent reviewers. Primary outcomes were sleep quality and quantity, assessed with validated tools. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Random ef...