1 Advertentie Nederlands tijdschrift voor anesthesiologie Wetenschap special volume 23, september Selectie van abstracts C. Boer, S.A. Loer Abstracts Wetenschapsdag 2011 Dr. M. Klimek, hoofdredacteur Dr. C. Boer, plaatsvervangend hoofdredacteur Officiële uitgave van de Nederlandse Vereniging voor Anesthesiologie
2 Zo vader, zo zoon Effectieve pijnstilling voor volwassenen van elke leeftijd 1 Breed toepasbaar 1, zoals bij lage rugpijn* Geen specifieke cardiovasculaire & gastro-intestinale complicaties 1 Uitstekend te combineren met lage dosering NSAID 2-4 OOK ALS BRUISTABLET Zie productinformatie elders in dit tijdschrift ZLD-ADV *voor de symptomatische behandeling van matige tot ernstige pijn Zeker Zaldiar
3 1 nederlands tijdschrift voor anesthesiologie september 11 inhoud Nederlands tijdschrift voor anesthesiologie volume 23 Nummer 4 september 2011 Coverbeeld: Dimitry de Bruin editorial 5 Samenwerken C. Boer, S.A. Loer programma wetenschapsdag abstracts wetenschapsdag 2011 o r a l p resentat i o n 9 Delayed fluorescence lifetime technique; exploring the use of PpIX for measuring mitochondrial oxygen tension in different types of tissue S.I.A. Bodmer, F.A. Harms, T. Johannes, R.J. Stolker, E.G. Mik o r a l p resentat i o n 9 Hypercapnia attenuates mechanical ventilationinduced diaphragm atrophy and dysfunction W.J.M. Schellekens, H.W.H. van Hees, M. Kox, M. Linkels, J.G. van der Hoeven, P.N.R. Dekhuijzen, G.J. Scheffer, L.M.A. Heunks o r a l p resentat i o n 10 ARA290, a peptide derived from the tertiary structure of erythropoietin, produces long-term relief of neuropathic pain An experimental study in rats and β-common receptor knockout mice M. Swartjes, A.M. Morariu, M. Niesters, M. Brines, A. Cerami, L.P.H.J. Aarts, A. Dahan o r a l p resentat i o n 11 Repetitive hind paw needle pricking in the neonatal rat in long-term alterations in the spinal nociceptive network L. Knaepen, J. Patijn, D. Tibboel, E.A.J. Joosten o r a l p resentat i o n 11 Prediction of fluid responsiveness by dynamic indices of volume status in mechanically ventilated patients undergoing major hepatic resection J.J. Vos, H.G.D. Hendriks, A.F. Kalmar, J.K.G. Wietasch, M.M.R.F. Struys, T.W.L. Scheeren o r a l p resentat i o n 12 The effectiveness of risk-dependent PONV prophylaxis in clinical practice: a before-after study T.H. Kappen, Y. Vergouwe, W.A. van Klei, L. van Wolfswinkel, C.J. Kalkman, K.G.M. Moons short oral presentation 15 ARA290, a non-erythropoietic EPO analogue reduces neuropathic pain in sarcoidosis patients: of a proof of concept study M. Niesters, A. Cerami, L.P.H.J. Aarts, A. Dahan short oral presentation 15 Towards cutaneous mitochondrial respirometry F.A. Harms, S.I.A. Bodmer, R.J. Stolker, E.G. Mik short oral presentation 16 Procedure-specific analysis of postoperative pain treatment H.J. Gerbershagen S. Aduckathil, B. van Wijck, W. Meissner, C.J. Kalkman short oral presentation 16 Impaired myocardial function during stress, but not during sevoflurane anesthesia after short-term high fat diet feeding C.E. van den Brom, C.S.E. Bulte, S.A. Loer, C. Boer, R.A. Bouwman short oral presentation 17 Diabetes mellitus, independent of insulin use, is associated with an increased risk of cardiac complications after vascular surgery E.J. Bakker, T.M. Valentijn, K.M. van de Luijtgaarden, S.E. Hoeks, M.T. Voute, F. Bastos Goncalves, J.I. van Waning, H.J.M. Verhagen, R.J. Stolker, D. Poldermans short oral presentation 17 Paradoxical and venous gas embolism during hysteroscopic surgery detected by trans esophageal echocardiography: A randomized controlled study using either bipolar or monopolar diathermia B.A. Dyrbye, L. Overdijk, P. de Haan, M. Kuut, P.J.M. Kesteren, E. Bakkum, B.M.P. Rademaker groep 1: parallel presentation 19 Routine troponin measurements after non-cardiac surgery J.A.R. van Waes, J.C. de Graaff, F.N. van Loosbroek, R.P.E. Niemeijer, H.N. Nathoe, W.A. van Klei groep 1: parallel presentation 19 Improving physician performance on administering antiemetic prophylaxis by adding an actionable recommendation to a risk assessment T.H. Kappen, W.A. van Klei, Y. Vergouwe, L. van Wolfswinkel, K.G.M. Moons, C.J. Kalkman groep 1: parallel presentation 20 Surveillance of cerebral perfusion reduces the incidence and severity of stroke related to coronary bypass surgery A.J. Runia, A. van Sonderen, B.D. Westerhof, M.A. Keyhan-Falsafi, R.W.M. Keunen, S.F.T.M. de Bruijn groep 1: parallel presentation 20 Capnography during propofol sedation by nonanesthesiologists does not prevent hypoxemia despite an increased number of airway interventions: A randomized controlled trial K. van Loon, B. van Zaane, A.T. van Rheineck Leyssius 1, M. Denteneer, C.J. Kalkman groep 1: parallel presentation 21 Routine 3-lead ECG ST-segment monitoring in the recovery room J.A.R. van Waes, L. van Wolfswinkel, W.A. van Klei groep 1: parallel presentation 21 Hemodynamic alterations during spinal anesthesia in control patients and diabetic patients with disturbances in heart rate variability R.K. Gigengack, K. Gigengack, R.A. Bouwman, C. Boer
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5 september 11 nederlands tijdschrift voor anesthesiologie 3 inhoud g r o e p 2 : pa r a l l e l p r e s e ntation 22 Shock and hypoperfusion after cardiac arrest are associated with hyperfibrinolyisis V.A. Viersen, S. Greuters, C. Boer g r o e p 2 : pa r a l l e l p r e s e ntation 22 NT probnp is predictive of short- but also of long-term mortality in critically ill patients in a MICU R.D. Plein, E.A.P. van Bockel, J.G. Zijlstra, J.E. Tulleken g r o e p 2 : pa r a l l e l p r e s e ntation 23 The level of agreement of a non-invasive continuous finger blood pressure measure ment device with intra-arterial blood pressure measurements in children R.P. Garnier, A.G.E. van der Spoel, R. Sibarani-Ponsen, D.G. Markhorst, C. Boer g r o e p 2 : pa r a l l e l p r e s e ntation 23 Effectiveness of a near-infrared vascular imaging system to support intravenous cannulation in children with a dark skin color; a cluster randomized clinical trial O.C.P. van der Woude, N.J. Cuper, C. Getrouw, R.M. Verdaasdonk, C.J. Kalkman, J.C. de Graaff g r o e p 2 : pa r a l l e l p r e s e ntation 24 Retrospective evaluation of chest ultrasound performed by a Dutch helicopter emergency medical service R. Ketelaars, N. Hoogerwerf, G.J. Scheffer g r o e p 2 : pa r a l l e l p r e s e ntation 24 Drug-induced liver injury following a repeated course of ketamine treatment for chronic pain in CRPS type 1 patients: A report of 3 cases I.M. Noppers, M. Niesters, L.P.H.J. Aarts, A. Dahan, E.Y. Sarton groep 3: parallel presentation 24 Structural plasticity of peptidergic fibers in the spinal cord of painful neuropathic rats R. Deumens, R.J.P. Jaken, E.A. Joosten, M.A.E. Marcus groep 3: parallel presentation 25 Menstrual cycle dependent modulation of pain-related brain activation D.S. Veldhuijzen, M.L. Keaser, D.S. Traub, Y. Zhou, R.P. Gullapalli 2, J.D. Greenspan groep 3: parallel presentation 25 Hyperalgesia after laparoscopic cholecystectomy: prevention by NMDA-antagonist methadone? A.J.M. Konijn, S.J. Rupert, A.R. Absalom, M.M.R.F. Struys, S. Schiere groep 3: parallel presentation 26 Clinical efficacy and safety of intrathecal preservative-free methylprednisolone acetate in postherpetic neuralgia patients: a randomized controlled trial M. Rijsdijk, A.J.M. van Wijck, P.C.W. Meulenhoff, I. van der Tweel, T.L. Yaksh, C.J. Kalkman groep 3: parallel presentation 26 Spinal cord stimulation-induced GABA release does not induce analgesia via GABAA receptor activation P.M. Janssen, S. Gerard, M. Raijmakers, M. Truin, M. van Kleef, E.A. Joosten groep 3: parallel presentation 28 Is there an association between acute postoperative pain and health care consumption during the first four days after day-case surgery? L.M. Kropman, A.A.A. Fiddelers, H.F. Gramke, M.A.E. Marcus groep 4: parallel presentation 28 Sevoflurane attenuates microvascular recruitment in the human myocardium C.S.E. Bulte, J. Slikkerveer, O. Kamp, S.A. Loer, C. Boer, R.A. Bouwman groep 4: parallel presentation 28 Artifacts in research data obtained from anesthesia information and management systems J.A.R. van Waes, N.P. Kool, J.B. Bijker, L. van Wolfswinkel, W.A. van Klei groep 4: parallel presentation 29 Helium induced preconditioning protocols in neonatal ventricular rat myocytes D. van de Vondervoort, B. Preckel, M.W. Hollmann, N.C. Hauck-Weber groep 4: parallel presentation 29 Quantifying the respiratory depressant effect of an experimental opioid analgesic in healthy volunteers in a phase I trial M.C.A. Boom, E. Olofsen, E.Y. Sarton, L.P.H.J. Aarts, A. Dahan groep 4: parallel presentation 30 Measurements of pre-ejection period, a component of pulse transit time, with echocardiography in healthy volunteers M.C. Kortekaas, E.A.A. Fierloos - van Tetering, M.D. Nieuwenhoff, E.J. Bakker, M.H.N. van Velzen, S.P. Niehof, R.J. Stolker, F.J.P.M. Huygen groep 4: parallel presentation 30 Bypassing the inflammasome; no vital role for caspase-1 in ventilator-induced lung injury K. Timmermans, S.E.I. van der Wal, M. Kox, M. Vaneker, J.A.W.M. van de Laak, J.G. van der Hoeven, L.A.B. Joosten, G.J. Scheffer
6 Bij perifere neuropathische pijn maximaal 1 uur aanbrengen 3 maanden pijnverlichting 1-3 Zie voor de verkorte productinformatie elders in dit blad
7 september 11 nederlands tijdschrift voor anesthesiologie 5 colofon editorial Het Nederlands Tijdschrift voor Anesthesiologie is het officiële orgaan van de Nederlandse Vereniging voor Anesthesiologie. Het stelt zich ten doel om door middel van publicatie van overzichtsartikelen, klinische en laboratoriumstudies en casuïstiek, de verspreiding van kennis betreffende de anesthesiologie en gerelateerde vakgebieden te bevorderen. Samenwerken Christa Boer Plaatsvervangend hoofdredacteur Stephan A. Loer REDACTIE Kernredacteuren: Dr. C. Boer, Prof. Dr. A. Dahan, Dr. H. van Dongen, Dr. H.G.D. Hendriks, Dr. M. Klimek, Prof. Dr. J. Knape, Prof. Dr. M.A.E. Marcus, Prof. Dr. G. Scheffer. Ondersteunend redacteuren: Drs. M. van der Beek, Dr. P. Bruins, Drs. G.P.G. Filippini-de Moor, Dr. D. Gommers, Dr. J.P. Hering, Prof. Dr. M. Hollmann, Dr. W. Klei, Dr. A. Koopman, Drs. M. Lance, Prof. Dr. S.A. Loer, Dr. A. Pijl, Dr. S. Schiere, Dr. M. Stevens, Dr. B. in het Veld, Dr. K. Vissers, Prof. dr. A. van Zundert Secretaresse: mw. W. van Engelshoven Voor informatie over adverteren en het reserveren van advertentieruimte in het Nederlands Tijdschrift voor Anesthesiologie: Mw W. van Engelshoven REDACTIE-ADRES Nederlands Tijdschrift voor Anesthesiologie, mw. W. van Engelshoven, Academisch Ziekenhuis Maastricht, Afdeling Anesthesiologie, Postbus 5800, 6202 AZ Maastricht; internet: INZENDEN VAN KOPIJ Richtlijnen voor het inzenden van kopij vindt u op of kunt u opvragen bij de redactie of de uitgever. OPLAGE exemplaren, 5x per jaar Het NTvA wordt uitsluitend toegezonden aan leden van de NVA. Adreswijzigingen: Nederlandse Vereniging voor Anesthesiologie, Postbus 20063, 3502 LB Utrecht, tel , fax , PRODUCTIE Bladcoördinatie: Drs. Thomas Eldering ( ) Ontwerp: Dimitry de Bruin Eindredactie: Monique de Mijttenaere AUTEURSRECHT EN AANSPRAKELIJKHEID De Stichting tot Beheer van het Nederlands Tijdschrift voor Anesthesiologie Nederlands Tijdschrift voor Anesthesiologie is een wettig gedeponeerd woordmerk van de Nederlandse Vereniging voor Anesthesiologie. Alle rechten voorbehouden. Niets uit deze uitgave mag worden verveelvoudigd, opgeslagen in een geautomatiseerd gegevensbestand of openbaar gemaakt, in enige vorm of op enige wijzen, hetzij elektronisch, mechanisch, door foto kopieën, opnamen of enige andere manier, zonder voorafgaande schriftelijke toestemming. Geachte lezer, In de voor u liggende editie van het Nederlands Tijdschrift voor Anesthesiologie vindt u de abstracts terug van de presentaties die tijdens de NVA Wetenschapsdag worden verzorgd door jonge onderzoekers die werkzaam zijn binnen een experimentele of klinische setting. Een van de grote uitdagingen voor onderzoek binnen de perioperatieve setting is het gebrek aan een uniforme en herkenbare patiëntenpopulatie en het kunnen focussen op een specifieke aandoening. In de afgelopen jaren is er daarom steeds meer focus binnen onze wetenschappelijke vereniging op samenwerking met verschillende onderzoekspartners. Anesthesiologen zijn daarmee in toenemende mate te vinden binnen samenwerkingsverbanden met preklinische afdelingen zoals fysiologie en celbiologie, en klinische afdelingen zoals heelkunde, cardiologie, cardio-thoracale chirurgie en intensive care geneeskunde. De toename in multidisciplinariteit en samenwerkingsverbanden is van groot belang voor de continuïteit van wetenschappelijk onderzoek, daar onderzoek steeds vaker alleen in aanmerking komt voor externe financiering, wanneer er sprake is van een nationaal samenwerkingsverband. En wanneer het onderzoek aansluit bij grote zorgthema s. Samenwerking leidt tevens tot schaalvergroting, waardoor de uitvoering van grote prospectieve klinische studies mogelijk wordt. Op deze manier kunnen strategische speerpunten worden gekozen, die een betere kans maken op financiering. De wetenschapscommissie van de NVA zal in toenemende mate aandacht besteden aan het ondersteunen van samenwerking binnen ons vakgebied en het stimuleren van samenwerking met onze klinische en preklinische partners. Het realiseren van samenwerking vormt een voorwaarde voor succesvolle financiering in de toekomst, en zal bijdragen aan het vergroten van de nationale impact van perioperatief wetenschappelijk onderzoek. Hierbij kan worden gedacht aan het oprichten van een nationaal anesthesiologisch onderzoeksplatform dat grote prospectieve klinische trials mogelijk maakt. Een dergelijke onderzoeksplatform is reeds zeer succesvol gebleken binnen andere vakgebieden, zoals de obstetrie en gynaecologie. Het verheugt het organiserend comité NVA Wetenschapsdag dat veel van de ingezonden abstracts zijn voortgekomen uit een samenwerkingsverband binnen of tussen ziekenhuizen. Het stimuleren van samenwerking van jonge wetenschappelijke onderzoekers met collega s uit andere ziekenhuizen en disciplines buiten de perioperatieve setting zal naar verwachting leiden tot een nog sterkere positie van het anesthesiologisch onderzoek binnen de medische wetenschap. Wij wensen u veel plezier met het lezen van deze editie van het NTvA. Stephan A. Loer Christa Boer
8 Be Aware of awareness! Sevorane : Al meer dan 16 jaar het vertrouwde anestheticum Wereldwijd meer dan 600 miljoen patiënten 1 Cardioprotectief 2 Veilig met Quickfill Stabiele anesthesie 1: Gebaseerd op internationale verkoopgegevens vanaf 1996 en 49,5 procedures per liter 2: Anesth Analg 2006;103:289 96
9 september 11 nederlands tijdschrift voor anesthesiologie 7 Wetenschapsdag 30 sep 2011 programma o n t va n g s t e n koffie Studio 3 oral presentations o p e ning S.A. Loer, voorzitter Organiserend Comité Wetenschapsdag Delayed fluorescence lifetime technique; exploring the use of PpIX for measuring mitochondrial oxygen tension in different types of tissue S.I.A. Bodmer, F.A. Harms, T. Johannes, R.J. Stolker, E.G. Mik Erasmus Medisch Centrum, Rotterdam Hypercapnia attenuates mechanical ventilation-induced diaphragm atrophy and dysfunction W.J.M. Schellekens, H.W.H. van Hees, M. Kox, M. Linkels, J.G. van der Hoeven, P.N.R. Dekhuijzen, G.J. Scheffer, L.M.A. Heunks Universitair Medisch Centrum St Radboud, Nijmegen Studio 3 short oral presentations ARA290, a non-erythropoietic EPO analogue reduces neuropathic pain in sarcoidosis patients: results of a proof of concept study M. Niesters, A. Cerami, L.P.H.J. Aarts, A. Dahan Leids Universitair Medisch Centrum, Leiden Towards cutaneous mitochondrial respirometry F.A. Harms, S.I.A. Bodmer, R.J. Stolker, E.G. Mik Erasmus Medisch Centrum Rotterdam, Rotterdam Procedure-specific analysis of postoperative pain treatment H.J. Gerbershagen 1, S. Aduckathil 2, B. van Wijck 1, W. Meissner 3, C.J. Kalkman 1 1 Universitair MedischCentrum Utrecht, Utrecht 2 University Cologne, Department of Anesthesiology, Cologne, Germany 3 University Jena, Department of Anesthesiology, Jena, Germany Impaired myocardial function during stress, but not during sevoflurane anesthesia after short-term high fat diet feeding C.E. van den Brom, C.S.E. Bulte, S.A. Loer, C. Boer, R.A. Bouwman VU Medisch Centrum, Amsterdam Studio 3 oral presentations Repetitive hind paw needle pricking in the neonatal rat results in long-term alterations in the spinal nociceptive network L. Knaepen 1, J. Patijn 1, D. Tibboel 2, E.A.J. Joosten 1 1 Maastricht Universitair Medisch Centrum, Maastricht 2 Erasmus Medisch Centrum Sophia Kinderziekenhuis, Rotterdam Prediction of fluid responsiveness by dynamic indices of volume status in mechanically ventilated patients undergoing major hepatic resection J.J. Vos, H.G.D. Hendriks, A.F. Kalmar, J.K.G. Wietasch, M.M.R.F. Struys, T.W.L. Scheeren Universitair Medisch Centrum Groningen, Groningen Studio Uitreiking award voor beste oral presentation en beste short oral presentation Uitreiking Ritsema van Eck Award ARA290, a peptide derived from the tertiary structure of erythropoietin, produces long-term relief of neuropathic pain. An experimental study in rats and β-common receptor knockout mice M. Swartjes, A.M. Morariu 1, M. Niesters 1, M. Brines 2, A. Cerami 2, L.P.H.J. Aarts 1, A. Dahan 1 1 Leids Universitair Medisch Centrum, Leiden 2 Warren Pharmaceuticals, Ossining, New York, USA keynote lecture Diastolic Heart Failure: From Pathophysiological Curiosity to Pandemia Walter Paulus pauze poster walk around groep 1 & 2 Diabetes mellitus, independent of insulin use, is associated with an increased risk of cardiac complications after vascular surgery E.J. Bakker, T.M. Valentijn, K.M. van de Luijtgaarden, S.E. Hoeks, M.T. Voute, F. Bastos Goncalves, J.I. van Waning, H.J.M. Verhagen, R.J. Stolker, D. Poldermans Erasmus Medisch Centrum, Rotterdam Paradoxical and venous gas embolism during hysteroscopic surgery detected by Trans Esophageal Echocardiography: A randomized controlled study using either bipolar or monopolar diathermia B.A. Dyrbye 1, L. Overdijk 2, P. de Haan 2, M. Kuut 3, P.J.M. Kesteren 2, E. Bakkum 2, B.M.P. Rademaker 2 1 Academisch Medisch Centrum/Onze Lieve Vrouwe Gasthuis, Amsterdam 2 Onze Lieve Vrouwe Gasthuis, Amsterdam 3 Universitair Medisch Centrum St Radboud, Nijmegen lunch poster walk around groep 3 & The effectiveness of risk-dependent PONV prophylaxis in clinical practice: a before-after study T.H. Kappen, Y. Vergouwe, W.A. van Klei, L. van Wolfswinkel, C.J. Kalkman, K.G.M. Moons Universitair Medisch Centrum Utrecht, Utrecht A fresh look at tissue oxygenation in the perioperative setting: a novel platform technology Bert Mik (Winnaar Young Investigator Grant 2009) Erasmus Medisch Centrum, Rotterdam pauze keynote lecture Mentoring Matters Adrian Gelb afsluiting + aperitief
11 september 11 nederlands tijdschrift voor anesthesiologie 9 oral presentation S.I.A. Bodmer, F.A. Harms, T. Johannes, R.J. Stolker, E.G. Mik Erasmus Medisch Centrum, Rotterdam 1 Oral Presentation oral presentations Delayed fluorescence lifetime technique; exploring the use of PpIX for measuring mitochondrial oxygen tension in different types of tissue. SIA Bodmer Delayed fluorescence lifetime technique; 1, F.A. Harms 2, T. Johannes exploring 2, RJ. Stolker 2, EG. Mik the use 2 of PpIX for measuring mitochondrial oxygen tension in different types of tissue Picture 1: Succesfull measurement of mitochondrial oxygen tension (mitopo2) in various tissues could shed a new light onto cellular oxygenation in numerous pathophysiological circumstances in the perioperative setting. Such a technique would be useful in the study of for example sepsis, ischemiareperfusion or cardiopulmonary resuscitation. In this study we tested the feasibility of measuring mitopo2 in kidney, intestine and liver by means of oxygen-dependent quenching of delayed fluorescence of aminolevulinic acid (ALA) induced protoporphyrine IX (PpIX). Animal experiments in accordance to institutional guidelines were performed on 18 anesthetized and mechanically ventilated male Wistar rats. Endogenous mitochondrial protoporphyrine IX (PpIX) was enhanced by intraperitoneal administration of ALA (200 mg/kg, 5-aminolevulinic acid, Sigma-Aldrich). Oxygen-dependent delayed fluorescence emission was recorded and mitopo2 was calculated from the delayed fluorescence lifetime. Caption Figure 1: MitoPO2 1 MitoPO2 during during normoxia normoxia versus versus varied varied FiO2 FiO2 (40, 100 and 21 oxygen%) in kidney, liver and intestine. Figure 1 shows mitopo2 measurements during norm-, hyper- and hypoxia and time-control groups for different abdominal organ tissues. Arterial blood gases (ABGs) were taken to compare and confirm proper FiO2 ventilation (respective po2 during normoxia 182mmHg 17, hyperoxia 486mmHg 49, and hypoxia 87mmHg 4). Discussion Hyper- and hypoxic FiO2 ventilation clearly demonstrated oxygen-dependency of the delayed fluorescence signal. The calculated mitopo2 values were well within range of previously reported tissue PO2 values in the literature. Overall, this study showed that the delayed fluorescence lifetime measurements for determining mitopo2 are feasible in several abdominal organs. Acknowledgment This study was funded by the NVA Young Investigator Grant oral presentation Hypercapnia attenuates mechanical ventilation-induced diaphragm atrophy and dysfunction W.J.M. Schellekens, H.W.H. van Hees, M. Kox, M. Linkels, J.G. van der Hoeven, P.N.R. Dekhuijzen, G.J. Scheffer, L.M.A. Heunks Universitair Medisch Centrum St. Radboud, Nijmegen Controlled mechanical ventilation (MV) results in diaphragm muscle atrophy and dysfunction, possibly through activation of pro-inflammatory pathways. Currently no adequate treatment of MV-induced diaphragm dysfunction is available. Recent studies suggest that hypercapnia reduces the systemic inflammatory response induced by MV. The aim of the current study was to investigate the effects of hypercapnia on MV-induced diaphragm atrophy and dysfunction in rats. Three groups of rats (all n=10) were studied: 1.18 hours MV hours MV with hypercapnia by changing Fico 2 5% (MV+H) 3.Unventilated control rats (CON). At the end of the experiment diaphragm muscle was excised and skinned muscle single fibers (SF) were isolated. Diaphragm fibers were analyzed for cross-sectional area (CSA). SF function was assessed by: 1. measuring maximal calcium-induced active force generation (F max ) 2. passive tension-length relationships by applying segmental extension tests. Diaphragm was analyzed for levels of cytokines (IL-1beta, IL-6, KC, TNF-alpha and IL-10). SF CSA was significantly decreased in MV rats compared to CON (p=0.001). Yet, SF CSA in MV+H was ~15% higher than in MV (p<0.05 versus MV). SF F max / CSA was significantly reduced after MV (p<0.05). Hypercapnia during MV did not
12 10 nederlands tijdschrift voor anesthesiologie september 11 abstracts 2011 significantly affect F max compared to MV. Passive force generation upon stretching of SF was significantly decreased in MV rats compared to CON (p<0.05). In contrast to MV, passive force-length relations of SF from MV+H rats were similar to CON. 18 hours MV resulted in increased levels of all analyzed cytokines in diaphragm of MV rats (p<0.05), hypercapnia dampened the inflammatory response in the diaphragm of MV+H rats. MV induces diaphragm atrophy and reduces diaphragm fiber active and passive force generation, even after correction for CSA. Hypercapnia during MV prevents: diaphragm atrophy, reduction in passive force generation and MV induced inflammation in the diaphragm. * p < 0.05 different from 18hMV, CON and 18h MV+H oral presentation ARA290, a peptide derived from the tertiary structure of erythropoietin, produces long-term relief of neuropathic pain. An experimental study in rats and β-common receptor knockout mice M. Swartjes 1, A.M. Morariu 1, M. Niesters 1, M. Brines 2, A. Cerami 2, L.P.H.J. Aarts 1, A. Dahan 1 1 Leids Universitair Medisch Centrum, Leiden 2 Warren Pharmaceuticals, Ossining, New York, USA Background Exogenous erythropoietin (EPO) inhibits development of allodynia in experimental painful neuropathy due to its anti-inflammatory and neuroprotective properties at spinal, supraspinal and possibly peripheral sites. Here we assess the effect of a nonhematopoietic EPO analogue, ARA290, on tactile and cold allodynia in a model of neuropathic pain in rats and mice lacking the -common-receptor (cr-/-), a component of the receptor complex mediating tissue protection. 24h following spared nerve injury, rats, wild-type (WT) and cr-/- mice were injected with ARA290 or vehicle (five 30 g/ kg ip injections at 2-day intervals, followed by once/week, n = 8/group). In a separate group of 8 rats ARA290 treatment was restricted to 5 doses over the initial 2 weeks after surgery. Figure 1: The long-term effect of ARA290 on allodynia Figure 2: ARA290 exerts its effect through the BCR In rats, irrespective of treatment paradigm, ARA290 produced effective and longterm (up-to 15-weeks) relief of tactile and cold allodynia. Retreatment in week-16 of animals that had received only the initial 5 doses of ARA290 did not further improve pain thresholds. Similarly, ARA290 was effective in WT mice producing significant relief of allodynia. In cr-/- mice no effect of ARA290 was observed.
13 september 11 nederlands tijdschrift voor anesthesiologie 11 oral presentations s ARA290 produces long-term relief of allodynia due to activation of the common receptor. It is argued that relief of neuropathic pain due to ARA290 treatment is related to its anti-inflammatory properties possibly within the CNS. Since, in contrast to erythropoietin, ARA290 is devoid of hematopoietic and cardiovascular side effects, ARA290 may be a promising new drug in the prevention of nerve injury-induced neuropathic pain in humans. oral presentation Repetitive hind paw needle pricking in the neonatal rat results in long-term alterations in the spinal nociceptive network L. Knaepen 1, J. Patijn 1, D. Tibboel 2, E.A.J. Joosten 1 1 Maastricht Universitair Medisch Centrum, Maastricht 2 Erasmus Medisch Centrum/Sophia Kinderziekenhuis, Rotterdam Life-saving care in the neonatal intensive care unit (NICU) entails daily repetitive exposure of neonates to up to 14 noxious routine procedures per day. Repetitive exposure to noxious stimulation during the critical postnatal period of fine-tuning of the vulnerable nociceptive network has been shown to affect nociception in later life. The objective of this study is to determine whether neonatal repetitive small painful procedures results in alterations in anatomy of the nociceptive network in later life. Neonatal Sprague-Dawley rat pups (N = 5) received four needle pricks per day to the left plantar hind paw during the first week of life. Control animals (N = 6) received four tactile non-noxious stimuli. Paw withdrawal thresholds (PWTs) to von Frey filaments were determined at the adult age of eight weeks. Quantitative immunohistochemistry was performed in adult animals to determine anatomy of primary afferents at the lumbar spinal cord level. A calcitonin-gene-relatedpeptide (CGRP) antibody was used to visualize peptidergic C/Ad-fibers, an isolectin-b4 (IB4) antibody for non-peptidergic C/Ad-fibers and a vesicular-glutamate-transporter-1 (VGLUT1) antibody for A-fibers. At the age of eight weeks basal nociception was not affected by neonatal needle pricking, since there was no difference in PWTs to mechanical stimuli between tactile control and needle prick animals. There was no difference in IB4-immunoreactivity or VGLUT-1 measurements between tactile control and needle prick animals. However, CGRP-immunoreactivity was bilaterally increased in needle prick animals. Although repetitive small routine painful procedures did not alter basal nociception in later life, they can affect spinal nociceptive CGRP-positive primary afferent anatomy, which might affect responses to injuries in later life. oral presentation Prediction of fluid responsiveness by dynamic indices of volume status in mechanically ventilated patients undergoing major hepatic resection J.J. Vos, H.G.D. Hendriks, A.F. Kalmar, J.K.G. Wietasch, M.M.R.F. Struys, T.W.L. Scheeren Universitair Medisch Centrum Groningen, Groningen Dynamic preload indices are increasingly used to assess a patient s fluid responsiveness. These indices include stroke volume variation (SVV), systolic pressure variation (SPV) and pulse pressure variation (PPV) and are obtained from the arterial pressure waveform. Furthermore, the plethysmographic variability index (PVI) is derived non-invasively via a finger clip. We compared the ability of these four indices to predict fluid responsiveness in patients undergoing major hepatic resection. After local IRB approval, 30 patients were included. Fluid was restricted to 6 ml/kg/ hr during resection. Thereafter, patients received a fluid challenge (FC) of 15 ml/kg in 30 minutes. Patients were considered responders when stroke volume index (SVI) increased > 20 % above pre-fc values. SVV and SVI were measured by the FloTrac- Vigileo system (Edwards Lifesciences, Irvine, USA), PVI by the Masimo Radical 7 pulse co-oximeter (Masimo Corp, Irvine, USA). Data were recorded using RugLoop software (Demed, Temse, Belgium) and SPV and PPV were retrospectively calculated from the arterial pressure waveform. Areas under the ROC curve (AUC) were calculated to assess the ability of dynamic indices to predict fluid responsiveness. 17/30 patients were fluid responsive. ROC analysis revealed an AUC for SVV, PVI,
14 12 nederlands tijdschrift voor anesthesiologie september 11 abstracts 2011 PPV and SPV of 0.81, 0.77, 0.77 and 0.75, respectively, while the AUC of CVP was much lower (Figure 1). SVV, SPV and PPV decreased significantly after FC whereas PVI did not (Table 1). Furthermore, all non-dynamic hemodynamic variables except CVP remained unchanged. All dynamic preload indices predict fluid responsiveness during major hepatic resection to a similar extent, whereas the actual effects of fluid challenge were best tracked by PPV and SVV but not by PVI. Thus, it seems that the non-invasive plethysmographic variability index should be further evaluated before it can replace arterial pressure based dynamic variables. oral presentation The effectiveness of risk-dependent PONV prophylaxis in clinical practice: a before-after study T.H. Kappen, Y. Vergouwe, W.A. van Klei, L. van Wolfswinkel, C.J. Kalkman, K.G.M. Moons Universitair Medisch Centrum Utrecht, Utrecht In a previous study, presenting a predicted risk of postoperative nausea and vomiting (PONV) in the anesthesia information management system resulted in a small increase in administration of PONV prophylaxis by anesthesiologists, without decreasing the PONV incidence. We hypothesized that the effect on administration of prophylaxis had been too small to effectively lower the PONV incidence. To this aim, we combined the presented PONV risk with a patient-specific recommendation on the number of antiemetics to be administered, and studied PONV prophylaxis prescription and PONV incidence. In the before period of a before-after study, care-as-usual and PONV outcomes within 24 hours postoperatively were documented (January-March 2010). During the intervention period (April-May 2010), anesthesiologists were presented with a risk-based recommendation on how many prophylactic antiemetics to prescribe to their current patient. Patients undergoing elective, non-cardiac surgery as inpatients were eligible(n = 1,483). The effects of the intervention on PONV incidence was analyzed by multivariable logistic regression. Baseline differences were too small to be considered as confounding. The crude PONV incidence was 49% in the care-as-usual group and 41% in the intervention group (p<0.05). The intervention led to a significant increase in the number of prophylactic antiemetics per patient (0.34 versus 0.96), particularly in high-risk patients (predicted risk >40%: 0.53 versus 1.5). of the regression analysis are shown in figure 1. In contrast to our previous study, providing anesthesiologists with patient-specific recommendations increased administration of PONV prophylaxis, and now significantly lowered the PONV incidence, especially in high-risk patients. Concluding, this type of risk-tailored PONV prophylaxis is effective in clinical practice.
15 perifere en centrale neuropathische pijn Het ondraaglijke kalmeren Lyrica. Snelle en aanhoudende pijnverlichting (1-5) 11.LYP.1.11
17 september 11 nederlands tijdschrift voor anesthesiologie 15 short oral presentations short oral presentation ARA290, a non-erythropoietic EPO analogue reduces neuropathic pain in sarcoidosis patients: of a proof of concept study M. Niesters, A. Cerami, L.P.H.J. Aarts, A. Dahan Leids Universitair Medisch Centrum, Leiden Exogenous erythropoietin (EPO) and the non-hematopoietic EPO analogue ARA290 prevent development of allodynia in animal models of painful neuropathy, a mechanism that is thought to relate to their anti-inflammatory and tissue protective properties. In this study we evaluate the analgesic and mood related effects of ARA290 treatment in patients with persistent severe neuropathic pain. Patients diagnosed with neuropathic pain related to sarcoidosis (n = 12) or diabetes mellitus type II (n = 12) were included in the study. On day 1, 3 and 5 of the study patients received an intravenous infusion of ARA290 (2 mg). Pain and mood were quantified using the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression Scale (HADS) on the infusion days, and at 1 and 4 weeks after the end of the treatment week. Baseline Most pain visual analogue scale (VAS) scores were cm with a predominance of pain in the lower extremities (lower legs and feet). One week ARA290 treatment resulted in a profound analgesic effect with > 50% reduction on the VAS for pain-related parameters (to cm) in the sarcoidosis patients. Furthermore, a 33% reduction was observed in the absolute scores of the HADS, which indicates that patients felt less depressed and anxious after treatment with ARA290. In patients diagnosed with type II diabetes mellitus no effect of ARA290 treatment on pain was observed. ARA290 effectively reduced pain, and improved mood in patients with neuropathic pain from sarcoidosis, without showing any side effects. The anti-inflammatory property of ARA290 may play a pivotal role in achieving this large analgesic effect. Absence of an effect in diabetes mellitus type II may suggest differences in the pathophysiologic pathways that underlie neuropathic pain. short oral presentation Towards cutaneous mitochondrial respirometry F.A. Harms, S.I.A. Bodmer, R.J. Stolker, E.G. Mik Erasmus Medisch Centrum Rotterdam, Rotterdam Measurement of mitochondrial oxygenation and oxygen consumption could be a potential tool for assessing aspects of mitochondrial function in vivo. This study was aimed at testing the feasibility of measuring mitochondrial oxygen tension (mitopo2) and oxygen consumption in skin, by means of protoporphyrin IX (PpIX) triplet state lifetime measurement (PpIX-TSLM). Animals. A total of 4 anesthetized and mechanically ventilated male Wistar rats were used. Measurements 5-aminolevulinic acid (ALA) cream was applied to the abdominal skin of rats to induce PpIX in the mitochondria. Photo-excitation with pulsed light was used to induce population of the PpIX triplet-state. The triplet state lifetime is related to mitopo2 and was measured by delayed fluorescence. Oxygen consumption was determined by repeated mitopo2 measurements while locally blocking oxygen supply. The latter was achieved by applying local pressure with the measurement probe. The mitopo2 was recorded before, during, and after a 90 second compression. Oxygen consumption was derived from the decay of the mitopo2 slope. Mitochondrial respiration was blocked by local application of cyanide cream. Baseline levels of mitopo2 were 4511mmHg. The slope of the mitopo2 oxygen disappearance rate was mmHg/second (Figure 1a). After cessation of respiration, baseline mitopo2 levels were mmhg and no oxygen disappearance was measured during application of pressure (Figure 1b). Our results show that PpIX-TSLM based mitochondrial respirometry is feasible in skin but accuracy of the measurement needs improvement. Further development of the PpIX-TSLM technique might ultimately enable clinical use for patients benefit. The ultimate goal is to provide clinicians technology that permits a look at oxygen supply and demand at the place where it matters most, the mitochondria. Figure 1 a Typical time course of mitochondrial PO2 during the microcirculation compression experiment in the skin of a rat. Figure 1 b Nonrespiring mitochondria after the application of cyanide cream.
18 16 nederlands tijdschrift voor anesthesiologie abstracts 2011 short oral presentation Procedure-specific analysis of postoperative pain treatment september 11 H.J. Gerbershagen 1, S. Aduckathil 2, B. van Wijck 1, W. Meissner 3, C.J. Kalkman 1 1 Universitair Medisch Centrum Utrecht, Utrecht 2 University Cologne, Department of Anesthesiology, Cologne, Germany 3 University Jena, Department of Anesthesiology, Jena, Germany Recent studies reconfirmed that patients still suffer from moderate to severe postoperative pain. The aim of this study was to develop procedure specific comparisons which may allow for an improved postsurgical pain therapy. To compare postoperative pain intensity, data of the QUIPS-project (Quality improvement in postoperative pain treatment) were analyzed. Patients completed the validated 15-item QUIPS questionnaire at the first postoperative day. Worst pain intensities since surgery were measured using NRS (0-10). The type of surgical procedure was recorded using codes of the German procedure codes. We defined 529 different surgical procedure groups. The data of patients of 105 hospitals and 584 surgical wards were analyzed. Surgical groups with more than 20 patients were included for comparison. Worst pain intensities could be compared among patients in 179 different surgeries. In addition, patients were grouped into those who received regional anesthesia and those who did not. Orthopedic and traumatological surgeries were associated with the highest worst pain intensities. It may be noticed that a rather small portion of patients received regional anesthesia. In some surgeries tissue trauma and length of incision are not associated with higher pain intensities. Thus, patients report higher pain intensities after open appendectomy (ranking 19), plastic reconstruction of hemorrhoids (ranking 23), and tonsillectomy (ranking 24) (all three: NRS median 6.0) than above-knee amputation (NRS median 4.0, ranking 115, open thoracotomy (NRS median 4.0, ranking 118) and mastectomy (NRS median 3.0, ranking 146) For the first time, this comprehensive procedure-specific comparison permits a quality analysis of everyday pain treatment. It is obvious that pain intensities after various procedures are underestimated. This may be one cause of insufficient postoperative pain treatment. In addition, the knowledge about optimal postoperative pain management should be employed forcefully such as the use of regional anesthesia. short oral presentation Impaired myocardial function during stress, but not during sevoflurane anesthesia after short-term high fat diet feeding C.E. van den Brom, C.S.E. Bulte, S.A. Loer, C. Boer, R.A. Bouwman VU Medisch Centrum, Amsterdam Previously, we showed that diet-induced metabolic alterations influences sevoflurane-induced cardioprotection during ischemia in the rat heart, suggesting that metabolic alterations may modulate the sensitivity of the heart to stress. However, whether metabolic altered hearts are more sensitive to stress and anesthesia-related alterations in myocardial function is not known. The purpose of the present study was to explore the effect of diet-induced metabolic alterations on myocardial function during pharmacological induced stress and sevoflurane anesthesia. Male Wistar rats (n=8 per group) were exposed to a high fat diet (HFD) or control diet (CD). After 4 weeks, rats underwent an oral glucose tolerance test. Accordingly, rats underwent echocardiography to determine myocardial function during the administration of 2% sevoflurane at rest and during dipyridamole-induced hyperemia (20 mg/kg for 10 min). Four weeks of HFD feeding resulted in impaired glucose tolerance compared to CD-fed rats (p<0.05). Systolic function as represented by fractional shortening was not altered after 4 weeks of HFD-feeding compared to CD fed rats under rest conditions (602% vs. 544%, ns). Administration of sevoflurane did not influence fractional shortening (584% vs. 542%, ns); however, HFD reduced fractional shortening during hyperemia (681% vs. 592%, p<0.05). Moreover, sevoflurane administration during hyperemia revealed no differences in fractional shortening (642% vs. 612%, ns). Four weeks of high fat diet feeding impaired myocardial function during stress. Hearts exposed to this diet are not more sensitive for sevoflurane-related effects on myocardial function at rest and during hyperemia. These findings may result in new insights into the effect of high dietinduced metabolic alterations on myocardial function during stress and sevoflurane anesthetics.
19 september 11 nederlands tijdschrift voor anesthesiologie 17 short oral presentations short oral presentation Diabetes mellitus, independent of insulin use, is associated with an increased risk of cardiac complications after vascular surgery E.J. Bakker, T.M. Valentijn, K.M. van de Luijtgaarden, S.E. Hoeks, M.T. Voute, F. Bastos Goncalves, J.I. van Waning, H.J.M. Verhagen, R.J. Stolker, D. Poldermans Erasmus Medisch Centrum, Rotterdam Background The Revised Cardiac Risk Index identifies insulin dependent diabetes mellitus as a risk factor for cardiac complications after noncardiac surgery. However, patients with non-insulin dependent diabetes also suffer from the atherosclerotic comorbities of insulin resistance, such as myocardial infarction. The current study aims to assess the risk of cardiac complications after vascular surgery in patients with insulin dependent and non-insulin dependent diabetes mellitus consecutive vascular surgery patients were included in this cohort study. Diagnosis of diabetes was based on the guidelines of the American Diabetes Association. Diabetes was categorized by insulin use. The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction or myocardial ischemia, within 30 days of surgery. In multivariable analysis, corrections were made for comorbidities and glucose control. Troponin T measurements and electrocardiograms were routinely obtained at baseline, and on postoperative day 1, 3, 7, and 30. Of a total of patients, 98 (7%) patients had insulin dependent diabetes and 249 (18%) had non-insulin dependent diabetes. The primary endpoint was reached in 171 (16%) non-diabetic, 55 (22%) non-insulin dependent diabetic, and 39 (40%) insulin dependent diabetic patients. After adjusting for age, high-risk surgery, and medical history, both insulin dependent (OR 2.36; 95%-CI ) and non-insulin dependent (OR 1.53; 95%-CI ) diabetes were associated with an increased risk of cardiac complications. Diabetes mellitus, independent of insulin use, is associated with an increased incidence of postoperative cardiac events. short oral presentation Paradoxical and venous gas embolism during hysteroscopic surgery detected by trans esophageal echocardiography: A randomized controlled study using either bipolar or monopolar diathermia B.A. Dyrbye 1, L. Overdijk 2, P. de Haan 2, M. Kuut 3, P.J.M. Kesteren 2, E. Bakkum 2, B.M.P. Rademaker 2 1 Academisch Medisch Centrum/Onze Lieve Vrouwe Gasthuis, Amsterdam 2 Onze Lieve Vrouwe Gasthuis, Amsterdam 3 Universitair Medisch Centrum St. Radboud, Nijmegen Trans Cervical Resection of Myoma (TCRM) and Endometrium (TCRE) are safe hysteroscopic minimal invasive procedures. However, potentially life threathening venous and paradoxal embolism has been described. Nowadays, bipolar hysterscopic resection using saline for uterine distension is replacing monopolar resection using electrolyte free distension fluid. However, it is unkwown whether there is a difference in incidence and grade of venous gas embolism (VGE) and paradoxical embolism between monopolar and bipolar resection. Fifty patints undergoing TCRM (n=36) or TCRE (n=14) were randomly allocated to undergo hysteroscopic surgery using either monopolar or bipolar diathermia. For detection of embolism, Trans Oesophageal Echography (TOE) was applied and the four chamber view was continuously monitored. Rating of intraoperative embolic events by a five stage classification (grade 1-5) was performed off-line by a blinded independent cardiologist. The overall incidence of VGE was similar in the monopolar and the bipolar group (both 95,8 %). In both groups a positive tendency was found between the amount of intravasation and the grade of VGE. Bipolar diathermia was associated with a higher incidence of VGE grade 4 (12,5% and 41,7 % respectively, P=0,031) at an average intravasation of 800 ml. Paradoxical embolism was observed in 2 patients (4,1 %), at intravasations of 300 ml and 2300 ml. Grade 1 VGE was seen in almost every patint using either monopolar or bipolar diathermia. More severe grade 3 and 4 VGE was seen in the bipolar group. Although paradoxical embolism was seen in only two patients, its potentially deleterious effects on vital organs raises concern. Irrespective of the type of distention fluid used, significantly more grade 4 VGE was observed when intravasation exceeded 1000 ml.
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