Paradigmashift in de anesthesiologische praktijk: naar een opiaatvrije anesthesie?

De klassieke algehele anesthesie bestaat uit drie hoekstenen: hypnose of slaap, immobilisatie door curarisatie en analgesie of pijnstilling. Deze drie elementen vullen we doorgaans aan met een vierde pijler: controle van het sympathische zenuwstelsel. Twee generaties anesthesiologen hebben steeds op basis van dit stramien gewerkt, en dit sinds de introductie van intraveneuze barbituraten, curares en opiaten. Wordt dit paradigma nu verlaten?

Volledige standaardisatie van de laparoscopische gastric bypass

Morbide obesitas is een chronische aandoening, geassocieerd met een verhoogd mortaliteitsrisico en met een groot aantal co-morbiditeiten (diabetes type 2, arteriële hypertensie, obstructief slaapapneu syndroom, hypercholesterolemie, gewrichtsproblematiek, …). De Wereldgezondheidsorganisatie (WHO) heeft obesitas uitgeroepen tot epidemie van de 21ste eeuw.

Therapeutische milde hypothermie bij reanimatie

Cardiovasculair lijden is nog steeds een van de belangrijkste doodsoorzaken in de Westerse Wereld. Zestig percent van deze mortaliteit doet zich voor na een plotse collaps van de patiënt. Ook al overleeft de patiënt de hartstilstand dankzij snelle reanimatie door omstaanders en professionele hulpverleners, dan nog is de kans op neurologische schade bijzonder groot. Drie tot vijf minuten na de hartstilstand worden de neuronen al onherstelbaar beschadigd. Zelfs na herstel van de eigen circulatie bij succesvolle reanimatie wordt de eerste uren en dagen verdere schade aangericht door veelvuldig ingezette cascades zoals calcium shifts, excitotoxiciteit, lipideperoxidatie en andere vrijradicaalreacties die leiden tot DNA-beschadiging en apoptose – beter bekend als het post-reanimatie syndroom. Deze agressors brengen eerst schade toe aan de meest kwetsbare delen van de hersenen (hippocampus, neocortex en cerebellum), wat leidt tot post-anoxische encephalopathie.

Langetermijneffecten van anesthesie

In oktober 2006 organiseerde de Dienst Anesthesiologie een symposium over de langetermijneffecten van anesthesie. Dit thema kan geneesheer noch patiënt onberoerd laten. Anesthesiologen hebben zich altijd bekommerd om de onmiddellijke peroperatieve morbiditeit en mortaliteit. Nu verruimen we echter de horizon.

Measuring intraoperative nociception.

Gent
17/12/2016

Does the SAD have any place in Obese patients?

UCL
08/12/2016

“Anesthesievoering bij elektroconvulsietherapie”

KUL, campus Kortenberg
01/12/2016

“Chiraliteit in anesthesie: relevantie”

AZ Sint-Jan Brugge-Oostende AV
25/11/2016

Pro-Con debate: Opioid free general anesthesia?

Brussel
19/11/2016

Hoe OFA implementeren in de derde wereld?

Sint-Truiden
16/11/2016

Der obese patient.

BASEL SGAR
04/11/2016

What extra ERAS recommendations do we need for obese patients.

Sydney
28/10/2016

Opioid free anesthesia in bariatric surgery and beyond ASA.

Chicago ISPCOP
24/10/2016

Sedaties in de anesthesiologie.

Den Haag
05/10/2016

New anti atelectasis strategies for optimizing ventilation in the morbidly obese.

Timisoara ESCTAIC
24/09/2016

Opioid reduction to the max.

Bern
07/09/2016

Impact of anesthesia on inflammation. do we need further research?

UCL
18/08/2016

Efficiency in Bariatric Anesthesiology

Spakenburg
08/06/2016

Post operative ventilation in obese patients

London
30/05/2016

Anaesthesia (opioid free) in Bariatric Surgery.

Moscow
21/04/2016

Optimizing deep Muscle paralysis and insufflation pressure during abdominal laparoscopic surgery.

Taipei
26/03/2016

Anesthetic technique in laparoscopic surgery and ventilation setting for morbidly obese patients.

Bangkok
25/03/2016

iologic and anaesthetic considerations in optimizing clinical outcome in high risk patients. Do we need Sevoflurane?

Singapore
24/03/2016

Anaesthetic considerations in optimizing clinical outcome.

Zhongda Hospital Eastsouth University Nanjing
23/03/2016

Efficiency in Anesthesiology.

Zhengzhou Medical University
22/03/2016

Improve total outcome in obese patients by adapting anesthesia.

KunMing China
21/03/2016

Improving surgical outcome in bariatric patients.

Hong Kong
20/03/2016

Pourquoi et comment éviter les opioids?

JEPU Paris
11/03/2016

Sedaties in de anesthesiologische praktijk: visie vanuit Vlaanderen.

CEEA Den Haag
09/03/2016

Enhanced recovery after bariatric surgery.

Rome
04/02/2016

Enquete peri operatieve activiteit in Belgie.

België
30/01/2016

Key points for bariatric anesthesia.

Diest
29/01/2016

Anesthesie bij risico patienten.

Brugge
22/01/2016

A randomized double blind study evaluating the effect of opioid free versus opioid anesthesia on postoperative pain and discomfort in 50 laparoscopic bariatric surgery patients.

London
01/01/2016

Opioid free (OFA) versus opioid (OA) and low opioid anesthesia (LOA) for the laparoscopic gastric bypass surgery. Immediate post operative morbidity and mortality in a single center study on 5061 consecutive patients from March 2011 till June 2015.

London
01/01/2016

Deep neuromuscular blockade versus remifentanyl or sevoflurane to augment measurable laparoscopic workspace during bariatric surgery.

London
01/01/2016

623 answers for World Survey on opioid free anaesthesia (OFA) today.

London
01/01/2016

Comparison of opioid free anaesthesia with opioid anesthesia on postoperative shivering in morbidly obese patients scheduled for bariatric surgery.

London
01/01/2016

Live anesthesia demonstraties in Az Sint Jan voor bariatrische anesthesia. (CAPE: Clinical Anesthesia Programme)

Brugge
01/01/2016

Anesthesie voor risico patienten.

Vives Brugge
26/02/2015

Optimized concepts for NMB management.

Madrid
05/02/2015

Zorginspectie Vlaanderen en Safety First.

SBAR
31/01/2015

Dexdor het ultieme sedatiemiddel bij opiaat vrije bariatrische anesthesie.

Congress Utrecht NVAM
17/01/2015

OFA Roeselare.

Roeselare
01/01/2015

ERAS and obesity pan arabic.

ERAS Dubai
01/01/2015

How to improve surgical outcome PAN arabic.

ERAS Dubai
01/01/2015

Low vs Standard Pneumoperitoneum Pressure during Abdominal Laparoscopic Surgery.

NIAS Mexico city
01/01/2015

Optimierte Konzepte für das NMB-Management.

01/01/2015

Sedation of obese patients in remote locations.

ESPCOP Ghent
20/12/2014

What you should know as an anaesthesiologist to help improve the bariatric surgical outcome.

IFSO Brussels
02/05/2014

Anaesthesia without opioids might reduce obstructive breathing, silent aspiration and post-operative pain in morbidly obese patients.

IFSO Brussels
02/05/2014

Best Practices in the OR: Anaesthesia-Surgery cooperation during RNY gastric bypass surgery.

IFSO Brussels
02/05/2014

Anesthesiologist ́s view on metabolic syndrome.

IFSO Brussels
30/04/2014

OFA Mogelijk? Voordelen, Nadelen en Moeilijkheden?

VVOV Blankenberge
04/04/2014

Why and how using protective lung ventilation in anaesthesia for morbid obese patients.

Siastok Budapest
27/03/2014

Pourquoi et comment éviter les opioïdes en anesthésie ambulatoire?

JEPU Paris
22/03/2014

Le syndrome du compartiment abdominal durant la laparoscopie.

JEPU Paris
21/03/2014

Safe sedation in morbid obese patients.

ISICEM Brussels
17/03/2014

Anesthesia for the high risk patient.

Vives Brugge
14/02/2014

Ventilation of morbid obese patients Networks in anesthesia.

Prague
06/02/2014

Opioid vrije anesthesie. Voordelen, Nadelen en Moeilijkheden.

Vives Brugge
06/02/2014

The place of Nicardipine in the opioid free anaesthesia and the Peri operative hypertension treatment.

Middelheim
30/01/2014

Assessing Abdominal Compliance and the Impact on Intra-abdominal Volume.

Networks in anesthesia Mexico
01/01/2014

Case Studies in Patients with Different Abdominal Elastance Patterns.

01/01/2014

Keypoints that are important for morbidly obese patients.

ESA Stockholm
01/01/2014

Best Practice Video lecture.

Montreal
01/01/2014

Opioid free anaesthesia.

Munster
01/01/2014

OFA Why and How.

Mortsel
01/01/2014

OFA ASA

New Orleans
01/01/2014

Controlled hypotension during opioid free anaesthesia.

Moorsel
01/01/2014

When is deep NMB needed TARK.

01/01/2014

Anaesthesia for endoscopic nasal surgery.

LOK Brugge
01/01/2014

Bleeding and leak prevention.

Breda
01/01/2014

ERAS and Obesity.

Breda
01/01/2014

Opioid free anaesthesia.

SIVA Cardiff
01/01/2014

Bariatric anesthesia subspeciality?

London Ethicon
01/01/2014

Best Practice video lect.

London Ethicon
01/01/2014

Pourquoi et comment éviter les opioïdes en anesthésie ambulatoire ?

JEPU Paris
01/01/2014

Le syndrome du compartiment abdominal durant la laparoscopie.

JEPU Paris
01/01/2014

kinderanesthesie in ontwikkelingslanden

Brugge
28/11/2013

167th Ether Day Celebration

Yangon MyanMar
14th October, 2013

167th Ether Day Celebration

Yangon MyanMar
14/10/2013

Kinderanesthesie ‘child with a cold’

Brugge
23/09/2013

Toon meer

Ability of Bispectral Index, Autoregressive Modelling with Exogenous Input- derived Auditory Evoked Potentials and Predicted Propofol Concentrations to Measure Patient Responsiveness during Anesthesia with Propofol and Remifentanil.

Ability of Bispectral Index, Autoregressive Modelling with Exogenous Input- derived Auditory Evoked Potentials and Predicted Propofol Concentrations to Measure Patient Responsiveness during Anesthesia with Propofol and Remifentanil.
2003

» http://www.ncbi.nlm.nih.gov/pubmed/

A Comparison of Bispectral Index and ARX-derived Auditory Evoked Potential Index in measuring the clinical interaction between ketamine and propofol anaesthesia.

A Comparison of Bispectral Index and ARX-derived Auditory Evoked Potential Index in measuring the clinical interaction between ketamine and propofol anaesthesia.
2003

» http://www.ncbi.nlm.nih.gov/pubmed/

Perioperative opioids aggravate obstructive breathing in sleep apnea syndrome:mechanisms and alternative anesthesia strategies.

Current opinion in anaesthesiology 29: 1. 129-133 Feb. 2016
01/02/2016

» http://www.ncbi.nlm.nih.gov/pubmed/

Pharmacokinetic and pharmacodynamic interactions in anaesthesia. A review of current knowledge and how it can be used to optimize anaesthetic drug administration.

British Journal of Anaesthesia, 118 (1): 44–57 (2017) doi: 10.1093/bja/aew312
01/01/2016

» http://www.ncbi.nlm.nih.gov/pubmed/

The role of abdominal compliance, the neglected parameter in critically ill patients – a consensus review of 16. Part 2: measurement techniques and management recommendations.

Anaesthesiol Intensive Ther. 2014 Nov-Dec;46(5):406-32. doi: 10.5603/AIT.2014.0063. Review. PubMed PMID: 25432559.
01/11-12/2015

» http://www.ncbi.nlm.nih.gov/pubmed/

Failure of sugammadex to reverse rocuronium-induced neuromuscular blockade: Simply an outlier or are we missing something?

Eur J Anaesthesiol. 2015 Oct;32(10):743-4. doi: 10.1097/EJA.0000000000000301. PubMed PMID: 26132985.
01/10/2015

» http://www.ncbi.nlm.nih.gov/pubmed/

Factors determining the smooth flow and the non-operative time in a one-induction room to one-operating room setting.

J Eval Clin Pract. 2015 Apr;21(2):205-14. doi: 10.1111/jep.12288. Epub 2014 Dec 11. PubMed PMID: 25496600; PubMed Central PMCID:PMC4406160.
01/04/2015

» http://www.ncbi.nlm.nih.gov/pubmed/

Sedation options for the morbidly obese intensive care unit patient: a concise survey and an agenda for development.

Multidiscip Respir Med. 2015 Mar 7;10(1):8. doi: 10.1186/s40248-015-0007-2. eCollection 2015. PubMed PMID: 25883785; PubMed Central PMCID: PMC4399437. d
01/03/2015

» http://www.ncbi.nlm.nih.gov/pubmed/

Factors determining the smooth flow and the non-operative time in a one-induction room to one-operating room setting.

Journal of evaluation in clinical practice 21: 2. 205-214 Apr.
01/01/2015

» http://www.ncbi.nlm.nih.gov/pubmed/

Sedation options for the morbidly obese intensive care unit patient: a concise survey and an agenda for development.

Multidisciplinary respiratory medicine 10: 1. 03.
01/01/2015

» http://www.ncbi.nlm.nih.gov/pubmed/

The role of abdominal compliance, the neglected parameter in critically ill patients – a consensus review of 16. Part 1: definitions and pathophysiology.

Anaesthesiol Intensive Ther. 2014 Nov-Dec;46(5):392-405. doi: 10.5603/AIT.2014.0062. Review. PubMed PMID: 25432558.
01/11-12/2014

» http://www.ncbi.nlm.nih.gov/pubmed/

The role of abdominal compliance, the neglected parameter in critically ill patients – a consensus review of 16. Part 2: measurement techniques and management recommendations.

Anaesthesiology intensive therapy 46: 5. 406-432 Nov/Dec.
01-12-2014

» http://www.ncbi.nlm.nih.gov/pubmed/

High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial.

Lancet. 2014 Aug 9;384(9942):495-503. doi: 10.1016/S0140-6736(14)60416-5. Epub 2014 Jun 2. PubMed PMID: 24894577.
01/08/2014

» http://www.ncbi.nlm.nih.gov/pubmed/

A COMPREHENSIVE GUIDE TO ORTHOFACIAL SURGERY vol 1 planning and operative techniques chapter: Anaesthesia for facial surgeons by J Mulier.

isbn:9789080776500.
01/01/2013

» http://www.ncbi.nlm.nih.gov/pubmed/
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