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de Grunt MN, de Jong B, Hollmann MW, Ridderikhof ML, Weenink RP. Parenteral, Non-Intravenous Analgesia in Acute Traumatic Pain-A Narrative Review Based on a Systematic Literature Search. J Clin Med 2024; 13:2560. [PMID: 38731088 PMCID: PMC11084350 DOI: 10.3390/jcm13092560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Traumatic pain is frequently encountered in emergency care and requires immediate analgesia. Unfortunately, most trauma patients report sustained pain upon arrival at and discharge from the Emergency Department. Obtaining intravenous access to administer analgesics can be time-consuming, leading to treatment delay. This review provides an overview of analgesics with both fast onset and parenteral, non-intravenous routes of administration, and also indicates areas where more research is required.
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Affiliation(s)
- Midas N. de Grunt
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
| | - Bianca de Jong
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
| | - Markus W. Hollmann
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
| | - Milan L. Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands;
| | - Robert P. Weenink
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
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2
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Kwee E, Borgdorff M, Schepers T, Halm JA, Winters HAH, Weenink RP, Ridderikhof ML, Giannakópoulos GF. Adjunctive hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries: a systematic review. Eur J Trauma Emerg Surg 2024:10.1007/s00068-023-02426-2. [PMID: 38386077 DOI: 10.1007/s00068-023-02426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE Traumatic crush injuries of the lower limb often accompany severe complications. The incorporation of hyperbaric oxygen therapy to standard trauma care may have the potential to diminish injury-related complications and improve outcome in such cases. This systematic review aims to evaluate the effectiveness of hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries. METHODS The electronic databases Medline, Embase and Cochrane Library were searched to identify studies involving patients with crush-associated sever lower limb soft tissue injuries who received hyperbaric oxygen therapy in conjunction with standard trauma care. Relevant data on type of injury, hyperbaric oxygen therapy protocol and outcome related to wound healing were extracted. RESULTS In total seven studies met the inclusion criteria, involving 229 patients. The studies included two randomized clinical trials, one retrospective cohort study, three case series and one case report. The randomized placebo-controlled clinical trial showed a significant increase in wound healing and decrease in the need for additional surgical interventions in the patient group receiving hyperbaric oxygen therapy when compared to those undergoing sham therapy. The randomized non-placebo-controlled clinical trial revealed that early hyperbaric oxygen therapy reduces tissue necrosis and the likelihood of long-term complications. The retrospective cohort study indicated that hyperbaric oxygen therapy effectively reduces infection rates and the need for additional surgical interventions. The case series and case report presented beneficial results with regard to wound healing when hyperbaric oxygen therapy was added to the treatment regimen. CONCLUSION Hyperbaric oxygen therapy is generally considered a safe therapeutic intervention and seems to have a beneficial effect on wound healing in severe lower limb soft tissue injuries when implemented as an addition to standard trauma care.
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Affiliation(s)
- Esmee Kwee
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marieke Borgdorff
- Department of Plastic, Reconstructive Surgery and Handsurgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jens A Halm
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hay A H Winters
- Department of Plastic, Reconstructive Surgery and Handsurgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Robert P Weenink
- Department of Hyperbaric Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Milan L Ridderikhof
- Department of Hyperbaric Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Emergency Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Georgios F Giannakópoulos
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Fakkert RA, Koopman MS, Preckel B, van Hulst RA, Weber NC, Weenink RP. Re: Cerebral arterial air emboli on immediate post-endovascular treatment CT are associated with poor short- and long-term clinical outcomes in acute ischaemic stroke patients. J Neuroradiol 2024:S0150-9861(24)00108-1. [PMID: 38382803 DOI: 10.1016/j.neurad.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Raoul A Fakkert
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, the Netherlands; Department of Hyperbaric Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Miou S Koopman
- Department of Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Benedikt Preckel
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, the Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Robert A van Hulst
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, the Netherlands; Department of Hyperbaric Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Nina C Weber
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Robert P Weenink
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, the Netherlands; Department of Hyperbaric Medicine, Amsterdam UMC, Amsterdam, the Netherlands.
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Fakkert RA, Koopman MS, Scheerder MJ, Beenen LFM, Weber NC, Preckel B, van Hulst RA, Weenink RP. Computer tomography perfusion patterns in iatrogenic cerebral arterial gas embolism: A retrospective cohort study. Eur J Radiol 2024; 170:111242. [PMID: 38043382 DOI: 10.1016/j.ejrad.2023.111242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE Cerebral arterial gas embolism (CAGE) occurs when air or medical gas enters the systemic circulation during invasive procedures and lodges in the cerebral vasculature. Non-contrast computer tomography (CT) may not always show intracerebral gas. CT perfusion (CTP) might be a useful adjunct for diagnosing CAGE in these patients. METHODS This is a retrospective single-center cohort study. We included patients who were diagnosed with iatrogenic CAGE and underwent CTP within 24 h after onset of symptoms between January 2016 and October 2022. All imaging studies were evaluated by two independent radiologists. CTP studies were scored semi-quantitatively for perfusion abnormalities (normal, minimal, moderate, severe) in the following parameters: cerebral blood flow, cerebral blood volume, time-to-drain and time-to-maximum. RESULTS Among 27 patient admitted with iatrogenic CAGE, 15 patients underwent CTP within the designated timeframe and were included for imaging analysis. CTP showed perfusion deficits in all patients except one. The affected areas on CTP scans were in general located bilaterally and frontoparietally. The typical pattern of CTP abnormalities in these areas was hypoperfusion with an increased time-to-drain and time-to-maximum, and a corresponding minimal decrease in cerebral blood flow. Cerebral blood volume was mostly unaffected. CONCLUSION CTP may show specific perfusion defects in patients with a clinical diagnosis of CAGE. This suggests that CTP may be supportive in diagnosing CAGE in cases where no intracerebral gas is seen on non-contrast CT.
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Affiliation(s)
- Raoul A Fakkert
- Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands; Hyperbaric Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Miou S Koopman
- Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Maeke J Scheerder
- Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Ludo F M Beenen
- Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Nina C Weber
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Benedikt Preckel
- Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Robert A van Hulst
- Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands; Hyperbaric Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Robert P Weenink
- Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands; Hyperbaric Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands.
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de Jonge SW, Hulskes RH, Zokaei Nikoo M, Weenink RP, Meyhoff CS, Leslie K, Myles P, Forbes A, Greif R, Akca O, Kurz A, Sessler DI, Martin J, Dijkgraaf MG, Pryor K, Belda FJ, Ferrando C, Gurman GM, Scifres CM, McKenna DS, Chan MT, Thibon P, Mellin-Olsen J, Allegranzi B, Boermeester M, Hollmann MW. Benefits and harms of perioperative high fraction inspired oxygen for surgical site infection prevention: a protocol for a systematic review and meta-analysis of individual patient data of randomised controlled trials. BMJ Open 2023; 13:e067243. [PMID: 37899157 PMCID: PMC10619062 DOI: 10.1136/bmjopen-2022-067243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 07/27/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION The use of high fraction of inspired oxygen (FiO2) intraoperatively for the prevention of surgical site infection (SSI) remains controversial. Promising results of early randomised controlled trials (RCT) have been replicated with varying success and subsequent meta-analysis are equivocal. Recent advancements in perioperative care, including the increased use of laparoscopic surgery and pneumoperitoneum and shifts in fluid and temperature management, can affect peripheral oxygen delivery and may explain the inconsistency in reproducibility. However, the published data provides insufficient detail on the participant level to test these hypotheses. The purpose of this individual participant data meta-analysis is to assess the described benefits and harms of intraoperative high FiO2compared with regular (0.21-0.40) FiO2 and its potential effect modifiers. METHODS AND ANALYSIS Two reviewers will search medical databases and online trial registries, including MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov and WHO regional databases, for randomised and quasi-RCT comparing the effect of intraoperative high FiO2 (0.60-1.00) to regular FiO2 (0.21-0.40) on SSI within 90 days after surgery in adult patients. Secondary outcome will be all-cause mortality within the longest available follow-up. Investigators of the identified trials will be invited to collaborate. Data will be analysed with the one-step approach using the generalised linear mixed model framework and the statistical model appropriate for the type of outcome being analysed (logistic and cox regression, respectively), with a random treatment effect term to account for the clustering of patients within studies. The bias will be assessed using the Cochrane risk-of-bias tool for randomised trials V.2 and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation methodology. Prespecified subgroup analyses include use of mechanical ventilation, nitrous oxide, preoperative antibiotic prophylaxis, temperature (<35°C), fluid supplementation (<15 mL/kg/hour) and procedure duration (>2.5 hour). ETHICS AND DISSEMINATION Ethics approval is not required. Investigators will deidentify individual participant data before it is shared. The results will be submitted to a peer-review journal. PROSPERO REGISTRATION NUMBER CRD42018090261.
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Affiliation(s)
- Stijn W de Jonge
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Rick H Hulskes
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Robert P Weenink
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kate Leslie
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ozan Akca
- Department of Anaesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrea Kurz
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of General Anaesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of General Anaesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Janet Martin
- Department of Anaesthesiology and Perioperative Medicine, and Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Marcel Gw Dijkgraaf
- Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Kane Pryor
- Department of Anaesthesiology, Weil Medical College of Cornell University, New York City, New York, USA
| | - F Javier Belda
- Department of Surgery, Hospital Clinico Universitario de Valencia, Valencia, Valenciana, Spain
- Department of Anaesthesia and Critical Care, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Carlos Ferrando
- Department of Anaesthesiology and Critical Care, Hospital Clínic de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Gabriel M Gurman
- Department of Anaesthesiology and Critical Care Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Christina M Scifres
- Department of Obstetrics and Gynaecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David S McKenna
- Department of Obstetrics and Gynaecology, Wright State University and Miami Valley Hospital, Dayton, Ohio, USA
| | - Matthew Tv Chan
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Pascal Thibon
- Centre d'appui pour la Prévention des Infections Associées aux Soins, CPias Normandie, Centre Hospitalo-Universitaire, Caen, Normandy, France
| | | | | | - Marja Boermeester
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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6
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Fakkert RA, Karlas N, Schober P, Weber NC, Preckel B, van Hulst RA, Weenink RP. Early hyperbaric oxygen therapy is associated with favorable outcome in patients with iatrogenic cerebral arterial gas embolism: systematic review and individual patient data meta-analysis of observational studies. Crit Care 2023; 27:282. [PMID: 37434172 DOI: 10.1186/s13054-023-04563-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Iatrogenic cerebral arterial gas embolism (CAGE) caused by invasive medical procedures may be treated with hyperbaric oxygen therapy (HBOT). Previous studies suggested that initiation of HBOT within 6-8 h is associated with higher probability of favorable outcome, when compared to time-to-HBOT beyond 8 h. We performed a group level and individual patient level meta-analysis of observational studies, to evaluate the relationship between time-to-HBOT and outcome after iatrogenic CAGE. METHODS We systematically searched for studies reporting on time-to-HBOT and outcome in patients with iatrogenic CAGE. On group level, we meta-analyzed the differences between median time-to-HBOT in patients with favorable versus unfavorable outcome. On individual patient level, we analyzed the relationship between time-to-HBOT and probability of favorable outcome in a generalized linear mixed effects model. RESULTS Group level meta-analysis (ten studies, 263 patients) shows that patients with favorable outcome were treated with HBOT 2.4 h (95% CI 0.6-9.7) earlier than patients with unfavorable outcome. The generalized linear mixed effects model (eight studies, 126 patients) shows a significant relationship between time-to-HBOT and probability of favorable outcome (p = 0.013) that remains significant after correcting for severity of manifestations (p = 0.041). Probability of favorable outcome decreases from approximately 65% when HBOT is started immediately, to 30% when HBOT is delayed for 15 h. CONCLUSIONS Increased time-to-HBOT is associated with decreased probability of favorable outcome in iatrogenic CAGE. This suggests that early initiation of HBOT in iatrogenic CAGE is of vital importance.
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Affiliation(s)
- Raoul A Fakkert
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Hyperbaric Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Noa Karlas
- Hyperbaric Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Patrick Schober
- Department of Anesthesiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Nina C Weber
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Benedikt Preckel
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Robert A van Hulst
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Hyperbaric Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Robert P Weenink
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Hyperbaric Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
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7
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Weenink RP, Wingelaar TT. Commentary: The circulatory effects of increased hydrostatic pressure due to immersion and submersion. Front Physiol 2022; 13:1029393. [PMID: 36330213 PMCID: PMC9623045 DOI: 10.3389/fphys.2022.1029393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert P. Weenink
- Diving Medical Center, Royal Netherlands Navy, Den Helder, Netherlands
- Department of Anesthesiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
- *Correspondence: Robert P. Weenink,
| | - Thijs T. Wingelaar
- Diving Medical Center, Royal Netherlands Navy, Den Helder, Netherlands
- Department of Anesthesiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
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8
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de Wolde SD, Hulskes RH, de Jonge SW, Hollmann MW, van Hulst RA, Weenink RP, Kox M. The Effect of Hyperbaric Oxygen Therapy on Markers of Oxidative Stress and the Immune Response in Healthy Volunteers. Front Physiol 2022; 13:826163. [PMID: 35173631 PMCID: PMC8843016 DOI: 10.3389/fphys.2022.826163] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Hyperbaric oxygen therapy (HBOT) consists of breathing 100% oxygen under increased ambient pressure. There are indications that HBOT induces oxidative stress and activates immune pathways. However, previous research on immunological effects of HBOT has mainly been established in in vitro experiments and selected patient populations, limiting generalizability and increasing the chances of confounding by comorbidities and specific patient-related factors. More insight into the immunological effects of HBOT would aid investigation and comprehension of potentially novel treatment applications. Therefore, in this study, we investigated the effects of three 110-min HBOT-sessions with 24-h intervals on immunological parameters in healthy, young, male volunteers. Blood samples were obtained before and after the first and third HBOT sessions. We assessed neutrophilic reactive oxygen species (ROS) production, systemic oxidative stress [plasma malondialdehyde (MDA) concentrations] as well as neutrophil phagocytic activity, plasma concentrations of tumor necrosis factor (TNF), interleukin (IL)-6, IL-8, and IL-10, and production of TNF, IL-6, and IL-10 by leukocytes ex vivo stimulated with the Toll-like receptor (TLR) ligands lipopolysaccharide (TLR4) and Pam3Cys (TLR2). We observed decreased neutrophilic ROS production and phagocytosis following the second HBOT session, which persisted after the third session, but no alterations in MDA concentrations. Furthermore, plasma concentrations of the investigated cytokines were unaltered at all-time points, and ex vivo cytokine production was largely unaltered over time as well. These results indicate no induction of systemic oxidative stress or a systemic inflammatory response after repeated HBOT in healthy volunteers but may suggest exhaustion of ROS generation capacity and phagocytosis.
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Affiliation(s)
- Silke D. de Wolde
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Hyperbaric Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
- *Correspondence: Silke D. de Wolde,
| | - Rick H. Hulskes
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Stijn W. de Jonge
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Robert A. van Hulst
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Hyperbaric Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Robert P. Weenink
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Hyperbaric Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Matthijs Kox
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, Netherlands
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9
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Weenink RP, Wingelaar TT. The Circulatory Effects of Increased Hydrostatic Pressure Due to Immersion and Submersion. Front Physiol 2021; 12:699493. [PMID: 34349668 PMCID: PMC8326965 DOI: 10.3389/fphys.2021.699493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
Increased hydrostatic pressure as experienced during immersion and submersion has effects on the circulation. The main effect is counteracting of gravity by buoyancy, which results in reduced extravasation of fluid. Immersion in a cold liquid leads to peripheral vasoconstriction, which centralizes the circulation. Additionally, a pressure difference usually exists between the lungs and the rest of the body, promoting pulmonary edema. However, hydrostatic pressure does not exert an external compressing force that counteracts extravasation, since the increased pressure is transmitted equally throughout all tissues immersed at the same level. Moreover, the vertical gradient of hydrostatic pressure down an immersed body part does not act as a resistance to blood flow. The occurrence of cardiovascular collapse when an immersed person is rescued from the water is not explained by removal of hydrostatic squeeze, but by sudden reinstitution of the effect of gravity in a cold and vasoplegic subject.
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Affiliation(s)
- Robert P Weenink
- Diving Medical Center, Royal Netherlands Navy, Den Helder, Netherlands.,Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Thijs T Wingelaar
- Diving Medical Center, Royal Netherlands Navy, Den Helder, Netherlands.,Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
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10
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Weenink RP, Preckel B, Hulst AH, Hermanides J, de Jong MD, Schlack WS, Stevens MF, Sperna Weiland NH, Hollmann MW. Second Update for Anaesthetists on Clinical Features of COVID-19 Patients and Relevant Management. J Clin Med 2020; 9:E2542. [PMID: 32781614 PMCID: PMC7464215 DOI: 10.3390/jcm9082542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/26/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 pandemic poses great challenges for healthcare workers around the world, including perioperative specialists. Previously, we provided a first overview of available literature on SARS-CoV-2 and COVID-19, relevant for anaesthetists and intensivists. In the current review, we provide an update of this topic, after a literature search current through May 2020. We discuss the evidence on perioperative risk for COVID-19 patients presenting for surgery, the risk of transmission of SARS-CoV-2 in the operating room, and the current literature on laboratory diagnostics. Furthermore, cardiovascular and nervous system involvement in COVID-19 are discussed, as well as considerations in diabetic patients. Lastly, the latest evidence on pharmacological treatment is summarised.
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Affiliation(s)
- Robert P. Weenink
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (B.P.); (A.H.H.); (W.S.S.); (M.F.S.); (N.H.S.W.); (M.W.H.)
| | - Benedikt Preckel
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (B.P.); (A.H.H.); (W.S.S.); (M.F.S.); (N.H.S.W.); (M.W.H.)
- Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Abraham H. Hulst
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (B.P.); (A.H.H.); (W.S.S.); (M.F.S.); (N.H.S.W.); (M.W.H.)
| | - Jeroen Hermanides
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (B.P.); (A.H.H.); (W.S.S.); (M.F.S.); (N.H.S.W.); (M.W.H.)
| | - Menno D. de Jong
- Department of Medical Microbiology & Infection Prevention, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands;
| | - Wolfgang S. Schlack
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (B.P.); (A.H.H.); (W.S.S.); (M.F.S.); (N.H.S.W.); (M.W.H.)
| | - Markus F. Stevens
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (B.P.); (A.H.H.); (W.S.S.); (M.F.S.); (N.H.S.W.); (M.W.H.)
| | - Nicolaas H. Sperna Weiland
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (B.P.); (A.H.H.); (W.S.S.); (M.F.S.); (N.H.S.W.); (M.W.H.)
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (B.P.); (A.H.H.); (W.S.S.); (M.F.S.); (N.H.S.W.); (M.W.H.)
- Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
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11
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Weenink RP, Kloosterman M, Hompes R, Zondervan PJ, Beerlage HP, Tanis PJ, van Hulst RA. The AirSeal® insufflation device can entrain room air during routine operation. Tech Coloproctol 2020; 24:1077-1082. [PMID: 32734478 PMCID: PMC7522110 DOI: 10.1007/s10151-020-02291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Abstract
Background Surgical procedures that use insufflation carry a risk of gas embolism, which is considered relatively harmless because of the high solubility of carbon dioxide. However, an in vitro study suggested that valveless insufflation devices may entrain non-medical room air into the surgical cavity. Our aim was to verify if this occurs in actual surgical procedures. Methods The oxygen percentage in the pneumoperitoneum or pneumorectum/pneumopelvis of eight patients operated with use of the AirSeal® was continuously measured, to determine the percentage of air in the total volume of the surgical cavity. Results Basal air percentage in the surgical cavity was 0–5%. During suctioning from the operative field air percentage increased to 45–65%. Conclusions The AirSeal® valveless insufflation device maintains optimal distension of the surgical cavity not only by insufflating carbon dioxide, but also by entraining room air, especially during suctioning from the operative field. This may theoretically lead to air embolism in patients operated on with this device.
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Affiliation(s)
- R P Weenink
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Kloosterman
- Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - R Hompes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | - P J Zondervan
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H P Beerlage
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - R A van Hulst
- Department of Hyperbaric Medicine and Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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12
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Preckel B, Schultz MJ, Vlaar AP, Hulst AH, Hermanides J, de Jong MD, Schlack WS, Stevens MF, Weenink RP, Hollmann MW. Update for Anaesthetists on Clinical Features of COVID-19 Patients and Relevant Management. J Clin Med 2020; 9:E1495. [PMID: 32429249 PMCID: PMC7291059 DOI: 10.3390/jcm9051495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023] Open
Abstract
When preparing for the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the coronavirus infection disease (COVID-19) questions arose regarding various aspects concerning the anaesthetist. When reviewing the literature it became obvious that keeping up-to-date with all relevant publications is almost impossible. We searched for and summarised clinically relevant topics that could help making clinical decisions. This is a subjective analysis of literature concerning specific topics raised in our daily practice (e.g., clinical features of COVID-19 patients; ventilation of the critically ill COVID-19 patient; diagnostic of infection with SARS-CoV-2; stability of the virus; Covid-19 in specific patient populations, e.g., paediatrics, immunosuppressed patients, patients with hypertension, diabetes mellitus, kidney or liver disease; co-medication with non-steroidal anti-inflammatory drugs (NSAIDs); antiviral treatment) and we believe that these answers help colleagues in clinical decision-making. With ongoing treatment of severely ill COVID-19 patients other questions will come up. While respective guidelines on these topics will serve clinicians in clinical practice, regularly updating all guidelines concerning COVID-19 will be a necessary, although challenging task in the upcoming weeks and months. All recommendations during the current extremely rapid development of knowledge must be evaluated on a daily basis, as suggestions made today may be out-dated with the new evidence available tomorrow.
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Affiliation(s)
- Benedikt Preckel
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands; (M.J.S.); (A.P.V.)
| | - Marcus J. Schultz
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands; (M.J.S.); (A.P.V.)
- Department of Intensive Care, and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand
- Nuffield Department of Medicine, University of Oxford, Old Road Campus Research Build, Roosevelt Dr, Headington, Oxford OX3 7DQ, UK
| | - Alexander P. Vlaar
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands; (M.J.S.); (A.P.V.)
- Department of Intensive Care, and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Abraham H. Hulst
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
| | - Jeroen Hermanides
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
| | - Menno D. de Jong
- Department of Medical Microbiology & Infection prevention, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands;
| | - Wolfgang S. Schlack
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
| | - Markus F. Stevens
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
| | - Robert P. Weenink
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands; (M.J.S.); (A.P.V.)
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13
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Weenink RP, de Jonge SW, Preckel B, Hollmann MW. PRO: Routine hyperoxygenation in adult surgical patients whose tracheas are intubated. Anaesthesia 2020; 75:1293-1296. [PMID: 32314343 DOI: 10.1111/anae.15027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2020] [Indexed: 12/01/2022]
Affiliation(s)
- R P Weenink
- Department of Anaesthesia, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S W de Jonge
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B Preckel
- Department of Anaesthesia, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M W Hollmann
- Department of Anaesthesia, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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14
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Weenink RP, Hollmann MW, Zomervrucht A, van Ooij PJAM, van Hulst RA. A retrospective cohort study of lidocaine in divers with neurological decompression illness. Undersea Hyperb Med 2014; 41:119-126. [PMID: 24851549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Lidocaine is the most extensively studied substance for adjuvant therapy in neurological decompression illness (DCI), but results have been conflicting. In this retrospective cohort study, we compared 14 patients who received adjuvant intravenous lidocaine for neurological decompression sickness and cerebral arterial gas embolism between 2001 and 2011 against 21 patients who were treated between 1996 and 2001 and did not receive lidocaine. All patients were treated with hyperbaric oxygen (HBO2) therapy according to accepted guidelines. Groups were comparable for all investigated confounding factors, except that significantly more control patients had made an unsafe dive (62% vs. 14%, p = 0.007). Groups had comparable injury severity as measured by Dick and Massey score (lidocaine 2.7 +/- 1.7, control 2.0 +/- 1.6), an adapted version of the Dick and Massey score, and the Blatteau score. Number of HBO2 sessions given was comparable in both groups (lidocaine 2.7 +/- 2.3, control 2.0 +/- 1.0). There was neither a positive nor a negative effect of lidocaine on outcome (relative risk for objective neurological signs at follow-up in the lidocaine group was 1.8, 95% CI 0.2-16). This is the first retrospective cohort study of lidocaine in neurological DCI. Since our study is under-powered to draw definitive conclusions, a prospective multicenter study remains the only way to reliably determine the effect of lidocaine in neurological decompression illness.
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Post ICJH, Weenink RP, van Wijk ACWA, Heger M, Böing AN, van Hulst RA, van Gulik TM. Characterization and quantification of porcine circulating endothelial cells. Xenotransplantation 2013; 20:18-26. [DOI: 10.1111/xen.12018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 12/13/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Ivo C. J. H. Post
- Department of Surgery (Surgical Laboratory); Academic Medical Center; University of Amsterdam; Amsterdam; The Netherlands
| | | | - Albert C. W. A. van Wijk
- Department of Surgery (Surgical Laboratory); Academic Medical Center; University of Amsterdam; Amsterdam; The Netherlands
| | - Michal Heger
- Department of Surgery (Surgical Laboratory); Academic Medical Center; University of Amsterdam; Amsterdam; The Netherlands
| | - Anita N. Böing
- Laboratory of Experimental Clinical Chemistry; Academic Medical Center; University of Amsterdam; Amsterdam; The Netherlands
| | | | - Thomas M. van Gulik
- Department of Surgery (Surgical Laboratory); Academic Medical Center; University of Amsterdam; Amsterdam; The Netherlands
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Abstract
Cerebral arterial gas embolism (CAGE) is well known as a complication of invasive medical procedures and as a risk in diving and submarine escape. In the underwater environment, CAGE is caused by trapped air, which expands and leads to lung vessel rupture when ambient pressure decreases during ascent. Pressure decrease also occurs during hypobaric activities such as flying and, therefore, CAGE may theoretically be a risk in hypobaric exposure. We reviewed the available literature on this subject. Identified were 12 cases of CAGE due to hypobaric exposure. Based on these cases, we discuss pathophysiology, diagnosis, and treatment of CAGE due to hypobaric exposure. The low and slow pressure decrease during most hypobaric activities (as opposed to diving) account for the low incidence of CAGE during these exposures and suggest that severe air trapping must be present to cause barotrauma. This is also suggested by the large prevalence of air filled cysts in the case reports reviewed. We recommend considering CAGE in all patients presenting with acute central neurological injury during or shortly after pressure decrease such as flying. A CT scan of head and chest should be performed in these patients. Treatment with hyperbaric oxygen therapy should be initiated as soon as possible in cases of proven or probable CAGE.
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Affiliation(s)
- Robert P Weenink
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, The Netherlands vy, P.O. Box 10000, 1780 CA, Den Helder, The Netherlands.
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17
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Weenink RP, Hollmann MW, van Hulst RA. Animal models of cerebral arterial gas embolism. J Neurosci Methods 2012; 205:233-45. [PMID: 22281296 DOI: 10.1016/j.jneumeth.2011.12.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 12/19/2011] [Accepted: 12/20/2011] [Indexed: 12/21/2022]
Abstract
Cerebral arterial gas embolism is a dreaded complication of diving and invasive medical procedures. Many different animal models have been used in research on cerebral arterial gas embolism. This review provides an overview of the most important characteristics of these animal models. The properties discussed are species, cerebrovascular anatomy, method of air embolization, amount of air, bubble size, outcome parameters, anesthesia, blood glucose, body temperature and blood pressure.
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Affiliation(s)
- Robert P Weenink
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, The Netherlands.
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18
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Weenink RP, Hollmann MW, Stevens MF, van Lienden KP, Ghazi-Hosseini E, van Gulik TM, van Hulst RA. Cerebral arterial gas embolism in swine. Comparison of two sites for air injection. J Neurosci Methods 2010; 194:336-41. [PMID: 21074559 DOI: 10.1016/j.jneumeth.2010.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 10/28/2010] [Accepted: 10/29/2010] [Indexed: 10/18/2022]
Abstract
Cerebral arterial gas embolism is a risk in diving and occurs as a complication in surgery and interventional radiology. Swine models for cerebral arterial gas embolism have been used in the past. However, injection of air into the main artery feeding the pig brain - the ascending pharyngeal artery - might be complicated by the presence of the carotid rete, an arteriolar network at the base of the brain. On the other hand, anastomoses between external and internal carotid territories are present in the pig. In order to determine the most appropriate vessel for air injection, we performed experiments in which air was injected into either the ascending pharyngeal artery or the external carotid artery. We injected 0.25 ml/kg of room air selectively into the ascending pharyngeal artery or the external carotid artery of 35-40 kg Landrace pigs (n=8). We assessed the effect on cerebral metabolism by measuring intracranial pressure, brain oxygen tension and brain glucose and lactate concentrations using cerebral microdialysis. Intracranial pressure and brain oxygen tension changed significantly in both groups, but did not differ between groups. Brain lactate increased significantly more in pigs in which air was injected into the ascending pharyngeal artery. Intracranial pressure, brain oxygen tension and brain lactate correlated after injection of air into the ascending pharyngeal artery, but not after injection into the external carotid artery. Our model is suitable for investigation of cerebral arterial gas embolism. The ascending pharyngeal artery is the most appropriate vessel for air injection.
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Affiliation(s)
- Robert P Weenink
- Diving Medical Center, Royal Netherlands Navy, PO Box 10000, 1780 CA, Den Helder, The Netherlands.
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